HomeMy WebLinkAbout1212 Georgiana St - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . INSPECTION REPORT. . . . . .
REQUEST
Date 1-1'1-01
Time /2 PM
Received by D el1 n / S E. (phone, person)
Location of Work to be inspected 12..1'- 6e.or-5t"~Vl.c:;...
Name of person requesting inspection D (LV\.. V\. ( ~ E-
Address of person requesting inspection C-ol' f YcA-.red Phone No 1-/7 r 'f~t..(q
Type of Inspection (circle appropriate one) Permi~ ~
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav o~~~
INSPECTION NOTES
Inspected Date Lj. -I t -i) ~
Remarks l<eJtJc..1 r SerVtr'-..e.
,
Time ;3 fJp",-- By be'h"t r .s .;;;.
I ; vle- ( IU\.~ e~l e.~ V\. ~ \I\. ""- ~i- e.. r ..
RESTORATION REQUIRED .
YES
NO X
~
\r) (; e or5~~~"'- 0
~
~
~~ ,; , ..... z" P"c. ( ~
1:' /20 -, 3 Da-fJ ~
oJ.. \ ) ',-
~ "'-J
1'L11- &o("j ,'a..c.v:....
SURFACE RESTORATION
SURFACE TYPE D Unimproved D Gravel
o Repaired by City
[] Repaired by Permittee
o No Damage Found
D Asphalt D PCC ~tner <e; 'Is ~L
Work Order # ler Z 78' .- Of S-
O COMPLETE
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.
Icrew 7/~ Y- Cfe..0
DATE REPORTED
1--/2.-01-
CONDITION EMERGENCY 0 ROUTINE 0 CITIZEN COMPLAINT ~
LEAKAGE SURVEY 0 OTHER 0
DATE OF REPAIR. if -- (t..f .-ot.(
TIME 3 - 00 DA.M. ~.M.
TYPE OF MAIN
P()c-
.
(; € 0('.5 r .....V\..c:......
SIZE 2- (t
REPAIR LOCATION
ADDRESS ( 2 , 2-
DEPTH OF MAIN
3'
( (
22
CLOSEST VALVE DEPTH.
COMPONENT REPAIRED.
MAIN JOINT 0 CIR. BREAK D SPLIT BELL D LONG BREAK 0
HOLE 0 CLAMP D OTHER
SERVICE TAP D CORP STOP D PIPE Pi. CURB STOP D FITTING D
METER SETTER D METER D
LINE VALVE. FLANGE NUTSIBOL TS 0 STEM D BONNET 0
HYDRANT BRANCH D VAL VE 0 BARREL D
OTHER.
COMPONENTS OF REPAIR. CLAMPO DRESSERD OTHER
" -
$/4 LOW1.() () 111 OYl
,
SITE CONDITION GRA VEL D ASPHALT 0 SIDEWALK D CURB D_
TOP SOIL AREA D SOIL TYPE C l 0..."; - NtA. fl J e.....
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 SAMPLE ' 3-S- P.P.M.
WATER OFF FROM
2.'OOfM. TO
2- 1St> M.
I
FROM
M.TO
M.
APP ARENT CAUSE OF LEAK. 0 I'd? aJ....e