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L <br /> LSurface/Subsurface Contamination Report Checklist <br /> NOA Project Number. E05021A <br /> Page 4 <br /> V <br /> 13. a.Are there any open or damaged containers containing unidentified substances observed on the subject <br /> Lproperty? <br /> Yes Q No m None observed;storage area was not accessible <br /> Lb.Within 250 feet? <br /> L Yes Q No m None observed <br /> 14. Identify any surface waters within 1,000 feet.of the subject property <br /> V <br /> None <br /> L <br /> 16. a. Identify the potable water supply source: <br /> Public Water System M Other <br /> L Q Private Well 10 None <br /> b. Is there observed evidence of a private well within 1,000 feet? <br /> Yes m No m <br /> 17. Identify the sewage disposal system: <br /> F7 Public Sewer System r7 Other <br /> r7 On-site septic system m None <br /> 18. Are there any pits,ponds,or lagoons located on the property in connection with waste treatment or waste <br /> disposal? <br /> L Yes Q No m <br /> L <br /> 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 /> k. Yes[----] No m <br /> 6. b.Any discharges observed within 200 feet? <br /> Yes[:] No None observed <br /> L <br /> L '..44 <br /> L <br />