Laserfiche WebLink
r 4 <br /> I <br /> 12. What is the depth to groundwater? <br /> Describe the source of information; <br /> 13. Are there any water wells on this parcel or adjacent,p.roperties? YES [] Nn yf <br /> TYPE OF"ArELLS DISTANCE TO TANKS(S) <br /> Z'ublic Well ft. <br /> Private Well �yN r* ft. <br /> Irri Lalion Well u' ft. <br /> Monitoring Well ft. <br /> -Other <br /> 14, Will the tank(s)pending closure be replaced with an aboveground or underground storage <br /> tank(s)? YES[] IN <br /> 15- Indicate the responsible party to be billed for additional EHD staff time expended beyond 3 hour-minimum <br /> permit payment per tank. If the party designated below is different than tiie permit applicant,e.g.property <br /> owner, the party must acknowledge tl,.is responsibility for the hiking by signature and date below. <br /> 7. r" <br /> Maine vi�tG �ljf <br /> Mailing Address /-- <br /> y <br /> Day Phone Number <br /> Signatur-- Title Date f <br /> EH 23 046(Revised)0/16/03) page 6 <br />