HomeMy WebLinkAbout1520 S C St - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT . . . . . . . . . . .
REQUE~T /!
Date fL ---:;-./ 0 ?
Time
Received by
(phone, person)
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one)
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I 11f( YO Phone No
Permit No
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Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other '-J s..~
INSPECTION NOTES
Inspected Date
Remarks
Time By
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~ RESTORA TION REQUIRED . YES NO .
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SURFACE RESTORATION ~
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SURFACE TYPE D Unimproved D Gravel
D Repaired by City
[] Repaired by Permittee
CI No Damage Found
D Asphalt D PCC D Other
W~r~der # S- 0 Y/
[j'COMPLETE
D INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
LIty 01 IJort Angeles
Public 'Vorks Departnlent
"1 ater Distribution Repair Report
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IWork Order No.
DATE REPORTED
5" D 1-1 (
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I Crew
7/Y
CONDITION E1\1ERGENCY 0 ROUTINE 0 CITIZEN COIvlPLAINT 0
LEAKAGE SURVEY 0 OTHER 0
DATE OF REPAIR. ~ - )__0 ? TIME I {- '')D
REPAIR LOCATION ADDRESS. I ~^6 ,5-
TYPE OF MAIN ~~I( C-;r:- SIZE
'1 \.1.: (
DEPTH OF MAIN .) r2. CLOSEST VALVE DEPTH.
.:6A.M. OP.M.
(
Csf-
COIvlPONENT REPAIRED.
MAIN JOINT 0 CIR. BREAK 0 SPLIT BELL. 0 LONG BREAK 0
HOLE 0 CLAIvlP 0 OTHER /
SERVICE TAP 0 CORP STOP 0 PIPE ~URB STOP 0 FITTING 0 / ~z /''/ C
METER SETTER 0 METER 0
LINE VALVE. FLANGE NUTS/BOLTS 0 STEM 0 BONNET 0
HYDRANT BRANCH 0 VAL VE 0 BARREL 0
OTIIER.
COIvlPONENTS OF REPAIR. CLAMPO DRESSERD OTIIER
SITE CONDITION GRAVEL 0 ASPHALT 0 SIDEWALK 0 CURB 0
TOP SOIL AREA 0 SOIL TYPE
CUTS ASPHALT CUT _FT CURB CUT _FT SIDEWALK_FT
DRlVEW A Y CUT _FT
MAlN CONDITION INTERNAL LINING TUBERCULATION-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
CHLORINE RESIDUAL SAIvlPLE t ? q P.P.M. , _" + C 6 /tv~ lfJl-e X 0 u-I-
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WATEROFF FROM I X>rM. TO ) )Dr M. 17~F J,'.J,?VJIC'Z 1.-r! V
FROM M. TO M.
APPARENT CAUSE Op.EAK. S"- 4 , Y'D
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