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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. INSPECTION REPORT. . . . . .
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REQUEST
Date~ I- -.J <f -07-
Time /0' O<J .;;'11 Received by
(phone, person)
Location of Work to be inspected I }. S E q ~
Name of person requesting inspection LJq $0..., 1!v/6/ JVI.
Address of person requesting inspection /7 rt.. fib s; T Phone No
Type of Inspection (circle appropriate one) Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav~~~~
INSPECTION NOTES
Inspected Date I J ).. <{ -0 2. Time /. t:/V /fff1 By ~~5cJ'" I~I b/dll<:.
Remarks ~"cC1~f I rc7/1. j'j/J~, "'- 13" e~(<, ('~<. vi> t" ~ ~'7 t,r < ~ ,...k;>!:;, ;~r;~/""~cl
U/ rt t-. {>, (( GI rC It: v' ~ LJePU r' -64. ,.'; c!.
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RESTORATION REQUIRED
YES X NO
N l'
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103' J. "(1"0"''':. > \i)
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SURFACE RESTORATION
SURFACE TYPE D Unimproved DGravel o Asphalt OPCC ~ther TD/5c),i
Work Order # g;l.. I S-
D Repaired by City
[] Repaired by Permittee
[] No Damage Found
o COMPLETE
W INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
CIty of Port Angeles
Public ,,, orks Departnlent
Water Distribution Repair Report
IWork Order No: }.. l- 7 7'
ICrew 7/&.7/7" 71fl. 7).:2..
DATE REPORTED' I 7- ;, 3 - <.) ~
CONDITION EMERGENCY 0 ROUTINE 0 CITIZEN COMPLAINT )K
LEAKAGE SURVEY 0 OTHER 0
DATE OF REPAIR. I) J.. C/ - V J.. TIME 7, UO
REP AIR LOCATION ADDRESS 7 ).. c; C- q It.. 5 f
)\rA.M. DP.M.
TYPE OF MAIN
c..t
"7 "
SIZE r7'
'7'
DEPTH OF MAIN ,2
CLOSEST VALVE DEPTH.
3'
COMPONENT REPAIRED:
MAIN JOINT 0 CIR. BREAK)( SPLIT BELL, 0 LONG BREAK 0
HOLE 0 CLAMP 0 OTHER
SERVlCE TAP 0 CORP STOP 0 PIPE 0 CURB STOP 0 FITTING 0
METER SETTER 0 METER 0
LINE VALVE. FLANGE NUTS/BOL TS 0 STEM 0 BONNET 0
HYDRANT BRANCH 0 VALVED BARREL 0
OTHER.
COMPONENTS OF REPAIR. CLAMPD DRESSERD OTHER
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.
SITE CONDITION GRAVEL 0 ASPHALT 0 SIDEWALK 0 CURB 0
TOP SOIL AREA)( SOIL TYPE
CUTS ASPHALT CUT _FT CURB CUT _FT SIDEWALK_FT
DRIVEWAY CUT _FT
MAIN CONDITION INTERNAL LINING A/ fi TUBERCULATION-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED 0 EXTENSIVE 0
CHLORINE RESIDUAL SAMPLE -" 33 P.P.M.
WATEROFF FROM 1:30 .4M. TO 1,0'0 AM.
FROM
M.TO
M.
APPARENT CAUSE OF LEAK.
L..a ,./<:,c: ~ 1>/ etA.f::
Tre<
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