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ENVIRONMENTAL QUESTIONAIRE <br /> TO BE COltVI.ETED BY OWNIWOWNERS REP.,AND FORWARDED TO EARNEST F.SNUM <br /> AND ASSOCIATES,t]YII.EN3U1m6R3 FOR DXL=ON IN SWACEJSM SURFACE <br /> CCWrAIHA[ATl0N REPORT. <br /> I-Dam you aequbw pemperty `'`,-v�' APN; O 3-���f — o l S7 Co. <br /> ZUsnofpmpertysiaceacgmdtian foflE pTHCR T1-JAJ <br /> f D l U LU I/J (,J Vit_t_ , <br /> 3.How wary ltrip don wells saw the pseperty: N Depth of wdl(s)if <br /> Imawo -� <br /> 4.DD you bave s p=lh to zp*cbrmicab a fertiflam to ft peed?Ifyta,for what years i O <br /> Describe the products prahroed <br /> 5.Do you haw any knowledge of arty of the following being presort ca the parcel Inde study! <br /> A.Any disposal Or,by fom=4resem owner,of!bels,b&mdan euuaiata,cbaoieals or aper <br /> subabnce coos]dacd a caomolled subst mw by LoaUSbtdpcdaet Itw. Yn Nb +/ (If Ya. <br /> place e�lala <br /> B.Existing ci oQu,heed dug weU or loch field,no longer Jo vse-Ya No of yes <br /> Please louse on property for the Edd review wblch is to be completed after mocipt oftlis form.) <br /> C Structures that are o=-Adored wuafc by you or local wnho sties. Yes No_� <br /> D.Floodlag ofparcel la pmt orwhota Yes No, ,/ if ab s yeszs .` <br /> E. Contamlaadon of air or sol]ftom adjaead parcels Yes _.�70 <br /> F.Failed septic systnm,that required repair or addltlooat wrork Yes N* yes describe work <br /> done <br /> O.A prim1pressent wodlrfoo tbatmay preclude devdopmtax of the pmcel(s)-Yes __No k/ <br /> K A spccl5c location wham cgtdpmatt was/Ls ltidad.Ya�lo� <br /> 6.Name of lamer ownnr M A P, C0 W 1�¢u R Do you kww what tare was <br /> made of the land by the owner?If so,please describe D r_ L a b PAr U RE <br /> 7.Has the land been deep ripped slats owned by you!Yp N0 <br /> I.Are you aware of any peacbed water tabldsp&4V a on occasion pools of waor on site?Ya,Noyl <br /> Commenu: <br /> (Ownm7xp.s4meurre) Dues <br /> r' �,r <br />