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CITY OF PORT ANGELES T>w.2-001-2"1'1
DEPARTMENT OF PUBLIC WORKS
. . . . . . . INSPECTION REPORT. . . . . . . . . .. 25B
REQUEST
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Date
11 '} V .41'7 /JIJ I"'" L C
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)
?It) 7V/J1/1
KptV
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Phone No
Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other
INSPECTION NOTES
Inspected Date r;,- 1 - ~ /-
Remarks I? If € /1/<: ? I /l t/ ~
C' tI f! .A1 /11/1/
Time
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or 'Iff e
By /(f//(/
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RESTORATION REQUIRED
YES ~ NO
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SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel G1 Asphalt 0 PCC
o Other
o Repaired by City
[] Repaired by Permittee
o No Damage Found
Wo~Order # ~ I 31
~COMPLETE
[34NCOMPLETE
/"11 xe-p , 'X 1 ;'
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STREET SUPERINTENDENT
(DATE)
CIty of Port Angeles
Public Works Departnlent D(.u.2.QO~.2/31
'" ater Distribution Repair Report
IWork Order No:
I Crew' I( t''''; t7 /If' ~ 7" E ~r= I
,?lIYI
,
DATE REPORTED'
REPAIR LOCATI0N ADDRESS
I~
SIZE. ,
I
CLOSEST VALVE DEPTH. I pC
TYPE OF MAIN
COMJ>ONENT REPAIRED:
MAIN JOINT 0 CIR. BREAK 0 SPLIT BELL. 0 LONG BREAK 0
HOLE 0 CLAMJ> 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
HYDRANT BRANCH 0 VALVE 0 BARREL 0
OTHER.
COMJ>ONENTS OF REPAIR. CLAMJ>O DRESSERO OTHER fI ~ f ~,At
SITE CONDITION GRAVEL 0 ASPHALT ~IDEWALK 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 SAMJ>LE P.P.M.
WATER OFF FROM
M.TO
M.
FROM
M.TO
M.
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . INSPECTION REPORT. . . . . . .
REQUEST
Date 3.- 3( - 0'->
Received by U~lS E (phone, p~)
Location of Work to be inspected f? 0 Oz Y v "'^-G\.. C 1- .
Name of person requesting inspection De vL-"'-l s E >
Address of person requesting inspection~{l Yo......d Phone No
Type of Inspection (circle appropriate one) Permit No -----
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav O~C-\..... + e... 9
Time
INSPECTION NOTES
Inspected Date 3......3 ( -D '3
Remarks
Time (2-- 5:0 jJftl.A.. By Oe vl II\. IS 1-
RESTORATION REQUIRED
YES X NO
west-
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JVlAA c...
C-"i"'
&07 Jv~c-..
SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel
~sphalt 0 PCC 0 Other
Work Order # 2. 55' '-f
o COMPLETE
o INCOMPLETE
o Repaired by City
[] Repaired by Permittee
o No Damage Found
/hSlreel 1a/C/~ 8x(.,
(Continue on reverse side if ne'cessary}
A -s jJ~ (t ~ ~+ c... t....
I I
STREET SUPERINTENDENT
(DATE)
LIty 01 lJort Angeles
Public 'Vorks Departnlent
'" ater Distribution Repair Report
f{ I~ =f} 2. 55'/-
IWork Order No
2-S-S '-f
,
ICrew 7(~, 7(" I '7 {7. 7 ('8.
, " ,. ,
DA TE REPORTED' 3 - 2 ca -O=)
CONDITION E1v1ERGENCY 0 ROUTINE 0 CITIZEN COMJ>LAINT )('L
LEAKAGE SURVEY 0 OTHER 0
DATE OF REPAIR. .5 - 3 ( ~ () 3
TIME l 30
JUWLtA C:t
~.M. DP.M.
REPAIR LOCATION ADDRESS 801
R t/c
TYPE OF MAIN
SIZE 2"
DEPlli OF MAIN
. I
if
CLOSEST VALVE DEPTH.
I '(
3~
COMJ>ONENT REPAIRED:
MAIN JOINT 0 CIR. BREAK 0 SPLIT BELL. 0 LONG BREAK 0
HOLE 0 CLAMJ> 0 OTHER
SERVICE TAP J& CORP STOP 0 PIPE tl' 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
Tuht ~
SITE CONDITION GRAVEL 0 ASPHALT l!l" SIDEWALK 0 CURB 0
TOP SOII,.., AREA 0 SOn.. TYPE
CUTS ASPHALT CUT ~4T CURB CUT _FT SIDEWALK_FT
DRIVEWAY CUT _FT
MAIN CONDITION INTERNAL LINING 000cR TUBERCULATION-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
COMJ>ONENTS OF REPAIR. CLAMJ>D DRESSERD OTHER
PE.
CHLORINE RESIDUAL SAMJ>LE ~ Z-t P.P.M.
WATEROFF FROM (O'Og<\M. TO /o.3oAM.
FROM
M.TO
M.
APPARENT CAUSE OF LEAK. De. fe r{ 0 f c....Tl 1'\..5 fl'f-e....