HomeMy WebLinkAbout1505 W 16th St - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . INSPECTION REPORT. . . . . . .
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REQUEST
Date 2 - 2 8' 0 'Z
Time
Received by
(phone, person)
Location of Work to be inspected /5 o~ W / t,-f!::
Name of person requesting inspection 'C> Ed51~-k'^-
Address of person requesting inspection ('Ov i:> ~rJ Phone No
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Type of Inspection (circle appropriate one) Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other vJc.......tey
INSPECTION NOTES
Inspected Date
Remarks Re/Ja.fr
I
Time
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RESTORATION REQUIRED
YES
NO X
SURFACE RESTORATION
SURFACE TYPE D Unimproved D Gravel D Asphalt D PCC
D Repaired by City
[] Repaired by Permittee
o No Damage Found
Work Order #
D Other
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I~l COMPLETE
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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I Crew. 7 (5 , 7 / 7 I '7 18
IWork Order No.
DATE REPORTED' 2. - Z. 7 ~ d 2.
CONDITION EMERGENCY 0 ROUTINE 0 CITIZEN COMPLAINT )!I
LEAKAGE SURVEY 0 OTIIER 0
DATE OF REPAIR. 2 - Z 8, 02.
TIME. /0 sD
GNA.M. OP.M.
REPAIR LOCA TI0N
ADDRESS
/5'05
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SIZE. 0
TYPE OF MAIN
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DEPTH OF MAIN
'II
I
CLOSEST VALVE DEPTH. ..5
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 1J. CURB STOP 0 FITTING 0
METER SETTER 0 METER 0
LINE VALVE. FLANGE NUTS/BOL TS 0 STEM 0 BONNET 0
HYDRANT BRANCH 0 VALVED BARREL 0
OTHER.
COMPONENTS OF REPAIR, CLAMPO DRESSERO OTHER 3A fE 'tubl~/ t:.OM/ Vt1loV'-/,
rle'J'e. V\.uT
SITE CONDITION GRA VEL tsl. ASPHALT 0 SIDEWALK 0 CURB 0
TOP SOn.. AREA 0 SOn.. TYPE
CUTS. ASPHALT CUT _FT CURB CUT _FT SIDEWALK_FT
DRIVEWAY CUT FT
MAIN CONDmON INTERNAL LINING * TIJBERCULA nON-MINOR 0 SEVERE 0
EXTERNAL CORROSION OCALIZED 0 EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE tV/A P.P.M.
I
WATER OFF FROM /()' 2-D A M. TO iO . ~AM.
FROM
M.TO
M.
APPARENT CAUSE OF LEAK. 6rouVld 6'eHte.