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Department of Industry, GROUNDWATER Safety & Buildings Divdsion <br /> Labor" and Human Relations MON I TOR I NG P.O. Box 7969 <br /> Bureau of Plumbing REPORT Madison, Wisconsin 53707 <br /> Note: Show depths in inches. <br /> Location: DEPTH FROM SURF4CE TO WATER/NONE <br /> IOW 1 V 1S R /T ' N/R 12-E(e•r)'J F QcLL 4'6 , OBSERVATION WELL WELL WELL WELL <br /> Township/Mrd $ r: DATE it / -# _f 3 i _, <br /> M DtNA <br /> County: <br /> Owner's Name: <br /> 3 '-i s-8 y No N E 7■1 oN . N 611/41E <br /> Di►.lE Tom' L.A-0 FEN9 - 6 • -3 —II 8y . <br /> Mailing Address:E .EN 51: W1 R-Si••{4Z U. Lit S35$1 �-'' - <br /> 1133 LEW— _ <br /> WELL -3 _Y- —8Y -� <br /> NUMBER: C(-�l-may <br /> WELL k �� �� <br /> DEPTH: 12 3a' 709' ti -1 6 -Of <br /> oPROPOSED 21 INDIVIDUAL Y-�--5_ <br /> SUBDIVISION LOT <br /> Rainfall Data Obtained From: cl-30-85' <br /> N. O. A. i4. - TR -i' F-1EL0 - MAO i So,JJ w/ 5-7-gy <br /> MONTHLY DATA , <br /> Sept Oct Nov „ Dec : Jan Feb Total(8.5") ,&"--/L{-3�}� <br /> D..45" a.Sq 3. 1g 2.30 O 34 I.2� i'a . s'f.' 5 .�( -ry <br /> March April May , Total (Need 7.6") <br /> 1.15' , 3. C6 3.3). 8.33" _5- _ 6- eY <br /> Provide daily rainfall data on a separate sheet for March, April and May. _! _�� Y <br /> Write total rainfall for March, April and May in the above boxes. 4. <br /> E-Li F4./ ) ,EC... q <br /> ART PICIAL DRAINAGE '" " <br /> Cho k the site for artificial drainage. If the site is affected by such <br /> dra.nags, submit complete details for the drainage system. Indiciats who _ <br /> — <br /> wi , be responsible for maintenance of the drainage system. CHECK ONE: <br /> }�f artificial drainage ri Information regarding artificial drainage <br /> JG]� ffecting this site. affecting this site is attached. <br /> Rtt ch a SBD-6395(115) or SBD-6309 (if a proposed subdivision), for soil --- ---.__ - <br /> 1p.lnf•r.ation and estimated depth to high groundwater using mottling. Submit <br /> 2 c•piss of the Groundwater Monitoring Report to the Bureau of Plumbing, <br /> P.0`••x 7969, Madison, Wi 53707 and submit 1 copy to the local authority. <br /> 41a4AA... 4 -• P • -Provide a diagram showing accurate locations and surface elevations of all <br /> e „ t\:, r,toring we SUBDIVISION-Attach a scaled map showin: well locations and relative <br /> .Lions, (1 in. = i= - -t .referred) . �,r eA <br /> I <br /> t lo. - • • .+S ■ '� !.' - -- --$'Dr _ - - <br /> KJOQ ` - I 6o L.8' ��1M� rie 1.",,,,...- 0.II <br /> • ZW3'• 1 IN _,___, <br /> PAT.-z E� 1 . I a it <br /> •NJ . ' .2- p . Q • t •__ wIF <br /> 1 <br /> 7t x <br /> 'I; , <br /> 7 A , __ --. . <br /> .fits, - yam_ 1� <br /> IMAM <br /> 2. 3 I I / ° !�: I SGT ol"�T <br /> I G- - 1 �� I <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: Signatur <br /> DILHR SBD-6412(N.05/81) f, ?- _ 02 a 3 F v ---_- <br />