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12. What is die Depth to grounduater° ApE oxunately 40 feet <br /> Describe the source of infotn►ation: Groundw•tter Data from it onitor well W-989411as sunuwlbzed in <br /> �oendix A. <br /> 13. Are there ally water wells on this parcel or.rdjacent pnipenies? YES ( X ( NO[ 1 <br /> TYPE OF WELLS DISTANC'F; TO TANK <br /> Public Well <br /> LI.NL/Off-site Water 23(!O/ 1.9X)A <br /> Su Iv Wells <br /> [m_auun Well <br /> o'0onne Well 1111) ft. <br /> Other(Pe <br /> Sorl ) ft. <br /> Va x Points) <br /> 14. Will die tank(s) pending closure be replaced with an atwivegruund or underground storage tank(s)? <br /> YES ( X J NO <br /> 15. Indicate the responsible party to be billed for additional PHS-EHD staff time expended beyond 3 hour minimum permit <br /> payment per tank. If the party designated lklow is different than the permit applicant.e.a.property owner.the party must <br /> acknowledge his responsibility for die billing by signature and date below. <br /> Nance_LAw_MUWLi <br /> Mailine Address 7(11x)F A•,t - <br /> AY nee P O Box 9OK I ivernuxe (`A 9.1550 <br /> Day Phone Number ( S to ) 421-61M <br /> Signature Date <br /> 6 <br />