HomeMy WebLinkAbout516 W 9th St - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . INSPECTION REPORT. . . . . .
REQUEST
Date f5 -2 -of.(
Time
~. If ttV\.
Received by D<:.vt.CI'\.. \<; E (phone, person)
Location of Work to be inspected S-; Go W,
Name of person requesting inspection .f)-e n.P1 t' 5
Address of person requesting inspection
Type of Inspection (circle appropriate one)
Sewer Foundation Framing Chimney Plumbing Final
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Phone No t.( 17 - L{ rt./ Cf
Permit No ~
SewerExcav Oth~f<c~
INSPECTION NOTES
Inspected ~te g - 'L - 0 <{
Remarks e # ~ / -..--- I 1', <54.1 vi
I
Time If If M
ItjJ.e aJ(.f-~ ~
By De~vt I 5 C
5' 'S. re/2~,'r ~"^-d
,
RESTORATION REQUIRED
YES
NO X
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2r' C T ,~ I~> 2 II C r '/I
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\j C/ Y I 0
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,voi<. \ 2 /'%.. 4<P
Ut;l'5c.J......e kow r\t(.vc.....k. / i, ?'f.R.-
"5 b.etve.L.... .-r~.;;~ Jc..tvc
SURFACE RESTORATION
SURFACE TYPE 0 Unimproved D Gravel
[] Repaired by City
Cl Repaired by Permittee
CI No Damage Found
o Asphalt 0 PCC D Other
Work Order # I ~ffz-'i? .... 0 2.lf
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 I 3 ~'Z B -02.4
ICrew 7 f ~ C:I Cr
]
DATE REPORTED
~
7 - ZJf ~o L(
CONDITION E1v1ERGENCY 0 ROUTINE 0 CITIZEN CONfPLAlNT jl(
LEAKAGE SURVEY 0 OTHER 0
DATE OF REPAIR
g - 2--0<-(
TIME (I
REPAIRLOCATION ADDRESS 5 (e, tJ. 1-1~
6cJ J SIZE I r,
DEPTII OF MAIN 2.. ~ I CLOSEST VALVE DEPTH. '2- I"
~.M. OP.M.
TYPE OF MAIN
CONfPONENT REPAIRED.
MAIN JOINT \3 CIR. BREAK 0 SPLIT BELL 0 LONG BREAK 0
HOLE ~ CLAMP 0 OTHER
SERVICE TAP 0 CORP STOP 0 PIPE 0 CURB STOP 0 FIITING 0
METER SE1TER 0 METER 0
LINE VALVE. FLANGE NUTSIBOL TS 0 STEM 0 BONNET 0
HYDRANT BRANCH 0 VAL VE 0 BARREL 0
OTHER.
COMPONENTS OF REPAIR. CLAMPl( DRESSERO OTHER
SITE CONDITION GRA VEL 0 ASPHALT 0 SIDEW N-K+o. CURB 0
TOP SOIL AREA 0 SOIL TYPE IJ 4. (v e....
CUTS ASPHAL T CUT _IT CURB CUT _FT SIDEWALK FT
DRIVEWAY CUT FT~
MAIN CONDITION INTERNAL LINING U 1lJBERCULATION-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE 1 ~ P P M. (
DfD- hK-el (fc/e
WATER OFF FROM M. TO M.
-----
FROM
M.TO M.
~ ( e. c-tro If "5 ( "S
\PP'\RENT CAUSE OF LEAK.