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i` <br /> Surface/Subsurface Contamination Report Checklist <br /> NOA Project Number: E05039A <br /> L Page 4 <br /> 13. a.Are there any open or damaged containers containing unidentified substances observed on the subject <br /> Lproperty? <br /> Yes 0 No 71 <br /> L <br /> b.Within 250 feet? <br /> Yes r7 No rWI <br /> 14. Identify any surface waters within 1,000 feet.of the subject property <br /> V <br /> Lone Tree Creek a located approximately 260 feet east of the property. <br /> r <br /> 16. a. Identify the potable water supply source: <br /> Q Public Water System ®Other Located on the.youth side ofthe house. <br /> ` 571Private Well ®None <br /> b. Is there observed evidence of a private well within 1,000 feet? <br /> Yes Q No rV1 None observed, but all properties are on water wells in the area. <br /> 17. Identify the sewage disposal system: <br /> Ir r7Public Sewer System ®Other Located west of the house. <br /> ® On-site septic system None <br /> L <br /> 18. Are there any pits,ponds,or lagoons located on the property in connection with waste treatment or waste <br /> disposal? <br /> LYes 0 No <br /> L 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 /> L Yes Q No 0 <br /> b.Any discharges observed within 200 feet? <br /> Yes 0 No Q <br /> L <br /> h. "044 <br /> L <br />