Instructions For Form FSA-851

ENVIRONMENTAL RISK SURVEY FORM

This form is to be used by FSA personnel as a first step in the due diligence process to screen real property for the presence of contaminants, hazardous materials, underground storage tanks (UST), lagoons, pits, ponds or other features which pose potential environmental hazards.  Environmental contamination may have a significant adverse effect on the value of real estate offered as collateral for loans or on property being offered for sale.

 

The use of this form assists the Preparer in complying with the Comprehensive Environmental Response, Compensation and Liability Act; the Resource Conservation and Recovery Act; the Clean Water Act; the Clean Air Act; and the Toxic Substances Control Act.  Lenders participating in the FSA guaranteed loan program may also use this form. 

 

Proper completion of this form enables FSA to determine if a higher level of environmental site assessment (ESA) by an environmental professional is necessary to determine the exact level of threat to the environment and to estimate costs to remediate the contamination.   An environmental professional must meet the certification requirements established by the Environmental Protection Agency.

 

Generally completion of this form will be sufficient, as the only level of review needed to document environmental risks associated with FSA loan making and servicing actions unless significant environmental risks are observed.

 

Submit the original of the completed form in hard copy or facsimile to the appropriate USDA servicing office. To submit this form by facsimile you must have submitted an original signature on FSA-237, Facsimile Signature Authorization and Certification.


Preparer must complete the form in its entirety.

 

 

Fld Name /Item No.

 

Instruction

 

Types of Review

 

Check Box A if this is the first or initial review of the subject property.

Check Box B if this is a subsequent review of the subject property.

Check Box C if this is an update of a the last 2 reviews.  Note:  Only 3 reviews of the subject property can be documented on this form.  After 3 reviews, the Preparer will need to use a new FSA-851 form.

 

Part A - Site Information

In conducting the site inspection, the Preparer should only conduct a visual inspection and indicate hazardous conditions on this form.  Do not attempt to touch, sample, taste, or smell any hazardous substances or containers.  An environmental professional must do sampling of any substances.   The Preparer should not attempt to open any containers or enter any unsafe areas such as confined spaces or buildings, which may not be structurally sound.  If a building cannot be safely entered, this information should be noted on the form.

 

 

Fld Name /Item No.

 

Instruction

 

1

Site Name

 

Enter the name of the owner of the property.  For Farm Loan Programs, if the subject property is an inventory property, insert the name of the property as contained in the official Agency file.

 

2

Address

 

Enter the address of the property.  Do not use post office box numbers.

 

3

Case Number

 

For loan applicants, enter the case number assigned to the application.  For Farm Loan Programs inventory property, enter the inventory property identification number assigned to the official Agency file.

 

4

Township

 

Enter the township number (assigned in the rectangular survey system) in which the subject property is physically located.

 

5

Range

 

Enter the range number (assigned in the rectangular survey system) in which the subject property is physically located.

 

6

Section

 

Enter the section number (assigned in the rectangular survey system) in which the subject property is physically located.

 

7

Directions to Property

 

Enter the driving directions to the subject property from the nearest town.  Include names of roads and any landmarks, which would assist in easily locating the subject property.

 

8

Nearest Intersection

 

If the subject property is located close to an intersection of roads, which would assist in determining its location, provide the name and location of this intersection.

 

9

Property Size

 

Enter the size of the subject property in acres.  If the property consists of several tracts, the Preparer may complete separate forms for each tract.

 

10

Use of the Property

 

Describe the current use of the subject property is.  For example, dairy farm, poultry farm, industrial site, or commercial business.

 

Part B - Site Ownership History and Background

Every attempt should be made to search records and trace the use of the property back to 1940.  The Preparer should review the FSA file to determine ownership history of the property.  The Preparer should make every attempt to interview the current property owner or occupant as well as adjoining property owners to determine the past uses of the property. If the property has been used solely for agricultural purposes, it will not require a large amount of detailed review.  Pay close attention to the ownership history and background to determine whether the property was ever used for an industrial use or for a location of a facility such as a gas station.  It will not be necessary to obtain a title opinion to accomplish this task, although if one is readily available, it may prove useful in determining ownership history.

 

 

Fld Name /Item No.

 

Instruction

 

11A Current Owner

 

Enter the name of the current owner of the subject property.  For loans, this will generally be the name of the loan applicant.  For Farm Loan Programs inventory property, insert FSA as the owner and indicate that it is an inventory property.

