HomeMy WebLinkAbout1104 E 5th St - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . INSPECTION REPORT. . . . . .
~.-) "
",/ I
, .Jy
/ I
REQUEST
Date J - A--6 }
,
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)
)/ 6 (( E ~fl1
]jLu I 'I C (\ -;xl'
Ht --(i-.' rj Phone No
Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other (;.....1 .J--r t/
INSPECTION NOTES
Inspected Date
Remarks
RESTORATION REQUIRED
/
YES V NO
1#
~
'~ )+i~
' \J ct
\D (
, r11 -. ~
~~, ( /~ ( c>y
"
~ , ,._..~ ~
AI'-
~J
U \ '~ pOJ'r \
,)tl i\! f.e
SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel 0 Asphalt
OPCC
o Other! Of' 50\ 1-
:);L77
,
[] Repaired by City
[] Repaired by Permittee
o No Damage Found
Work Order #
o COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
CIty of l)ort Angeles
Public 'Vorks Departnlent
Water Distribution Repair Report
IWork Order No. 'J:]... 71
I Crew
71Y
,
DATE REPORTED' /;z- 3 i - 62-
CONDITION EMERGENCY 0 ROUTINE 0 CITIZEN COMPLAINT /
LEAKAGE SURVEY 0 OTHER 0
DATE OF REPAIR.
TIME 7/1-)-1.
J I () 1.,( JE- 5-(),
TYPE OF MAIN ~ (r ( ~ .:c:- SIZE.
DEPTH OF MAIN <~ 11-- I CLOSEST VALVE DEPTH.
)- J.... - o?-
DA.M. DP.M.
REPAIR LOCATION
ADDRESS
COMPONENT REPAIRED. . /
MAIN JOINT D CIR. BREAK Uz(' SPLIT BELL. D LONG BREAK D
HOLE 0 CLAMP D OTHER
SERVICE TAP 0 CORP STOP 0 PIPE D CURB STOP D FITTING D
METER SETTER D METER 0
LINE VALVE. FLANGE NUTS/BOLTS 0 STEM 0 BONNET D
HYDRANT BRANCH 0 VALVE 0 BARREL 0
OTHER.
COMPONENTS OF REPAIR. CLAMP~RESSERD OTHER
SITE CONDITION GRAVEL 0 ASPHALT D SIDEWALK D CURB 0
TOP SOIL AREA)(r SOIL TYPE
CUTS ASPHALT CUT _FT CURB CUT _FT SIDEWALK_FT
DRIVEWAY CUT _FT
MAIN CONDITION INTERNAL LINING TUBERCULA nON-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE / 7) P.P.M.
WATER OFF FROM '/ / }o PM. TO ~ I }O 11.
)0 /;DUSe.~ ~ u f
/4r,
FROM
M.TO M.
5e~
ir
,J J-C-, C( I(
APPARENT CAUSE OF LEAK.