HomeMy WebLinkAbout923 W 11th St - Engineering
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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . INSPECTION REPORT. . . . . .
.....
REQUEST
Date /2 - '.3 I ~ 0 I
Time
Received by '0e ....... V\ : c,> r;.. (phone, person)
a ~ tJ ( I rt...
Location of Work to be inspected I 2 '7 -
Name of person requesting inspection
Address of person requesting inspection Phone No
Type of Inspection (circle appropriate one) Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other tUa..1er
INSPECTION NOTES
8 'of PE
Time
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By
V1A<:..te f
Inspected Date
Remarks kR tJ I c--- c e
f
.
10 f1I\. ~ I or\.
RESTORATION REQUIRED
YES
NO X
1 f ~ Cjz3 w ' I tl.<
1 I~
a
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I~ 2'15-' ~
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SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel 0 Asphalt
OPCC
o Other
2oo(P
o Repaired by City
[] Repaired by Permittee
o No Damage Found
Work Order #
o COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
CIty of Port Angeles
Public Works Department
Water Distribution Repair Report
.::() tN -.J. " 0 1- - .2 0 0 'l-(P
2oo~
.
I Crew 7 ( s~ r 7 (<:0 I 7 I 7
IWork Order No.
DATE REPORTED I Z - 3' - of
CONDITION EMERGENCY 0 ROUTINE 0 CITIZEN COMPLAINT ~
LEAKAGE SURVEY 0 OTHER 0
REP AIR LOCATION ADDRESS
TIME It) 30
W J/~
TYPE OF MAIN ~ E <5 e,v ,,-<- SIZE 3/~
DEPTH OF MAIN ~/A- CLOSEST VALVE DEPTH. Z'
~.M. OP.M.
DATE OF REPAIR. 12 ,J( -01
'77..-3
COMPONENT REPAIRED:
MAIN JOINT 0 CIR. BREAK 0 SPLIT BELL. 0 LONG BREAK 0
HOLE 0 CLAMP 0 OTHER
SERVICE TAP 0 CORP STOP 0 PIPE 0 CURB STOP 0 FITTING 0
METER SETTER 0 METER D
LINE VALVE. FLANGE NUTSIBOLTS 0 STEM 0 BONNET D
HYDRANT BRANCH 0 VALVE 0 BARREL 0
OTHER.
COMPONENTS OF REPAIR, CLAMPD DRESSERD OTHER
SITE CONDITION GRA VEL 0 ASPHALT 0 SIDEWALK 0 CURB 0
TOP SOIL AREA 0 SOIL TYPE
CUTS ASPHALT CUT _FT CURB CUT _FT SIDEW ALK _FT
DRIVEWAY CUT _FT
MAIN CONDITION INTERNAL LINING TUBERCULATION-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED D EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE ~P,P.M.
WATER OFF FROM M. TO M.
FROM
M.TO
M.
APPARENT CAUSE OF LEAK. O(~ 4~