HomeMy WebLinkAbout1141 Grant Ave - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. INSPECTION REPORT. . . . . .
REQUEST
I ( '-I C -t/ C/
Date ./
Time / I ~ vi-' /lJ'11 Received by I e If ~ i-' J - (eh2ne. person)
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one)
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Phone No
Permit No
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Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other
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INSPECTION NOTES
Inspected Date J I ~ ! s: -t/ C/ Time ) :> (/ rt"Z? By I( /#'
Remarks C t/ IV (/C ~ C "( /J r f-' ^ ,/9"y 7' ~ jl P K E 5' F~ VI C t="
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RESTORATION REQUIRED
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YES
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SURFACE RESTORATION
SURFACE TYPE D Unimproved D Gravel D Asphalt D PCC
D Other
[] Repaired by City
[] Repaired by Permittee
[] No Damage Found
Work Order # I 7 :) ?
~OMPLETE
D INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
City of Port Angeles
Public Works Department
Water Distribution Repair Report
IWork Order No: / 7 ?- r
Reported 1~1 /5/ vV'
Repaired. ILl 1..5 I Pc--
Condition.
Source.
lerew. .7 /f .5"'tA/ ,~ltV J<'ICtf--4IRJJ
, I
Emergency ~ Routine
Citizen Complaint
Leakage Survey _ Other L t IV T ;<:/f L / ~ F
Address. I / Y I CIf /?,J/ r
Loc. Description. r C [ -I C! J / W t::.f'T pr V /J L (/ EON /11 tv C? X N C /7
ti F rr ,e /9-1/1 r cf r t') /? T e It
Main Line ID#:
Repair Location.
Component Repaired.
Main. Joint Cir Break .......--- Split Bell _
Long. Break_ Hole Clamp _ Other
Service: Tap_ Corp. Stop L/' Pipe _ Curb Stop _
Line Valve: Flange Nuts, Bolts Stem Bonnet
Hydrant: Branch Valve Barrel
Other:
Repair Type: Clamp _
Site Condition: Surface
Curb
Damage:
Cuts: Street Cut: Ft.
Dresser ~.
Other ,_
Gravel Roadway _ Asphalt Street ~ Sidewalk
Top Soil Area _ Soil Type _
Main Condition.
Diameter'
Material.
Depth of Cover'
Internal Lining:
Tuberculation.
External Corrosion:
Special Conditions:
Curb Cut: Ft.
Sidewalk Cut: Ft.
Inches :)
C X
Ft. -; Joint Type
fl A 17 It 15E PONt; External Prot:
~~1/1fr wITH LATe,e
NI A Minor
N/A Localized
Bedding: {:;. ~ A '" E- l...
Other Structures:
,.
9.- .(
Severe
Extensive
Samples Taken: Pipe Section _
Coupon _
Water Off: From (111)It/v Tol/~vv~M
From /1 1 I) IC/o To 1;;']pLM
Apparent Cause of Leak: C C Ifl r/< /1 c 7"
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5/19/98
Page 1
PW-902.09