Laserfiche WebLink
Department of Industry, GROUNDWATER Safety & Buildings Di`vi= <br /> Labor and Human Relations MON I TOR I NG P.O. Box 7969 ;' <br /> Bureau of Plumbing REPORT Madison, Wisconsin 5370 <br /> • Ngte: Show depths in inches. <br /> Location: DEPTH FROM SURFACE TO WATER/NONE <br /> 104/ 1/404)1S q IT 17 N/R /2.E(0144#.1 OW. („ it OBSERVATION WELL WELL WELL WELL <br /> Township/ : DATE # / I # : # <br /> YKEV► N A , <br /> County: �own er's Name: 3 -I -8y NoNE NoiV NONE _ <br /> D Pe E_ 1 TnA LA•%) Nf'34-2-1- -3 —,e 8y --- <br /> Mailing Address: 3-'14 -8 <br /> ii,33 Lat-JE.L.I..E041 sr: 1£t..✓ .f3S3 9 <br /> WELL Z 3 -3 -8Y <br /> NUMBER: _ <br /> WELL 4-y`may _.__ . <br /> DEPTH: 7P v -30�� �. C./ —16 -eV 4$ <br /> ri PROPOSED pon INDIVID AL ✓el/k <br /> SUBDIVISION LOT Y-D-3-ey 040, . <br /> Rainfall Data Obtained From: (/-"o-A' ly_C �`�'�A� _ <br /> N. 0. R. A. TR -I' c FIELD - MAO► SO J,w/ . �'F <br /> MONTHLY DATA S.-7-8y - end. <br /> Sept Oct Nov „ Dec Jan Feb Total(8.5")' S-/ti-g}� -Ni 7 <br /> a.45" 2.S " 3. 1>� ?.3v" o•3` I.2L IQ , 54-t" 4'A► j <br /> March April May .. Total (Need 7.6") S '7-( -a"T <br /> 115' 3 86 3.V. '8 33„ -2G- ey 1 <br /> Provide daily rainfall data on a separate sheet for March, April and May. <br /> Write total rainfall for March, April and May in the above boxes. L -1 —'y w V <br /> • <br /> ARTIFICIAL DRAINAGE <br /> Check the site for artificial drainage. If the site is affected by such -- - <br /> drainage, submit complete details for the drainage system. Indiciate who <br /> will be responsible for maintenance of the drainage system. CHECK ONE: -4 - — <br /> 10 No artificial drainage ii Information regarding artificial drainage <br /> affecting this site. affecting this site is attached. <br /> Attach a SID-6395(115) or SBD-6309 (if a proposed subdivision), for soil •-- _ <br /> information and estimated depth to high groundwater using mottling. Submit <br /> 2 copies of the Groundwater Monitoring Report to the Bureau of Plumbing. • . <br /> P.O. Box 7969, Madison, Wi 53707 and submit 1 copy to the local authority. <br /> INDIVIDUAL LOT PLAN-Provide a diagram showing accurate locations and surface elevations of all <br /> mon toring wells. SUBDIVISION-Attach a scaled map showing well locations and relative <br /> ele ations (1 in. 9 100 feet .referred) . 4-. .1 <br /> HIM �.LieiE,98cq Irtl���■t _ __ .,..dolly+ <br /> 11111 ■■■ GoN?•k-T P ff Q EM -a- <br /> 11114' ■■ I mugs . --- <br /> IiIS NOM �I_ -!lal:;rr a i1II !Simi Itilimis ,0,.6 it - :.A! 11■ OZ. i i II. /0(.0- ili! midi <br /> ��/ .. <br /> III ' Imo i , ,r -F ,"£; <br /> v iolo <br /> 11111111111111R1111111111111111 t <br /> I, the undersigned, hereby certify that the data recorded and location <br /> of tests reported on this form are correct to the best of my knowledge <br /> and belief. <br /> Date: CST No: S ign tare: __DILHR SBD-6412(N.05/81) 6 --7-gle P. 3 Y <br />