HomeMy WebLinkAbout1325 E Lauridsen Blvd - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT . . . . .
......
REQUEST
Date t/ - ^ Lf - c '3
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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Phone No
Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other Wo......-f--fy
INSPECTION NOTES
Inspected Date
Remarks
Time
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RESTORATION REQUIRED YES NO V
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SURFACE RESTORATION
SURFACE TYPE D Unimproved 0 Gravel
D Repaired by City
[] Repaired by Permittee
[] No Damage Found
D Asphalt 0 PCC D Other
Work Order # :-s 5 0 'J.-..
~PlETE
D INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
LIty OllJort Angeles Hn:- wp-t1 3S-o 2-
Public 'V orks Departnlent
'" ater Distribution Repair Report
IWork Order No
DATE REPORTED
3. ,5" 6 '::2
ij- 2/j-61
I Crew
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CONDITION ErvlERGENCY 0 ROUTINE 0 CITIZEN COMPLAINT ~
LEAKAGE SURVEY 0 OTHER 0
DATE OF REPAIR. t( - 'J-lf- 0 1 TIME "3( J D DA.M. ~M.
REP AIR LOCATION ADDRESS / 3 2- S- E- 13 /1/ D /
TYPE OF MAIN t?{ (~ I/- C SIZE
DEPTH OF MAIN lJ t 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
METER SETTER 0 METER 0
LINE VALVE FLANGE NUTS/BOLTS 0 STEM 0 BONNET 0
OTHER.
HYDRANT BRANCH 0 VAL VE 0 BARREL 0
K-epla (-el llt/ Pf
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}yJ)11 .fj71 tf/ 'f7 -Iv ~y
COMPONENTS OF REPAIR. CLAMPO DRESSERO OTHER
SITE CONDITION GRA VEL 0 AS~T 0 SIDEWALK 0 CURB 0
TOP SOIL AREA SOIL TYPE
CUTS ASPHALT CUT _IT C CUT _IT SIDEWALK_IT
DRIVEWAY CUT _IT
MAIN CONDITION INTERNAL LINING TUBERCULATION-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE ,21 P.P.M. . --+ crF ~
WATER OFF FROM ]1)6 I'M. TO 5. ;6 e '6/;6 iJ S-€5" 6 u
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FROM M. TO M. ,;
APPARENT CAUSE OF LEAK. . olJ, /3hffl-e 1~ ?-.E ,;P/~
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