HomeMy WebLinkAbout816 W 6th St - Engineering
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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUEST
Date J]- 11- OD
,
Time
Received by
(phone, person)
Sewer Foundation Framing
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}l{ll <h 6 Phone No ~
Permit No ~
Chimney Plumbing Final Sewer Excav Other l( )~t'c'1'r ~
\g:
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one)
INSPECTION NOTES
Inspected Date
Remarks
Time By
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YES NO
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It c./Y'
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~
~
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SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel 0 Asphalt 0 PCC
o Repaired by City
Cl Repaired by Permittee
CI No Damage Found
WorkjPder #
[]./COMPLETE
o INCOMPLETE
c ' o Other
/730
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
City of Port Angeles
Public Works Department
Water Distribution Repair Report
l) to - 2.~-() (- I 9~ 0
'Work Order No: J 7 J 6
, Crew'
71tj~
,
Reported: LLI 11-, fK?
Repaired: ILl ill Lit>
Condition.
Source
Emergency
Citizen Complaint
Leakage Survey _
Routine
~
Other
Repair Location.
Address
~/L
W 6+/1
Loc Description.
Component Repaired:
Main.
Main Line ID#:
Joint Cir Break: t/" Split Bell _
Long. Break: _ Hole Clamp _
Other
Service: Tap_ Corp Stop_ Pipe _ Curb Stop _
Line Valve: Flange Nuts, Bolts Stem Bonnet
Hydrant: Branch Valve Barrel
Other:
Clamp t/ .-
Repair Type: Dresser Other
Site Condition: Surface
Curb
Damage:
Gravel Roadway _ Asphalt Street _ Sidewalk
Top Soil Area _ Soil Type _
Cuts: Street Cut: Ft.
Curb Cut: Ft.
Sidewalk Cut: Ft.
Main Condition.
Diameter- Inches .::z. t C - .J:--
Material.
Depth of Cover' Ft.
Internal Lining:
"
Joint Type
External Prot:
,. ,
Tuberculation:
External Corrosion.
Special Conditions:
N/A
N/A
Bedding:
Other Structures:
Minor
Localized
Severe
Extensive
Samples Taken.
Pipe Section _
Coupon /IJ ~ )I.e..-
Ft Y, !;f.(fa6L-<J Y\
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Apparent Cause of Leak:
Water Off: From_/_'_ TO__M
From / / TO__M
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5/19/98
Page 1
PW-902.09