HomeMy WebLinkAbout2134 Clipper Cv - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUEST
Date }~-"-()l
Time
Received by
(phone, person)
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one)
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/7 -fit '6> tJ ~hone No
Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other '0^ fCA::;t-tv--
INSPECTION NOTES
Inspected
Remarks
Date Time By
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RESTORATION REQUIRED YES V NO
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SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel
o Repaired by City
[] Repaired by Permittee
[] No Damage Found
Tfi[t::~e~;~~t!c~t~ h:h
sphalt 0 PCC 0 Other
Work Order # ,f:J.. 3 lj 1 I\(
~ COMPLETE ~~\?c.J-tci::9. '-0\ ~l
o INCOMPLETE ~()t- Jv\ \" \ )q -OS
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STREET SUPERINTENDENT (DATE)
City of Port Angeles
Public Works Department
Water Distribution Repair Report
IWork Order No
CONDITION
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I / ~'-I'6>-oJ
EMERGENCY 0 ROUTINE 0 CITIZEN COMPLAINT /'
LEAKAGE SURVEY D OTHER D
DATE REPORTED
REP AIR LOCATION
ADDRESS
-
I ~-II-c1 TIME
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DA.M. DP.M.
DATE OF REPAIR.
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TYPE OF MAIN
....
DEPTH OF MAIN
CLOSEST VALVE DEPTH.
COMPONENT 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~URB STOP D FITTING 0
METER SETTER D METER 0
LINE VALVE. FLANGE NUTS/BOL TS D STEM D BONNET D
HYDRANT BRANCH D VAL VE D BARREL D
OTHER.
COMPONENTS OF REPAIR. CLAMPD DRESSERD OTHER ! I t' () f- Jj r j?....E ?IP-R.-
SITE CONDITION GRAVEL 0 ASPHALT D SIDEWALK D CURB 0
TOP SOIL AREA D SOIL TYPE
CUTS ASPHAL T CUT _IT CURB CUT _IT SIDEWALK_IT
DRIVEWAY CUT _IT
MAIN CONDITION INTERNAL LINING TUBERCULATION-MINOR D SEVERE D
EXTERNAL CORROSION LOCALIZED D EXTENSIVE D
CHLORINE RESIDUAL SAMPLE I J..... ~ P.P.M.
WATEROFF FROM If M.TO ~M.
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FROM
M. TO
M.
,.
APP ARENT CAUSE OF LEAK.
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