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1l- CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUEST:
Date tj - 28 ~ o'-/- Time cf:OD 111M Received by Dc""",-", E ~ person)
~ Fe rest
Location of Work to be inspected Tn+e..-seci<co'^- 0-\ LAu/r'L(
Name of person requesting inspection VeL"-,^-"s IE:....
Address of person requesting inspection cZc,-(J Y<u-J.
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Type of Inspection (circle appropriate one):
Sewer Foundation Framing Chimney Plumbing Final
Phone No. 1/-17-'/84'1
Permit No. ~
Sewer Excav. Othe0J<z:fc:"(~ ')
INSPECTION NOTES:
Inspected: Date 4 -z8~oL{ Time II :00 ALIA. By Del1.";s iF
Remarks:kl?:~Cc,'.~eJ ~'r ,LIre. 4..1/+"- -nJo dv-e<;<;er Cou,ol"~s
Ir I f r/' ('" d 1-'( . -/
c:( ,S-z yJ,eLL o-t- 0 UC'fl C (ruf/\- jJl':?-L.
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(t-LiL rc c~, r t..V(~<; CD Vered tier G
-rl~ tree, + ofl T{~ Iv) (e 4('{ led (.J I
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RESTORATION REQUIRED . . . . .. YES X NO
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SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved OGravel
o Repaired by City
[] Repaired by Permittee
[] No Damage Found
,c"":J:'~J-jr.f;0..~.~ LP /01
%,AsPhalt [] pcc [] Other
Work Order # tL/31L{ -dD2
[] COMPLETE
[] INCOMPLETE
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Public Works Department
Water Distribution Repair Report
IWork Order No: /'-f3i'-{ ~ 007
ICrew: '7(5 "t- C'~e cV
DATE REPORTED:
<-( ~ Z{?-{)c.f
CONDITION EMERGENCY Xl ROUTINE 0 CITIZEN COlvlPLAlNT K
LEAKAGE SURVEY 0 OTIJER 0
DATE OF REPAIR: fI-Z(f-O"-f TIME
REPAIR LOCATION: ADDRESS: j.t+c/$;.ec-f,c","-
TYPE OF MAIN:
A.c.
c",-uv<,-I
'(
SIZE: &,
.-, ,
DEPTH OF MAIN: c::'
CLOSEST VALVE DEPTH:
2-(
COMPONENT REPAIRED:
MAIN: JOINT 0 cm. BREAK 0 SPLIT BELL 0 LONG BREAK 0
HOLE X CLAMP 0 OTIJER
SERVICE: TAP 0 CORP. STOP 0 PIPE 0 CURB STOP 0 FITTING 0
lv1ETER SETTER 0 lv1ETER 0
LINE VALVE: FLANGE NUTSfBOL TS 0 STEM 0 BONNET 0
HYDRANT: BRANCH 0 VALVED BARREL 0
OTHER:
COMPONENTS OF REP Am: CLAMP Q DRESSER~ OTIJER 0 rr D I . Pr t2-L
r
SITE CONDITION: GRAVEL 0 ASPHALT'l!( SIDEWALK 0 CURB 0
TOP SOIL AREA 0 SOIL TYPE
CUTS: ASPHALT CUT <:2>Kll-FT. CURB CUT _FT. SIDEWALK _FT.
DRlVEW A Y CUT _FT.
MAIN CONDITION: INTERNAL LINING Good TUBERCULATION-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE < 201 P.P.M.
WATER OFF FROM 'f j C'A M TO '1: 3LI/4 M.
FROM M. TO M.
APPARENTCAUSEOFLEA.K: /1!J<. I;MrJ'~Or1(( it lJdJcd.
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