HomeMy WebLinkAbout626 E 4th St - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . INSPECTION REPORT. . . . . .
. . . .
REQUEST
Date I Z - 2 { - 0 --I
Time I Z.
/","1
Received by
Mn.u S L
(phone, person)
Location of Work to be inspected k.: L "- E Y-{4. S*
Name of person requesting inspection Oc vI '1. I'" E.
Address of person requesting inspection Co TI-) ';c\.r J 17 f!:.: 'f g Phone No i (7 - '-I ~ '1'1
I
Type of Inspection (circle appropriate one) Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other ~i-.,.,~]
INSPECTION NOTES
Inspected Date I Z - 2- i - 0'1 Time
Remarks ^~rc1.,rt:d 3/1 II <:"0//(" (1vLC. c:{ t
4...t d C{. C L~..vt.,.(' C/ rtl Q J/\.
I
By
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RESTORATION REQUIRED
YES
NO X
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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 0 Other
Work Order # It{ 2- 78- o7C}
o COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
CIty of Port Angeles
Public Works Department
Water DIstribution Repair Report
IWork Order No /'-12,78 -070,
/Crew ? (5- 7- c..;,reJ
]
DATE REPORTED
I 2 r- Z (- 0 L/
CONDITION Elv1ERGENCY 0 ROUTINE 0 CITIZEN CO!vfPLAlNT 1(
LEAKAGE SURVEY 0 OTHER 0
DATE OF REPAIR. IL-"l.t -0<1 TIME (2 00
REPAIR LOCATION ADDRESS C:> Zb E '-{ L~
DA.M. iZW.M.
I'i/L
TYPE OFMAlN
SIZE.
"z. II
I , '2
DEPTH OF MAIN 2. 'Z CLOSEST VALVE DEPTH.
CO!vfPONENT REPAIRED.
MAIN JOINT D CIR. BREAK D SPLIT BELL D LONG BREAK D
HOLE D CLAMP D OTHER
SERVICE TAP D CORP STOP D PIPE]a: CURB STOP D FITTING D
METER SETTER D METER D
LINE VALVE. FLANGE NUTS/BOL TS 0 STEM 0 BONNET D
HYDRANT BRANCH D VAL VE D BARREL 0
OTHER.
COMPONENTS OF REP AIR. CLAMPD DRESSERD OTHER :3/-( P E +v b I "'":} ) (. <-') >LA..f U Ullo ''\...
SITE CONDITION GRAVEL 0 ASPHALT 0 SIDEWALK D CURB D
TOP SOIL AREA){ SOIL TYPE
CUTS ASPHAL T CUT _IT CURB CUT _IT SIDEWALK_IT
DRIVEWAY CUT _IT
MAIN CONDITION INTERNAL LINING TUBERCULATION-MINOR D SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE ",l S- P.P M.
WATER OFF FROM 12 50 PM. TO I (5 PM.
FROM M. TO M.
A.PP.A.RENT CAUSE OF LEAK. Oid c-tdL.