HomeMy WebLinkAbout126 W Forest Ave - Engineering
CITY OF PORT ANGELES Uo-J."l-c)o-:f -'2-"13
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUEST.
Date 1- f) l5 ..- '6/
Time
Received by
(phone, person)
{ 4tJ /
Location of Work to be inspected ~
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one)
~ K'~,f- li-U~
t'W,j C~
I ? f/{. -t- 13 Phone No
Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other
L U6\~Y
INSPECTION NOTES
Inspected Date
Remarks
Time
Ik~ f(c-e~tA:-;; _1~l(+f;
By
$-eru I c..~
J- r)v -'<-
)!,
f
F6 H 51- \j
I~'_ q.;
4 t ~ \. A'l (_ Y ~
' ,L' / A
"'"
..... ~
{ 7
~:r Ilk S-r '\j
pr
SURFAC RESTORATION ,
RESTORATION REQUIRED
/
YES L/' NO
SURFACE TYPE 0 Unimproved 0 Gravel
[] Repaired by City
[] Repaired by Permittee
[] No Damage Found
o Asphalt 0 PCC D Other "7)~ ~ I 1-
Work Order # ?.)...1:3 I
o COMPLETE
D INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
CIty of Port Angeles
Public 'Vorks Departnlent bc.u. "Z.oOt - 2~c;'3
", ater Distribution Repair Report
'Work Order No.
DATE REPORTED
:A ~ 11
1- :;(0- oJ
I Crew
71t'
CONDITION
REPAIR LOCATION
ADDRESS
EMERGENCY 0 ROUTINE 0 CITIZEN COMPLAINT 0
LEAKAGE SURVEY 0 OTHER 0
! /"' ,z 0 -~? TIME / /r J b )(lA.M. DP.M.
,
I ~ {, [6--;'" e5 + A-tlJC
,tl<l c-~
SIZE
DATE OF REPAIR.
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 CL~ 0 OTHER
SERVICE TAP 0 CORP STOP 0 PIPE ~URB STOP 0 FITTING 0
METER SETTER 0 METER 0
LINE VALVE. FLANGE NUTS/BOL TS 0 STEM 0 BONNET 0
HYDRANT BRANCH 1J VAL VE 0 BARREL 0
OTHER.
COMPONENTS OF REPAIR. CL~O DRESSERO OTHER l/r j/- E Ptp-e ( ~ Cc; YJ1P,~ '; ,,1\
. Ii U Ai ( 0 IV
SITE CONDITION GRA VEL 0 ASPHALT 0 SIDEWALK 0 CURB 0
TOP SOn.. AREA 0 SOn.. TYPE
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 f J Y P.P.M.
WATER OFF FROM
/ If 31> 1tM. TO
{
I a. r h M.
.-
)1- A~ IJ j-€-,"
ou1- thy,
FROM
M.TO
M.
tfJ J-l <-H-/-e
P E-
,
APPARENT CAUSE OF LEAK.