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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUEST:
Date '8' -rJ - 0 ~I
Time
9;07J I!/YI Received by
711
(phone. personl
'...-
Location of Work to be inspected de) ( fi/ I.bl? /' f y
Name of person requesting inspection W..J-<)r ,~'/'SiM-"'",
Address of person requesting inspection J 7 T7-- (is
Type of Inspection (circle appropriate one):
Sewer Foundation Framing Chimney Plumbing Final
Phone No, l//7 -'If:f'I9
Permit No, C'
Sewer Excav. e (, n;t r':e.r
Inspected: Date
Remarks:
INSPECTION NOTES:
'3'-,?- -0 Y
Time q.'dV /J~y ,). rlo/fY"'7i
0+
f2.ell:<"e-~ J." c'r
I (
side: uJall Sc>c.('Orl.
ma,;, br0!!4 k (e;1'l,?i/e.6-
(:r<>/Yl ,n<'i"~' s,de<o.A<..lk fw
a il/,), ,;<)r '{' t)1<,ce
I 1 '
cv/b
.
RESTORATION REQUIRED . . . . .. YES Y NO
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frDr1 T sr. $
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SURFACE RESTORATION: I
SURFACE TYPE: 0 Unimproved OGravel 0 Asphalt 0 PCC MOther .<)IJet:Vcoli: I
o Repaired by City Work Order # I s~-O.;lC;- \ ~ I
o Repaired by Permittee ~ COMPLETE ,l ~~ t:::.,t I
ONo Damage Found 0 INCOMPLETE '6-\1 ~GL\ '~L :
/10 jir~J B tH04 )}-
--IContinue.on.reverse.sidejinece~~~~Yl _ __ STREET SUPERINTENDENT (DATEl
City of Port Angeles
Public 'Works Department
Water Distribution Repair Report
IWork Order No: I \.~ 'fJ ~ O.l-5""
lerew: 7/0 }/) I 7;l.:L.
.
I
DATE REPORTED:
g~J -0'-/
CONDITION EMERGENCY 0 ROUTINE)!( CITIZEN C01vlPLAINT 0
LEAKAGE SURVEY 0 OTIfER 0
DATE OF REPAIR: 'ff -(). -O'f TIME q;o-o ~.M OP.M.
REPAIR LOCATION ADDRESS: .?-of A/ lbe/ f;/
TYPE OF MAIN: cr SIZE: d. 1\
'7' 3'
DEPTIl OF MAIN:,2 CLOSEST VALVE DEPTH:
C01v!PONENT REPAIRED:
MAIN: JOINT 0 CIR. BREAK)( SPLIT BELL 0 LONG BREAK 0
HOLE 0 CLPuVW 0 OTIfER
SERVICE: T/oJ' 0 CORP. STOP 0 PIPE 0 CURB STOP 0 FITTING 0
METER SETTER 0 METER 0
LINE VALVE: FLANGE NUTS/BOL TS 0 STEM 0 BONNET 0
HYDRANT: BRANCH 0 VALVE 0 BARREL 0
OTIfER:
C01v!PONENTS OF REPAIR CLAMPO DRESSERO OTIfER :55 .fs:.:Jcur baA d
,
SITE CONDrrlON GRAVEL 0 ASPHALT 0 SIDEWALK)( CURB 0
TOP SOIL AREA 0 SOIL TYPE
CUTS: ASPHALT CUT _FT CURB CUT _FT. SIDEWALK iRx'l FT.
DRlVEW A Y CUT _FT.
MAIN CONDITION: INTERNAL LINING ,/t/,4 TUBERCULATION-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
CHLORlNE RESIDUAL SAMPLE #A PPM fefl'rr"'~ ~<7/' f05,flve l/e6S'd/"e
WATER OFF: FROM 10.'Jo hM. TO lo;q') AM.
FROM
M. TO
M.
.'\PP.'\RENT CAUSE OF LE/J:(:
D/ {] P,/} e
,
.....
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . INSPECTION REPORT. . . . . .
.....
REQUEST
Date I Z - ~- 0 s
Time
I /'M
Received by 1Jt'vtVf(S E_
(phone, person)
Location of Work to be inspected L 0 ( ~fl L I k-er + ('
Name of person requestin~ in~pectio~ j)~ C Jj(~tc ""-
Address of person requesting inspection 0 r p YU(X r J. Phone No
Type of Inspection (circle appropriate one) Permit No__ _~I ,
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav OthZlV4..0
INSPECTION NOTES
Inspected Date I Z - 0 r 0;
Remarks Ke .t-?a, re4. z.. If CL
t~ (J
-
Time 3- {J Iq
~1M. hric
By D 6J-5{~--fo~
WI f-h S_~ - re ~Alr
,
RESTORATION REQUIRED
YES ><
NO
ZOl
tV Li \:J~/
. i
I zIt L-.r 2{ ()~~p
r ~ -
'IS-(-
~
-i--
\ 'v)
~ ~ F (() vet- "
~ C ~
--.. ~0
"-.J
SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel
o Repaired by City
CJ Repaired by Permittee
CI No Damage Found
o Asphalt 0 PCC 0 Other Co I:-L r e+ e:
0(&e w-,<-( k
Work Order # (1..:?,Z:Z.-- Aflroj( 5~ 71
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-,32.2-
lCrew 71S, ((G.) 7( 7
,
DATE REPORTED' 12 -ro ~05
CONDITION EMERGENCY ~ ROUTINE D CITIZEN COMPLAINT ~
LEAKAGE SURVEY D OTHER D
DATE OF REPAIR. I Z- ~ ~- 05 TIME
REPAIR LOCATION ADDRESS Z 0 ( cJ
I . O{) DA.M. ~.M.
L I be r+,-/
I
TYPE OF MAIN
C T SIZE Z (I
2 ~ I CLOSEST VALVE DEPTH. .'3 /
DEPTH OF MAIN
COMPONENT REPAIRED.
MAIN JOINT D CIR BREAK ~ SPLIT BELL D LONG BREAK D
HOLE D CLAMP D OTHER
SERVICE TAP D CORP STOP D PIPE D CURB STOP D FITTING D
METER SETTER D METER D
LINE VALVE FLANGE NUTS/BOL TS D STEM D BONNET 0
HYDRANT BRANCH D VALVE D BARREL D
OTHER
COMPONENTS OF REPAIR. CLAMP)( DRESSERD OTHER
SITE CONDITION GRAVEL D ASPHALT D SIDEWALK eki CURB D
TOP SOIL AREA D SOIL TYPE Q c...~
CUTS ASPHALTCUT_Ff CURB CUT _Ff StDEWALK~Ff
DRIVEWAY CUT _Ff
MAIN CONDITION INTERNAL LINING P TUBERCULATION-MINOR D SEVERE D
EXTERNAL CORROSION LOCALIZED D EXTENSIVE D
CHLORINE RESIDUAL SAMPLE ~ 3,'f P.P.M.
-c+r-~1--'.--:: ~L/
r
WATEROFF FROM ( 30';oM. TO 2 ooPM.
FROM
M. TO
M.
APPARENT CAUSE OF LEAK. 6 rovV't ~{ Scff Ie...