HomeMy WebLinkAbout1012 E 6th St - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUEST )-0;
Date / ^ - ).
,
t ~C1 () (:)
Time
Received by
(phone, person)
Location of Work to be inspected /0 J J- I:- t-l it
Name of person requesting inspection --r- L0 \ -, ( oy
Address of person requesting inspection 1'114. f t3 Phone No
Type of Inspection (circle appropriate one) Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other {.J.....J t/'tf-(t~
INSPECTION NOTES
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Time By
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Inspected Date
Remarks
~ ----^
RESTORA TION REQUIRED YES NO
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SURFACE RESTORATION
SURFACE TYPE D Unimproved D Gravel 0 Asphalt
o Repaired by City
[] Repaired by Permittee
o No Damage Found
o PCC 0 Other
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Work Order #
~MPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
City of Port Angeles
Public Works Departnlent
Water Distribution Repair Report
IWork Order No
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I Crew
IIY
CONDITION
I:A- :A )... -D ')
EMERGENCY 0 ROUTINE 0 CITIZEN COMPLAINT /'
LEAKAGE SURVEY 0 OTHER 0
I:A--A)-O; TIME
/0 /2-
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DA.M. DP.M.
DATE REPORTED
DATE OF REPAIR.
REP AIR LOCATION
ADDRESS
f- {fA
TYPE OF MAIN
SIZE.
...
DEPTH OF MAIN
7'
CLOSEST VALVE DEPTH.
COMPONENT REPAIRED. /
MAIN JOINT 0 CIR. BREAK ~ SPLIT BELL 0 LONG BREAK 0
HOLE 0 CLAMP 0 OTHER
SERVICE TAP 0 CORP STOP D PIPE D CURB STOP D FITTING D
METER SETTER 0 METER D
LINE VALVE. FLANGE NUTS/BOL TS D STEM D BONNET 0
HYDRANT BRANCH 0 VAL VE D BARREL D
OTHER.
COMPONENTS OF REPAIR. CL~RESSERD OTHER
SITE CONDITION GRA VEL 0 ASPHALT 0 SIDEWALK D CURB D
TOP SOIL AREA D SOIL TYPE
CUTS ASPHAL T CUT _FT CURB CUT _FT SIDEWALK_FT
DRIVEWAY CUT _FT
MAIN CONDITION INTERNAL LINING TUBERCULATION-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
FROM
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CHLORINE RESIDUAL SAMPLE P.P.M.
WATER OFF FROM M. TO M.
M.TO
M.
APP ARENT CAUSE OF LEAK.