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1 None observed <br /> Within 200 feet? <br /> F ' None observed <br /> 10. Is there evidence that fill dirt has been brought onto the site which originated from a <br /> contaminated site or of an unknown origin? <br /> ! l No <br /> 11. Is there evidence of any pesticides, automotive or industrial batteries, paints, or other <br /> chemicals being stored or used at the property? <br /> F1 <br /> No <br /> Within 500 feet? <br /> None observed <br /> 12. Are there any industrial drums or sacks of chemicals located on the subject property? <br /> None observed <br /> f ,' Within 250 feet? <br /> F None observed <br /> 13. Are there any open or damaged containers containing unidentified substances on the <br /> subject property? <br /> F'i <br /> None observed <br /> Within 250 feet? <br /> Fit" <br /> None observed <br /> F! 14. Identify any surface waters on the subject property within 1000 feet. <br /> None observed <br /> F115. Is there evidence that the subject property is serviced by a private well? <br /> Yes <br /> E J Evidence of a private well within 1000 feet? <br /> F Yes <br /> 16. Identify the potable water supply source: <br /> Well water <br /> F�' <br /> 17. Identify sewage disposal system: <br /> F <br /> I <br />