HomeMy WebLinkAbout916 S Chase St - Engineering
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CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . INSPECTION REPORT. . . . . .
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REQUEST
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Date ~ c.. .:> - 0 (
Time 2 '1;;0 f'!1.1 Received by Def/lVlrC; t3-". (phone, person)
Location of Work to be inspected 1((;, ~ C~Se
Name of person requesting inspection Oe~(A ':S- E
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Address of person requesting inspection /1 - C:/-- b LOr I' Yarc\' Phone No ,l7 - 'f 8ft
Type of Inspection (circle appropriate one) Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other ttJet.f e.-
INSPECTION NOTES
Inspected Date 5-?3- 01
Remarks ~ j('J a u-' :5 e r v, L e
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Time Z 50 By ~l(7 C
(eCi.k bet..;(/t4 Wc:;+er ate_r. (3/c( t'( /!E )-
RESTORATION REQUIRED
YES
NO X
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SURFACE RESTORATION
SURFACE TYPE D Unimproved 0 Gravel
D Repaired by City
[] Repaired by Permittee
[] No Damage Found
o Asphalt 0 PCC 0 Other 6, fA 55
Work Order # /215-:;-
~ COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
CIty of Port Angeles
Public 'Vorks Departnlent
Water Distribution Repair Report
D (A,) 200 T - t8b-O-
IWork Order No: I~~S
'Crew 72'-'- 7Z9 - 7 Z3
DAlEREPORlED' 5-~Z3~-o'
CONDITION EMERGENCY 0 ROUTINE 0 CITIZEN COMPLAINT M
LEAKAGE SURVEY 0 OTHER 0
DAlE OF REPAIR. 5'....23,01
REP AIR LOCATION ADDRESS q /"
TIME (0 Ii'
~.M. OP.M.
L
:./0
(~~5e
TYPE OF MAIN
AlA
SIZE. .---
DEPTH OF MAIN
CLOSEST VALVE DEPTH.
COMPONENT REPAIRED.
MAIN JOINT 0 CIR. BREAK 0 SPLIT BELL. 0 LONG BREAK 0
HOLE 0 CLAMP 0 OTHER
SERVICE TAP 0 CORP STOP 0 PIPE 0 CURB STOP 0 FITTING 0
MElER SETTER 0 MElER 0
LINE VALVE. FLANGE NUTSlBOL TS 0 SlEM 0 BONNET 0
HYDRANT BRANCH 0 VALVED BARREL 0
OTHER. 31-{ f? E-
l ( vt.e _ be tll~ t-4.e. -f e r
COMPONENTS OF REPAIR. CLAMPO DRESSERO OTHER 1411-<. qo/ tf4e:de X c~~ IU(I ) Co~f U~1.I(;
SIlE CONDITION GRAVEL 0 ASPHALT 0 SIDEWALK 0 CURB 0
TOP SOIL AREA IX SOIL TYPE C-!4..i:,
CUTS ASPHALT 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
CJ-aORINE RESIDUAL SAMPLE P.P.M.
WAlEROFF FROM /2 t5 t M. TO /2 "30p M.
FROM
M.TO
M.
APPARENT CAUSE OF LEAK. de 9cc +-,1/(. ~{ 4-e
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