HomeMy WebLinkAbout323 Columbus Ave - Engineering
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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . .. /
REQUEST
I -?-.-1- 00
Date D Time
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one)
3.L~
Phone No
Permit No
(phone, person)
~
~
~
~
C:>
C
~
V
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Received by
Sewer Foundation Framing
Chimney Plumbing Final Sewer Excav Other
INSPECTION NOTES
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Time 1..
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By
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Inspected Date
Remarks
RESTORATION REQUIRED
YES
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NO V
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SURFACE RESTORATION
SURFACE TYPE D Unimproved D Gravel
o Repaired by City
[] Repaired by Permittee
[] No Damage Found
o Asphalt 0 PCC
Wor~er #
~OMPLETE
o INCOMPLETE
o Other
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(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
t)vV'c)'5l'l-lG>s-3
City of Port Angeles
Public Works Department
Water Distribution Repair Report
IWork Order No: /6 J 7
Reported: ~ IJ...?I-.t%)
Repaired: -XJ 1f1J.QQ
Condition:
Source:
Repair Location:
Address.
Loc. Description.
Component Repaired:
Main:
Joint
Long. Break_
Service: Tap_
Line Valve: Flange Nuts, Bolts
Hydrant: Branch
Other:
Repair Type: Clamp L
Site Condition: Surface
Curb
Damage:
Cuts: Street Cut: Ft.
Emergency
Citizen Complaint
Leakage Survey _
,If :2 J
I Crew:
-7/r;
,
V
Other
C o JUVYibUc;
err Break /
Hole
Corp. Stop _
Valve
Dresser
Main Line ID':
Split Bell _
Clamp _ Other
Pipe _
Stem
Barrel
Curb Stop _
Bonnet
Other
Gravel Roadway ~ha1t Street_
Top Soil Area -L Soil Type
Curb Cut: Ft.
Tuberculation: N/ A
External Corrosion: N/ A
Special Conditions: Bedding:
Other Structures.
Sidewalk
Diameter' Inches :2. r ( C - .f-
Material.
Depth of Cover- Ft. Lf ·
Internal Lining:
Samples Taken:
Water Off:
Sidewalk Cut: Ft.
,.
Joint Type:
External Prot:
,.-..,:.<<
Main Condition.
Minor
Localized
Severe
Extensive
Pipe Section _
From 6 /2-1/00
From 6 12-'1/ 0 i>
Apparent Cause of Leak:
,s~f/--I-e
1s-
Coupon JJ~"-Z _
To -----'-fJ M .s- h 0 {) 5 -e '5. () u+-
To ---J-f!- M p(SY A- h V- ~
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5/19/98
Page 1
PW-902.09