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ENVIRONMENTAL QUESTIONNAIRE <br /> TO BE COMPLETED BY OWNER/OWNER'S REP.,AND FORWARDED TO EARNEST F. SMITH <br /> AND ASSOCIATES,CIVIC ENGINEERS FOR INCLUSION IN SURFACElSUB SURFACE <br /> CONTAMINATION REPORT. <br /> I_Daze you acquired property // 19 AP/N:Q 0 -1- .;7Y0 -Q Z SIC*. <br /> Z. Use of property since acquisition P S/7 /�Q !/�e <br /> i <br /> 3.How many irrigation wells serve the property: / Depth of well(s)if <br /> known 3�S <br /> 4. Do you have a permit to apply chemicals or ferlilims 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 study? <br /> A_Any disposal site,by former/present owner,of fuels,hazardous materials,chemicals or any other <br /> substance considered a controlled substance by Local/StumWederal Law. Yes­Nb—_(If Yes, <br /> Please explain. <br /> B.Existing cistern,hand dug well or leach field,no larger in use.Yes No ,_(If yes <br /> please locate on property for the field review which is to be completed after receipt of ibis form.) <br /> C. Structures that are considered unsafe by you or local authorities. Yes Nom` <br /> D.Flooding of parcel In part,or whole. Yes No )(, If yes,what years <br /> E. Contamination of air or soil from adjacent parcels Yes No <br /> F. Failed septic system, that required repair or additional work.Yes No V If yes describe work <br /> done <br /> G.A pnodpresent condition that may preclude developement of the parcd(s).Yes No <br /> H. A specific location where equipment was/s fueled.Yes Nom <br /> 6.Name of former owner V1 a Do you know what use was <br /> made of the land by the owner?If so,please describe a P i <br /> 7.Has the land been deep ripped since owned by you?Yes_No se <br /> 8.Are you aware of arty perched water taWelsprings or on occasion po h of water on site?Yes_No'x <br /> Comments; <br /> y- <br /> er/Rep.S�rratu ) Date <br /> o ` ' <br />