HomeMy WebLinkAbout214 W 5th St - Engineering
.....
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . INSPECTION REPORT . . . . . .
.....
REQUEST
Date I Z - ~ I - 0 4
A Dr
Time /0. l{S 14 Received by C~1"11$ ~_ (phone, person)
--.
,~i!:
IE
yO,. r d
Phone No t( ( 7 -Cf8'4~
Permit No --~
SewerExcav Othe0cc+0
Location of Work to be inspected ~ l '-f iV
Name of person requesting inspection D<..1. V\ . s
Address of person requesting inspection 0) r 1/J
I
Type of Inspection (circle appropriate one)
Sewer Foundation Framing Chimney Plumbing Final
INSPECTION NOTES
Inspected Date 12 - 3 ( - 0 <.f
Remarks ~ e~CA..' r Z. t C I
.s S r.e /.Jt/'...i v- Io~,- ",-d .
I
Time e:z /2 <1.5-- ;1Jl.tBy J/<VlI-1 {S E
~A(~ bv- e.~:.....lc lJ;-tL... c,,- G f, ? 5g r""tr-
RESTORATION REQUIRED. . . YES NO
OI1K 01
I \J
5t-
-1 L.----
1/0 5~
i- I bra J
-.1> ~
r ""'(..;I
Z fL( w 51f. 2' L I
Z~. /Jetl
\
SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel
D Repaired by City
[] Repaired by Permittee
D No Damage Found
o Asphalt 0 PCC 0 Other -r;;rs..c I I
Work Order # I?; S?Z g ,- 0<{ '-I
o COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
CIty of Port Angeles
Public Works Department
Water Distribution Repair Report
IWork Order No IS?(Lg --Ot<{ 1
JCrew 7 l ~- oj- C-.r<.--....J
]
DATE REPORTED i Z - 31-0 y-
CONDITION EMERGENCY 0 ROUTINE 0 CITIZEN COMPLAINT IX:...
LEAKAGE SURVEY 0 OTHER D
DATE OF REPAIR. I Z - '3 ( - 0 '1 TTh1E (2.. '"'?
REP AIR LOCATION ADDRESS Z (~ LU S- ~
DAM. ~.M.
TYPE OFMAlN
C_ I SIZE. Z "
il Af7- (
2..z:- CLOSEST VALVE DEPTIl g- Z
DEPTH OF MAIN
COMPONENT REPAIRED.
MAIN JOINT D cm. BREAK)i SPLIT BELL D LONG BREAK D
HOLE D CLAMP 0 OTHER
SERVICE TAP 0 CORP STOP 0 PIPE 0 CURB STOP 0 FITTING 0
:tv1ETER SETTER 0 :tv1ETER 0
LINE VALVE. FLANGE NUTS/BOL TS 0 STEM 0 BONNET 0
HYDRANT BRANCH 0 VAL VE 0 BARREL 0
OTIIER.
COMPONENTS OF REP AIR. CL~ DRESSERO OTIffiR
SITE CONDITION GRAVEL 0 ASPHALT 0 SIDEWALK 0 CURB 0
TOP SOIL AREA 0 SOIL TYPE
CUTS ASPHAL T CUT _IT CURB CUT _IT SIDEWALK IT
DRIVEWAY CUT IT
MAIN CONDITION INTERNAL LINING AJ ~ TUBERCULATION-MINOR 0 SEVERE 0
EXTERNAL CORROS~ED 0 EXTENSIVE 0
CHLORlNE RESIDUAL SAMPLE ~ P PM. Fi>< e d I, v' e..
WATER OFF FROM .- M. TO - M.
FROM
M. TO
M.
~p '\RENT CAUSE OF LEAK. 6"r7:;:Ju,,~ S e tf-l e