HomeMy WebLinkAbout1111 S B St - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . INSPECTION REPORT . . . . . .
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REQUEST
Date I A - / 3 - 0 ;2..
Time
Received by
(phone, person)
Location of Work to be inspected /111 SOJ 1-( B
Name of person requesting inspection d4.. ? bl1l )16 i b r D ok
Address of person requesting inspection /1 f/ \ + f} Phone No
Type of Inspection (circle appropriate one) Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other W tf',,-,t-e ;,--
INSPECTION NOTES
Inspected Date / }.. - I J ~ 0 J..
Remarks c9--" rYl Pi I r-- b rePt i
Time :2' sO P r1--- By,)C( So ^" JIc/b/Grd)
r-er?(t< 'l<--e cf Lu . ~h. {2u I' (' f lye I~ hel t..~
I
--
RESTORA TION REQUIRED YES NO X
\) S \. tN
I I 5r
~ 5"d' 1 ~ h c-J:
'V" ~~~,-V'
~~t.o.l'"
SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel
o Repaired by City
[] Repaired by Permittee
[] No Damage Found
o Asphalt OPCC JiSjOther 6 raSS
Work Order # ? J.. 7 0
% COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT (DA TEl
CIty of 1Jort Angeles
Public 'Vorks Departnlent
Water Distribution Repair Report
tWork Order No' ~;. 7 0
ICrew 7/7 I lIb I 7,1)..
DATE REPORTED' I J.. -I s- c.J J.-.
CONDITION EMERGENCY 0 ROUTINE 0 CITIZEN COMPLAINT )(
LEAKAGE SURVEY 0 OTHER 0
DATE OF REPAIR. I).. - /3 - () ~ TIME. I,' u 0 DA.M. )(P.M.
REPAIR LOCATION ADDRESS 1111 So~tt.... Is s f
.
TYPE OF MAIN c...a ~ r I ro",,-
A ''\
SIZE.
DEPTH OF MAIN
3'
CLOSEST VALVE DEPTH.
3'
COMPONENT REPAIRED.
MAIN JOINT 0 CIR. BREAK)( SPLIT BELL. 0 LONG BREAK D
HOLE 0 CLAMP 0 OTHER
SERVICE TAP 0 CORP STOP D PIPE 0 CURB STOP D FITTING 0
METER SETTER 0 METER 0
LINE VALVE. FLANGE NUTSIBOL TS 0 STEM 0 BONNET 0
HYDRANT BRANCH 0 VALVE 0 BARREL 0
OTHER.
COMPONENTS OF REPAIR. CLAMPO DRESSERO OTHER 4ull C'r(;j~ rt!:,tM,tI" b4n2
.
SITE CONDITION GRA VEL 0 ASPHALT 0 SIDEWALK 0 CURB 0
TOP SOIL AREA)q SOIL TYPE
CUTS ASPHALT CUT _FT CURB CUT _FT SIDEWALK_FT
DRIVEWAY CUT FT
MAIN CONDITION INTERNAL LINING ;t/~ TUBERCULATION-MINOR 0 SEVERE 0
.
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE P.P.M. ref/a t...~~ ....h1.J l!! r poslflve fIe s~ J /'e
WATEROFF FROM j'uo PM. TO :J.,()O (1M. :) h.4JUs.<::s
FROM
M.TO
M.
APPARENT CAUSE OF LEAK. 5 e,f1/e U ,'I c:!. GI4 c./,