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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . INSPECTION REPORT. . . . . . . .
REQUEST:
Date 3- 11 -oc;
Time Ir~D Arf.,(
Received by
(}.enn. . S ('
(phone. person)
Location of Work to be inspected S.6:. Ll>.-vt...e r -:I'vt.e.S ct- G.,o/, ~
Name of person requesting inspection [)e"l"t /S 6..
Address of person requesting inspection G,t1 \1tv& 17"" B Phone No. 4/7- '18'17
I
Type of Inspection (circle appropriate one): Permit No. _
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav. Oth~J"l+0
INSPECTION NOTES:
Inspected: Date 3- /""-05' Time
Remarks: 5+r4.~j~-te."" kydvA"-.-t- k\'--t
3: 30 r1M
l.:1y eo... v-.
By .o.ek",;"5 E-.
No cl" ""-"j <. --h>
ky d'M-t".
RESTORATION REQUiRED...... YES
NO X
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La.r" L'vu.. S-r. K
-1. 5" IE- " 3{ tJ,,~/)
(, A.c..
v
.Y
SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved DGravel
o Repaired by City
o Repaired by Permittee
o No Damage Found
o Asphalt 0 PCC 0 Other
Work Order # 3o's'i7-00(
o COMPLETE
o INCOMPLETE
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City of Port Angeles
Public Works Department
Water Distribution Repair Report
IWork Order No: ..5D3'-11-0D(
lerew: 7{~ V-- Lve,J
DATE REPORTED 3-/0~05
CONDITION EMERGENCY 0 ROUTINE 0 CITIZEN COtvIPLAlNT 0
LEAKAGE SURVEY 0 OTHER 0
DATE OF REPAIR:
,3-1-r-i)5 TIME: 3:~o OA.M. &.M.
ADDRESS S.~. L6:iN'..r ~'^"'-S '*- (2.\.-<,:, II'VI.z.
REPAIR LOCATION:
TYPE OF MAIN:
A,c,
. t(
SIZE: &,
DEPTH OF MAIN:
,?"
:::>
CLOSEST VALVE DEPTH:
I I
2-2
COMPONENT REPAIRED:
MAIN: JOINT 0 CIR. BREAK 0 SPLIT BELL 0 LONG BREAK 0
HOLE 0 CLAMP 0 OTHER
SERVICE: T.AJ' 0 CORP. STOP 0 PIPE 0 CURB STOP 0 FITTING 0
METER SETTER 0 METER 0
LINE VALVE: FLANGE NUTS/BOL TS 0 STEM 0 BONNET 0
~RANT~RANCH 0 VAL VE ~ BARREL 0
OTHER: 1-(yJv,"-v\.t' L + by c",- v-_
bolt<;
5tfo...~k tevted A."I.d r-d';kteV\,
V1.6AW\.<-"::/_ "to kyJ rt\v...T',
COMPONENTS OF REPAIR: CLAMPO DRESSERO OTHER
SITE CONDITION: GRAVEL 0 ASPHALT 0 SIDEWALK 0 CURB 0
TOP SOIL AREA 0 SOIL TYPE bvc,Je...\
CUTS: ASPHALT CUT _FT. CURB CUT _FT. SIDEWALK _FT.
DRlVEWAYCUT _FT.
MAIN CONDITION INTERNAL LINING TIJBERCULATION-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE P.P.M.
WATER OFF FROM
M. TO M.
FROM
M. TO M.
Su Cl bOlle. '
."J'PARENT CAUSE OF LEAK.