HomeMy WebLinkAbout1136 Grant Ave - Engineering
City of Port Angeles
Public Works Departnlent
", ater Distribution Repair Report
t) w - 'OO~ - '2..05 T
IWork Order No: 9.. () S 1
ICrewe oj I Y.
DATE REPORTED' j - 5- 0 ?-
CONDITION EMERGENCY 0 ROUTINE ~ITIZEN COMPLAINT V'
LEAKAGE SURVEY D OTHER D
DATE OF REPAIR. ~) - ~ -- 6:L TIME. '<l It W1 DA.M. OP.M.
REPAIR LOCATI0N ADDRESS
1/3(,
6-rULn -r
TYPE OF MAIN
ql' 0--1:
SIZE.
DEPTH OF MAIN
CLOSEST VALVE DEPTH.
COMPONENT REPAIRED:
MAIN JOINT 0 CIR. BREAK 0 SPLIT BELL. 0 LONG BREAK 0
HOLE 0 CLAMP 0 OTHER
SERVlCE TAP 0 CORP STOP 0 PIPE 0 CURB STOP 0 FITTING 0
(\..+ METER SETTER ~ METER D
HYDRANT BRANCH 0 VALVE 0 BARREL 0
OTHER. /? -ep Ja (~ d CD h +f-a c for C;
BONNET D
. -eel /-: '}/rl- (U dJh.+-
und-e~ ~+~/y BIZ( 55 Lou/:)It):/J
/+ f.A..; 4. 5 5;J//'0.;-
LINE VALVE. FLANGE NUTSIBOLTS D STEM D
COMPONENTS OF REPAIR. CLAMPO DRESSERO OTHER
SITE CONDITION GRA VEL D ASPHAI;f 0 SIDEWALK 0 CURB D
TOP SOIL AREA ~ SOIL TYPE
CUTS ASPHALT CUT _FT CURB CUT _FT SIDEWALK_FT
DRIVEWAY CUT _FT
MAIN CONDITION INTERNAL LINING 11/ If TUBERCULATION-MINOR 0 SEVERE D
EXTERNAL CORROSION' LOCALIZED D EXTENSIVE D
CHLORINE RESIDUAL SAMPLE ' '] L P.P.M.
WATEROFF FROM g n M. TO r It M.
FROM
M.TO
M.
h1c) 11 [1~
APPARENT CAUSE OF LEAK.
Co
{!; /6 L k ( rff};O-d
i) t.V - .2.-0 0 1- - 2.<) 5'" =1
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUEST
Date 3 - [/- 0 '2-
\~J
Time
Received by
(phone, person)
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one)
I , 3 ~ ~rttl1 +-
,.,-W II (oX
/1111 ir f3 /
Phone No
Sewer Foundation Framing
Permit No
Chimney Plumbing Final Sewer Excav Other U-JoJ-eV
INSPECTION NOTES
Inspected Date
Remarks
Time
By
V--uw-
.
Iy -Pp fA-1 'r
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L.uA..:--/-ey
~{)I c-€
RESTORA TION REQUIRED YES NO
A/1
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~
G-V--Ct Il t 5~ ~
( ~
~31 < ~I
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SURFACE RESTORATION
./
t.,/
SURFACE TYPE
o Unimproved 0 Gravel
o Repaired by City
[] Repaired by Permittee
CI No Damage Found
o Asphalt 0 PCC
Wor~rder #
crCOMPLETE
o INCOMPLETE
o Other
9-6~7
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)