HomeMy WebLinkAbout1013 Campbell Ave - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . INSPECTION REPORT. . . . . .
REQUEST
Date c; ~ 8-0'1
Time /2 1M
Received by
Oe;t '1. I 5 E
(phone, perso~
Location of Work to be inspected 10 13 Uvvr fJ be- { (
Name of person requesting inspection D.eM. VI (S ~
Address of person requesting inspection Wr/J 'lie.... yJ Phone No
I
Type of Inspection (circle appropriate one) Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other f.1.)e:L~-Y
INSPECTION NOTES
Inspected Date ,,~,g - 0 "-I
Remarks 5er-vl-c... e KJ <...J L (e J
,
Time L t /'VI..
DU-t 09 ~cz.1 Vl
By
by
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ex. CR t.h-... t e v
RESTORATION REQUIRED
YES
NO X
[ f a IOl~ ~
CC4~P kJe.ll 011\ ~)
(. SllnJlC-e. vto{
IS
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~
~ hS-(-7 ,
{58 } ] Ref':;' "-r,,,,- ~
(, /0' ,,~ '3/4 PE \j
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11 ,
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(se,\Jtc.~ ~eT ()V\... (V\(}.,~)
,
SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel
D Repaired by City
[] Repaired by Permittee
[] No Damage Found
D Asphalt D PCC D Other
Work Order # Ie{- z 7?l ~ 05"5
o 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 rr.{ 1-- n-03 3
I Crew ? ( :; , 7 ( 7
"
]
DATE REPORTED
(;,-'8~D4
CONDITION E1v1ERGENCY Ii. ROUTINE 0 CITIZEN COMPLAINT 0
LEAKAGE SURVEY 0 o.THER 0
DATE OF REPAIR. 0 - '8 ~ Do..(
1Th1E
(7-
~J1be{(
,
"7 (r
SIZE c.-
DA.M. ~.M.
REF AIR Lo.CA TION
ADDRESS
(ot3
TYPE o.FMAIN
C 7-,
?.!; ,
:;) ~ CLo.SEST VALVE DEPTH.
DEPTH OF MAlN
3r
COM~PONENT REPAIRED.
MAIN JOINT 0 CIR. BREAK D SPLIT BELL D LONG BREAK D
HOLE D CLAMP D OTHER
SERVICE TAP D CORP STOP)1 PIPE D CURB STOP D FIITING D
METER SEITER 0 METER 0
LINE VALVE FLANGE NUTSIBOL TS 0 STEM D BONNET 0
HYDRANT BRANCH 0 VAL VE D BARREL D
OTHER.
CONfPONENTS OF REP AIR. CLAlVIPO DRESSERD OTHER Cor t 5+''1 .' Lo.-f1.p
SITE CONDITION GRAVEL 0 ASPHAL T D SIDEW ALK D CURB D
TOP SOIL AREA D SOIL TYPE AJc...-h \Je...
CUTS ASPHAL T CUT _IT CURB CUT _IT SIDEWALK_IT
DRIVEWAY CUT _IT
.
c.)Wo'^r
t- E. 'f1.h':'5
MAIN Co.NDITION INTERNAL LINING TUBERCULATIo.N-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED D EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE .. 5~ P,P M.
WATEROFF FROM 12 ~PM. TO. l~oofM.
FROM
M.TO
\11.
-\PP.A.RENT CAUSE OF LEAK. (cr-
t oco....+e