 

11B Current Operator

 

Enter the name of the current operator of the subject property.  For loans, this will generally be the name of the loan applicant.  For Farm Loan Programs inventory property, leave blank unless the property is being leased.  If the property is being leased, insert the name of the lessee.

 

12A Previous Owner(s)

 

Enter the name(s) of any previous owner(s) of the subject property.

 

12B

Dates Owned

 

Enter the dates that the subject property was owned by the owner(s) listed in Item 14A.

 

 

13

Dates FSA Became Involved with the Property

 

Enter the date of the first involvement by FSA with the subject property.  This will usually be the date of the application for the applicant’s first loan.

 

14 Buildings on the Property

 

Indicate whether there are any buildings on the property by checking the box yes or no. If  “YES”, complete Table 1.

 

 

PART C - Site Data

The completion of this part requires that the Preparer makes a site inspection of the real property and conduct a records search as a supplement.  The Preparer must make every possible attempt to interview either the owner or the occupant of the property.

 

 

Fld Name /Item No.

 

Instruction

 

Table 1-A Type of Structure

 

 

Enter the type of structure such as barn, dwelling, or silo.

 

Table 1-B Map Symbol

 

Enter the appropriate map symbol from Part F of this form.

 

Table 1-C Year Built

 

Enter the year in which the structure was constructed.

 

Table 1-D Used for Chemical Storage or Mixing

 

Indicate whether the structure was/is used for storing or mixing chemicals such as pesticides. Check the box yes, no, or unknown.

 

Table 1-E Lead Based Paint

 

Indicate whether the structure contains lead based paint.  A test by a certified lead based paint inspector will usually be necessary to properly ascertain this information. If the structure was constructed prior to 1978, there is a high probability that lead based paint is present unless abatement of the hazard has occurred.  Check the box “YES”, “NO”, or “Unknown”

 

Table 1-F Contains Asbestos

 

Indicate whether the interior or exterior of the structure contains asbestos.  Check “YES” if clear visible signs such as asbestos shingles are present.  If clear visible evidence is not available, the assistance of an environmental professional would usually be needed to answer “YES” or “NO” to this question.  Attach photographs of any structures containing potential asbestos products to the form an exhibit. 

 

15-25,

A and B

 

These questions are self-explanatory and are used to establish the present use of the property as well as any historical use which may be a contributing factor in any present contamination concerns. The Preparer should answer these questions based on interviews with the owner or occupant, document searches, and visits to the subject property. Check the box “YES”, “NO” or “Unknown”.    

 

26 Chemical Containers

 

Indicate whether there are any chemical containers located on the subject property.  Inspect and document all types of containers, regardless of size. Smaller containers can be grouped together if they have same or similar contents. Check the box “YES”, “NO”, or “Unknown”. If “YES”, complete Table 2.

 

Table 2-A Container Location

 

Provide a brief description of where the container is physically located.  For example:  Shed #1 rear floor.

 

 

Table 2-B Map Symbol

 

Enter the appropriate map symbol from Part F of this form.  Attach photographs of any large numbers of containers or leaking containers to the form an exhibit. 

 

Table 2-C Container Contents

 

If known, list the contents of the container.  Be specific if the container label is intact and readable.  If a label is not available, enter unknown.

 

Table 2-D

EPA Reg.

 

If available, insert the EPA registration number from the container.  If a label is not available, enter unknown.

 

Table 2-E

Estimated Quantity

 

Enter the estimated quantity in the container.

 

Table 2-F

Is the Container Leaking?

 

The Preparer should indicate, to the best of their knowledge, whether the container is leaking.  Check “YES” if evidence such as stained soil around the container is easily observed.  The Preparer should not attempt to move containers to make these determinations.  Where evidence of leaking is not easily observed or is not present, the Preparer should check “NO” or “Unknown”.

 

27

Batteries

 

Indicate whether there are any batteries present on the property by checking the box “YES”, “NO”, or “Unknown”. If “YES”, complete Table 3.

 

Table 3-A Location of Batteries

 

Provide a brief description of where the batteries are physically located.  For example:  Shed #1 rear floor.

 

Table 3-B Map Symbol

 

Enter the appropriate map symbol from Part F of this form.  Attach photographs of any large quantity of batteries to the form an exhibit. 

 

Table 3-C Estimated Quantity

 

Provide the number of batteries in each location.

