HomeMy WebLinkAbout1103 Grant Ave - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . INSPECTION REPORT. . . . . .
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REQUEST
Date J 1- JC> - 11
Time
Received by
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(phOn~erson)
I ':l. 6' .4- 1'1
Location of Work to be inspected I D./ ,- rAIl, rrl/--<-
Name of person requesting inspection " LV I \ Lc> x:
Address of person requesting inspection 11-1~11 1;- 8 Phone No
Type of Inspection (circle appropriate one) Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other U JZ"-t:t <v-
INSPECTION NOTES
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Inspected
Remarks
Date
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RESTORATION REQUIRED
YES
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SURFA E RESTORATION
SURFACE TYPE D Unimproved 0 Gravel
~paired by City
[] Repaired by Permittee
D No Damage Found
o Asphalt 0 PCC D Other
Work Order # Ie; t( 7
~MPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
City of Port Angeles
Public Works Department
Water Distribution Repair Report DtlJ;L 561- I q C; 7
IWork Order No: / if er1
Reported: JJJ .3EJ !J.j Condition:
Repaired: J.1J.2!2J..!IJ Source:
RtWair Location:
Component RtWaired:
Main:
.J
I Crew:
Emergency / Routine
Citizen Complaint (. /
Leakage Survey _ Other
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Address:
II {, J
c- rAlrt 1ft; -e
Loc. Description:
Main Line IDU:
Joint / Cir Break
Long. Break ~ Hole ~
Split Bell _
Clamp _
Other
Service: Tap _ Corp. Stop _
LIne Valve: Flange Nuts, Bolts
Hydrant: Branch Valve
Other:
)
Pi
pe-
Stem
Barrel
Curb Stop _
Bonnet
Dresser ~ Other L; ( (> (2
/J-J:- PIP~
p ..
Repair Type: Clamp _
Site Condition: Surface
Curb
~ Damage:
-.
Gravel Roadway Asphalt Street _
Top Soil Area --..;;z- Soil Type _
Sidewalk
Cuts: Street Cut: Ft.
Main Condition:
Apparent Canse of Leak:
5119/98
Curb Cut: Ft.
Sidewalk Cut: Ft.
Diameter-
Material.
Depth of Cover-
Internal Lining:
Inches Lj , ( If c...
Ft. ') Y2- If,
f( () J:::ti: t1
"
Joint Type: fl.rn1 f-;:J~- f/-ob5
External Prot:
Tuberculation: NI A
External Corrosion: NI A
Special Conditions: Bedding:
Other Structures:
Minor
Localized
Severe
Extensive
Samples Taken: Pipe Section ~\1R tJ Coupon M.. m j}
Water Off: From ili 3" I '1 f To)2 '5/M
From Lll.1J__-' ~! To 3 P M
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Page 1~~; 0 F- 13 0 d., -e+ ( PW-902.09.
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