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Surface/Subsurface Contamination Report Checklist <br /> NOA Project Number: E05029A <br /> Page 4 <br /> L13. a.Are there any open or damaged containers containing unidentified substances observed on the subject <br /> property? <br /> L Yes 0 No Q Chemical buckets partially full of unknown oil-like substance observed to west of shop <br /> b.Within 250 feet? <br /> Yes Q No ® None observed <br /> L <br /> 14. Identify any surface waters within 1,000 feet.of the subject property <br /> l <br /> None observed <br /> 6.I <br /> 16. a. Identify the potable water supply source: <br /> M Public Water System M Other <br /> Private Well MNone <br /> V <br /> b. Is there observed evidence of a private well within 1,000 feet? <br /> Yes[Z] No Q Residence to west has private well;other residences likely have wells also <br /> 17. Identify the sewage disposal system: <br /> Q Public Sewer System [::]Other <br /> On-site septic system 0 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 ® None observed <br /> 19. a.Is there evidence that the subject property discharges waste water,other than storm water,directly into a <br /> ditch or stream on or adjacent to the property? <br /> Yes Q No MI <br /> b.Any discharges observed within 200 feet? <br /> Yes Q No ® None observed <br /> r. <br />