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u <br />ENVIRONMENTAL QUESTIONNAIRE <br />`TO BE CobaLMW BY S EARNEST <br />AND ASSOCIATES,CIVIL ENGINEERS FOR INCLUSION IN SMPI H <br />CONfAMIKATION REPORT. <br />` 1. Date you acquired pupeM_44a aZ AFN. �7-32D— sl Co. <br />2. Use of pmpeniy since <br />L Depth of well(s) if <br />3. How ninny y irrigation wells serve the / <br />known / <br />4. Do you have a permit to apply chemicals or fertilizers to the parcel? If yes, for what years <br />Describe the products produced <br />5_ Do you have any knowledge of any of the following being present on the parcel under tudy? <br />s <br />A. Any disposal site, by former/presixrt Owner, of fps, hazardous materials, chemicals or any other <br />substance considered a controlled substance by LOQd StatdFederA Law. Yes No�_ other <br />please explain. <br />B. Existing cistern, band dug well or leach field, no longer in use_ Yes-140---A—%L" Of this form.) rw <br />please locate on property for the field review which is to be completed afker receipt <br />C. Structures that are considered unsafe by you or local ardi arilw& Yes No _/ <br />D. Flooding of parcel in part, or whole. Yes No—X1-_ 1f ye's+ what yeas <br />E. Contamination of air or soil fi=n adjacent parcels Yes —N4-9— <br />F_ Failed septic system, drat required repair or additional worir. Yes Noj_Ifyes describe wont <br />done <br />G. A prior/present condition that may preclude developemeut of the pwmks)L Yes No _ <br />H_ A specific location where equignent wasrns fueled. Yes No_,L _ <br />owner Do you know whatuse was <br />6. Name of former <br />made of the land by the owner? If so, please describe <br />7. Has the land been deep ripped since owned by you? Yes -140 X <br />8. Are you aware of any perched water table/springs or on occasion pools of water on site? Yes Nom <br />L <br />�lll�/C9i[n � <br />(OwnerlRep. Signature) Date <br />lVow,77 e Cas/) a3AI 9l// <br />&,io,vp 9i6) 86 / 9093 <br />L <br />