HomeMy WebLinkAbout1420 S O St - Engineering
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUEST
Date ~_- ~ q --0 )
Time
Received by
(phone, person)
Location of Work to be inspected
Name of person requesting inspection
Address of person requesting inspection
Type of Inspection (circle appropriate one)
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D 5~if
Phone No
Permit No
Sewer Foundation Framing Chimney Plumbing Final Sewer Excav Other ()JlA~
INSPECTION NOTES
Inspected Date
Remarks
Ti";r By
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RESTORATION REQUIRED
YES
//
NO V
SURFACE RESTORATION
SURFACE TYPE 0 Unimproved 0 Gravel
[] Repaired by City
[] Repaired by Permittee
[] No Damage Found
o Asphalt 0 pcc 4 ~ ~ Other
Worlyehder # t
cvCOMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
CIty of Port Angeles
Public 'V orks Departnlent
", ater Distribution Repair Report
'Work Order No
DATE REPORTED
~b' ,
2-27-0>
, Crew
1/1
CONDITION EMERGENCY 0 ROUTINE 0 CITIZEN COrvtPLAINT 0
LEAKAGE SURVEY 0 OTHER 0
DATE OF REPAIR. ~ - ~~-l>) TIME. / pm
.5-
TYPE OF MAIN
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o
DA.M. DP.M.
51r-c~
REPAIR LOCATION ADDRESS
SIZE.
DEPTH OF MAIN
CLOSEST VALVE DEPTII.
COrvtPONENT REPAIRED.
MAIN JOINT 0 CIR. BREAK D SPLIT BELL. D LONG BREAK 0
HOLE D CLArvtP 0 OTHER /
SERVlCE TAP D CORP STOP D PIPE ~CURB STOP D FITTING D
METER SETTER 0 METER D
LINE VALVE. FLANGE NUTS/BOL TS 0 STEM D BONNET 0
OTHER.
HYDRANT BRANCH 0 VAL VE D BARREL 0
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,
COrvtPONENTS OF REPAIR. CLArvtPD )JRESSERO OTHER
SITE CONDITION GRA VEL VASP~T D SIDEWALK D CURB 0
TOP SOIL AREA {J:T SOIL TYPE
CUTS ASPHALT CUT _FT CURB CUT _FT SIDEWALK_FT
DRIVEWAY CUT _FT
MAIN CONDITION INTERNAL LINING TUBERCULATION-MINOR 0 SEVERE 0
EXTERNAL CORROSION LOCALIZED D EXTENSIVE 0
CHLORINE RESIDUAL SArvtPLE P.P.M.
WATER OFF FROM Lr!m- M. TO
FROM jfZn1- M. TO
APPARENT CAUSE OF LEAK.
M.
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