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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . INSPECTION REPORT. . . . . .
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REQUEST
Date I -- I ro ~ {;) <f
Time 5- 20 1'11/( Received by De"V'tiS E ~ person)
Location of Work to be inspected ; ( Z5 fA) 7 ~
Name of person requesting inspection V'? ~1~~V-
Address of person requesting inspection ~TIJ V"-V J
I
Type of Inspection (circle appropriate one)
Sewer Foundation Framing Chimney Plumbing Final
Phone No
Permit No.
SewerExcav e"'-t~~
INSPECTION NOTES
Inspected Date I - (0 0 f
Remarks Ke ,/e"'l ( e d Z " c.. T
I
Time 7 rS- fJJ1A... By D(;;~tS ~(~foV'-
?~, VI. t-..J(fLt a. +u II Lt""--cle (~e'jc,-(r bc,~
RESTORATION REQUIRED
YES X
NO
~ 'i-'
tl L \1)\
)tl... ~
~ IAJ llj
'<:
~ ':J
( , ~ 250 6 ~
-:? i, e_I z.-:z.' Oe~1'
C>- L-
- ...J
2 38 0."0
SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel
D Repaired by City
Cl Repaired by Permittee
o No Damage Found
~ , I
o Asphalt 0 PCC D Other ( c f' So I \
u
Work Order # (3'828-007
o COMPLETE
o INCOMPLETE
~~I
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
CIty of Port Angeles
Public Works Departnlent
Water Distribution Repair Report
'Work Order No r 3cpZ-8 --000
1
[Crew 7 (5,
,
1
DATE REPORTED
( -- (G::, - 01
CONDITION EMERGENCY 0 ROUTINE 0 CITIZEN COMPLAINT )(
LEAKAGE SURVEY 0 OTHER 0
DATE OF REPAIR. I-(~-O<.{ TIME 7 aD DA.M. dqi,M.
REP AIR LOCATION ADDRESS ( (8 W 71(,
TYPE OF MAIN C-I SIZE 2-(( ..""
2- ( ( 31
DEPTII OF MAIN r; CLOSEST VALVE DEPTH.
<---
COMPONENT REPAIRED.
MAIN JOINT D CIR. BREAK)t 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/BOL TS D STEM D BONNET D
HYDRANT BRANCH 0 VAL VE D BARREL D
OTHER.
COMPONENTS OF REP AIR. CL~ DRESSERD OTHER
SITE CONDITION GRAVEL D ASPHALT D SIDEWAl-K D CURB D
TOP SOIL AREA D SOIL TYPE /1/4-+, v' e - C ( G...1
CUTS ASPHALT CUT _FT CURB CUT _FT SIDEWALK_FT
DRIVEWAY CUT _FT
MAIN CONDITION INTERNAL LINING tV/A TUBERCULATION-MINOR D SEVERE D
EXTERNAL CORROSION 'LOCALIZED 0 EXTENSIVE D
CHLORINE RESIDUAL SAMPLE ~A P.P.M, F, f eJ L I v'~
WATER OFF FROM ~A M. TO M.
FROM
M. TO
M.
APPARENT CAUSE OF LEAK. 6 '-~vvt..d $..e ft (e