HomeMy WebLinkAbout1730 E 3rd St - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS /)5 4
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
+~
REQUEST 2-
Date 1---?-b .'- ~ Time
Received by
(phone, person)
Location of Work to be inspected I r--;
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one)
')0 1: J'vj
-:; fit I .j;~ r Phone No
Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other L]-J(A...+-e)"..-
INSPECTION NOTES
Inspected Date
Remarks
Time d
~ 11 :::fJ; I~ (lu~
By
,^ '< c- { ~~/~e'V
C L'l-- cJ~ ~ '
RESTORATION REQUIRED
~
~
ct
1:- ?wj,
~
~
cr
~
~
~ .)(
'I
(
~ Jr ~~
I .( 'T"
o [) -- ....-
~
J~
,1 <rtLa1
~ ~ ..efAt y-
SURFACE RESTORATION
SURFACE TYPE D Unimproved 0 Gravel 0 Asphalt D PCC
D Repaired by City
o Repaired by Permittee
[] No Damage Found
Work Order #
DOthertDf~ I 1.-
26/6
o COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
CIty of Port Angeles t)L0-J.,S"'Ot-OlO=F(..
Public Works Department
Water Distribution Repair Report
IWork Order No: ~ -I f, /crew 7 f. f .
DATEREPORTED J - J.-~ - 62-
CONDITION EMERGENCY 0 ROUTINE 0 CITIZEN COMPLAINT ~
LEAKAGE SURVEY 0 OTIIER 0
DATE OF REPAIR. t) -- ~ - 6 1- TIME. 1,}7;) '~A.M. DP.M.
REPAIR LOCA TI0N ADDRESS t 7 3 b E-:3 rei (
TYPE OF MAIN J.. (' (- T- SIZE.
DEPTH OF MAIN LJ t'
_ CLOSEST VALVE DEPTH.
COMPONENT REPAIRED. 1 /
MAIN JOINT 0 CIR. BREAK /;!:( SPLIT BELL. 0 LONG BREAK 0
HOLE 0 CLAMP 0 OTHER
SERVICE TAP 0 CORP STOP 0 PIPE 0 CURB STOP 0 FITTING 0
METER SETTER 0 METER 0
LINE VALVE. FLANGE NUTS/BOL TS 0 STEM 0 BONNET 0
HYDRANT BRANCH 0 VALVE 0 BARREL 0
OTHER.
COMPONENTS OF REPAIR. CL~SSERD OTHER
SITE CONDITION GRA VEL 0 ASPHAJ..T 0 SIDEWALK 0 CURB 0
TOP SOIL AREA &Y' SOIL TYPE
CUTS ASPHALT CUT _FT CURB CUT _FT SIDEWALK_FT
DRIVEWAY CUT _FT
MAIN CONDITION INTERNAL LINING 1/ - If- TUBERCULATION-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE P.P.M. R...R pt / 'r e ~I U /!/cl-e t/- j7 t3 5 5 I +, V-e...
WATEROFF FROM M.TO M. pv-€5 .su~
FROM
M.TO
M.
0- fH:-e 'i- !7rect k
APPARENT CAUSE OF LEAK.