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INDUSTRY, LABOR & HUMAN RELATIONS 237 <br /> ILHR 83 Appendix <br /> �1 <br /> ON—SITE INVESTIGATION FOR Safety s BPlumbing <br /> 131LHR Division Bureau Of plumbing <br /> CONVENTIONAL SYSTEM IN—FILL P.O.p.0. BOX 7969 <br /> -� — MADISON, YI 53707 <br /> Ornara Nae,: Le{ 1 DeecrS Dtions: <br /> EU3age: <br /> ng O New Building Replacement System Public O Residential No. or Bedroom. <br /> Z <br /> eet Depth In Inert. to Ia Pawed Io Oe came Depth To: Fill Plated 2a Feet Around Are,ed <br /> il <br /> il e,ulro: � Or111na1 Oredeting r F[w Oroumnater Bedrock And RnPropoap1 eewe,tiA ee llalOYeY I.YS No <br /> ^'� ee11 etd NmedF e(etaL On Ibnitorin{ �•7S Set! Raved Prier to I y Yee U Yo ae,ored Prior To Yes O Iq MQulred: OYo• tel/ Plaoement Of Fill:f Fill 1r•7� Inolcete Texture Doea norm o®Yea O Yo <br /> Same I X.1Yes xe Of Fill Material: Section N 6;.10(6)in 9011: ��LL77 Vis, Admin. Code: <br /> Explain Any Problems: <br /> Complete The Following: /j/) c <br /> Bench Nark Elevation As Established On 119 - I✓V Finished Grade Elevation 9 . S✓ <br /> FI L)ISH[D <br /> G0.AOE—� <br /> e. II D � d C ,`k, Depth aetdrt <br /> r } ¢ <br /> OR4GIAIAL GRADE Depth Of FS31 Notarial:SOIL wir" �1 <br /> OT7LJOA4. AM 13" <br /> pepch or Topsoil ud amsoor Soil' 17-) <br /> With Lean Tbsm 12^ of lbttllpN ./ <br /> FInlahed Depth To Limiting Factor: <br /> �I►ITERFACE OF D <br /> LIMITIh1G FACTOR "V. J <br /> — �Y -- —r —_ `_ � �•— Total Length Of Area Failed: <br /> G <br /> E U I <br /> \ - Total Width Of Area Filled: <br /> F / <br /> �= <br /> or <br /> / 41 ti \�' Dimension From Proposed Edge Of <br /> E z T_ v H MAXIMUM '5 1 Trench To Edge Or Fill (min. 27') <br /> Or SLOPE -ALL SIDES- <br /> 41 <br /> IDES- <br /> v \ Cx pC <br /> T <br /> Q� \ Dimension From Proposed Edge Of <br /> o- \ Treaen To Edge Of Fill (air.. 201) <br /> ESeperatien of Trenches (Fla. b') <br /> Signature of C,ou y Representative/On—Smite Neste Specialist <br /> DILHR SBD-6196 (1.02!83) Name: ?'�f Date: G // 7�1 <br /> Register,February,1994,No.458 <br />