HomeMy WebLinkAbout222 E Lauridsen Blvd - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUEST
Date ~ - LJ --at{
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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/1 fie ~B Phone No
Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other (~icr-
INSPECTION NOTES
Inspected Date Time By
Remarks - ~~.C~>; 7@" ~-~ '~
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RESTORATION REQUIRED
YES
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SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel
o Repaired by City
[] Repaired by Permittee
[] No Damage Found
o Asphalt 0 PCC
~or~der #
~COMPLETE
o INCOMPLETE
o Other
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STREET SUPERINTENDENT
(DATE)
CIty of Port Angeles
Public Works Departnlent
Water Distribution Repair Report
IWork Order No
DATE REPORTED
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I Crew
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CONDITION EMERGENCY 0 ROUTINE 0 CITIZEN COrvtPLAINT /'
LEAKAGE SURVEY 0 OTHER 0
DATE OF REPAIR. :z. _1-( -() ~ TIME DA.M. DP.M.
REP AIR LOCATION ADDRESS ?--- ?-.. 'l... f=- 13) V 0
TYPE OF MAIN
Q. f t C - j:-SIZE
=
DEPTH OF MAIN
CLOSEST VALVE DEPTH.
COrvtPONENT REPAIRED. /
MAIN JOINT 0 cm. BRE^!< V SPLIT BELL 0 LONG BREAK 0
HOLE 0 CLAMP OTHER
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 0 BARREL D
OTHER.
COrvtPONENTS OF REP AIR. CL~RESSERD OTHER
SITE CONDITION GRA VEL D ASPHALT 0 SIDEWALK D CURB 0
TOP SOIL AREA D 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
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M.
CHLORINE RESIDUAL SArvtPLE P.P.M.
WATER OFF FROM M. TO
FROM
M.TO
M.
APP ARENT CAUSE OF LEAK.
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