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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . INSPECTION REPORT. . . . . .
REQUEST
Date (;, ~ Z ( --0'+
Time too A jA/( Received by ve't"'r rs E. (phone, person)
Location of Work to be inspected g (t.(. <50
Name of person requesting inspection V&1.vt. S
Address of person requesting inspection 6 t"" /)
I
Type of Inspection (circle appropriate one) Permit ~~
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Ot r y~ ')
L
E
Vo.-rJ
(7 q... '8
Phone No 1ft 1 -~8 <t.C(
INSPECTION NOTES
Inspected Date I> ~ ?I.... () <f
Remarks J<ehe..J /AA...~-te...r
....t- 0 ( r(
Time II 60 itA/\.. By O~i-1.1t Ie:, E--
Se++e.r J.~ avt.A 5.e<'"v<c....e +vo..............
'5/ 'f t.
RESTORATION REQUIRED
YES K
NO
~ ,,- ~
-e ~...
J ~
! \V) t\
J: \J I
....~, ~~ ~ ~
~
~ - J
:),- ~
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~
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~ -
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SURFACE RESTORATION
SURFACE TYPE 0 Unimproved D Gravel
[] Repaired by City
[] Repaired by Permittee
[] No Damage Found
~' X k, ~
~Asphalt OPCC o Other
Work Order # /q Z 1 ij- 6"$ S-
O COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
CIty of Port Angeles
Public Works Department
Water DIstribution Repair Report
IWork Order No 1t/7..78 --035"
I Crew 7 (5' '"f- ere lJ
]
DATE REPORTED ~ - '8 -o'f
CONDITION ElvlERGENCY 0 ROUTINE)( CITIZEN COMPLAINT 0
LEAKAGE SURVEY 0 OTHER 0
DATE OF REPAIR. C. -"Z-l ~ o'-f TIME ..... I ( ~A.M. ~
REP AIR LOCATION ADDRESS 8 (4- '5D, \.c.. I,
TYPE OF MAIN
A~L
QU
SIZE 0
DEPTH OF MAIN
s'
Z{
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 0 CURB STOP)!:( FITTING 0
lvfETER SETTER 0 lvfETER 0
LINE VALVE. FLANGE NUTSIBOL TS 0 STEM 0 BONNET 0
HYDRANT BRANCH 0 VAL VE 0 BARREL 0
OTHER.
COMPONENTS OF REPAIR. CLAMPO DRESSERO OTHER ~~e! elA-+~~ ~.rVl~.e
SITE CONDITION GRAVEL 0 ASPHALT 0 SIDEWALK 0 CURB 0
TOP~OPt AREA 0 SOIL TYPE
CUTS ASPHAL T CUT ~IT CURB CUT _IT SIDEWALK_IT
DRIVEWAY CUT _IT
MAIN CONDITION INTERNAL LINING TUBERCULATION-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE ~A P.P M.
WATER OFF FROM g:~O It M. TO '1 3DAM.
FROM M. TO M.
APPARENT CAUSE OF LEAK. 6vokeVl Lvrh s--kp.