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ENVIRONMENTAL QriJESTIONAIRE <br /> TO SECp14�Is.Y Q"EWWWSCVARDED TO EARNEST F. SMITH <br /> AND AlH6';Gtttq _ StiAtt5U13 IfFACE <br /> CON?'A'h>I9+l:+i�'1Qh1'11�1'OR1". , , <br /> 1.Dace you acquiredproperty <br /> 2. Use of PmPerty since acquisition_ <br /> Di s C- / b24,1 Gr9+2M„Y <br /> 3, How mmyjaigahaa well&40r th�*ptppwetp µ T <br /> known ' of" 8)if <br /> 4. Do you have a permit to apply chemicals or fwWl=rs to ft'Parcel?if yes, forwhat years YES- 19q-7 <br /> Describe the producfsproduced tis NO CMEh4a4S axcF� Ixou,s�-up) <br /> 5. Do you have any knowledge of any ofthe following bah4peesent on the parcel under stody7 <br /> A. Any disposal sift,by fotmerfpresetat owAw',of fuels,i owdous materials,chemicals or any other <br /> substance considered a'controfled suhatatteeby L*0W% 4eWederal Law_ Yes_,Nh; X, ([gyri, <br /> please explain. <br /> B. Existing c""M, trend dug we}1 or leach field,no leu>ger irS use. Yes No X (If yes <br /> P' <br /> locate on propt>rty for toe field t eview which is to be ootupletad after receipt a£this form.) <br /> C. Stnicttaes that are consid cent[utDeafa by you or loQa{autlioritias. Yes No <br /> D.Flooding of parcel in part or wh o!e Y �No X if yes, <br /> E.Cotttatninseion of air w soil8ottiatxnt pnreels Y®s� No k <br /> F. Patted septic system that tutred repair or alltiprial Werk Yes No X If yes describe work <br /> done <br /> G. A priorlprasent condition 11W may preclude desws opement of the parcel(4 yes Nom_ <br /> H.A specific location when equipineol worm foaled.Yes ?e <br /> 6:'idy{fyq. E <br /> mage o>9ii fend 6y the owner?[f so,plsase descr}be, Y tot v Disc 2 ._Lem hiN� <br /> 7. Has Elia land baeq deep Aad-aistea by you?Yes--- No <br /> 8.Are you awatae of arry.peabptl vfEw takprings Or On oCCasion pools of water on site?Yes No <br /> Comments; <br /> _. <br /> I <br /> i <br /> 373/0 Z <br /> (Owtter)1Rep. Sigrtsra9 T7eite <br /> -:Z66ZLE9£b Oft/£1 :51 1S/bl `SI CO .0e 3 (3ri L) '173H OI3IOW NOMA <br />