HomeMy WebLinkAbout1109 S Lincoln St - Engineering
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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUEST
Date 4 - ~5 -- 0 I
Time
/
//
Received by
(phone, person)
LI 11 ('c~J M
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one)
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11th -(.;- 13
.
Phone No
Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other (J.-I?ckr
INSPECTION NOTES
Inspected Date
Remarks
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RESTORATION REQUIRED
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YES
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NO ~
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SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel 0 Asphalt 0 PCC
o Repaired by City
o Repaired by Permittee
[] No Damage Found
o Other
J<i V D
Work Order #
~PLETE
o INCOMPLETE
(Continue on reverse side if necessary)
(DATE)
STREET SUPERINTENDENT
City of Port Angeles
Public Works Department
Water Distribution Repair Report
Ij w - 2.001- 1840
IWork Order No: 11 [( 0 ICrew: 7 / Cf
DATE REPORTED' 4 .- ~ 5"a.J:j I
CONDITION EMERGENCY 0 ROUTINE 0 CITIZEN COMPLAINT ~
LEAKAGE SURVEY 0 OTHER 0
DATE OF REPAIR. Lf - J..S- - 0 ( TIME )1' )() r^.M. DP.M. /
REPAIR LOCATION ADDRESS II D q :5'!-/ Nt:.- (J /1
TYPE OF MAIN:
SIZE.
DEPTH OF MAIN
CLOSEST VALVE DEPTII.
COMPONENT REPAIRED:
MAIN JOINT 0 CIR. BREAK 0 SPLIT BELL 0 LONG BREAK 0
HOLE 0 CLAMP 0 OTHER
SERVICE. TAP 0 CORP STOP 0 PIPE){ CURB STOP 0 FITTING 0
METER SETTER 0 METER 0
LINE VALVE. FLANGENUTSIBOLTS 0 STEM 0 BONNET 0
HYDRANT BRANCH 0 VALVE 0 BARREL 0
OTIIER. ~ ~ X}--(,W --e J j tl {U F-v cJ}11.
(urb 5JvP f-o CfnJLf-r~
,
COMPONENTS OF REPAIR. CLAMPD DRESSERO OTHER
SITE CONDITION' GRAVEL 0 ASPHALT 0 SIDEWALK 0 CURB 0
TOP SOIL AREA 0 SOIL TYPE
CUTS ASPHALT cur _FT CURB CUT _FT SIDEWALK_FT
DRIVEWAY cur _FT
MAIN CONDITION. INTERNAL LINING TUBERCULATION-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
Cffi..ORINE RESIDUAL SAMPLE ,3.2-P.P.M.
WATER OFF FROM I J I }l)fiM. TO ) ').. 30 M.
FROM
M.TO
M.
011 k f(b m"
of ~ A)l)
/ hb US L ) hr'
()u+tt1-'L-
vf;~~ Yy f/r~
APPARENT CAUSE OF LEAK.. wtcl
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