HomeMy WebLinkAbout2211 W 4th St - Engineering
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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUEST .
Date / - I (1- 6 l
Time
Received by
(phone, person)
Location of Work to be inspected ~ .~ II. Ly ~l-tit
Name of person requesting inspection~l A1 t , (. () r:
Address of person requesting inspection I { tIt ct.() Phone No
Type of Inspection (circle appropriate one) Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other ~
INSPECTION NOTES
Inspected
Remarks
Date
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By
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RESTORATION REQUIRED
YES
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SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel 0 Asphalt
D Repaired by City
[] Repaired by Permittee
D No Damage Found
OPCC
o Other
).0/ y
Wor~rder #
avcOMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
CIty of Port Angeles
Public Works Department
Water Distribution Repair Report
D Lv 2--00f - 7--01L{
IWork Order No.
. 26 I f.(
I Crew
7/y
J- J' LI - D (i
DATE REPORTED'
CONDITION EMERGENCY 0 ROUTINE ~TIZEN COMPLAINT ~
LEAKAGE SURVEY 0 OTHER 0
DATE OF REPAIR.. I ~ I i( -0 ,
TIME
7, A- t1', DA.M. DP.M.
~ '7 f1,
REP AIR LOCATION
ADDRESS
9--AJI
1H /+C
SIZE
TYPE OF MAIN
DEPTH OF MAIN
CLOSEST VALVE DEPTH.
COMPONENT REPAIRED.
MAIN JOINT D CIR. BREAK D SPLIT BELL- 0 LONG BREAK D
HOLE D CLAMP D OTHER
SERVICE TAP D CORP STOP rIPE ~URB STOP D FITTING D
METER SETTER D METER D
LINE VALVE. FLANGE NUTS/BOLTS D STEM D BONNET D
OTHER.
BRANCH D VALVE D BARREL D
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HYDRANT
COMPONENTS OF REPAIR. CLAMPD DRESSERD OTHER
SITE CONDITION GRA VEL D ASPHALT D SIDEWALK D CURB D
TOP SOIL AREA D 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 D
CHLORINE RESIDUAL SAMPLE ~P.P.M.
WATER OFF FROM 11 ft ;yt M. TO Cf,lt M.
(- (.') l.!.f-
/h6L1/<-
FROM
M.TO M.
APPARENT CAUSE OF LEAK.
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