HomeMy WebLinkAbout504 E 3rd St - Engineering
City of Port Angeles
Public Works Departnlent
Water Distribution Repair Report
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'Work Order No:
DATE REPORTED:
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L(-/o- 6!
ICrew: 71 (j
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CONDITION: EMERGENCY D ROUTINE D CITIZEN COMPLAINT D
LEAKAGE SURVEY)( OlliER D
DATE OF REPAIR: (f----2.') - 6 ( TIME:
DA.M. DP.M.
50 [I E In.l
C - J:.. SIZE:
REPAIR LOCATION: ADDRESS:
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TYPE OF MAIN: a'\,.
DEPTII OF MAIN: "J l
CLOSEST VALVE DEPTII:
COMPONENT REPAIRED:
MAIN: JOINT D CIR. BREAK D SPLIT BELL D LONG BREAK 0
HOLE 0 CLAMP 0 OTHER
SERVICE: TAP 0 CORP. STOP 0 PIPE K CURB STOP 0 FITTING 0
METER SETTER 0 METER 0
LINE VALVE: FLANGE NUTS/BOLTS 0 STEM D BONNET D
HYDRANT: BRANCH 0 VALVED BARREL 0
OTHER:
COMPONENTS OF REPAIR: CLAMPO DRESSERO OTHER f( -e /lJ ~ CUe c/ S:-e rUt 2 -e... %C/.. ( ) 1 h
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SITE CONDITION: GRAVEL 0 ASPHALT 0 SIDEWALK VCURB 0
TOP SOIL AREA 0 SOIL TYPE
CUTS: ASPHALTqIT _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 13,b P.P.M.
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WATER OFF: FROM
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APPARENT CAUSE OF LEAK:
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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . INSPECTION REPORT. . . . . .
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REQUEST:
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Date c_ .:--
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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Phone No.
Permit No.
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav. Other {.u;;Z .-j--tl./-
INSPECTION NOTES:
Inspected: Date
Remarks:
Time
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SURFACE RESTORATION: '
SURFACE TYPE: 0 Unimproved o Gravel 0 Asphalt ~
o Repaired by City
o Repaired by Permittee
o No Damage Found
Work Order #
o COMPLETE
o INCOMPLETE
o Other
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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . INSPECTION REPORT. . . . . .
zr
REQUEST:
Date Lj - J... ) - D I
,
, -
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):
S-6 21 E 3 ;-4
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Phone No.
Permit No.
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav. Other LJJ't\ '-j-li/
INSPECTION NOTES:
Inspected: Date
Remarks:
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RESTORATION REQUiRED...... YES i/ NO
SURFACE RESTORATION:
SURFACE TYPE: D Unimproved DGravel
D Repaired by City
[] Repaired by Permittee
D No Damage Found
~Phalt ~ 0 Other
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Wor~Order # ,/ Y
LWCOMPLETE O-w '2 C,6 -Z
o INCOMPLETE
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(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)