HomeMy WebLinkAbout1109 Hazel St - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUEST. .'1 / 'I
Date 1 ~ - C7\b -(5
r
I 2>> t1
Time
Received by
(phone, person)
location of Work to be inspected / I D cl II- A :t. -e L ~ + (
Name of person requesting inspection --r-1.A...J ,'". J ~ ~
Address of person requesting inspection J 7,f'J1 '6--G Phone No
Type of Inspection (circle appropriate one) Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other ~
INSPECTION NOTES.
Inspected Date
Remarks
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,
RESTORATION REQUIRED YES
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SURFACE RESTORATION.
SURFACE TYPE 0 Unimproved 0 Gravel
o Repaired by City
o Repaired by Permittee
o No Damage Found
o Asphalt 0 PCC
Wor~rder #
~OMPlETE
o INCOMPLETE
Q Other
I ~6 S- V
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
CIty of Port Angeles
Public Works Departnlent
Water Distribution Repair Report
IWork Order No
DATE REPORTED
I '),b7JL(
1'A-9-bf D I
I Crew
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REPAIR LOCATION ADDRESS
CONDITION EMERGENCY 0 ROUTINE 0 CITIZEN COMPLAINT ~
LEAKAGE SURVEY 0 OTHER 0
DATE OF REPAIR. j A - ~~ -6 I TIME
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DA.M. DP.M.
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TYPE OF MAIN
SIZE
DEPTII OF MAIN
CLOSEST VALVE DEPTII.
COMPONENT REPAIRED.
MAIN JOINT 0 CIR. BREAK 0 SPLIT BELL 0 LONG BREAK 0
HOLE D CLAMP 0 OTHER
SERVICE TAP D CORP STOP D PIPE ~URB STOP D FITTING D
METER SETTER 0 METER 0
LINE VALVE. FLANGE NUTS/BOL TS 0 STEM 0 BONNET 0
HYDRANT
BRANCH 0 VALVE 0 BARREL D
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OTHER.
COMPONENTS OF REPAIR. CLAMPO DRESSERD OTHER
SITE CONDITION GRAVEL 0 ASPHALT D SIDEWALK D CURB D
TOP SOIL AREA D SOIL TYPE
CUTS ASPHAL T CUT _IT CURB CUT _IT SIDEWALK_IT
DRIVEWAY CUT _IT
MAIN CONDITION INTERNAL LINING TUBERCULA TION-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE I J q P.P.M.
WATER OFF FROM
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FROM M. TO
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APP ARENT CAUSE OF LEAK.