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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUEST
Date / }. - / q - (i :1 Time ;<, 5 CO) f r11 Received by UL <- et15
(phone, person)
Location of Work to be inspected ;{ CJ 75 (-1.../1 'I II....
Name of person requesting inspection lie /6r oC I:
Address of person requesting inspection I 7 rt...... t/ /3 Phone No
Type of Inspection (circle appropriate one) Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other~ "- t~
INSPECTION NOTES
Inspected Date 1 -:; - / 1- c :::3
Remarks
Time .7 ) ['/ f/~ 1. By } Ie." /6 rook
b, eFtk
.
treL7,plllrr>~ (/f/ (ff.
f
f'c-' II ~ I/C IV?
,'J.. \\ ~I /77[/'1'\
f/' -e 0/1 n - bCt, 1 j.
,
RESTORATION REQUIRED
YES
NO~
I ~ ~
;Jj <
); q I "-- \~
1- t:C;;' -,
t)" C:.I "3 s' X "
SURFACE RESTORATION
SURFACE TYPE D Unimproved D Gravel D Asphalt D PCC
~Repaired by City
[] Repaired by Permittee
[] No Damage Found
Work Order #
IiVnther reI? Sc~ I /
LAJ I
I .;(75 L" ~-
~ COMPLETE
D INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
City of Port Angeles
Public Works Department
Water Distribution Repair Report
IWork Order No
1~S-05""
I Crew
7/11 7/6 J 7/7
.
DATE REPORTED I ;;. - /1-0 s
CONDITION EMERGENCY ~ ROUTINE D CITIZEN COMPLAINT D
LEAKAGE SURVEY D OTHER D
REP AIR LOCATION
ADDRESS
; 30
(,;vI 1 T"-
DA.M. Ji'lP.M.
TYPE OF MAIN
SIZE ~ "
....
COMPONENT REPAIRED.
MAIN JOINT D CIR. BREAK ~ 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 D VAL VE D BARREL D
OTHER.
COMPONENTS OF REPAIR. CLAMPD DRESSERD OTHER ~<.JII CUyle f"-eOQI;-' b4",J
I
SITE CONDITION GRA VEL D ASPHALT D SIDEWi\LK P CURB D
TOP SOIL AREA)K SOIL TYPE Mv\, +-\ l.I<.
CUTS ASPHALT CUT _FT CURB CUT _FT SIDEWALK_FT
DRIVEWAY CUT _FT
MAIN CONDITION INTERNAL LINING /J./ A TUBERCULATION-MINOR D SEVERE D
EXTERNAL CORROSION LOCALIZED D EXTENSIVE D
CHLORINE RESIDUAL SAMPLE A/A P.P.M. ~efa/'"l! J UvtJ.qr f(.)~,f,ve f'/'e~5o.1/'e
WATER OFF FROM . '3 'a:) P M. TO )'.X? 1M.
FROM M. TO M.
APPARENT CAUSE OF LEAK. 6r"..... t1J 5' e IIIe