HomeMy WebLinkAbout3509 Old Mill Rd - Engineering
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L+-r-G 7315
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
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REQUEST
Date 9 - I<t- -,0 I
Time
Received by
(phone, person)
Location of Work to be inspected ] S~ CJ r 0/ d.. ~1 / ) ( ;? / ...
Name of person requesting inspection -; Lv I Ie 0 y
Address of person requesting inspection I 7 {ft <6- D Phone No
Type of Inspection (circle appropriate one) Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other LA:.)civ~V--
INSPECTION NOTES
Inspected Date
Remarks
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RESTORATION REQUIRED
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SURFACE RESTORATION
SURFACE TYPE D Unimproved 0 Gravel
o Repaired by City
[] Repaired by Permittee
o No Damage Found
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YES {/ NO
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~Pha t 0 PCC D Other
Work Order # 73 I?; l
.g COMPLETE A~ ~\i)'-c:0. vJ \\- '\
D INCOMPLETE t-\a\ .fv\t 'f ~-- ~-03
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STREET SUPERINTENDENT (DATE)
CIty 01 ~ort Angeles -
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Public 'Vorks Departnlent
\" ater Distribution Repair Report
DATE REPORTED
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IWork Order No'
CONDITION ErvIERGENCY 0 ROUTINE 0 CITIZEN COMPLAINT 0
LEAKAGE SURVEY 0 OTHER 0
DATE OF REPAIR. .-g ~ 't6r~o3 TIME.
Di)M. DP.M.
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REP AIR LOCA nON
ADDRESS
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SIZE
TYPE OF MAIN
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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
rvIETER SETTER 0 METER 0
LINE VALVE. FLANGE NUTS/BOL TS 0 STEM 0 BONNET 0
HYDRANT BRANCH 0 VALVE 0 BARREL 0
OTHER.
COMPONENTS OF REP AIR. CLAMPD DRESSERD ~R
SITE CONDITION GRA VEL 0 ASPHALT ~ 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 TUBERCULATION-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE '- 'If P.P.M.
WATER OFF FROM tg;p'-p'l M. TO 10 A- M.
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FROM M. TO
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APP ARENT CAUSE OF LEAK. It .
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