HomeMy WebLinkAbout112 W 5th St - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT . . . . . . . . . . .
REQUE~T '. __ {j 1
Date b. - 10 Time Received by (phone, person)
Location of Work to be inspected J I 2- ,UJ ) {)1
Name of person requesting inspection f r-r- &-> j \ (6 X
Address of person requesting inspection / 1 f'Jl 't-B Phone No
Type of Inspection (circle appropriate one) Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other (;-J~-f--c',.,,-
INSPECTION NOTES
Inspected Date
Remarks
Time By
f? ~ IU,-: C0 _ ~ ,5 <' yu /c--e h- Ai -< .5._
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SURFACE RBSTORA TION
RESTORATION REQUIRED
//
vesY NO
SURFACE TYPE
o Unimproved 0 Gravel
o Repaired by City
CJ Repaired by Permittee
o No Damage Found
o Asphalt ~ 0 Other
Work Order # ~I 36 I
o COMPLETE I 'U~D3
o INCOMPLETE ~ Sired ~ "fr-
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(Continue on reverse side if necessary)
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STREET SUPERINTENDENT
(DA TE)
LIty Oll.Jort Angeles
Public 'Vorks Departnlent t+~ LUP# Sl~~
'" ater Distribution Repair Report
'Work Order No'
DATE REPORTED
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REP AIR LOCATION ADDRESS
CONDITION EMERGENCY 0 ROUTINE 0 CITIZEN C01\.1PLAINT ~
LEAKAGE SURVEY 0 OTIfER 0
DATE OF REPAIR. 6> - ! D - 07 TIME. "/ It Jt\ DA.M. DP.M.
j I J- LJ ~ f/i
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:;< r ( C - t SIZE
-
TYPE OF MAIN
DEPTH OF MAIN
CLOSEST VALVE DEPTH.
COMPONENT REPAIRED.
MAIN JOINT D CIR. BREAK D SPLIT BELL. D LONG BREAK D
HOLE D CLAMP D OTIIER
SERVICE TAP D CORP STOP D PIPE~URB STOP D FITTING D
METER SETTER D METER D
LINE VALVE. FLANGE NUTSIBOLTS D STEM D BONNET D
HYDRANT BRANCH D VAL VE D BARREL D
OTIfER.
COMPONENTS OF REPAIR. CLAMPD DRESSERD OTIfER
SITE CONDITION GRAVEL D ASPHALT D SIDEWALK D CURB D
TOP SOn.. AREA D SOn.. TYPE
CUTS ASPHALT CUT _FT CURB CUT _FT SIDEWALK._FT
DRIVEWAY CUT _FT
MAIN CONDITION INTERNAL LINING 1lJBERCULATION-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED D EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE I ., b P.P.M.
WATER OFF FROM
'611-
M.TO
9 )1- M.
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FROM M. TO
M.
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APPARENT CAUSE OF LEAK.
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