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SSSCR Site Reconnaissance Checklist <br /> NOA Project Number: E040123A <br /> Page 4 <br /> V <br /> 13. a.Are there any open or damaged containers containing unidentified substances observed on the subject <br /> property? <br /> � None observed <br /> Yes Q No <br /> i. <br /> b.Within 250 feet? <br /> Yes Q No None observed <br /> 14. Identify any surface waters within 1,000 feet.of the subject property <br /> 6' None <br /> L <br /> 16. a. Identify the potable water supply source: <br /> ® Public Water System O Other Well near barn <br /> Private Well O None <br /> b. Is there observed evidence of a private well within 1,000 feet? <br /> Yes 0 No <br /> 17. Identify the sewage disposal system: <br /> OPublic Sewer System O Other Undeterminable from site visit <br /> OOn-site septic system O None <br /> ,^ 18. Are there any pits,ponds,or lagoons located on the property in connection with waste treatment or waste <br /> disposal? <br /> Yes Q No m <br /> r <br /> 19. a.Is there evidence that the subject property discharges waste water,other than storm water,directly into a <br /> L ditch or stream on or adjacent to the property? <br /> Yes Q No <br /> b.Any discharges observed within 200 feet? <br /> L Yes O No <br /> i <br /> '044 <br /> 6. <br /> L <br /> I <br />