HomeMy WebLinkAbout1015 Georgiana St - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS 11tJ!
. . . . . . INSPECTION REPORT . . . . . . . . . . .
t> c..u . Z. 00 1- . 2.1 0 '3
REQUEST
Date S-" ?.. - c ?-
2/4-
Time
Received by
(phone, person)
/D I c:;- G- .e (:1 V CL I l'", Vl ~
Location of Work to be inspected L
Name of person requesting inspection -r w · \ (p. ')(:
Address of person requesting inspection j I tit if- {; Phone No
Type of Inspection (circle appropriate one) Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other L)...)CA,. .+-tv-
INSPECTION NOTES
Inspected Date
Remarks
f2vd~
1- e tJ..-/<
Time
f<. -+> 11)..e cu .~ J
l~c\..;)1 -I-c>
By
'7, . .
;/ {/ Wc( Hi,' 5 ~ VT/.. C'.JZ
"'7~ -c: .f-t:' V L1 u -e .k
RESTORATION REQUIRED
/
YES V NO
!U(\
{if
J'. ^:( fJv c- -.
~, 1-7 ... ~
\ q Y I !::-- '\
V\ \i
\~ (]_-e DY"t)- / Ct I'l t\..
~,
'\
~J ~
I ') ~~
C
SURFACE RESTORATION
SURFACE TYPE D Unimproved D Gravel D Asphalt D PCC
D Repaired by City
Cl Repaired by Permittee
CI No Damage Found
Work Order #
DOther ~561'L-
A/6 ;:
o COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
CIty of IJort Angeles
Public Works Departnlent ~~. ~Do.,.-,'03
'" ater Distribution Repair Report
IWork Order No. ~I 6 3
ICrew:
(Ii
DATE REPORTED
')--1-0-2-
CONDITION
EMERGENCY 0 ROUTINE 0 CITIZEN COMPLAINT ~
LEAKAGE SURVEY 0 OTIffiR 0
.!) ..... J- .- 0 Z-- TIME I ~ If~. DP.M.
ADDRESS It:> IS 6--e~ f~h A...-
?-<< fVc
SIZE.
DATE OF REPAIR.
REP AIR LOCA TI0N
TYPE OF MAIN
DEPTH OF MAIN
CLOSEST VALVE DEPTH.
COMPONENT REPAIRED:
MAIN JOINT 0 CIR. BREAK 0 SPLIT BELL. 0 LONG BREAK 0
HOLE 0 CLAMP 0 OTIffiR
SERVlCE TAP 0 CORP STOP 0 PIPE ~URB STOP 0 FITTING 0
METER SETTER 0 METER 0
LINE VALVE. FLANGE NUTSIBOL TS 0 STEM 0 BONNET 0
HYDRANT BRANCH 0 VAL VE 0 BARREL 0
OTIiER.
COMPONENTS OF REPAIR. CLAMPD DRESSERD OTIffiR
Ne0 ?(r P-E /';f?~
SITE CONDITION GRA VEL 0 ASPHALT 0 SIDEWALK 0 CURB 0
TOP SOIL AREA 0 SOIL TYPE
CUTS ASPHALT CUT _IT CURB CUT _IT SIDEWALK_Ff
DRIVEWAY CUT _IT
MAIN CONDITION INTERNAL LINING f'( A- TUBERCULATION-MINOR 0 SEVERE 0
EXTERNAL CORROSION" LOCALIZED 0 EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE ," () P.P.M.
WATER OFF FROM
J b J+ M. TO
II If M.
) h6VS-€-
our
FROM M. TO
M.
fJ if 1fI-f? ~- E r/ /'~
APPARENT CAUSE OF LEAK.