HomeMy WebLinkAbout412 Lopez Ave - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUEST
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Date
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)
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Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other LUA f-cp--
INSPECTION NOTES
Inspected Date
Remarks
Time By
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RESTORATION REQUIRED
YES
/
NO L/
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SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel 0 Asphalt
o Repaired by City
[] Repaired by Permittee
CI No Damage Found
o Other
Work Order # J '5 "Y?-?- 0 ))
[ZVC"OMPlETE
o INCOMPLETE
OPCC
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
City of Port Angeles
Public Works Department
Water Distribution Repair Report
'Work Order No
CONDITION
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EMERGENCY 0 ROUTINE 0 CITIZEN COMPLAINT /'
LEAKAGE SURVEY 0 OTHER 0
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Q.(( c - J:- SIZE
ICrew<
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DATE REPORTED
DATE OF REPAIR
REPAIR LOCATION
ADDRESS
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TYPE OF MAIN
....
DEPTH OF MAIN
CLOSEST VALVE DEPTH,
COMPONENT REPAIRED. /'
MAIN JOINT 0 CIR. BREAK e(' SPLIT BELL 0 LONG BREAK 0
HOLE 0 CLAMP 0 OTHER
SERVICE TAP 0 CORP STOP 0 PIPE 0 CURB 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. CL~RESSERO OTHER
SITE CONDITION GRAVEL 0 ASPHALT 0 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 P.P.M.
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WATER OFF FROM M. TO M.
FROM M. TO
M.
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APP ARENT CAUSE OF LEAK.