HomeMy WebLinkAbout1103 Campbell Ave - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT . . . . . . . . . . .
REQUEST.
"
Date
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)
Sewer Foundation Framing Chimney Plumbing
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/1 tt 1-.0 Phone No
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Permit No
Final Sewer Excav Other
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INSPECTION NOTES
Inspected Date
Remarks
RESTORATION REQUIRED . . .. . YES
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SURFACE RESTORATION:
SURFACE TYPE D Unimproved D Gravel
o Repaired by City
o Repaired by Permittee
o No Damage Found
Asphalt 0 PCC lO. 0 Other
Work Order # 'JJ J:l b
o COMPLETE
o INCOMPLETE
STREET SUPERINTENDENT
(DATE)
CIty of Port Angeles
Public Works Department
Water Distribution Repair Report
IWork Order No
DATE REPORTED
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I Crew
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I
1
CONDITION EMERGENCY 0 ROUTINE 0 CITIZEN COl\1PLAlNT ~
LEAKAGE SURVEY 0 OTHER 0
DATE OF REPAIR. ,; - 6 - 0'7 TIME.
REP AIR LOCATION ADDRESS / / () J
r.::7 ( , JJ.- <-. SIZE
TYPE OF MAIN {) 7'
DA.M. DP.M.
CcUJ41 J;7& 1/ /1-~
/
=
DEPTH OF MAIN
CLOSEST VALVE DEPTH.
COl\1PONENT REPAIRED.
MAIN JOINT 0 CJR. BREAK D SPLIT BELL 0 LONG BREAK 0
HOLE 0 CLAl\1P D OTHER
SERVICE TAP -0 CORP STOP D PIPE ~CURB STOP D FITTING 0
!'vfETER SEITER 0 !'vfETER 0
LINE VALVE. FLANGE NUTSIBOL TS 0 STEM 0 BONNET 0
HYDRANT BRANCH 0 VAL VE 0 BARREL D
OTHER.
COl\1PONENTS OF REP AIR. CLAl\1PO DRESSERO OTHER
SITE CONDITION' GRAVEL 0 ASPHALT 0 SIDEWALK D 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 0
CHLORINE RESIDUAL SAl\1PLE P.P.M.
WATER OFF FROM 114- ),Jt1 M. TO /6 11M.
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5~t/(/i . ~
FROM
M.TO M.
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APP ARENT CAUSE OF LEAK.
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . INSPECTION REPORT . . . . . .
. . . .
.....
REQUEST
Date <t "3/-c:")'
Time 7,' d?1 -+~ Received by 71' 7
(Phone~D
Location of Work to be inspected / / 0 "3 W~'l /.lie;1 ;I,,'-e
Name of person requesting inspection f-J fA. Te / 'iJ; t/
Address of person requesting inspection /70,<' .<)'0 P SI Phone No 07-'/~C/7
Type of Inspection (circle appropriate one) Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav @t'~(/e ~
INSPECTION NOTES
Inspected Date ~ -;3 /-c." <)
Remarks
Time '8"': ~.n.' A~ft By 71'7
3 4 ~l .) t' r V It: e / ..er< k J" L?t fc.L ,
RESTORATION REQUIRED
YES
NO
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SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel
o Repaired by City
o Repaired by Permittee
o No Damage Found
o Asphalt 0 PCC ~ Othe[1C:tJ So: /
I
Work Order # ]oJ'Ie. ---063
o COMPLETE
~ INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)