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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. INSPECTION REPORT. . . . . .
;-lIE' WP 77~?
REQUEST:
.g -/0--0 ~
Date
Time S- ; dV f (Yl Received by
(phone, person)
Location of Work to be inspected cg). 0 E ~" c!
Name of person requesting inspection ~Sc?;/\.. I~/b/'<.XJJ
Address of person requesting inspection /7u"3 5 13 Phone No. ~ /7 - V'~)S-
Type of Inspection (circle appropriate one): Permit No.
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav. Other C-Va.. ft".r
INSPECTION NOTES:
Inspected: Date
Remarks:
Time
By
RESTORA TION REQUIRED . . . . .. YES 'X NO
f 1 ~
N
~,
) (l!
...-
" J..... CJ .-
~- '-CN
I ~II' l
-
SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved 0 Gravel 0 Asphalt 0 pcc
~ Other rot ~ 6iL
o Repaired by City
[] Repaired by Permittee
o No Damage Found
Work Order #
o COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
CIty 01 IJort Angeles tf-re w~ 77 'fJ9
Public 'Vorks Departnlent
\Vater Distribution Repair Report
IWork Order No: 77cf9
'Crew: }I.JIIN'.:ck I f/"l'l!"s I f'/ell'/~~~'
DATE REPORTED: 8 -Iu-- 0 .~
CONDITION: EI\1ERGENCY 0 ROUTINE 0 CITIZEN COMPLAINT 0
LEAKAGE SURVEY 0 OTHER 0
DATE OF REPAIR: ~ - /u ~ 0 ..~
REPAIR LOCATION: ADDRESS: &~c::> e ;l""l.
? l\
SIZE: ~
TII\1E :
5- ; u-v
DA.M. JilP.M.
TYPE OF MAIN:
c;c
3'"
DEPTII OF MAIN:
CLOSEST VALVE DEPTH:
3'
COMPONENT REPAIRED:
MAIN: JOINT D CIR. BREAK k SPLIT BELL. D LONG BREAK D
HOLE 0 CLAMP 0 OTHER
SERVICE: TAP D CORP. STOP D PIPE D CURB STOP D FITTING D
METER SETTER D METER D
LINE VALVE: FLANGE NUTS/BOLTS 0 STEM 0 BONNET 0
HYDRANT; BRANCH D VAL VE 0 BARREL D
OrnER:
COMPONENTS OF REPAIR: CLAMPD DRESSERD OTHER ~ It eIre-I, r~f'~' ~c!
SITE CONDITION: GRAVEL D ASPHALT 0 SIDEWALK D CURB D
TOP SOIL AREA)( SOIL TYPE
CUTS: ASPHALT CUT _FT. CURB CUT _FT. SIDEWALK _FT,
DRIVEWAY CUT _FT.
MA1N CONDITION: INTERNAL LINING /f/ A TUBERCULATION-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE A/ A P.P.M.
WATER OFF: FROM M.TO M.
FROM M.TO M.
APPARENT CAUSE OF LEAK: (.,r<>Vrt ~ sellle
.
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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . INSPECTION REPORT. . . . . . .
REQUEST
Date 7 - 2.-D - i) '-I
Time I Z- 0 D PM. Received by [)ef,'tv\ I S E. (phone, person)
n.J2
Location of Work to be inspected 820 E. 2 -
Name of person requesting inspection [)en Vl ; s E-
Address of person requesting inspection C::o r,() Yu. rdJ Phone No tf-l -, - i.f i>Y4
/
Type of Inspection (circle appropriate one) Permit No__
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Ot~
INSPECTION NOTES
Inspected J;>ate '7 - 20 - 0 t..(
Remarks h?'c;,. r 2 " C I
I . .
Ie "t'J......i y- heL Vld
,
Time 2-'~OD P/M... By
VV{~ , "t. h f- e Cc. k. tA..l; f- L.. 4.
De",," V\ I S E-.
S:s ..f'uU C(rc.(e
RESTORATION REQUIRED
YES)( NO
~
\f'\ E Y-
'- Z
\J
~ \)
~ t ( } ; ( ~
l~ 22 I Z z /J-eef ~
7" CI --0
I ~
SURFACE RESTORATION ( 3 ~ 8 I
SURFACE TYPE 0 Unimproved 0 Gravel 0 Asphalt 0 pcc 0 Other UKC. re f..t...
'5 Id c::.... I.(.) c.. ( k.
[] Repaired by City Work Order # I? 82 &> - OZ3 ,
[] Repaired by Permittee ~ COMPLETE v..b f' l. CcJv\~t~~
C]No Damage Found 0 INCOMPLETE <()~\'l- ()~ --n<(.
/fj; ShJ r;1?-3/t;4r.v
(Continue on reverse side if necessary) STREET SUPERINTENDENT
(DATE)
CIty of Port Angeles
Public Works Department
Water Distribution Repair Report
'Work Order No / 3~z.3 -0"2..."3
JCrew ? 15 'If Cre0
]
DATE REPORTED
7- ZO-DL{
CONDITION E1v1ERGENCY D ROUTINE D CITIZEN COlvfPLAINT K
LEAKAGE SURVEY D OTHER D
DATE OF REPAIR.
7-2D..-0t.{.
ADDRESS f?Zo
TYPE OF MAIN
C.-r
TTh1E
E
'Z6D
~
2.-
DAM. #M.
REF AIR LOCATION
2((
SIZE
i . i i
DEPTH OF MAIN 2..-z ( CLOSEST VALVE DEFTIl Z. 'z.
COMPONENT REF AIRED.
MAIN JOINT 0 Crn.. BREAK;g{ SPLIT BELL 0 LONG BREAK D
HOLE 0 CLAMP 0 OTHER
SER \!ICE TAP 0 CORP STOP 0 PIPE 0 CURB STOP 0 FITTING 0
1v1ETER SE1TER 0 METER 0
LINE VALVE. FLANGE NUTS/BOL TS D STEM 0 BONNET 0
HYDRANT BRANCH D VAL VE 0 BARREL 0
OTHER.
COMPONENTS OF REF AIR. CLAMP~ DRESSERO OTHER
SITE CONDITION GRAVEL 0 ASPHALT 0 SIDEWALK ~ CURB 0
TOP SOIL AREA 0 SOIL TYPE
CUTS ASPHAL T CUT _IT CURB CUT _FT SIDEWALK ~FT
DRIVEWAY CUT _FT
MAIN CONDITION INTERNAL LINING J fA 1lJBERCULATION-MINOR D SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE D
CHLORiNE RESIDUAL SAMPLE 'VA P.P M. ;::il<ed v~e.c p r(!>SiJ,<>-
,..---
WATER OFF FROM M. TO M.
FROM
\.1, TO
blOt/Mod
M.
A2PARENT CAUSE OF LEAK.
S-e- if ( ~