HomeMy WebLinkAbout2916 S Peabody St - Engineering
CITY OF PORT ANGELES \)Lu.~()O~'<-loCf
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUEST I _
Date b-b. (5/-
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Time
Received by
(phone, person)
Location of Work to be inspected 2. 1. L {, 5 /1:! "'-- b ~ Jy
Name of person requesting inspection "fl..}."> 1 I ~ r
Address of person requesting inspection .J 7 f/f T:r f3 ' Phone No
Type of Inspection (circle appropriate one) Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other l,Lkt +- C;J/"
INSPECTION NOTES
1-; N-e-
Time 6
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By
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Inspected
Remarks
Date
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----
RESTORATION REQUIRED
.. YES
/
NO~
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SURFACE RESTORATION
SURFACE TYPE D Unimproved 0 Gravel
D Repaired by City
[] Repaired by Permittee
o No Damage Found
o Asphalt 0 PCC
Wor~er #
~OMPLETE
D INCOMPLETE
D Other
:21 J r
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
CIty of Port Angeles
Public Works Departnlent tJ4J.~001-2.'3f
Water Distribution Repair Report
'Work Order No: Q I '? Cf
/Crew. 7/ y
DATE REPORTED' , - ) -- 6)-
CONDITION EMERGENCY 0 ROUTINE 0 CITIZEN COMPL~
LEAKAGE SURVEY 0 OTHER 0
DATE OF REPAIR. /, -l- 02- TIME
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REPAIR LOCA TI0N
ADDRESS
TYPE OF MAIN
SIZE.
DEPTH OF MAIN
CLOSEST VALVE DEPTH.
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 ~URB STOP 0 FITTING 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 REPAIR. CLAMPO DRESSERO OTHER f(~ptU ~e j W I Ih CcJ~ U /J ( (3) l
SITE CONDITION GRAVEL 0 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 CONDITION INTERNAL LINING TUBERCULATION-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE I J r P.P.M.
FROM
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M.
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WATER OFF FROM
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APPARENT CAUSE OF LEAK.