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Surface/Subsurface Contamination Report Checklist <br /> ►� NOA Project Number: E05007A <br /> Page 4 <br /> �. 13. a.Are there any open or damaged containers containing unidentified substances observed on the subject <br /> property? <br /> Yes® No <br /> b.Within 250 feet? <br /> Yes M No © None observed <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 /> Public Water System r7 Other <br /> Private Well ®None <br /> b. Is there observed evidence of a private well within 1,000 feet? <br /> Yes 2] No® Private well likely at residence to southeast <br /> 17. Identify the sewage disposal system: <br /> Public Sewer System El Other <br /> On-site septic system © None <br /> L. 18. Are there any pits,ponds,or lagoons located on the property in connection with waste treatment or waste <br /> disposal? <br /> Yes[::] No El <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 /> Yes[--] No <br /> b.Any discharges observed within 200 feet? <br /> Yes® No ® None observed <br />