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SSSCR Site Reconnaissance Checklist <br /> NOA Project Number: E05106A <br /> Page 4 <br /> 4� <br /> 13. a.Are there any open or damaged containers containing unidentified substances observed on the subject <br /> property? <br /> Yes 0 No W1 <br /> +.� b.Within 250 feet? <br /> Yes a No <br /> 14. Identify any surface waters within 1,000 feet.of the subject property <br /> None <br /> 16. a. Identify the potable water supply source: <br /> 0 Domestic well <br /> b. Is there observed evidence of a private well within 1,000 feet? <br /> Yes rM No® Domestic well on the adjacent pmperty to the east of the subject pmperty. <br /> 17. Identify the sewage disposal system: <br /> ` <br /> 18. Are there any pits,ponds,or lagoons located on the property in connection with waste treatment or waste <br /> disposal? <br /> Yes[:3 No GD <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 /> Yes[--] No <br /> b.Any discharges observed within 200 feet? <br /> Yes Q No <br />