HomeMy WebLinkAbout509 W 5th St - Engineering
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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT . . . . . . . . . . .
REQUEST
Date } ::t- :3 - D 1
I
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)
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TWI\CD/
I L~~ ~ t1 Phone No
Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other W ~-
INSPECTION NOTES
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Time .
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By
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Inspected Date
Remarks
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RESTORATION REQUIRED
YES
/
NOV
SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel 0 Asphalt 0 PCC
o Repaired by City
[] Repaired by Permittee
o No Damage Found
Work Order #
~MPLETE
o INCOMPLETE
o Other
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(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
City of Port Angeles
Public Works Department
Water Distribution Repair Report
D w - ::?- ::0 'v - ! 'H 0
IWork Order No:
DATE REPORTED
If 16
/ ~ - 3-0 I
I Crew'
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CONDITION EMERGENCY D ROUTINE D CITIZEN COMPLAINT /
LEAKAGE SURVEY D OTHER D
L~-~-61 /~fMM /
DATE OF REPAIR.. TIME. DA.M. ~~"-L
REPAIR. LOCATION ADDRESS G z; r w ~ rr/
, t :r:-
TYPE OF MAIN ;2.. t - SIZE.
I
DEPTH OF MAIN :L Y:z.. CLOSEST VALVE DEPTH.
COMPONENT REPAIRED. /
MAIN JOINT D CIR, BREAK f?!' SPLIT BELL. D LONG BREAK D
HOLE D CLAMP D OTHER
SERVICE TAP D CORP STOP D PIPE D CURB STOP D FITTING D
METER SETTER D METER D
LINE VALVE. FLANGE NUTS/BOLTS D STEM D BONNET D
HYDRANT BRANCH D VALVED BARREL D
OTHER,
COMPONENTS OF REPAIR, CLAMP~SSERD OTHER
SITE CONDITION GRAVEL D ASP~D SIDEWALK D CURB D
TOP SOIL AREA Y SOIL TYPE
CUTS ASPHALT CUT _FT CURB CUT _FT SIDEWALK_FT
DRIVEWAY CUT _FT
MAIN CONDITION INTERNAL LINING ~U $+'1 TUBEBeULATION-MINOR D SEVERE D
EXTERNAL CORROSION LOdALIZED ~ EXTENSIVE 0
P.P.M. {Q-efVvc)...d vNd.e+- tr-c-::>5'~
M. AI trf- 0 P- P- IJ-ef/Ci./f}td h)!l--e
CHLORINE RESIDUAL SAMPLE
WATER OFF FROM
M.TO
FROM
M,TO
M.
;Qo6+5
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APPARENT CAUSE OF LEAK.