Land Contamination Questionnaire
For small (1 or 2 dwelling) housing developments on existing residential or greenfield sites.
Q1.
Please give a brief description of the current state of the site and a description of any
existing buildings and their current and former uses.
Q2.
Please give a brief description of the proposed layout of the site, including any hard
landscaping and garden areas planned for the development (Please provide a plan of the
location of these areas)
Q3.
Please describe the type of land usage currently surrounding your site.
North:
East:
West:
South:
Q4. Has any of the above surrounding land uses affected the application site?
YES
NO
If YES then please provide further information
Site Address:
Proposal:
Q5. Please provide an independent Environmental Search report for the site. These can be
obtained online from a several environmental search report companies. Please also provide
your own comments about previous land use and previous surrounding land use of the
application site
Q6. Are there any fuel storage facilities on the site including underground and above ground
petrol, diesel or domestic heating oil tanks?
YES
NO
If YES then please provide further information, including condition and history of leaks
Q7.
Are there any infilled pits, wells or ponds on the site?
YES
NO
If YES then please provide further information
Q8. Is there any staining, smells or other evidence of spillages or contamination on the site?
YES
NO
If YES then please provide further information
Befor
e signing below, please make sure you have attached the following:
A plan of the proposed layout including garden and hard landscape areas
An Environmental Search Report
By signing below you are declaring that to the best of your knowledge, information and belief
the information you have been given is correct.
Completed by (Print name):
Completed by (Signed):
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