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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . INSPECTION REPORT. . . . . .
REQUEST
Date /'-Z{ -Od
Time 7 00 Ii ilL.-'\.. Received by Dc?_l-'l..iIl.- \s E- (phone, person)
Location of Work to be inspected 1'30 ( ~Ii-( v~
Name of person requesting inspection DEJAtA IS L
Address of person requesting inspection L.s- liP YO-r&.
Type of Inspection (circle appropriate one)
Sewer Foundation Framing Chimney Plumbing Final
Dr
Phone No
Permit No
Sewer Excav Oth~
INSPECTION NOTES
Inspected Date ( - Z- '3
Remarks f< e ltVU~) _.j eA-
-by-
( e~ k ( v'::5
Time
<S€. r v
3;JM-
.-(' \/- C '^^--
By De 1I\.t\. \ '"
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E
RESTORATION REQUIRED
YES )<
NO
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SURFACE RESTORATION
SURFACE TYPE D Unimproved D Gravel E1 Asphalt D PCC D Other
D Repaired by City Work Order # ( 4 1-"1 g ~oo '>
[] Repaired by Permittee 0 COMPLETE
D No Damage Found D INCOMPLETE
(DATE)
City of Port Angeles
Public Works Department
Water DIstribution Repair Report
IWork Order No (4? 7'3 -DO'7
, Crew 7 ('S '"f- 0-<-~ _
DATE REPORTED (.- z.. <' - 0 t.(-
CONDITION E1v1ERGENCY t( ROUTINE 0 CITIZEN COMPLAINT 0
LEAKAGE SURVEY 0 OTHER D
DATE OF REPAIR. 1- 2- ? -D4
TIME
? OV DA.M. ~.M.
REP AIR LOCATION ADDRESS (~O (
~VIV\...L D.r
TYPE OF MAIN
A. -L
l(
SIZE ( L
~
DEPTH OF MAIN cd
CLOSEST VALVE DEPTIL
c.{1"
COMPONENT REPAIRED.
MAIN JOINT 0 CIR. BREAK D SPLIT BELL D LONG BREAK D
HOLE)tt CLAMP 0 OTHER ~rA re~ve.d.- ~ ~nJ(c..e. iA-o-t vs..e..d
I
SERVICE TAP D CORP STOP D PIPE D CURB STOP D FITTING D
METER SETTER 0 METER D
LINE VALVE. FLANGE NUTS/BOL TS 0 STEM 0 BONNET 0
HYDRANT BRANCH 0 VAL VE D BARREL D
OTHER.
COMPONENTS OF REPAIR. CLAMP): DRESSERD OTHER
SITE CONDITION GRAVEL 0 ASPHALT 0 SIDEWALK 0 CURB D
TOP SOIL AREA D SOIL TYPE
CUTS ASPHALT CUT 3. D>tT '3 CURB CUT _IT SIDEWALK_IT
DRIVEWAY CUT _IT
MAIN CONDITION INTERNAL LINING tJ / A TIJBERCULA TION-MINOR 0 SEVERE 0
EXTERNAL CORROSION I LOCALIZED 0 EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE 3"1 P.P.M.
WATER OFF FROM 1 '$oA M. TO '5 uO P M.
FROM 7 3c1\ M. TO ::3 oop M.
APPARENT CAUSE OF LEAK. 5L..-~- J l <-L. (( "LL ,o--H.cl j~l v' \?.vl....i '2...e.4
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CITY OF PORT ANGELES ~ :;_\
DEPARTMENT OF PUBLIC WORKS },~e(..t\ ~,~
. . . . . INSPECTION REPORT. . . . . . . . . . .
REQUEST'
Date i -2; ~Od
Time ? 0 0 A IlL--\.. Received by D~v\.~\'7 E- (phone, person)
Location of Work to be inspected Iso { ~V(.~
Name of person requesting inspection D~lA.IS tc-.
Address of person requesting inspection ~ v-p YO--rdJ
Type of Inspection (circle appropriate one)
Sewer Foundation Framing Chimney Plumbing Final
Dr.
Phone No
Permit No
Sewer Excav Oth@=~
INSPECTION NOTES:
Inspected Date ( - Z-"'3 -.01+
Remarks R. ~ i"^-O v ~ ( ec:.. k ( ~
Time
~rv
3 PItA.- By DeiA.t\. ( '? E..
..r::; v-e vv..... ~ \ ~ '^--
RESTORATION REQUIRED . . . . .. YES)< NO
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.:: D -
wc:...v-~\r..o"'se.. [~ ~o.. v e.. Y\.
D ( 30 l ~V'" .ou.D...
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Jo..~';t.. r ~\fvr
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... t.. (2 AL ~ De.!.j)
4j? 270 r >I
.....
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Hill ~1
SURFACE RESTORATION:
SURFACE TYPE 0 Unimproved 0 Gravel
D Repair!!d by City
D Repaired by Permittee
D No Damage Found
El Asphalt ~cc DOthar
Work Order # ( if 1-."18'-003
cg COMPLETE --- ~i'e.cJ.. \J-~J\'I'"e0.\
D INCOMPLETE L.\ -6 -<Y-\ - \ l~
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