HomeMy WebLinkAbout1133 W Hwy 101 - Engineering
City of Port Angeles
Public Works Department
Water Distribution Repair Report
IWork Order No l'i ?- 7'8 -D 7 /)
, Crew 7 I -, ,... Lf <. ~
DATE REPORTED /2... 5 -0 .....t
CONDITION E1vlERGENCY 0 ROUTINE 0 CITIZEN CONIPLAINT i't
LEAKAGE SURVEY 0 OTHER 0
DATE OF REP AIR. l '2. - 3 -Dc..( TIME 3'3D DA.M. ,MP.M.
REP AIR LOCATION ADDRESS 113 '5 l-liWA.Y /0 I tJ~-sA:.
TYPE OF MAIN A-c SIZE 8' -
I r 3 (
DEPTH OF MAIN 3'2.. CLOSEST VALVE DEPTII.
CONIPONENT REPAIRED.
MAIN JOINT 0 CIR. BREAK D SPLIT BELL D LONG BREAK 0
HOLE 0 CLAMP 0 OTIffiR
SERVICE TAP D CORP STOP D PIPE f;( CURB STOP D FITTING 0
METER SETTER 0 METER 0
LINE VALVE. FLANGE NUTS/BOL TS 0 STEM 0 BONNET 0
HYDRANT BRANCH 0 VAL VE 0 BARREL 0
OTHER.
CONIPONENTS OF REPAIR. CLAMPO DRESSERO OTHER L.:>~. VKI-Oo"L ~ P E. +iJhi"'5
SITE CONDITION GRAVEL 0 ASPHALT 0 SIDEW~ 0 CURB D
TOP SOIL AREA 0 SOIL TYPE IV ~ +j i/e_
CUTS ASPHAL T CUT _FT CURB CUT _IT SIDEWALK_FT
DRIVEWAY CUT _FT
MAIN CONDITION INTERNAL LINING AlA TUBERCULATION-MINOR 0 SEVERE 0
EXTERNAL CORROSION {LOCALIZED 0 EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE r 2 <8 P P M.
WATEROFF FROM L ~DPM. TO ~ f M.
FROM
M. TO
M.
.:..PP.i\RENT CAUSE OF LEAK
11>1... h.ole.
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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . INSPECTION REPORT. . . . . . .
REQUEST
Date /2 ~ 3-0 L{
Time 2 3-0 P"^-. Received by 0-e.iIlJ.'l ( S E. (phone, person)
..--
Location of Work to be inspected 1/33 f/;we;...y 10 I
Name of person requesting inspection DelA~C::-s t
Address of person requesting inspection G<Y.r{) Y(.l.. rJ.
Type of Inspection (circle appropriate one) I
Sewer Foundation Framing Chimney Plumbing Final
tJ ~ s.k
Phone No t.{ ('7 - t./ 8 <I ~
Permit No . ...~
Sewer Excav Ot~"'- -+...~
INSPECTION NOTES
Inspected Date I Z. - ? -() L-( Time ~
Remarks f(€fj~l'(' '3/~ ~'VtL<' (,.V\....L
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f-/ I W P- Y 10 { 0a,:>1'
RESTORATION REQUIRED
YES
NO X
SURFACE RESTORATION
SURFACE TYPE D Unimproved D Gravel
o Repaired by City
o Repaired by Permittee
[] No Damage Found
D Asphalt D PCC D Other
Work Order # (t.fL78 '--015"
o COMPLETE
D INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)