HomeMy WebLinkAbout1236 W 15th St - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . INSPECTION REPORT. . . . . . .
REQUEST
Date I ( -/ Z -0"-1
Time 10.. 0 0 /f"VI... Received by V~ ~ I'" E.. (phone, person)
IZ'SG.:. lJ IS~
Location of Work to be inspected
Name of person requesting inspection V-eIA-V\.; S 6-
Address of person requesting inspection c:..o -r,;} l(t>...r&(
Type of Inspection (circle appropriate one) I
Sewer Foundation Framing Chimney Plumbing Final
I 7 t-- '6 Phone No
Permit ~T-~
Sewer Excav Othe~~ ')
INSPECTION NOTES
Inspected Date ((..../ "Z. -0'-( Time
Remarks Re,tJ~(v-- 2. c-T. ~\'If'\.. "8, J<..
f
By j).e~ Vll S E:.
RESTORATION REQUIRED
YES
NO
r ~
~
,t\t ~
-
"
l-L j I iI C.L j.' }~
~LJ g ~ Z- 3z.
~ 0 .,;
..,
SURFACE RESTORATION
SURFACE TYPE D Unimproved 0 Gravel D Asphalt 0 PCC
D Other
D Repaired by City
[] Repaired by Permittee
D No Damage Found
Work Order #
o COMPLETE
D INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
City of Port Angeles
Public Works Department
Water DIstribution Repair Report
IWork Order No /~~28 -l>"3-'
I Crew 7 r$"" / Lr
1
DATE REPORTED If -/2-o~
CONDITION ENlERGENCY D ROUTINE 0 CITIZEN CONIPLAINT P<
LEAKAGE SURVEY D OTIIER 0
DATE OF REPAIR.
II ,. /'?-- 0 c.f TIME
ADDRESS / Z '3 '--
3
tJ
DA.M. ~.M.
7-"'-
IS- -
REF A1R LOCATION
TYPE OF MAIN
c.r
SIZE
? I ( 3 I
DEPTH OF MAIN ~ Z CLOSEST VALVE DEPTH.
COMPONENT REPAIRED.
MAIN JOINT 0 CIR BREAK ~ SPLIT BELL 0 LONG BREAK 0
HOLE 0 CLAMP 0 OTHER
SERVICE TAP 0 CORP STOP 0 PIPE 0 CURB STOP 0 FITTING 0
METER SETTER 0 METER 0
LINE VALVE. FLANGE NUTS/BOL TS 0 STEM D BONNET 0
HYDRANT BRANCH 0 VAL VE 0 BARREL 0
OTHER.
CONIPONENTS OF REF AIR. CLAMPP( DRESSERO OTHER
SITE CONDITION GRA VEL C ASPHALT 0 SIDEW ALK 0 CURB 0
TOP SOIL AREA Jl SOIL TYPE
CUTS ASPHAL T CUT _IT CURB CUT _IT SIDEW ALK _IT
DRIVEW A Y CUT _IT
MAIN CONDITION INTERNAL LINING J /A. TUBERCULATION-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE ^1M P P.M. r,-~.e. J I ( J e.
WATER OFF FROM
M.TO
M.
FROM M. TO M.
APP'illENT CAUSE OF LEAK. ~OV~ 'S-L +/-1 e.-