HomeMy WebLinkAbout818 W 14th St - Engineering
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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . INSPECTION REPORT. . . . . .
REQUEST '
Date 1).- '3 1 -- AD6/
-
II -i-J- q
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) Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other LA/4:..t-er-
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INSPECTION NOTES
Inspected
Remarks
Date
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Time .
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RESTORATION REQUIRED
YES
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SURFACE RESTORATION
SURFACE TYPE D Unimproved DGravel D Asphalt D PCC
[] Repaired by City
[] Repaired by Permittee
[] No Damage Found
Work Order #
~PlETE
D INCOMPLETE
D Other
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(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
CIty of Port Angeles
Public Works Departnlent
Water Distribution Repair Report
O\.U - 2.. oC) y., /8'0
IWork Order No:
DATE REPORTED'
19'0
S- /' '3/ --0 ,
I Crew
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EMERGENCY 0 ROUTINE 0 CITIZEN COMPLAINT ri/
LEAKAGE SURVEY 0 OTIffiR 0
5- j- 2> ( TIME.
911
DA.M. DP.M.
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CONDITION
DATE OF REPAIR.
REP AIR LOCATION
ADDRESS
TYPE OF MAIN
c-~
SIZE.
DEPTH OF MAIN
CLOSEST VALVE DEPTH.
COMPONENT REPAIRED:
MAIN JOINT D CIR. BREAK D SPLIT BELL. D LONG BREAK D
HOLE D CLAMP 0 OTIffiR
SERVICE TAP D CORP STOP D PIPE V CURB STOP D FITTING D
METER SETTER 0 METER D
LINE VALVE. FLANGE NUTS/BOL TS D STEM D BONNET D
HYDRANT BRANCH 0 VALVE 0 BARREL D
OTHER.
COMPONENTS OF REPAIR. CLAMPO DRESSERO OTIffiR
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SITE CONDITION GRA VEL 0 ASPHALT 0 SIDEWALK 0 CURB 0
TOP SOIL AREA 0 SOIL TYPE
CUTS ASPHALT CUT _FT CURB CUT _FT SIDEWALK_FT
DRIVEWAY CUT _FT
MAIN CONDITION INTERNAL LINING TUBERCULA nON-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED D EXTENSIVE D
CHLORINE RESIDUAL SAMPLE I ~.P.M.
WATEROFF FROM J~ f M. TO ~ M.
M.TO
FROM
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M.
APPARENT CAUSE OF LEAK.