HomeMy WebLinkAbout1301 S I St - Engineering
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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS /
. . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUEST
Date ::L -- / /6- 0 ()
Time
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other ~_f-q--
Time By
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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)
INSPECTION NOTES
Inspected Date
Remarks
0.+
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Received by
(phone, person)
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11+4 <{- e '
)+1
Phone No
Permit No
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RESTORATION REQUIRED . '.
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SURFACE RESTORATION.
SURFACE TYPE 0 Unimproved 0 Gravel
o Repaired by City
o Repaired by Permittee
o No Damage Found
.//'
YES V NO
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Work Order # :; - ~' '
o COMPLETE ---__ ..~
o INCOMPLETE
(Continue on reverse side if necessary)
(DA TE)
City of Port Angeles
Public Works Department
Water Distribution Repair Report
IWork Order No: Is- s- (
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[Crew:
?Ie;'
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1
Reported: 2- I Iii 0 r[)
Repaired: A I!tJ 60
Condition.
Source
Emergency
Citizen Complaint
Leakage Survey _
v-
Routine
//
Other
Repair I.A)('$ltion;
Address
/30 I
Lac Description.
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5+(
Component R~airpQ:
Main.
Main Line ID#:
Joint Cir Break
Long. Break _ Hole
Split BeIl _
Clamp _
Pipe ~"
Stem
Barrel
Other
Service:
Line Valve:
HYdrant:
Other:
Tap _ Corp Stop_
Flange Nuts, Bolts
Branch Valve
Curb Stop _
Bonnet
Repair Type:
Clamp _ Dresser
Other AJ e i.U
~~E //p~
Site Condition: Surface
Curb
Cuts:
Damage;
. 1/
Street Cut: Ft. 4! Curb Cut: Ft.
Gravel Roadway _ Asphalt Street _ Sidewalk
Top Soil Area _ Soil Type _
Main Condition:
Sidewalk Cut: Ft.
Diameter' Inches
Material.
Depth of Cover' Ft.
Internal Lining:
,.
Joint Type:
External Prot:
Tuberculation. N/A
External Corrosion. N/A
Special Conditions. Bedding:
Other Structures:
Minor
Localized -
-
Severe
Extensive
Samples Taken.
Pipe Section _
Coupon --IIJ S Jt.1 e
TO~M / ,.1.:>05 R.. oJf-
To --.!l.-.Lt:.M .:) f- (...<->~A- cV
? E /~, ?~ '-'A/If
... ////.-- -
Water Off.
From ..2-;/ /, 1 b 0
From J-.- /)6 I--;;;D
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Apparent Cause or Leak:
~
5119/98
Page 1
PW-902.09