HomeMy WebLinkAbout2619 S Race St - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . INSPECTION REPORT. . . . . .
.....
REQUEST '11 /)
Date 3 -;.... --""6)
Time
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one)
Sewer Foundation Framing Chimney
INSPECTION NOTES
Inspected
Remarks
.....
Received by
(phone, person)
~ {q . S ;Q(~ (~
Tmr
/1+1 . - Phone No
Permit No
Plumbing Final Sewer Excav Other
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SURFACE RESTORATION
SURFACE TYPE 0 Unimproved
o Repaired by City
[] Repaired by Permittee
o No Damage Found
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t,-)~ k 5+-,
o Asphalt 0 PCC
Wor~er #
@'COMPLETE
o INCOMPLETE
o Other
J. (l Y'3
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
LIty 01 IJort Angeles
Public 'Vorks Departnlent Hr*-.- .. 24~3
", ater Dlstribution Repair Report
'Work Order No'
~4 .rj
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I Crew
7,/1
"1_ ') '-'-6 I
DATE REPORTED L ./---L
CONDITION BvIERGENCY 0 ROUTINE 0 CITIZEN COMPLAINT ~
LEAKAGE SURVEY 0 OTHER 0
DATE OF REPAIR. 3.-2-1-6J TIME r/}o~ OP.M.
REPAIRLOCATION ADDRESS Q..l:~/ 9 s )fa. c....~
TYPE OF MAIN :2.' (C-:.-t- SIZE
DEPTH OF MAIN
1)(
./ CLOSEST VALVE DEPTH.
COMPONENT REPAIRED. . ./
MAIN JOINT 0 Crn.. BREAK ~PLIT BELL. 0 LONG BREAK 0
HOLE 0 CLAMP 0 OTHER /
SERVICE TAP 0 CORP STOP 0 PIf~ o...J CURB STOP 0 FITTING 0
METER SETTER 0 METER 0
LINE VALVE FLANGE NUTS/BOL TS 0 STEM 0 BONNET 0
HYDRANT BRANCH 0 VAL VE 0 BARREL 0
OTHER.
COMPONENTS OF REPAIR. CLMfl6~:SERO OTHER
SITE CONDITION GRAVEL 0 ASPHALT 0 SIDEWALK 0 CURB 0
TOP SOIL AREA 0 SOIL TYPE
CUTS ASPHALT CUT _FT CURB CUT _FT SIDEWALK_FT
DRIVEWAY CUT _FT
MAIN CONDITION INTERNAL LINING TUBERCULATION-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE ~P.P.M.
WATER OFF FROM /0 I}- M. TO 1;2.. r> M.
I j.,..)/ /\U+ 0 F
J 8/CJAJ'-- u
FROM M. TO
M.
-PS-e~ +- ~mck(
APPARENT CAUSE OF LEAK.