Have there been any fuel/chemical spills or Yes No leaks? If to either of the above, please state ‘Yes’ fuel/chemical, storage method and location, and details of any spillages. Have there been any pollution incidents, Reported Unreported either reported or unreported? For information please refer to the Environment Yes No Yes No Agency’s in your Backyard’ website. ‘What’s Provide details of any surface water present onsite (including drains, ponds, streams and rivers). Provide details of any groundwater or surface water abstractions (including wells and boreholes). WASTE DISPOSAL ACTIVITIES Landfill sites can sometimes contaminate surrounding land. For more information and to check if any landfill sites are located near your site, please refer to the Environment Agency’s ‘What’s in your Backyard’ website or contact the Council’s Contaminated Land Officer. Have any waste disposal activities (including the burning of waste) been carried out Yes No onsite? Have any waste disposal activities been carried out on surrounding land within 250 Yes No metres of the site? Is there any evidence of demolition activities Yes No (e.g. rubble) onsite? If to any of the above, please provide ‘Yes’ details. Adjacent Land Use Domestic Agricultural Commercial Industrial Other (give details) Current land use (tick all that apply) Past land use 150 years (tick all that apply) Provide details of any surface water present on adjacent land (including drains, ponds, streams and rivers).
Have there been any fuel/chemical spills or leaks? Yes No If ‘Yes’ to either of the above, please state fuel/chemical, storage method and location, and details of any spillages. Have there been any pollution incidents, either reported or unreported? For information please refer to the Environment Agency’s ‘What’s in your Backyard’ website. Reported Unreported Yes No Yes No Provide details of any surface water present onsite (including drains, ponds, streams and rivers). Provide details of any groundwater or surface water abstractions (including wells and boreholes). WASTE DISPOSAL ACTIVITIES Landfill sites can sometimes contaminate surrounding land. For more information and to check if any landfill sites are located near your site, please refer to the Environment Agency’s ‘What’s in your Backyard’ website or contact the Council’s Contaminated Land Officer. Have any waste disposal activities (including the burning of waste) been carried out onsite? Yes No Have any waste disposal activities been carried out on surrounding land within 250 metres of the site? Yes No Is there any evidence of demolition activities (e.g. rubble) onsite? Yes No If ‘Yes’ to any of the above, please provide details. Adjacent Land Use Domestic Agricultural Commercial Industrial Other (give details) Current land use (tick all that apply) Past land use 150 years (tick all that apply) Provide details of any surface water present on adjacent land (including drains, ponds, streams and rivers).
screening_assessment_form_version_7.2_for_single_home_developments.docx