HomeMy WebLinkAbout628 E Lauridsen Blvd - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . INSPECTION REPORT. . . . . .
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REQUEST
Date ~ ...- /7.- 0 D
Time
Received by
(phone, person)
Phone No
Permit No
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Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one)
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Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other
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INSPECTION NOTES
Inspected Date
Remarks
ESTORA TION REQUIRED
YES
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NO ~
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SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel 0 Asphalt 0 PCC
D Repaired by City
[] Repaired by Permittee
D No Damage Found
Work Order #
~PLETE
o INCOMPLETE
o Other
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(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
City of Port Angeles
Public Works Department 0 W
Water Distribution Repair Report
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IWork Order No: 1 b 01
Reported: ~ II ~I rib
Repaired: S-I J~J J:J)
I Crew:
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Condition.
Source.
Emergency
Citizen Complaint
Leakage Survey _
Routine
V-
Other
Repair Location:
Address
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Lac Description.
Component Repaired:
Main Line IDN:
Main:
Joint Cir Break
Long. Break _ Hole
Split Bell _
Clamp _
Other /(, 'n" fi.j.<L Ilvb
LCAk
Service:
Une Valve:
Hydrant:
Other:
Tap _ Corp Stop_
Flange Nuts, Bolts
Branch Valve
Pipe _
Stem
Barrel
Curb Stop _
Bonnet
Dresser /'
Repair Type: Clamp _
OIher + f)-:t- PI r-z-
Site Condition: Surface
Curb
Damage:
Gravel Roadway _ Asphalt Street _ Sidewalk
Top Soil Area _ Soil Type _
Cuts: Street Cut: Ft.
Curb Cut: Ft.
Sidewalk Cut: Ft.
Main Condition:
Diameter.
Material
Depth of Cover.
Internal Lining
Inches 6 C,( /l-L
~d ~t
Ft.
"
Joint Type:
External Prot:
Tuberculation. NI A
External Corrosion. N/A
Special Conditions. Bedding:
Other Structures:
Minor
Localized
Severe
Extensive
Samples Taken: Pipe Section _ Coupon~.I-€- .
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Water Off. From '':!!_J ll-' C:JD To --2..!3P..AM ~ 1/ 1>>-'
From ~ 1 n-, Cl..Q To ~ .04- "/ 2... ~
Ap_CauseofLeak: s-dfl--e l1A..+ tL'';[-h+-e Nub
u hA; l---It ).. ~+ / ,- +- ~/.
5/19/98
Page 1
PW-902.09