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SSSCR Site Reconnaissance Checklist <br /> L NOA Project Number: E05017A <br /> Page 4 <br /> 13. a.Are there any open or damaged containers containing unidentified substances observed on the subject <br /> property? <br /> None observed <br /> Yes ED No <br /> V <br /> b.Within 250 feet? <br /> ` Yes a No (Z] None observed <br /> L. 14. Identify any surface waters within 1,000 feet.of the subject property <br /> None <br /> r <br /> 16. a. Identify the potable water supply source: <br /> ® Public Water System M Other <br /> r Private Well a None <br /> b. Is there observed evidence of a private well within 1,000 feet? <br /> Yes O No Q <br /> 17. Identify the sewage disposal system: <br /> Public Sewer System O ether <br /> OOn-site septic system Q 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 <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 m <br /> b.Any discharges observed within 200 feet? <br /> Yes Q No [M None observed <br /> l <br />