HomeMy WebLinkAbout2043 W 12th St - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS 7:JCt p'
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
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REQUEST
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Date . - l J ~ 0
Time
Received by
(phone, person)
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Location of Work to be inspected }
Name of person requesting inspection -r- u ) ; \J (d y
Address of person requesting inspection I {..f:-Il 6-- [J Phone No
Type of Inspection (circle appropriate one) Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other u.J2,-,~
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INSPECTION NOTES
Inspected Date
Remarks
Time By
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RESTORATION REQUIRED
/
. YES l/ NO
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SURFACE RESTORATION
SURFACE TYPE D Unimproved D Gravel
D Repaired by City
[] Repaired by Permittee
CI No Damage Found
D Asphalt D PCC D Other /op 56 )' 1--
Work Order # ~ 7 ()
o COMPLETE
D INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
City of Port Angeles
Public Works Departnlent
Water Distribution Repair Report
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IWork Order No:
DATE REPORTED'
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"7- 12-62
I Crew
7/Y,
CONDITION EMERGENCY 0 ROlITINE 0 CITIZEN COMPLAlNT V
LEAKAGE SURVEY 0 OTHER 0
TYPE OF MAIN
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DATE OF REPAIR.
REPAIR LOCATION
ADDRESS
SIZE.
DEPTH OF MAIN
CLOSEST VALVE DEPTII.
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;/ CURB STOP 0 FIITING 0
METER SETTER 0 METER 0
LINE VALVE. FLANGE NlITSIBOL TS 0 STEM 0 BONNET 0
HYDRANT BRANCH 0 VALVE 0 BARREL 0
OTHER
SITE CONDITION GRA VEL 0 ASPHALT 0 SIDEWALK 0 CURB 0
TOP SOIL AREA 0 SOIL TYPE
ClITS ASPHALT ClIT _FT CURB ClIT _FT SIDEWALK_FT
DRIVEWAY CUT _FT
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COMPONENTS OF REPAIR. CLAMPO DRESSERO OTHER
MAIN CONDITION INTERNAL LINING TUBERCULATION-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE I ~ ( P.P.M.
WATER OFF FROM /1 JOA'M. TO ~ I )D lAM.
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FROM M. TO
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APPARENT CAUSE OF LEAK.