 

Table 3-D Leakage

 

The Preparer should indicate, to the best of their knowledge, whether any of the batteries are leaking.  Check “YES” if evidence such as stained soil around the battery is easily observed or if there are visible cracks.  The Preparer should not attempt to move batteries to make these determinations.  Where evidence of leaking is not easily observed or is not present, the Preparer should check ‘NO” or “Unknown”.

 

28 Appliances, Junk, and Abandoned Items

 

The Preparer should indicate whether there are any junk or abandoned appliances, automobiles, tractors, farm machinery, tires, or related parts on the subject property by checking “YES”, “NO” or “Unknown”. If “YES”, complete Table 4.

 

 

Table 4-A Location

 

Provide a brief description of where the items are physically located.  For example:  Behind Shed #2.

 

Table 4-B Map Symbol

 

Enter the appropriate map symbol from Part F of this form.

 

Table 4-C Estimated Quantity

 

Enter the number of items in each location.

 

Table 4-D Type of Tires or Parts

 

Enter a brief description of the items. For example, auto tires or tractor tires.  This is important, as there are large cost differences in disposing of different size items.

 

29

Fill Dirt

 

Check the box “YES”, “NO”, or “Unknown”. If “YES”, indicate whether any fill dirt has been deposited on the subject property.  The Preparer should check for signs of fresh fill dirt or areas where it is apparent that fill dirt was dumped as evidenced by differences in the growth of vegetation Provide a brief description of the site location along with the appropriate map symbol from Part F of this form.  Attach photographs of any areas containing fill dirt to the form an exhibit.

 

30

Stained Soil

 

Check the box “YES”, “NO”, or “Unknown”. If “YES”, indicate whether there are any areas of stained soil on the property. Provide a brief description of the site location along with the appropriate map symbol from Part F of this form.    Attach photographs of any stained areas to the form an exhibit. 

 

31

Stained Areas in Buildings

 

Indicate whether there are any stained areas within buildings such as floors.  It is important to indicate the type of flooring in buildings such as whether it is dirt or concrete. Check the box “YES”, “NO”, or “Unknown”. If “YES”, provide a brief description of the site location along with the appropriate map symbol from Part F of this form.  Attach photographs of any stained areas to the form an exhibit. 

 

32 Electrical Trans-formers

 

Indicate whether there are any electrical transformers located on the subject property.  Check the box “YES”, “NO”, or “Unknown”. If “YES”, provide information on whether they are owned by the property owner or are property of the local power company. Provide a brief description of the location along with the appropriate map symbol from Part F of the Form FSA

 

33

USTs or ASTs

 

Check the box “YES”, “NO”, or “Unknown” to identify whether there are any Underground Storage Tanks (USTs) or Above Ground Storage Tanks (ASTs) present on the property. If “YES”, complete Table 5.

 

Table 5-A Tank Location

 

Provide a brief description of where the tank is physically located.  For example:  Left of Shed #2.  Attach photographs of any AST or UST fill pipes, vent pipes, or pumps to the form an exhibit.

 

Table 5-B Size

 

If information is readily available, indicate the approximate or exact size of the tank.

 

Table 5-C Map Symbol

 

Enter the appropriate map symbol from Part F of this form.

 

Table 5-D Type

 

Check the box indicating whether the tank is a UST or AST.

 

Table 5-E Registration

 

If the tank is a UST, indicate whether it is registered by checking the box “YES”, “NO”, or “Unknown”.  An interview with the owner or occupant will usually be necessary to make this determination

 

Table 5-F Does the Tank Contain Any Substance?

 

Indicate whether the tank contains any substance or product by checking the box “YES”, “NO”, or “Unknown”.  The best way to answer this question is to interview the owner or operator.  If “YES”, complete column G.

 

Table 5-G Name of Substance

 

Enter the name of the substance contained in the tank if known.

 

Table 5-H Leakage

 

The Preparer should answer this question to the best of their knowledge by checking the box yes, no, or unknown.  An interview with the owner or operator would greatly assist in answering this question. 

 

Part D - Water and Waste Information

 

Fld Name /Item No.

 

Instruction

 

34

Ponds, Lagoons or Holding Facilities

 

Indicate by checking the box “YES”, “NO”, or “Unknown”, whether there are any holding facilities such as ponds or lagoons located on the property that may contain hazardous waste or serve as treatment facilities for animal waste, thus creating a potential environmental risk. If “YES”, complete Table 6.

