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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . INSPECTION REPORT. . . . . .
REQUEST
Date S - to - 0 V
Time 1;00 A f1/l Received by j/e#1/lJ~ E (phone, person)
-
II ,. t'
Location of Work to be inspected g I (0 , <)0 C 5::e
Name of person requesting inspection D-e YI Y1 I S E...
Address of person requesting inspection ~ r~ V ~ r c:i 17 fI.q. /5 Phone No
v
Type of Inspection (circle appropriate one) Permit No _..~
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Oth~ttJ,,-~
INSPECTION NOTES
Inspected Date S- - ID ~ uL{- Time
Remarks /Ze r:J Ie.. L~ 3/<-f S~J'''VI c.,.e.
,
(_' 00 jJ fVl By !J"(Y1 pItS {;
I,'vee ~O\l'l"'\. ~~'^ '-t-D ~-re-r
RESTORATION REQUIRED
YES )( NO
8(q A /let
J~
~
~'Iit.;w
~~
"
'N
LiI/lLO(1/t
SLkoo l
~
,
o cr --t~ S,f-..
SURFACE RESTORATION Sx.'1 (
SURFACE TYPE D Unimproved D Gravel }?J Asphalt D PCC 0 Other
[] Repaired by City Work Order # /'/27$'- 02-1 - \'\$0<6 q:I:. (
[] Repaired by Permittee ~ COMPLETE Ateo. \'e..~C'.>..\ f'cd. ~,~V\
/ [] No Damage Found 0 INCOMPLETE \\ot' JJt X 'S - r1- a~
--h)Jkce-l 6-j,sI01yr= LK
(Continue on reverse side if necessary) STREET SUPERINTENDENT IDA TE)
CIty of Port Angeles
Public Works Department
Water DIstribution Repair Report
IWork Order No
1'1278 r 0 Z I
,
ICrew< 7/5"' +- Lf~u/
DATE REPORTED :s- - Co -o'{-
CONDITION EMERGENCY 0 ROUTINE 0 CITIZEN COMPLAINT)f.
LEAKAGE SURVEY 0 OTIIER 0
DATE OF REP AIR.
5 - { 0- 0 '-f
TIME
( .. 00
DA.M.~,M.
REPAIR LOCATION ADDRESS .8 f c;. -So 'c. s*-
A-L
SIZE ~r'
....
TYPE OF MAIN
(
DEPTH OF MAIN 3'--2
CLOSEST VALVE DEPTH.
( .
2z.'
COMPONENT REPAIRED.
MAIN JOINT 0 cm. BREAK 0 SPLIT BELL 0 LONG BREAK 0
HOLE 0 CLAMP 0 OTIIER
SER VICE TAP 0 CORP STOP 0 PIPE ~ CURB STOP 0 FIITING 0
METER SETTER 0 METER 0
LINE VALVE FLANGE NUTS/BOL TS 0 STEM 0 BONNET 0
HYDRANT BRANCH 0 VAL VE 0 BARREL 0
OTHER.
COMPONENTS OF REP AIR CLAMPO DRESSERO OTIIER
I!E- -(-J61~
_, If
..> ,/~
SITE CONDITION GRA VEL 0 ASPHALT 0 SIDEWALK 0 CURB 0
TOP SOIL AREA 0 SOIL TYPE
CUTS ASPHAL T CUT _FT CURB CUT _IT SIDEWALK_FT
DRIVEWAY CUT _IT
MAIN CONDITION INTERNAL LINING 600& 1lJBERCULATION-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE . 3 ~ P.P M.
WATEROFF FROM 10 A M. TO /0 '!'iI4M.
FROM
M. TO
M.
APPARENT CAUSE OF LEAK I e?r..1< A- f ..p/~-re. YLvt.