HomeMy WebLinkAbout127 Lopez Ave - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS 5h
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
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REQUEST
Date '<6 -( ~ -- 0 J-
Time
Received by
(phone, person)
Location of Work to be inspected J 2.. 1 _ 1-.0 p-e 2-
Name of person requesting inspection -; 0V I I ( c, y
Address of person requesting inspection ! 1-f1, IT- ~ Phone No
Type of Inspection (circle appropriate one) Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other ~
INSPECTION NOTES
Inspected Date
Remarks
Time By r
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f3ACJc_ ,\--:51 - C> _ ~ {?,k
RESTORATION REQUIRED YES
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/'
L/NO
)~~'
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Ll!:Jp-e?
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~
~
sphalt 0 PCC D Other
Work Order # ~ ~ (S L
o COMPLETE
D INCOMPLETE
SURFACE RESTORATION
SURFACE TYPE D Unimproved 0 Gravel
o Repaired by City
[] Repaired by Permittee
o No Damage Found
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(Continue on reverse side if necess y)
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f
STREET SUPERINTENDENT
(DATE)
CIty of Port Angeles
Public '''orks Departnlent
Water Distribution Repair Report
0,,-> . ~ (:)0 1- .2 '2 0 "2.-
IWork Order No:
CONDITION
~A61-
~--r-l)/'OL-
EMERGENCY 0 ROUTINE 0 CITIZEN COMPLAINT~
LEAKAGE SURVEY 0 OTHER 0
'f ~ JS--o 7- TIME,
ADDRESS I 1- (
fZ( ( c- - r- SIZE,
I Crew.
111
DATE REPORTED
TYPE OF MAIN
1 VA.M. DP,M,
r
16 ):J-e Z-
I
DATE OF REPAIR
REPAIR LOCATION
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
SERVlCE 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 VALVED BARREL 0
OTHER.
COMPONENTS OF REPAIR. CLAMPO DRESSERO OTHER rfi-ebUllt h?lck- 5id~ qt'JLQft:r-
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 /.1P P.P.M.
WATER OFF FROM
7p,-
M.TO
qltM.
I h DU S.~
-1- :A.hr I
01/'--,
FROM M. TO
M~ld
f'PJ~t
APPARENT CAUSE OF LEAK.