HomeMy WebLinkAbout714 E 3rd St - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUE~T:
Date 6 - :;2. ~ -- 0 J Time
Received by
(phone, person)
Sewer Foundation Framing
7 J f.. .f 3v-cI
~"~
-fit. fr.15 Phone No.
Permit No.
Chimney Plumbing Final Sewer Excav. Other {.J-J A...:f-er-
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one):
INSPECTION NOTES:
Inspected:
Remarks:
Date Time
. PrOWl r'~
--/v A RA ~
By
--Ply Ct.. ~. I C:--e ~ ~
+6 c:rn.-e LJu ~
. . . . . .
-- JJ1
y Q...H P II c-
t\.; ...
1V
"- - .-
~ ~ ~ is-~ .,
,
1 <;.'( yJIf c, "^
~ - -
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f:: ",r;J
SURFACE RESTORATION:
RESTORATION REQUIRED
YES
~
NO ~
SURFACE TYPE: D Unimproved DGravel
D Repaired by City
[] Repaired by Permittee
D No Damage Found
D Asphalt D PCC . D 7r
Work Order # 5)7
~PLETE
D INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
City of Port Angeles
Public 'Vorks Departnlent HTE W ~ SS 1(p
Water Distribution Repair Report
DATE REPORTED:
S-~ 7 b I
6-Q....?-O?
ICrew:
;I,y
IWork Order No:
CONDITION: EMERGENCY D ROUTINE D CITIZEN COMPLAINT 6,/'
LEAKAGE SURVEY D OTIffiR D
DATE OF REPAIR:
(,-?-16?
TIME:
DA.M. OP.M.
E- '3 rei
REPAIR LOCATION: ADDRESS: 71 ~
TYPE OF MAIN: c;;t (( pile SIZE:
DEPTH OF MAIN:
CLOSEST VALVE DEPTH:
COMPONENT REPAIRED:
MAIN: JOINT D CIR. BREAK D SPLIT BELL ~ONG BREAK D
HOLE D CLAMP D OTIffiR
SERVICE: TAP 0 CORP. STOP 0 PIPE ~URB STOP 0 FITTING 0
.METER SETTER 0 METER 0
LINE VALVE: FLANGE NUTS/BOLTS 0 STEM 0 BONNET 0
HYDRANT: BRANCH 0 VALVE 0 BARREL 0
OTHER:
COMPONENTS OF REPAIR: CLAMPO DRESSERO OTHER
SITE CONDITION: GRAVEL 0 ASPHALT 0 SIDEWALK 0 CURB 0
TOP SOn.. AREA 0 SOn.. 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.
) 61iM.
/ h 0 U 5-e
6~
WATER OFF: FROM
~ A-M. TO
M.
13 vt {ftc.
p- k p/)9JC
.
FROM M. TO
APPARENT CAUSE OF LEAK: