HomeMy WebLinkAbout428 E 12th St - Engineering
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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . INSPECTION REPORT. . . . . .
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REQUEST
Date J J.... - 1 cr - 0 0
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)
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Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other
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INSPECTION NOTES
Inspected
Remarks
Date
Time
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By
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RESTORATION REQUIRED
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YES_b./ NO
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SURFACE RESTORATION
SURFACE TYPE D Unimproved D Gravel D Asphalt D PCC
D Repaired by City
[] Repaired by Permittee
[] No Damage Found
Worl- Order #
Dathert; PSD ( l-
17 ~r '
.;OMPLETE
D INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
City of Port Angeles
Public Works Department
Water Distribution Repair Report
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IWork Order No: oJ 1 S q
Reported. W f6 / C"'l)
Repaired. I J-I JJ..J r5v
ICrew:
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Condition. Emergency Routine
Source' Citizen Complaint ~
Leakage Survey _ Other
Repair Location.
Address
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Loc Description.
Component Repaired.
Main Line IDU'
Main.
Joint
Long Break_
Cir Break c/'
Hole
Split Bell _
Clamp _
Other
Service:
Line Valve:
Hydrant:
Other:
Tap_
Flange Nuts, Bolts
Branch
Corp. Stop _
Pipe _
Stem
Barrel
Curb Stop _
Bonnet
Valve
Repair Type: Clamp ~
Dresser
Other
Site Condition: Surface
Curb
Damage:
Gravel Roadway _ Asphalt Street Sidewalk
Top Soil Area _ Soil Type ~
Cuts: Street Cut: Ft.
Curb Cut: Ft.
Sidewalk Cut: Ft.
Main Condition.
'I . ( C__"r
Diameter' Inches ^ C
Material.
Depth of Cover' Ft.
Internal Lining:
,.
Joint Type
External Prot:
.' ,
Tuberculation. NI A
External Corrosion. NI A
Special Conditions: Bedding:
Other Structures:
Minor
Localized
Severe
Extensive
Apparent Cause of Leak:
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Coupon /IJ /J AI Z
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TO__M JUD Snt/ f/
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Samples Taken:
Pipe Section _
Water Off:
From I ?--I If 1 &D
From '11-- If q 1 {)O
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5/19/98
Page 1
PW-902.09