 

Table 6-A Location

 

Enter a brief description of where the lagoon, pond, or facility is physically located.  For example:  25 feet southwest of the dairy barn.  Attach photographs of any ponds, lagoons, or holding facilities to the form an exhibit.

 

Table 6-B  Size

 

Enter the approximate size of the lagoon, pond, or facility.  Size should be provided in perimeter measurements.  If capacity measurements are known, they can be provided as well.

 

Table 6-C Map Symbol

 

Enter the appropriate map symbol from Part F of this form.

 

Table 6-D Primary Use

 

Enter a brief description of what the lagoon, pond, or facility is used for.  For example:  manure lagoon for dairy.

 

Table 6-E Condition

 

Provide an assessment of the condition of the lagoon, pond, or facility by checking the box good, fair, or poor. Assess the condition of any berms or containment structures.

 

Table 6-F Permitted or Registered

 

Indicate whether the lagoon, pond, or facility if permitted or registered by local or state governmental officials by checking the box “YES”, “NO”, or “Unknown”.

 

35

Wells

 

Indicate whether there are any wells located on the property by checking the box “YES”, “NO”, or “Unknown”. If “YES”, complete Table 7.  Include those wells used for domestic or irrigation purposes.

 

Table 7-A Location of the Well

 

Enter a brief description of where the well is physically located.  For example:  25 feet southwest of the dwelling.  Attach photographs of any well heads or pumps to the form an exhibit.

 

Table 7-B Map Symbol

 

Enter the appropriate map symbol from Part F of this form.

 

Table 7-C Use

 

Check the appropriate box to indicate the use purpose: D (domestic), I (irrigation), O (other), or A (abandoned).

 

Table 7-D Depth

 

If known, provide the exact or approximate depth of the well.

 

Table 7-E Condition of Well and Casing

 

Provide an assessment of the condition of the well and its casing by checking the box, good, fair or poor.  An interview with the owner or operator is useful in determining the condition of the casing.

 

Table 7-F Construc-tion

 

By checking the appropriate box, indicate whether the well is drilled or dug and has a casing.

 

36 Evidence of Well Con-tamination

 

Indicate whether there is evidence of contamination by checking the box “YES”, “NO”, or “Unknown”. Check to see if areas immediately adjacent to wells are being used for chemical mixing operations that could possibly contaminant the water source. If “YES”, please describe the signs or evidence along with the location of the well. Attach copies of any water test results.provide the number of the well(s) from Table 7.

 

37 

Well Con-taminants

 

Indicate whether there is evidence that the contaminants have been identified by checking the box “YES”, “NO”, or ‘Unknown”. If “YES”, please describe the signs or evidence along with the location of the well. Attach copies of any water test results.provide the number of the well(s) from Table 7.

 

38

Drinking Water

 

If the domestic water source on the subject property is not potable, indicate where drinking water comes from.

 

39

Waste or Septic System

 

If a residence is located on the subject property, it should be inspected for the presence of a septic or waste system and the type identified.  Other information such as the condition of such systems should be described along with its location.

 


Part E - Records Search

 

Fld Name /Item No.

 

Instruction

 

40-41

 

Check the box yes or no. These questions pertain to lists maintained by either Federal or State regulatory authorities.  The Federally maintained lists can be obtained through the Environmental Protection Agency’s website at  www.epa.gov/superfund/sites and  www.epa.gov/enviro/html/ej/  or through The Right-To-Know Network at   www.rtk.net. 

42-44

 

Check the box “YES” or “NO”. These questions are to be answered by checking state maintained lists that can be obtained either through accessing websites hosted by the appropriate State Regulatory Authority or by calling their office and requesting a hard copy.  The FSA State Environmental Coordinator (SEC) should be contacted if necessary for assistance in completing this section if data is difficult to obtain.  If “YES” is checked on any question, the Preparer should provide further information in an attachment by describing the type of site, location, and distance from the subject property

 

Part F - Sketch of the Property

 

Fld Name /Item No.

 

Instruction

 

Part F

Visual Representa-tion of Property

 

A visual representation of the subject property is very important in documenting and locating any environmental risk factors such as USTs, stained soil, or leaking containers.  Visual representation may consist of a sketch of the property drawn by the Preparer on the form; an attached aerial photograph with areas of concern identified; or appropriate photographs of areas or issues of concern.  Proper visual representation will enable an environmental professional to provide the Agency with a quicker assessment of the property’s potential hazards.

