HomeMy WebLinkAbout430 E 6th St - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT . . . . . . . . . . .
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REQUEST .
. 9 r'
Date It -), - 0 )
Time
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one) Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other {,0c-t+-C? v---
INSPECTION NOTES
Inspected Date
Remarks
Received by
(phone, person)
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/1 (i( 't- (};; Phone No
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Time By .
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RESTORATION REQUIRED
YES L/-" NO
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SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel
o Repaired by City
o Repaired by Permittee
[] No Damage Found
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o Asphalt 0 PCC 0 Other M /" ;; (\ ; "J-
~o!:JvOrder # -/6 7C;-C 1
iff" COMPLETE 11- J 7- 0 y~0
o INCOMPLETE
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(Continue on reverse side if necessary) STREET SUPERINTENDENT (DA TE)
CIty of Port Angeles
Public Works Department
Water Distribution Repair Report
'Work Order No.
DA TE REPORTED
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L Crew
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CONDITION
EMERGENCY 0 ROUTINE 0 CITIZEN COMPLAINT 0
LEAKAGE SURVEY 0 OTIIER 0
/0 - .:l. J' -C')TIME 1f,)6 ~.M DPM.
lj 30 E 6 lei
I
ADDRESS
DATE OF REPAIR.
REPAIR LOCATION
TYPE OF MAIN ;;2'< (- +-- SIZE
DEPTII OF MAIN
j'
CLOSEST VALVE DEPTH.
COMPONENT REP AlRED. /'
MAIN JOINT 0 CIR. BREAK E(' SPLIT BELL 0 LONG BREAK 0
HOLE 0 CLAMP 0 OTIIER
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 VAL VE 0 BARREL 0
OTHER.
/
COMPONENTS OF REPAIR. CLAMPO DRESSER~ OTIIER
SITE CONDITION GRAVEL 0 ASPHALT 0 SIDEWALK 0 CURB 0
TOP SOIL AREA 'i;( SOIL TYPE
CUTS ASPHAL T CUT _IT CURB CUT _IT SIDEWALK_IT
DRIVEWAY CUT _IT
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, - C ()UjV" / f h q i-- J, /:/ (/
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MAIN CONDITION INTERNAL LINING TUBERCULATION-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE l ~ ') P.P.M.
., (J (' 1""'-
WATER OFF FROM ,I I, k ftr. TO ),) M.
FROM M. TO M.
APPARENT CAUSE 7 LEAK. I ~C' I L (' ~(rf( -e C -!- ~ltfM.( dtJ (
, ).P-<, J ) I', B ~ /€-Pl.7f~r ~C