HomeMy WebLinkAbout937 W 12th St - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. INSPECTION REPORT . . . . . .
REQUEST
Date 1- / 'F- oS-
Time II :] c/ 4111 Received by J/u/6-znJ.
(phone, person)
Location of Work to be inspected 937 tJ /3--i"--
Name of person requesting inspection AI C)VT/-el".5
Address of person requesting inspection 170 ~ so 13 sr
Type of Inspection (circle appropriate one)
Sewer Foundation Framing Chimney
Phone No VI 7 - (/'3'<-/9
Permit No
(Oth~
Plumbing Final Sewer Excav ~er iN/A t e (
INSPECTION NOTES
/1-/5-D 5 /1 )) /! 7/7
Inspected Date ,: Time ' :-" (. .6-/ "... By
Remarks
d'.... ffUio-'l... b/-..;?~(I (..efaikci VI !/~ 55 te:jhur bavJcl
RESTORATION REQUIRED .
YES K NO
L 7't\~ t
1 4 \'
IV " .-
:J ,\ L.-I
1--
V)
\J ~ I~Tl,- ~u..c:l --~-- --
"
SURFACE R~STORA TION -
SURFACE TYPE 0 Unimproved 0 Gravel
D Repaired by City
D Repaired by Permittee
D No Damage Found
o Asphalt 0 PCC ~ Other
Work Order # 3c<3' YA
o COMPLETE
~ INCOMPLETE
I (,"0 -Selt /
I .
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
CIty of Port Angeles
Public Works Department
Water DIstribution Repair Report
IWork Order No ~'):) 'IJ.....
JCrew } /7 j Z?~ I 7)<6
,
]
DATE REPORTED
}-/S-U)
CONDITION EIvlERGENCY 0 ROUTINE)lf CITIZEN COMPLAINT 0
LEAKAGE SURVEY 0 OTHER 0
TYPE OF MAIN
J -I ~-{)S TIME /,}.' Jo
ADDRESS q J 7 t/V I .J. T t.....
CT /')"
J- SIZE J'
DA.M. ~.M.
DATE OF REP AlR.
REP AlR LOCATION
"'"
DEPTH OF MAIN
ij'
CLOSEST VALVE DEPTH.
If.C'
COMPONENT REPAIRED.
MAIN JOINT D CIR. BREAK!t. SPLIT BELL D LONG BREAK 0
HOLE 0 CLAMP D o.THER
SERVICE T.-'\P D Co.RP STo.P D PIPE D CURB STo.P D FITTING 0
METER SETTER 0 METER 0
LINE VALVE FLANGE NUTSIBOL TS 0 STEM 0 BONNET 0
HYDRANT BRANCH 0 VAL VE 0 BARREL 0
OTHER.
Co.rvtPONENTS OF REPAIR. CLAMPO DRESSERD o.THER S5 ~"'e #C<t, tcm c!
,
SITE CONDITION GRAVEL 0 ASPHALT 0 SIDEWALK 0 CURB 0
TOP SOIL AREA K SOIL TYPE
CUTS ASPHAL T CUT _FT CURB CUT _FT SIDEWALK_FT
DRIVEWAY CUT _FT
MAIN CONDITION INTERNAL LINING /// /f TUBERCULATIo.N-MINOR 0 SEVERE 0
EXTERNAL Co.RROSION LOCALIZED 0 EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE #;1- P P.M. 1te-1t41/<21 vV/.<:!.s2, fos,(,ve //'(?'5 Svl'f'
WATER OFF FROM
M.TO
M.
FROM
M. TO.
M.
APP.A.RENT CAUSE OF LEAR.. (){t? P'VQ
/ I