HomeMy WebLinkAbout237 W 4th St - Engineering
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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUEST:
Date ~ --- ) (--- () 0
Time
Received by
(phone, person)
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection Phone No.
Type of Inspection (circle appropriate one): Permit No.
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav. Other (.uaj-e
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INSPECTION NOTES:
Inspected: Date
Remarks:
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RESTORATION REQUIRED . . . . .. YES
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SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved 0 Gravel
o Repaired by City
[] Repaired by Permittee
o No Damage Found
o Asphalt . 0 PCC) 0 Other
Work Order # i f I
~MPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
City of Port Angeles
Public Works Department
Water Distribution Repair Report
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IWork Order No: 16 :t /
Reported: !i....J lJJ 0 t;>
Repaired: !lfJjJ Do
I Crew:
7(f~
Condition:
Source:
Emergency Routine
Citizen Complaint ~
Lealcage Survey _ Other
Repair Location:
Address:
Loc. Description:
:L~7
~ . if/A
Component RtW8ired:
.' Main Line IDN:
Split Bell _
Clamp _
Pipe~
Stem
Barrel
Other
Main: Joint Cir. Break
Long. Break _Hole
Service: Tap _ Corp. Stop _
Une Valve: Flange Nuts, Bolts
Hydrant: Branch Valve
Other:
Curb Stop _
Bonnet
RepaIr Type: C1amp -
Dresser
Other. U ,yi2Tn -t- p U<.J P E/} /'-R.....
SIte Condition: Surface
Curb
Damage:
~vel Roadway _ Asphalt Street _ Sidewalk
Top Soil Area _ Soil Type _
Cuts: Street Cut: Ft.
Curb Cut: Ft.
Sidewalk Cut: Ft.
MaIn Condition:
. t1. (C C _'T _
Diameter: Inches C. :..-r-
Material:
Depth of Cover: Ft. Joint Type:
Internal Lining: Bxtcma1 Prot:
,.
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Tuberculation: N/A
External Corrosion: NI A
Special Conditions: Bedding:
Other Structures:
Minor
Localized
Severe
Extensive
Water Off:
Pipe Section _ Coupon --.lJJ 6)/.-'<- '
From ~ I'} I I07J To ~ I hchu >~ l' rkut .R...
From~ f}IJ~6 To 9r b~ I (J- 6."'" /
fJ rifff-,< f" 1= ,;:?/r~
CkLk--e~"
Samples Taken:
Apparint Cause 01 Leak:
5/19/98
Page 1
PW-902.09