HomeMy WebLinkAbout1916 W 4th St - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUEST:
Date~ - 9-b l.{
Time
Received by
(phone, person)
Location of Work to be inspected 'L1- } -' (;J V.j11
Name of person requesting inspection ~ vV ; I Go "(-
Address of person requesting inspection 11 tit + B Phone No.
Type of Inspection (circle appropriate one): Permit No.
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav. Other l h~
INSPECTION NOTES:
Inspected: Date
Remarks:
Time By
'R1hcv1'r ~YV'~~
WI Q...X I
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RESTORATION REQUIRED. . . . .. YES
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V NO
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SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved DGravel
D Repaired by City
o Repaired by Permittee
o No Damage Found
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o Asphalt 0 PCC 0 Other tdv 5c) ,'L
Work Order # J 4:2 tl{- 6 0 ;
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:
DATE REPORTED:
/ 4 ~ ,5< 00 II
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[Crew:
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REPAIR LOCATION: ADDRESS:
CONDITION: EMERGENCY D ROUTINE D CITIZEN COMPLAINT ~
LEAKAGE SURVEY D OTHER D
DATE OF REPAIR: ,. -- q ...- 0 L( - TIME: ) r 'J () DA.M. ~.M.
J Cf / b fA L/ fit
c. -t:-- SIZE:
TYPE OF MAiN:
;;r(
51
DEPTII OF MAIN:
CLOSEST VALVE DEPTII:
COMPONENT REPAIRED:
MAIN: JOINT D CIR BREAK D SPLIT BELL 0 LONG BREAK D
HOLE 0 CLAMP D OTHER
SERVICE, TAP ~ORP.STOP 0 PIPE 0 CURB STOP 0 FlTTING 0 +~dJk
METER SETTER 0 METER D
LINE VALVE: FLANGE NUTS/BOLTS D STEM D BONNET D
HYDRANT: BRANCH D VAL VE 0 BARREL 0
OTIfER:
COMPONENTS OF REPAIR: CLAMPO DRESSERO OTHER
SITE CONDITION: GRAVEL 0 ASPHAL T D SIDEWALK D CURB 0
TOP SOIL AREA ~ SOIL TYPE
CUTS: ASPHAL T CUT _FT. drnB 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.
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M.
WATER OFF: FROM M. TO
FROM M. TO
APP ARENT CAUSE OF LEAK: