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.
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . .
/
REQUEST
Date J / - I-- ~ - 1 f
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)
;z ~ 1 [0 9111 5f~
fo...) .- I (?s/x
/1fJ, 'i- B Phone No
Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other , AJ 4.~~
INSPECTION NOTES
Inspected Date
Remarks
Time
~ ~P: I r
% -eo -e I
By
C}J1-e- ~ r / ..5 e ru,.C'-e
/
L-e~
tAT
YES
RESTORATION REQUIRED
3'B2?'
*
~
rIA s+
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 #
o COMPLETE
o INCOMPLETE
(DATE)
City of Port Angeles
Public Works Department
Water Distribution Repair Report
'Work Order No: t ~ q ?-
Reported: l!J:f-.:2t -1 C/ Condition.
Repaired: lL/~?t -1.. q Source:
R~air Location:
Component Repaired:
Address:
Loc. Description:
f I Crew:
/Iy
Emergency R~tine
Citizen Complaint t/"
Leakage Survey _ Other
~ ~q
q+~
Lv
Main Line ID#:
Mm: fu~ CrrBr~
Long. Break _ Hole
Service:
Une Valve:
Hydrant:
Other:
)
Repair Type:
Site Condition:
Pipe _ Curb Stop _
Stem Bonnet
Valve Barrel
:t1U ~ V't. Yl +- ~ F- t:n1 .e-+-e ~ I/J -e-llL V P)n -{'~
Other Ai -<- w P t; I, p -e F/cfl41 C ur~
' .s ftJl
-to "7l1 ~ +-t" yo-
Gravel Roadway -+- Asphalt Street _ Sidewalk ~
Top Soil Area -1L- Soil Type _
Tap_
Flange Nuts, Bolts
Branch
Clamp _
--
Surface
Curb
~ Damage:
Split Bell_
Clamp _
Other
Corp. Stop _
Dresser
Cuts: Street Cut: Ft.
Curb Cut: Ft.
Sidewalk Cut: Ft. :2..
Main Condition:
Apparent Cause of Leak:
5/19/98
;,,((
Diameter' Inches _ A..
Material.
Depth of Cover' Ft.
Internal Lining:
Tuberculation: NI A
External Corrosion: NI A
Special Conditions: Bedding:
Other Structures:
,.
f,r"'..,;..
Joint Type:
External Prot:
Minor
Localized
Severe
Extensive
Samples Taken: Pipe Section _ Coupon ---..&/ ~ AI ~
Water Off: FromJLI?-2-1 'if To~.lLM
From JLJ 2-'LJ 'if To -.!LLLM
IJI~P.f/-e rf[~d ouft
Page 1
PW-902.09