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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. INSPECTION REPORT. . . . . .
REQUEST
Date ) -- /I - 9 9
Time II: 0 (I .~ ft1 Received by P ~ ,1/ L (
(
(phone, person)
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one)
Sewer Foundation Framing Chimney
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Phone No
Permit No
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Plumbing Final Sewer Excav
Other
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INSPECTION NOTES
Inspected Date Jl ,... I (- 79 Time J~" vp .f? d'7
Remarks StlevtC,E Pt/l.LtF /' ;)/r (" f'v7
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RESTORATION REQUIRED
YES
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SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel 0 Asphalt 0 PCC
Ale?/J
D Repaired by City
[] Repaired by Permittee
[] No Damage Found
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,
Work Order #
o Other LA Wv
13~ 7
.
o COMPLETE
[B'iNCOMPLETE
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(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
City of Port Angeles
Public Works Department
Water Distribution Repair Report
IWork Order No: /3# '?
17
Reported: :?- I !!..J
Repaired: .;t III I , if
I Crew: ~fA/, t7 t::'iV1f'1 J,i J?'CIf..fL~
Condition:
Source:
Emergency V
Citizen Complaint
Leakage Survey _
Routine
Other
Repair Location:
Address.
Loc. Description:
I() J~ CA~(jLltVc
S Ct:1I icE (lit( ,41/?I'/V
Component Repaired:
Main Line ID#:
Main: Joint Cir Break Split Bell _
Long. Break_ Hole Clamp ~ Other AI et,v $'c~Vft:. r Dlr
Service: Tap_ Corp. Stop V Pipe _ Curb Stop _
Line Valve: Flange Nuts, Bolts Stem Bonnet
Hydrant: Branch Valve Barrel
Other: /J~/)K..E /J/(b II NP Cp/! I' J'T~'
Repair Type: Clamp V Dresser Other /'I cUt SEltv IcE T~'
Site Condition: Surface
Curb
Damage:
Gravel Roadway _ Asphalt Street _ Sidewalk
Top Soil Area ~ Soil Type _
Cuts: Street Cut: Ft.
Curb Cut: Ft.
Sidewalk Cut: Ft.
Main Condition:
Diameter-
Material.
Depth of Cover-
Internal Lining:
"
Inches b
A ~C.
Ft. .3
,.
Joint Type:
External Prot:
,..-.;;....
Tuberculation: N/ A Minor
External Corrosion: N/ A Localized
Special Conditions: Bedding: G I! A 1/ e c:
Other Structures:
Severe
Extensive
Samples Taken: Pipe Section _
Coupon _
Water Off: From 2JJ'-J 7~ To -1..l::.2I1I'M
FromL/~/~&) To I~ lfYLM
Apparent Cause of Leak:
f111f I ,,(1
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cu~r
5/19/98
Page 1
PW-902.09