HomeMy WebLinkAbout333 Columbus Avenue - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . INSPECTION REPORT. .
/
REQUEST
Date II - l,f - 9 9
Time (; tv rM
R . db y/]brvL.r-
ecelve y l/ V ~
(~hon_e, person)
Location of Work to be inspected } y J C 0 L f., At j}' ? J
Name of person requesting inspection rP P' r L e
Address of person requesting inspection I 7 ~ 1-. j:)
Type of Inspection (circle appropriate one)
Phone No
Permit No
Sewer Foundation Framing
Chimney Plumbing Final Sewer Excav Other
1J tv ;2 C't/?
GUO~ I L(9t'
INSPECTION NOTES
Inspected Date 1/ - I '? -
Remarks ~ t' T T IE. ;(/
r '7 Time I 0 . 7 C'
C /lL i/,. /'/;?E ) C V T
By It t? 11'
J'Er:T It~/
0"';-
.
RESTORATION REQUIRED
1-
tv
YES
NO ..--
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36' rEf b~l
SURFACE RESTORATION
SURFACE TYPE D Unimproved D Gravel D Asphalt D PCC
D Repaired by City
o Repaired by Permittee
[] No Damage Found
Work Order #
B-COMPLETE
D INCOMPLETE
D Other
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(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
City of Port Angeles
Public Works Department
Water Distribution Repair Report
IWork Order No: I V-
Reported: ~I I <;-1 9~
Repaired: I LII '1 I ??
Repair Location:
Component Repaired:
9{/
Condition:
Source:
I Crew: I( t Iv
, I?lcr(AIl~.JAMlt I
,
Emergency V-' Routine
Citizen Complaint
Leakage Survey _ Other
Address. '3 J.J C t/ L t/ tv! /J v .J'
Loc. Description. J' e ft // ICE L E .4/-c
Main Line ID#:
Main: Joint Cir Break
Long. Break _ Hole
Split Bell _
Clamp _
Service: Tap _ Corp. Stop _
Line Valve: Flange Nuts, Bolts
Hydrant: Branch Valve
Other:
)
Pipe ~
Stem
Barrel
Other
Curb Stop _
Bonnet
Repair Type: Clamp _
I "I
f?EICf'
Site Condition: Surface
Curb
~ Damage:
Dresser ~
Other (() T
Sidewalk
Gravel Roadway _ Asphalt Street _
Top Soil Area ~ Soil Type _
Cuts: Street Cut: Ft.
Main Condition:
Apparent Cause of Leak:
5119/98
Diameter- Inches .) /y - I ~ 't
Material.
Depth of Cover- Ft. ()...
Internal Lining:
Curb Cut: Ft.
Sidewalk Cut: Ft.
Joint Type:
External Prot:
Tuberculation: NI A
External Corrosion: NI A
Special Conditions: Bedding:
Minor
Localized
50ft..
,.
tr~c
Severe
Extensive i.--"
Other Structures:
Samples Taken: Pipe Section _
Coupon _
Water Off: From_'_'_ To _M
From-1_'_ To _M
f(1J T7eN
C'/lLV. PiPE
Page 1
PW-902.09