HomeMy WebLinkAbout431 Vashon Ave - Engineering
City of Port Angeles
Public Works Departnlent
Water Distribution Repair Report
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DATE REPORTED J~/!)- 01
CONDITION EIvlERGENCY D ROUTINE D CITIZEN CONfPLAINT ~'
LEAKAGE SURVEY D OTIfER D
I Crew
IWork Order No
7/Cf
,
DATE OF REPAIR.
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TIIvIE
DA.M. DP.M.
[lex.. 51, 0 N
REP AIR LOCATION
ADDRESS
TYPE OF MAIN
SIZE
.....
DEPTII OF MAIN
CONfPONENT REPAIRED.
MAIN JOINT D CIR. BREAK D SPLIT BELL D LONG BREAK D
HOLE D CLAMP D OTIfER
SERVICE TAP D CORP STOP 0 PIPE KURB STOP 0 FITTING 0
IvIETER SETTER D IvIETER D
LINE VALVE FLANGE NUTS/BOL TS D STEM D BONNET D
HYDRANT BRANCH D VAL VE D BARREL D
OTHER.
CONfPONENTS OF REP AIR. CLAMPO DRESSERO OTIfER
SITE CONDITION GRAVEL 0 ASPHALT 0 SIDEWALK 0 CURB 0
TOP SOIL AREA 0 SOIL TYPE
CUTS ASPHALT CUT _FT CURB CUT _FT SIDEWALK_IT
DRIVEWAY CUT _FT
MAIN CONDITION INTERNAL LINING TUBERCULATION-MINOR D SEVERE D
EXTERNAL CORROSION LOCALIZED D EXTENSIVE D
CHLORINE RESIDUAL SAMPLE ; I q P.P.M.
WATER OFF FROM --; If na.. TO q If JI'1.M.
)/;6 uS ~ cJU'+
6 F J-er(/I 2 ~
FROM
M.TO
M.
APPARENT CAUSE OF LEAK.
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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUEST
Date ) ^ - /I--c>~
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 ~
L/3 I
Vet ~ ho 1J A-lI~
~ \
~ 1~8\C~Y
/1 ' Phone No
INSPECTION NOTES
Inspected Date
Remarks
Time
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By
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RESTORATION REQUIRED
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YES V NO
SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel 0 Asphalt
o Repaired by City
[] Repaired by Permittee
I~~
(Continue on reverse side if necessary)
o Other -,-;; j;J 50 I' L
,
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D INCOMPLETE (. 1: /1- ( <6/
OPCC
STREET SUPERINTENDENT
(DATE)