HomeMy WebLinkAbout1203 Campbell Ave - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUEST ~ ~
Date 1- gO?
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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Il..lfJ1 +-8 Phone No
Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other L.U~V-
INSPECTION NOTES
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Tit By
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Inspected Date
Remarks
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RESTORATION REQUIRED
YES
/'
NO t./
SURFACE RESTORATION
SURFACE TYPE D Unimproved 0 Gravel
D Repaired by City
[] Repaired by Permittee
D No Damage Found
o Asphalt 0 PCC 0 Other
Wor~rder # S <g<B 7
LB"COMPLETE
o INCOMPLETE
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(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
CIty 01 IJort Angeles ~
Public 'Vorks Departnlen~f 5'B~+
'Vater Distribution Repair Report
IWork Order No.
CONDITION
~~~1 I
-~ - ~ - 0 ; /
EMERGENCY 0 ROUTINE 0 CITIZEN COMPLAlNT V
LEAKAGE SURVEY 0 OTIIER 0
7-- 1--0 J TIME
I ;2.. 0 r;
I Crew
71 L(
DATE REPORTED
DATE OF REPAIR.
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REP AIR LOCATION
ADDRESS
TYPE OF MAIN
'9( ( J4- C-
SIZE
DEPTH OF MAIN
CLOSEST VALVE DEPTH.
COMPONENT REPAIRED:
MAIN JOINT 0 CIR. BREAK 0 SPLIT BELL- 0 LONG BREAK 0
HOLE 0 CLAMP 0 OTIIER /"
SERVICE TAP 0 CORP STOP 0 PIPE ~URB STOP 0 FIITING 0
METER SETTER 0 METER 0
LINE VALVE. FLANGE NUTS/BOL TS 0 STEM 0 BONNET 0
HYDRANT BRANCH 0 VALVE 0 BARREL 0
OTHER.
COMPONENTS OF REP AIR. CLAMPD DRESSERO OTIIER
SITE CONDITION GRA VEL 0 ASPHALT 0 SIDEWALK 0 CURB 0
TOP SOIL AREA 0 SOIL TYPE
CUTS ASPHALT CUT _IT CURB CUT _IT SIDEW ALK _IT
DRIVEWAY CUT _IT
MAIN CONDITION INTERNAL LINING TUBERCULA TION-rvrrNOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
WATER OFF FROM
,7 I/-
M.TO
P.P.M.
fA--
M.
CHLORINE RESIDUAL SAMPLE
FROM
M.TO M.
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APP ARENT CAUSE OF LEAK.