• Environmental Questionnaire

  • 1. To the best of your knowledge, is the property presently used for industrial and/or commercial purposes including, but not limited to, a landfill, gasoline station, motor repair facility, printing facility, dry cleaners, photo developing laboratory, junkyard, research laboratory, chemical manufacturing, mining, military facility or as a waste treatment, storage, disposal, processing, or recycling facility; or do you have any knowledge that the property was used for the above purposes in the past?
  • 2. To the best of your knowledge, is the adjoining property presently used for industrial and/or commercial purposes including, but not limited to, a landfill, gasoline station, motor repair facility, printing facility, dry cleaners, photo developing laboratory, junkyard, research laboratory, chemical manufacturing, mining, military facility or as a waste treatment, storage, disposal, processing, or recycling facility; or do you have any knowledge that the adjoining property was used for the above purposes in the past?
  • 3. To the best of your knowledge, are there currently any dumping, storage, burying, or burning of any hazardous substances, petroleum products, unidentified waste materials, industrial batteries, pesticides, paints, industrial drums, sacks of chemicals, or any other chemicals greater than 5 gallons at this property; or do you have any knowledge that the above activities occurred on the property in the past?
  • 4. To the best of your knowledge, are there currently any registered or unregistered underground and/or above ground storage tanks, vent pipes, fill pipes, injection and/or drywells, transformers, capacitors, hydraulic equipment, stained soils, or contaminated wells at this property; or did you observe evidence or do you have any knowledge that the above were used/observed on the property in the past?
  • 5. Did you observe evidence, or do you have any knowledge that fill material, other than topsoil with a maximum depth of 4 feet, was ever brought to the property?
  • 6. Do you have knowledge of any past or present violations or alleged violations of environmental laws at the property?
  • 7. To the best of your knowledge, have any studies been prepared to address the impacts of any contamination that may exist on your property on the design, construction, and safe operation of water and sewer systems?
  • 8. Have you submitted an Environmental Database Search Map Report or Phase 1 Environmental Site Assessment as per the ASTM E-1527 standard?
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  • I have answered the above questions to the best of my knowledge and have included an explanation for any "yes" answers. I have attached copies of any reports referenced in Item 7 above, or all of their sections relevant to the design, construction and safe operation of water and sewer systems. Also I hereby attest that I have the authority to sign this questionnaire as the owner or agent/engineer of the owner of this property.

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