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` `/ N%/ <br /> bm <br /> L NOA Project Number: E04106A <br /> Page 4 <br /> 14. Identify any surface waters on the subject property within 1,000 feet. <br /> None <br /> 15. Is there evidence that the subject property is serviced by a private well? <br /> 4 <br /> Yes® No M Two domestic wells serve the residences;third well to be abandoned <br /> Evidence of a private well within 1,000 feet? <br /> Yes rV7 No a Adjacent residences most likely have private wells <br /> ` 16. Identify the potable water supply source: <br /> Private wellr <br /> 17. Identify the sewage disposal system: <br /> Three private septic systems <br /> 18. Are there any pits,ponds,or lagoons located on the property in connection with waste <br /> treatment or waste disposal? <br /> Yes Q No <br /> 19. Is there evidence that the subject property discharges waste water, other than storm water, <br /> directly into a ditch or stream on or adjacent to the property? <br /> Yes a No <br /> Any discharges within 200 feet? <br /> Yes M No [iZ] None observed <br /> 20. Is there evidence of underground/aboveground storage tanks on the subject property? <br /> Yes rM No M 200 gal fuelAST observed near barn <br /> Within 200 feet? <br /> L <br /> Yes Q No ® None observed <br /> 21. Are there any vent pipes, fill pipes,or access ways indicating a fill pipe protruding from the <br /> 6' ground on the subject property? <br /> Yes Q No <br /> kop Within 200 feet? <br /> Yes M No ® None observed <br /> OM '.-OA <br />