 

In completing a sketch, the Preparer should start with a rough outline of the property boundaries and include any roads, railways,  water channels, buildings, or other landmarks.  Then draw in the appropriate map symbols provided in the legend.  If additional map symbols are needed they should be added to the legend by the Preparer.  Also, indicate the orientation of the map.  The Preparer should list the map symbols on the back of applicable photographs.   When there are numerous findings of similar objects or sites, the Preparer will add a number to the map symbol.  For example, there may be two (USTs) on the property.  The first UST would be given a map symbol of U-1 and the second UST would be given a map symbol of U.

 

If an aerial photograph is used in lieu of the sketch, similar techniques should be used to identify the boundaries and areas/issues of concern on the subject property.

 

When photographs are attached, the Preparer should attach no more than two photographs per page.  All photographs should be labeled so they reference the appropriate section of the form that they support.

 

Part G

Conclusion

 

Preparer should include all applicable information as requested to the best of  their ability.  If there is any doubt as to the significance of a potential threat, the Preparer should recommend further investigation by an environmental professional or seek further advice from the SEC.  The Agencys conclusion on future action is based on the following:

 

G1 Evidence of Contamina-tion Was Found

 

This response should be chosen if signs of contamination were observed that could potentially have significant effects upon the value of the real property and the environment.  Examples would include, but not be limited to, large amounts of abandoned hazardous waste, large areas of stained soil, or known or suspected leaking USTs.  The Preparer should evaluate each property differently as a small stained area of sandy soil on one property may be just as significant as a large stained area of clay soil on another property.  Another example of when further evaluation would be warranted is if the subject property is adjacent to or in close proximity to a Superfund National Priorities List (NPL) site.

 

* Phase II ESA is a detailed investigation and evaluation of a propertys environmental condition, including a review of all pertinent records, a site reconnaissance of the property and taking soil, water and our air samples to determine contaminant content or verify that no contaminants are present or likely to be present.

 

G2

Inconclu-sive Results

 

This response should be chosen when the Preparer is alerted to the fact through interview or research that the real property may be more significantly affected by environmental risks than is apparent through normal observation.  One example of this scenario would be the discovery by the Preparer that unknown objects or substances were buried on the real property.  Another example would be that research or interview indicates that the property once contained a facility such as a gas station which could cause significant environmental contamination.

 

G3 Evidence of Contamina-tion Found But Not Significant

 

This response should be chosen if small amounts of environmental contamination are noted on the property but are not present in sufficient quantities to pose a significant threat to the environment.  Examples that meet the requirements for this response include, but are not limited to, small shallow and insignificant soil stains, empty and rinsed pesticide containers, small quantities of tires, and containers of hazardous substances stored in a protective structure

 

G4

No Evidence of Contamina-tion Found

 

This response should be chosen when the review of the property does not reveal any signs of potential contamination or other environmental concerns.  Normal and safe storage of agricultural chemicals, tires, petroleum products, and batteries will not be considered as potential sources of contamination.

 

G5 Signature

 

The Preparer must sign the form in ink

 

G6

Date

 

The Preparer must enter the date that the form is signed.

G7

Printed Name of Preparer

The Preparer must print or type their name.

 

G8

Title of Preparer or Agency

 

The Preparer must insert their job title along with the name of the agency or lender for which the form has been completed.

 

G9

Address

 

The Preparer must insert the address of the agency or lender.

 

G10 Telephone Number

 

The Preparer must insert their telephone number at which they can be reached should any questions arise.


 

Part H - Update Information

Use this section when it is necessary to only update a previously completed form as allowed by procedure.  The form may only be updated twice before a new form will need to be completed.

 

The following items will be attached to the completed form and labeled as follows:

Attachment A - Legal description

Attachment B - Plat map or aerial photo with the boundaries of the property outlined

Attachment C - Photographs

                                                                                   

 

Fld Name /Item No.

 

Instruction

 

1A and 2A

Date Updated

 

Enter the date of the update.

1B and 2B Updated By

Enter the name of the person completing the update

 

1C and 2C Title

 

The person completing the update must enter their job title.

 

1D and 2 D

Agency or Lender

 

Enter the name of the appropriate agency or lender completing this form.