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Y:3 <br /> SVSIT,Vlg RzCZYTO" SURVEY <br /> SITZ SURVEY AND LIT&RA'TgRZ SMCA <br /> Project No, : <br /> Client: <br /> i GG P•( : <br /> P. L <br /> Station No. : <br /> Location: <br /> city/state: <br /> provide answers to the following questions: <br /> I. 1 well <br /> public water Supp Y YIN N <br /> - A. IS there a p ----ft <br /> within 2500 feet? If Yes, Distance <br /> 1 well NiilS <br /> Is there a private water <br /> Supply YIN <br /> B. <br /> -• within 1000 feet? If Yes, Distance <br /> rl o <br /> within 10DYIN ^� <br /> C. Is there a subway If Yes, istance <br /> within 1000 feet? YIN <br /> D. IS there abasement if Yes, Distance — <br /> Is there a school within 1000 feet? YIN Jq f <br /> E. If Yes, Distance <br /> Is there a surface body of water YIN 0 <br /> F. feet? Distance —� <br /> -- within 1040 If Yes, <br /> Name <br /> II. Describe type of local water supplY• <br /> public: <br /> Suppliers Name: Gi �r �Fccs'F[<.. [o.oa•e �� tNeN 0 o i necr rrr: <br /> ce <br /> Su pliers Source: ra Ri`-' uFtC S A9f7Gr. 1 , �• <br /> _ Distance to <br /> ` °` � Private: <br />