HomeMy WebLinkAbout1020 S Valley St - Engineering
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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . INSPECTION REPORT. . . . . .
REQUEST
Date )'-/ fJ - 0 '--/
Time Lf ,oV P I'M
Received by
(phone, person)
Location of Work to be inspected I . /0 ~O V~tI ~y
Name of person requesting inspection wt,?.ft? F Clc/ t <;/tJ ~
Address of person requesting inspection I 7 rl... ~ {J Phone No 'il 7 - v~ '19
Type of Inspection (circle appropriate one) Permit No
Sewer Foundation Framing Chimney ~ Final Sewer Excav Other
INSPECTION NOTES
Inspected Date ')-/6 - 0 V
Remarks
Time
if ifO f;Yl By 7 I 7
R. e j)~/.r' e i 8 X ~ )t c7. CO/J/l e <'./1 t:' h-
I
RESTORA TION REQUIRED YES )(' NO
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SURFACE RESTORATION
SURFACE TYPE D Unimproved 0 Gravel
[] Repaired by City
[] Repaired by Permittee
[] No Damage Found
~ Asphalt D PCC 0 Other
Work Order # 13$Ol~.... ,J.J.
o COMPLETE
p( INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
City of Port Angeles
Public Works Department
Water Distribution Repair Report
IWork Order No 13 f)il'O .0; 7.
Icrew 7/7, 7/6 I 7/~
DATE REPORTED
)"-/'0-0'(
CONDITION EtvlERGENCY % ROUTINE 0 CITIZEN COMPLAINT 0
LEAKAGE SURVEY 0 OTHER 0
DATE OF REPAIR. )-1'0-0 'l TIME 'f.ou DA.M.~.M.
REF AIR LOCATION ADDRESS -'- 0;4;> !/c;J! e y
f
TYPE OF MAIN l filL SIZE J ''-
DEPTH OF MAIN ......, \ (c:r \ ,
0< CLOSEST VALVE DEPTH. 0
COMPONENT REPAIRED:
MAIN JOINT 0 CIR. BREAK 0 SPLIT BELL 0 LONG BREAK 0
HOLE 0 CLAMP 0 OTHER aX~t~ c..r:>AlIe~n4-"
SERVICE TAP 0 CORP STOP 0 PIPE 0 CURB STOP 0 FITIING 0
METER SETTER 0 METER 0
LINE VALVE FLANGE NUTS/BOL TS 0 STEM 0 BONNET 0
HYDRANT BRANCH 0 VAL VE 0 BARREL 0
OTHER.
COMPONENTS OF REP AIR CLAMPO DRESSERO OTHER J" 8r4:!>s (Iff) ,Ie
,
SITE CONDITION GRAVEL 0 ASPHALT ~ SIDEWALK 0 CURB 0
TOP SOIL AREA)( SOIL TYPE
CUTS ASPHALT CUT ~FT CURB CUT _FT SIDEWALK_FT
DRIVEWAY CUT _FT
MAIN CONDITION INTERNAL LINING ./1/ A 1lJBERCULATION-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE /1/ -4 P.P M.
WATER OFF FROM
M.TO
M.
FROM
M.TO
M.
APP ARENT CAUSE OF LEAK
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