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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . INSPECTION REPORT. . . . . .
REQUEST
Date 1- /5 -o~
Time ~ Jey'!; ff'-'l Received by De",,~\'.:> E
(~one person)
Location of Work to be inspected L/. Z tel Z -f':::
Name of person requesting inspection D.e.'\.. ""- \ ~ E-.
Address of person requesting inspection Corp Va..rd / {"\- g Phone No lf~1-L/-f?4o,
Type of Inspection (circle appropriate one) Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Othe~
INSPECTION NOTES
Inspected Date I - I ~ - 0 S
Remarks Re (h-I r 2 -, L. r:
Time II' Z'> P/V\. By O-e.1.V\. ,. s E
~ l v1. Wi+ k c::A... "5 S re.f&Z.\r b,,-~
~
~ 1 )/ z" L..r "3 ( vRef' 0
.~ (~ 2,2-'-
~ ~
~ Z--t/,.., , -s:
,- J - ~ -
~ t- ~
~ -,
RESTORATION REQUIRED. .
YES
NO 'X
SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel
o Repaired by City
[] Repaired by Permittee
[] No Damage Found
o Asphalt 0 pec 0 Other
Work Order #~c 3'f;"(:-C}
o COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
City of Port Angeles
Public Works Department
Water DIstribution Repair Report
IWork Order No ~O 3L/'A - co'7
JCrew 7/5 Of Cre.....,J
DATE REPORTED 1- (~-OS-
CONDITION E1v1ERGENCY ~ ROUTINE 0 CITIZEN COMPLAINT jJ(
LEAKAGE SURVEY 0 OTHER 0
DATE OF REP AIR, I - I ~ - o{" TIME 1 . ~ 5' DA.M. t:)tP.M.
REP AIR LOCATION ADDRESS t./Zl E , z. "f!.
(I
TYPE OF MAIN L.I. SIZE z -
~; ;
DEPTH OF MAIN CLOSEST VALVE DEPTH. Z--z
COMPONENT REPAIRED.
MAIN JOINT D Cm.. BREAK)(. SPLIT BELL 0 LONG BREAK 0
HOLE D CLANW D OTHER
SERVICE TAP D CORP STOP D PIPE D CURB STOP D FITTING D
METER SETI'ER 0 METER 0
LINE VALVE. FLANGE NUTS/BOL TS 0 STEM 0 BONNET 0
HYDRANT BRANCH D VAL VE D BARREL 0
OTHER.
COIvlPONENTS OF REP AIR. CLANWP( DRESSERO OTHER
SITE CONDITION GRA VEL 0 ASPHALT D SIDEW ALK 0 CURB 0
TOP SOIL AREA 0 SOIL TYPE
CUTS ASPHAL T CUT _FT CURB CUT _IT SIDEWALK_IT
DRIVEW A Y CUT _IT
MAIN CONDITION INTERNAL LINING tJlA 11JBERCULATION-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE -+-PoP M. F; )( e.A ( I.Ve...
WATER OFF FROM - M. TO M.
FROM M. TO M.
APPARENT CAUSE OF LEAK a~v",-d s..e...t1- (e.