HomeMy WebLinkAbout1107 Hazel St - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. INSPECTION REPORT. . . . . .
D w - ~-"l-I/pOl'f
REQUEST
Date {-?- 3 '- 0 C;
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Time 7, vP .-1h
Received by 11; ( '-
(phone, person)
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one)
1/()"7 H/12
ILL
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Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other
Phone No
Permit No
INSPECTION NOTES
Inspected Dat~ 0.-';< 3> ._(/ [ Time 9 . ~~ ,P/'1
Remarks /It A /,ltl B R (;-- A c. A #1/ L P L A r / R,-Y
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RESTORATION REQUIRED
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SURFACE RESTORATION
SURFACE TYPE 0 Unimproved rB'Gravel 0 Asphalt
OPCC
o Other
/bcl-7
~epaired by City
o Repaired by Permittee
[] No Damage Found
Work Order #
~OMPLETE
o INCOMPLETE
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STREET SUPERINTENDENT
(DATE)
City of Port Angeles
Public Works Department
Water Distribution Repair Report
bw-~S-O( -/"d.-9
tWork Order No: i (, ;)..1
Reported: , I ';';?-f C- (.,
Repaired: ~ 1)- '} Ie,.
f
'Crew: f( Ct /1/ I fJ e IV /III J' " .T -4-5'17 #' I
Condition.
Source
v-
Emergency Routine
Citizen Complaint ~
Leakage Survey _ Other
Repair LOl'.ation:
Address
Ilv? 1-f/12-e(
S 5" WEST (;If V1LV €' I1Iw
Loc Description.
Component R~aired:
Main Line ID#:
c: C'Ietfl'(? /< ?' F [/..'L L I r
cj. If~ z- € L
Main.
Joint Cir Break V
Long. Break _ Hole
Split BelI _
Clamp _
Other
Service:
Line Valve:
Hydrant:
Other:
Tap _ Corp Stop_
Flange Nuts, Bolts
Branch Valve
Pi
pe-
Stem
Barrel
Curb Stop _
Bonnet
Repair Type: Clamp _
Site Condition: Surface
Curb
Damage:
Cuts: Street Cut: Ft.
~ fvC f'lre
J. Dresser'" ~ Other
Gravel Roadway ~ Asphalt Street _ Sidewalk
Top Soil Area _ Soil Type _
Curb Cut: Ft.
Sidewalk Cut: Ft.
Main Condition:
Diameter'
Material.
Depth of Cover'
Internal '.ining:
Inches d-
rvC
Ft. J I
/1
l'
Joint Type:
External Prot:
Tuberculation. Nt A
External Corrosion. Nt A
Special Conditions. Bedding:
Minor
Localized
GIZ /JvE L
Severe
Extensive
Samples Taken: Pipe Section _
Other Structures:
Coupon -
Apparent Cause of Leak:
Water Off' From / b till Cc To? I{/ A M
From I' t r/ J IV () To 'l J t' It M
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5/19198
Page 1
PW-902.09