SU0003884 SSCRPT - Laserfiche WebLink

Home Browse Search

Mar-27-03 12 :41P El_EC?,,.,r-DIST & ASSOCIATES 209 82J-4685 P_02 ENVIRONMENTAL QUESTIONAIRE TO BE COMPLETEI) BY OWNER/OWNER'S REPRBSENTATIVF AND FORWARDED TO WALTER IF.CURTIS,CIVIL ENGINEER,FOR INCLUSION IN A"SURFACE AND SUBSURFACE CONTAMINATION REPOR V. i �nn 1. Date you acquired property._... - APN. (if known) 2. Use of-property since acquisition AG q it t/ 3 How many irrigation wells domestic wells J�• serve the property? o17 4911 i 4. Depth(if known)of irrigation wells _ ----- domestic wells/cru - 5, Do you have a permit to apply chemicals or fertilizer to the parcel?Yes /` No y Iff Yes. for what years _- Name the products used 6, Do you have knuwledge of the following;being present on the parcel under study? (A)Any disposal site, by former/present owner, of fuels,hazardous materials, chemicals or any other substance considered a controlled substance by Locsl/Stater Federal I.aw?1`es_ _No k—If yes please explain _ (B) Existing cistern,hand dug well or leach field Yes No><' (lfyes please locate them on property for the field review, which is to be completed after receipt of this f(rm.) (C)Structures that urc considered unsafe by you or local authorities. Yes _ Nox_ (D)Any flooding of parcel in pan or whole Yes_No _X 1 f yes what years (1=) Any contamination of air or soil from adjacent parcels Yes No,If yes, identify contamination type _ (F)A failed septic Systent, which required repair or additional work Yes_ No If yes describe the work done (G)A prior/present condition that may preclude development of the property Yes_-__ No If'yes.explain (1-I)A specific location where equipment was/is fueled Yes_No. 7. Name of former owner Do you know what use was made ofthe land b the owner? Ifs», please describe Com,}r/' lam $_ Inas the land been ripped since owned by you Yes No_ if yes,years 9. if and when the property is irTigated or water flows across it,what is the direct on of i Q flow of thu water? Q 1.!.e, Owner/Rtprescntative Signature Date