HomeMy WebLinkAbout300 & 270 Brown Rd - Engineering
CITY OF PORT ANGELES tKC WP= 82'1
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUEST ~
Date ~ - ~ J -D ? Time
Received by
(phone, person)
P- Gc{ ~/
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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Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other L0(-~~
INSPECTION NOTES
Inspected Date
Remarks
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RESTORATION REQUIRED
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SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel 0 Asphalt 0 PCC
o Repaired by City
[] Repaired by Permittee
[] No Damage Found
Work Order #
~PLETE
o INCOMPLETE
B;J 0 Other
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STREET SUPERINTENDENT
(DATE)
CIty 01 IJort Angeles H"fe wF fS z.~ t.f
Public 'Vorks Departnlent
", ater Distribution Repair Report
DATE REPORTED
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ICrew
IWork Order No.
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CONDITION E:tvIERGENCY D ROUTINE D CITIZEN COMPLAINT D
LEAKAGE SURVEY D OTHER D
DATE OF REPAIR.. 1-:J. k- D ~
TIME
DA.M. OP.M.
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REP AIR LOCATION
ADDRESS
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TYPE OF MAIN
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 ./
SERVICE. TAP 0 CORP STOP 0 PIPE ~URB STOP 0 FITTING 0
METER SETTER 0 METER 0
LINE VALVE. FLANGE NlITS/BOL TS 0 STEM 0 BONNET 0
HYDRANT BRANCH 0 VALVED BARREL 0
OTHER.
COMPONENTS OF REPAIR. CLAMPD DRESSERD OTHER
SITE CONDITION GRA VEL 0 ASPHALT 0 SIDEWALK 0 CURB 0
TOP SOIL AREA 0 SOIL TYPE
CUTS ASPHALT CUT _Ff CURB CUT _Ff SIDEW ALK _IT
DRIVEWAY CUT _Ff
MAIN CONDITION INTERNAL LINING TUBERCULA TION-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE / / r P.P.M.
WATEROFF FROM /0 A- M. TO lilt M.
FROM M. TO M.
APPARENT CAUSE OFLEAK } ( -----;;zJk '31 r G-ct/ u n p----Q..
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