HomeMy WebLinkAbout1705 W 10th St - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. INSPECTION REPORT. . . . . .
.....
REQUEST
/ I-iI ,OL/
Time Cj ( U7J /l /J/1 Received by
I
Location of Work to be inspected /705 W / D rL
Name of person requesting inspection (..;V'~ tt? /' I::llL/ 15/ t) V\
Address of person requesting inspection /7 fA. (f6 <;r Phone No Y 17. '/ff'/ '7
Type of Inspection (circle appropriate one) Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav @ t-v~ r e r
(phone, person)
Date
INSPECTION NOTES
Inspected Date /1-1 ( - 0 '/
Remarks
Time
Cf; OV ~ JI}/\
/
By
7/7
;:). \1.. C I prJp';h,. b/'e'l i \ fepa//eJ. '-vi (h.. 5fdtOlles r-e~~//' bAAd
RESTORA TION REQUIRED . YES NO )C
Ksr I tJ
~
I C ~
d. /}." c.r -
" -
~3g' ~
) 0 rh..
SURFACE RESTORATION
SURFACE TYPE P' Unimproved 0 Gravel
D Repaired by City
[] Repaired by Permittee
D No Damage Found
o Asphalt 0 PCC D Other
Work Order # 10~tj-03'
~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 13 <8~~ . 03 6
/Crew 717 i 7~J., 7)5, 7;1./
i
DATE REPORTED 1/ -I (-0 <.f
CONDITION ENlERGENCY Jr ROUTINE 0 CITIZEN CONfPLAlNT 0
LEAKAGE SURVEY 0 OTIIER 0
DATE OF REF AIR. II-II-o'l TIME Lf r <--~ DA.M. )a'P.M.
REF AIR LOCATION ADDRESS I 70') (.A../ 10 Tt.....
cr ~ \'
TYPE OF MAIN SIZE. -
3.5"" "3 - \
DEPTII OF MAIN CLOSEST VALVE DEPTH. . ~
CONfPONENT REPAIRED.
MAIN JOINT 0 CIR BREAK}q SPLIT BELL 0 LONG BREAK 0
HOLE 0 CLAMP D OTHER
SERVICE TAP D CORP STOP D PIPE D CURB STOP D FITTING 0
NlETER SETTER 0 METER D
LINE VALVE. FLANGE NUTS/BOL TS 0 STEM 0 BONNET 0
HYDRANT BRANCH 0 VAL VE 0 BARREL 0
OTHER.
COMPONENTS OF REP AIR. CLAMPO DRESSERO OTHER S ICtdl ~~ It ~a:u/' JUi"z d
,
SITE CONDITION GRA VEL ~ ASPHALT 0 SIDEWALK 0 CURB 0
TOP SOIL AREA 0 SOIL TYPE
CUTS ASPHAL T CUT _FT CURB CUT _FT SIDEW ALK _FT
DRIVEWAY CUT _FT
MAIN CONDITION INTERNAL LINING .A/ 4- TUBERCULATION-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE 4/1/ P.P.M. {;~d.. vVl.2"r f/-4I5Svr-e
WATER OFF FROM
M.TO
M.
FROM
M. TO
M.
APP.A.RENT CAUSE OF LEAK 11CYuIA J. 5dll~