HomeMy WebLinkAbout227 W 5th St - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . INSPECTION REPORT. . . . . .
REQUEST
Date I - i 3 0 ~
Time q 60 P'fUr\. Received by j). [).j{~--I-b~Phone, person)
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Location of Work to be inspected ZZ 7 tU -5 -
Name of person requesting inspection 'j) t{-lji '^j..fo v'--
Address of person requesting inspection ~ ~ JLJ Ya.v--J. Phone No ifl? - '{;Pel?
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Type of Inspection (circle appropriate one) Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other W?<--+e i'r'
INSPECTION NOTES
Inspected Date / - i :;.- 04-
Remarks tZ e IJ c,- i' r 2 (, c.-L ,
I
Time
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RESTORATION REQUIRED
YES >('
NO
SURFACE RESTORATION
SURFACE TYPE D Unimproved D Gravel D Asphalt
D Repaired by City
[] Repaired by Permittee
CI No Damage Found
D PCC D Othe;1;~\ I
I
Work Order # 13.82?? - 00(.;>
o COMPLETE
D INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
Llty 01 lYort Angeles
Public Works Department
Water Distribution Repair Report
IWork Order No 13?fZ '3- .::JOG::.
ICrew ((:5 - 7((, '-:- 1(1 -722. 1
DATE REPORTED
(- f'3 - 04
CONDITION EIYfERGENCY D ROUTINE D CITIZEN COMPLAlNT )'!
LEAKAGE SURVEY D OTHER D
DATE OF REPAIR. I - i'3 --0 t./
TIME
ADDRESS 2 .., 7 ,\ L- -fL
REP AIR LOCATION (;... ~. J
C. 'L
Z(
DEPTH OF MAIN CLOSEST VALVE DEPTH.
DA.M. OP,M.
TYPE OF MAIN
SIZE 2 ((
,.
2
COMPONENT REPAIRED.
MAIN JOINT 0 CIR BREAK ~ SPLIT BELL 0 LONG BREAK D
HOLE D CLAMP D OTHER
SERVICE TAP 0 CORP STOP D PIPE D CURB STOP D FITTING D
IYfETER SETTER 0 IYfETER D
LINE VALVE FLANGE NUTS/BOL TS 0 STEM D BONNET D
HYDRANT BRANCH D VAL VE D BARREL D
OTHER.
COMPONENTS OF REP AIR CLAMP)( DRESSERD OTHER
SITE CONDITION GRA VEL D ASPHALT D SIDEWALK D CURB D
TOP SOIL AREA D SOIL TYPE !....k_-,h J e.. c:. (tt.-:{
CUTS ASPHALT CUT _IT CURB CUT _IT SIDEWALK ~IT
DRIVEWAY CUT IT
MAIN CONDITION INTERNAL LINING 0/A TUBERCULATION-MINOR D SEVERE D
EXTERNAL CORROSION LOCALIZED D EXTENSIVE D
CHLORINE RESIDUAL SAMPLE ~P.P.M. F( )( e J ( ( vi e-
WATER OFF FROM
M.TO
-
M.
FROM
M.TO
M.
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APPARENT CAUSE OF LEAK. 6 rov~