HomeMy WebLinkAbout1450 Campbell Ave - Engineering
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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . INSPECTION REPORT. . . . . .
REQUEST
Date / -- / 7 - D I
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)
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Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other /,J. j?~-f-t~y
INSPECTION NOTES
Inspected
Remarks
Date
Time
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RESTORATION REQUIRED
YES
NO
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SURFACE RESTORATION
SURFACE TYPE D Unimproved 0 Gravel 0 Asphalt 0 PCC
[] Repaired by City
[] Repaired by Permittee
[] No Damage Found
Wor~der #
[It''COMPLETE
o INCOMPLETE
o Other
17 -75
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
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City of Port Angeles
Public Works Department
Water Distribution Repair Report
IWork Order No: I {'7 ~
Reported: LII Ie, I J:!..j
Repaired: L-ll!:.J ~ I
Repair Location.
Component Repaired:
Main:
Service:
Line Valve:
Hydrant:
Other:
Repair Type:
I Crew:
IIY
Condition. Emergency ~e
Source. Citizen Complaint
Leakage Survey _ Other
Address. J lj c:- () C~'-- /41 b-p 1/ /ff- 0 .+:.._-
,
Lee Description.
Joint
Long Break_
Cir Break /
Hole
Main Line ID#'
Split Bell _
Clamp _ Other
Tap_
Flange Nuts, Bolts
Branch
Pipe _ Curb Stop _
Stem Bonnet
Barrel
Corp. Stop _
Valve
Clamp V'
Dresser
Other
Site Condition: Surface
Curb
Damage.
,
Gravel Roadway V Asphalt Street _ Sidewalk
Top Soil Area _ Soil Type _
Cuts: Street Cut: Ft.
Main Condition:
Apparent Cause or Leak:
5/19/98
Curb Cut: Ft.
Sidewalk Cut: Ft.
Diameter- Inches
Material
Depth of Cover' Ft.
Internal Lining:
l (< ('-1'
If'. ... ~
,-
Joint Type'
External Prot.
Tuberculation. N/ A
External Corrosion. NI A
Special Conditions. Bedding:
Other Structures:
Minor
Localized
Severe
Extensive
Samples Taken: Pipe Section _
Water Off: From I 1 J 7, L\( To ~M
From I 1/11 6 I To I () A- M
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Page 1
PW-902.09