HomeMy WebLinkAbout534 E Lauridsen Blvd - Engineering
CIty of Port Angeles
Public Works Department
Water Distribution Repair Report
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'work Order No:
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DATE REPORTED'
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CONDITION EMERGENCY 0 ROUTINE 0 CITIZEN COMPLAINT ~
LEAKAGE SURVEY 0 OTHER 0
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DATE OF REPAIR. ,) -../ - 0 /-- TIME / ' I
REPAIR LOCA TI0N ADDRESS 'J I '3 Lf
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TYPE OF MAIN
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DEPTH OF MAIN
CLOSEST VALVE DEPTH.
COMPONENT REPAIRED: /
MAIN JOINT 0 CIR. BREAK rzf 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 NtITS/BOL TS 0 STEM 0 BONNET 0
HYDRANT BRANCH 0 VALVE 0 BARREL 0
OTHER.
COMPONENTS OF REPAIR. CL~RESSERO OTHER
SITE CONDITION GRAVEL 0 ASPHALT 0 SIDEWALK 0 CURB 0
TOP SOIL AREA ');(". SOIL TYPE
CUTS ASPHALT CUT _IT cURB CUT _IT SIDEWALK_IT
DRIVEWAY CUT _IT
MAIN CONDITION INTERNAL LINING dI It TUBERCULATION-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE P.P.M. :R .....(JrC{ ().... e u/ /.,J..J;' +4 ~tJ 5 r ( f I II'-Z-
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WATER OFF FROM
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FROM
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APPARENT CAUSE OF LEAK.
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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . .. . .
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REQUEST
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Date -;:;I- J
Time
Received by
(phone, person)
Location of Work to be inspected 5 3 Lj E r 1) ) l/ j)
Name of person requesting inspection 7 (NI \ (0') ><-
Address of person requesting inspection II {it '6-- 13 Phone No
Type of Inspection (circle appropriate one) Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other U)O.....~~
INSPECTION NOTES
Inspected Date
Remarks
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By
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RESTORATION REQUIRED
. YES
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C/ NO
SURFACE RESTORATION
SURFACE TYPE D Unimproved D Gravel
D Repaired by City
[] Repaired by Permittee
D No Damage Found
D Asphalt D PCC D Other ~~6 I J.-
Work Order # k) s- q ,
o COMPLETE
D INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DA TEl