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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . INSPECTION REPORT. . . . . .
REQUEST: .
Date It - "1 -0<1
Time 1: 00 II'-'-\.. Received by l>e...>tL's C (phone, person)
Ol:k ~ tJ ~
Location of Work to be inspected 0 - <>fr- ~ g . t:. cor Ke r
Name of person requesting inspection De",,,,; s E .
Address of person requesting inspection Go rp 'Yo."i {? <:f- E Phone No. 'II? - '1'?<t9
Type of Inspection (circle appropriate one): Permit No.
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav. OthCt-t.JcA....+L~~)
INSPECTION NOTES:
Inspected: pate Time
Remarks:k'e,t!A,',ed. 2" L-L. l"eo/:-. U,' I,'
ioo. e I +~ 8" ",--f~\Jc-./ve..., A 3'
fJ.-v.c.. WAS use.J 1-'" +1.-.;;. re'oA.V w,'.t/.,.. 2
I f
By
i.J . y:
Ptee.e .01; 2". ?Lt.... %
d re.S.:;.e, LoU() 1/"55
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RESTORATION REQUIRED . . . . .. YES X NO
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'~3.;j Z" I 3 Fl'<r LJ~e.p
-
8" CI tI Fed /Jeep
(A) S-t"'-
I ~l
\~
SURFACE RESTORATION: ~(>< g (
SURFACE TYPE: 0 Unimproved OGravel fl?!Asphalt OPCC OOther
Work Order # 13sr::;:;:'2 a
'l8i COMPLETE ~ ~ e-~I K:,Q,\
o INCOMPLETE \JJ\\\\ -V\:,J"t Mt {
I f \' - A)-G1
t11/s7r)Ij-n~ ~ rt
_ . STREET SUPERINTENDENT (DATE)
o Repaired by City
o Repaired by Permittee
o No Damage Found
/16fh~J
. IContinJl.e on reverse side if necessary)
City of Port Angeles
Public Works Department
Water Distribution Repair Report
IWork Order No: 13'32.8-035
lerew: '7 ( "> -f- CI.
I
DATE REPORTED If -'1 r 64-
CONDITION: EMERGENCY;t ROUTINE 0 CITIZEN COlvIPLAlNT 0
LEAKAGE SURVEY 0 OTHER 0
DATE OF REPAIR: If -"1 - oc( TIME:
--R...
REPAIR LOCATION: ADDRESS: 8 - "r E
-;: 00 )(A.M. OP.M.
S+. /J.E. LorPlef
TYPE OF MAIN:
C_T.
31
{,
SIZE: 2.-
DEPTH OF lvWN:
CLOSEST VALVE DEPTH:
( i
2-z.-
CO!vIPONENT REPAIRED:
MAIN: JOINT 0 CIR. BREAK j)( 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 NUTSIBOLTS 0 STEM 0 BONNET 0
HYDRAi'\fT: BRANCH 0 VALVED BARREL 0
OTHER:
3(~" l
CO!vIPONENTS OF REI' AIR: CLAMPO DRESSER)( OTHER ~ T 5<::.. 8'0 fire .
SITE CONDITION: GRAVEL 0 ASPHALT jJ( SIDEWALK 0 CURB 0
TOP SOIL AREA 0 SOIL TYPE
CUTS: ASPHALT CUT _FT. CURB CUT _FT. SIDEWALK _FT.
DRlVEWA Y CUT _FT.
MAIN CONDITION: INTER.N"AL LINING 1lJBERCULATION-MlNOR 0 SEVERE ~
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE}/:(
CHLORlNE RESIDUAL SAMPLE . "ft-( PPM
WATEROFF FROM 8:l.{SAM TO '7:'1'AM
FROM M. TO M.
APPARENT CAUSE OFLEAK r:;:;-e s..dffed
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