HomeMy WebLinkAbout1301 Campbell Ave - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . INSPECTION REPORT. . . . . .
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REQUEST'
Date /I~ 5 ~ qr
Time
Received by
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(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
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Phone No
Permit No
Plumbing Final Sewer Excav Other
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INSPECTION NOTES
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Time
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Inspected
Remarks
Date
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RESTORATION REQUIRED
YES
NO~/
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SURFACE RESTORATION
SURFACE TYPE D Unimproved D Gravel D Asphalt
o Repaired by City
[] Repaired by Permittee
[] No Damage Found
o Other
Work Order # ! C; q:>
~MPLETE
o INCOMPLETE
OPCC
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
City of Port Angeles
Public Works Department
Water Distribution Repair Report
IWork Order No: / (I 1'3
Reported: iLl S I 91
Repaired: .1.1..1 C;-I q 1
Repair Location:
Component Repaired:
Main,
Service:
Line Valve:
Hydrant:
Other:
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Repair Type:
Site Condition:
--
IIY
I Crew:
Condition: Emergency Routine
Source: Citizen Complaint V
Leakage Survey _ Other
Address.
/36 I
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Main Line ID#:
Clamp _
Dresser Other (/e Ie' -e
"6-
Gravel Roadway _ Asphalt Street _
Top Soil Area _ Soil Type _
Loc. Description:
Joint Cir Break
Long. Break_ Hole
Split Bell _
Clamp _
Pipe d
Stem
Barrel
Tap _ Corp. Stop _
Flange Nuts, Bolts
Branch Valve
Other
Curb Stop _
Bonnet
o P ?/lJ-(! ')/f
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Sidewalk
Cuts: Street Cut: Ft.
Surface
Curb
~ Damage:
Main Condition:
Apparent Cause of Leak:
5/19/98
Curb Cut: Ft.
Sidewalk Cut: Ft.
t"Q{A-C
Diameter: Inches . L'
Material.
Depth of Cover- Ft.
Internal Lining:
Joint Type:
External Prot:
Tuberculation: NI A
External Corrosion: N/A
Special Conditions: Bedding:
Other Structures:
Minor
Localized
,..
t'JI"',c
Severe
Extensive
Samples Taken: Pipe Section_
Coupon _
Water Off: From J..!...J S-'-fi To ~/Jr M
From-1..i! )' 1J.1.. To -LL~M
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Pagel
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PW-902.09