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ENVIRONMENTAL QUESTIONNAIRE <br /> TO BE COMPLETED BY OWNS WWN6R'3 RW.,AND FORWARDED TO EARNEST F SMITH <br /> AND ASSOCIATES;CIVIL ENGMERS FOR INCWSIOI+i W SURFACE/SUB SURFACE <br /> CONTAMERATION REPORT. <br /> 1.Date you erired pity (3 ApN;_ 40 ? r 3 op — v WSJ Co. <br /> 2.Use of popery sirs Gn r.! �20v u v D� ►r,5 U <br /> 6. <br /> SToc -- PA-S'rvC2� -. i2krt�3 <br /> Lm 3.How maay inigatioee Wdk Sam the PADepth of wdKs)if <br /> lam A pa ' <br /> ` 4_DD you have a permit to apply chanieeb ar ferdl&s to ft parcel?If ?+ for vdm years I1192 - i ooh <br /> Desci betbe pvduM pvdpcW <br /> 5.Do you have aqy knowk4p ofaY of the Mkxft bdn it on dee pard ender stndy'I <br /> . A-Any dopoW siW,by f)%-k IpE+eaen,Owner,offuea,Jdoers cab or any odw <br /> subsumm mni& ed a cooko&:d mbgonw by Law Yes No x (If yes, <br /> Phme,explain. <br /> B.Existing cistern,hand dug well or lead fadd,no longer in ase.Yes Nom�ffYc, <br /> please low an prnpety for to Redd review why b to be cmaWlemed.atm ofthes form.) <br /> �. C_Stnuctmm dW am comi&m d ewe by you or iocai odwritim Yes No X <br /> D.Floncbeg of pared is part,or whoia. Yas No„ lfM Mid yr s <br /> E.Coa�einaation e�f aia'a soa7$um�penods Yes Ha 1C - <br /> F.Far'led septic system,deet wqumDd nVorar I fidin 11 wodr. esY No�X Ifycs wort: <br /> done <br /> G.A pd adprement coon 69 may pedude dieadoPament ofdee Pwcws)L Yes TIb—&— <br /> LN H A qmfic location whoe e*mp nmtwaslb faab&Yes No X <br /> 6.Nave offoffmar owner A,r.rN u%Q f4. iZE FD " Da you lanow vYbat use was <br /> Heade of fire hod by the owma?If so,please a PA 5-'u IRs! ;'oa <br /> 7.Has the land been dmp upped Anm owned by you?Yes No <br /> „^ <br /> &Are you a0re of any parted wMW Ubk4dW Or oar 0cmdW pot of w der on sitd?Yes No X <br /> c. Com: <br /> L. <br /> T _ <br /> V • - <br /> Me <br /> Lm <br /> 6. <br />