HomeMy WebLinkAbout4001 S Eunice St - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUEST
Date I - C(-- () if
,
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) Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other ~
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INSPECTION NOTES
Inspected
Remarks
Date
Time
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By
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RESTORATION REQUIRED
//'
YESV NO
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SURFACE RESTORATION I !
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SURFACE TYPE D Unimproved 0 Gravel
D Repaired by City
[] Repaired by Permittee
CI No Damage Found
D Asphalt D PCC r ~ Other 7Cij 56 I L
Work Order # '] ~ ~ / 60 /-
D COMPLETE
D INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
City of Port Angeles
Public Works Department
Water DIstribution Repair Report
IWork Order No
DATE REPORTED
13 .g;2.. "2 j (J D2-'
1~9- c> L(
I Crew'
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I
CONDITION EMERGENCY D ROUTINE D CITIZEN COMPLAlNT ~
LEAKAGE SURVEY D OTHER D
DATE OF REPAIR. / - q -6 II TI1v1E 7 r~ DA.M. DP,M.
REP AIR LOCATION
ADDRESS
If 00 I
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~- C- U,JUt 2--<-
TYPE OF MAIN
SIZE
....
DEPTH OF MAIN
CLOSEST VALVE DEPTH.
COMPONENT REPAIRED. /
MAlN JOINT 0 CIR. BREAK VSPLIT BELL 0 LONG BREAK 0
HOLE 0 CLAMP 0 OTHER
SERVICE TAP 0 CORP STOP 0 PIPE 0 CURB STOP 0 FITIING 0
1v1ETER SEITER 0 METER D
LINE VALVE FLANGE NUTS/BOL TS D STEM 0 BONNET 0
HYDRANT BRANCH 0 VAL VE D BARREL 0
OTHER.
COMPONENTS OF REP AIR. CL~RESSERO OTHER
SITE CONDITION GRAVEL 0 ASPHALT 0 SIDEWALK 0 CURB 0
TOP SOIL AREA 0 SOIL TYPE
CUTS ASPHAL T CUT _FT CURB CUT _FT SIDEWALK_FT
DRIVEWAY CUT _FT
MAIN CONDITION INTERNAL LINING TIJBERCULATION-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE D
CHLORINE RESIDUAL SAMPLE P.P.M.
WATER OFF FROM? A- M. TO / [) It,
2.A ov5--€ 5'
, - (' t"'~Yi/'J C:~
cJ V 1- 0 j- .-/- \.
FROM M. TO
M.
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APP ARENT CAUSE OF LEAK.