VILLAGE ENVIRONMENTAL SURVEY ADEC ver 1.1 Village: _______________________________ Date: ________________________________ Surveyor: _____________________________ Title: ________________________________ The following is a list of questions for an environmental issue that may be present in your village. To the best of your ability and knowledge, answer each question that applies to your village. Many questions can be answered with a "yes," "no" or "unknown." Some of the questions will require that you contact the village council or the person or operator responsible for a particular facility, such as the water treatment plant. Other questions will ask for a specific answer that involve Stime or amounts. As necessary, search out the answer to a specific question and use the "unknown" only as a last resort. COMMUNITY INFORMATION Does your village have a [ ] City Council, [ ] IRA Tribal Council or [ ] both? Which Council is responsible for the sanitation services in your village? [ ] City Council [ ] IRA Council YES NO UNK Do the council(s) actively enforce fee collection for [ ] [ ] [ ] village services?(water, sewer, landfill, etc.) YES NO UNK Has the village had problems with non-regulatory State or [ ] [ ] [ ] Federal agencies on rural sanitation issues? YES NO UNK Has the village had problems with regulatory State or [ ] [ ] [ ] Federal agencies on rural sanitation issues? YES NO UNK Does your village receive technical assistance from [ ] [ ] [ ] environmental programs or environmental agencies? If so, whom?________ YES NO UNK Does your village school have an environmental program or [ ] [ ] [ ] curriculum? If so, what school grades?________ DRINKING WATER Does your village have a [ ] water treatment plant or a [ ] washeteria/water treatment plant? Does your water treatment plant get water from a [ ] well or from a [ ] pond, river, or stream? YES NO UNK Do most village residents use the water from the water [ ] [ ] [ ] treatment plant? YES NO UNK Do the village residents believe the water from the water treatment [ ] [ ] [ ] plant is safe to drink? If not, why and where do they get their drinking water from? _______________________________________________________ YES NO UNK Does the village feel that the sewage lagoon, dump or tank farm, effects [ ] [ ] [ ] the drinking water supply? If so, how?________ YES NO UNK Does your village ever run out of drinking water? If so, [ ] [ ] [ ] how often and when?________ YES NO UNK Does your village have private wells? If so, how many?___ [ ] [ ] [ ] YES NO UNK Does your village have piped water to the houses or other [ ] [ ] [ ] buildings? If so, to how many?________ YES NO UNK Does your village have a flush-haul water system? If so, [ ] [ ] [ ] to how many houses or other buildings?________ YES NO UNK Does your village use dip buckets for their drinking water [ ] [ ] [ ] storage? If so, How many houses or other buildings _______ YES NO UNK Does the water treatment plant have operators? If so, how [ ] [ ] [ ] many and who?_____________________________________________ YES NO UNK Do the water treatment operators get paid? If so, how much [ ] [ ] [ ] and for how many hours a day?________ YES NO UNK Are the water treatment plant operators certified by the [ ] [ ] [ ] State of Alaska? If so, when do the certifications expire?__ YES NO UNK Is the washeteria and/or water treatment plant clean and [ ] [ ] [ ] orderly? YES NO UNK Is the water treatment plant locked up and secure when the [ ] [ ] [ ] operator is not there? YES NO UNK Does the water treatment plant operator have the test kits [ ] [ ] [ ] and test kit chemicals to correctly monitor the water quality? YES NO UNK Does the operator maintain a daily log of the water testing [ ] [ ] [ ] results? When was the last date it was filled in?________ YES NO UNK Is fluoride added to the drinking water? If so, how often [ ] [ ] [ ] is the fluoride test conducted and what is the fluoride level today?________ YES NO UNK Does the water treatment plant operator take a chlorine [ ] [ ] [ ] residual every day? If not, how often?________What is the chlorine residual today? How many days________, weeks________, or months________ of chlorine supply does the operator have on hand for use? YES NO UNK Does the water treatment plant use HTH (chlorine powder), [ ] [ ] [ ] to disinfect the drinking water? If not, what form of chlorine is used?________ YES NO UNK Are chlorine warning signs posted on the entrance doors [ ] [ ] [ ] to the water treatment plant? YES NO UNK Are there any pieces of equipment in the washeteria and/or [ ] [ ] [ ] water treatment plant broken or not operating? If so, what are they?________ YES NO UNK Does the washeteria and/or water treatment plant have [ ] [ ] [ ] safety defects, such as bare electrical wires, split or cracked chemical containers, etc.? If so, what are they?___ ___________________________________________________________ What are your village's main complaints with the washeteria and/or water treatment plant?________ WASTEWATER YES NO UNK Have there ever been outbreaks of sewage related diseases [ ] [ ] [ ] in your village? If so, what disease and when?________ YES NO UNK Are the health aides informed of sewage spills within the [ ] [ ] [ ] village? YES NO UNK Does the village have a sewage lagoon? If so, how far from [ ] [ ] [ ] the village? _____________________________________________ YES NO UNK Does the sewage lagoon ever leak or overflow? If so, why and [ ] [ ] [ ] when? YES NO UNK Does your village have piped sewer? If so, to how many house [ ] [ ] [ ] or other buildings?________ YES NO UNK Does your village have sewage holding tanks? If so, to how [ ] [ ] [ ] many houses or other buildings?________ YES NO UNK Does your village use privies or outhouses? If so, how many [ ] [ ] [ ] houses or other buildings?________ YES NO UNK How many houses or other building use honey buckets?________ [ ] [ ] [ ] YES NO UNK Does your village have an operating honey buck haul or [ ] [ ] [ ] flush-haul system? YES NO UNK Is any of the equipment for the honey bucket haul or [ ] [ ] [ ] flush-haul system broken? If so, for how long?________ YES NO UNK Is the honey bucket haul or flush-haul system operated [ ] [ ] [ ] safely so that no sewage is spilled on the ground in the village? YES NO UNK Are there village residents who improperly dispose of their [ ] [ ] [ ] honey buckets? YES NO UNK Do the honey bucket haul or flush-haul operators get paid? [ ] [ ] [ ] If so, how much and for how many hours per day?________ YES NO UNK Do the honey bucket haul and/or flush haul operators have [ ] [ ] [ ] a place to clean up and change out of their work clothes before going home? If so, where? ________________________ YES NO UNK Does the village school actively promote safe sanitation [ ] [ ] [ ] methods and/or have a sanitation curriculum? If so, what grades?________ YES NO UNK Do the health aides assist the village school with [ ] [ ] [ ] sanitation presentations? SOLID WASTE How far away from the village is the landfill/dump located and in what direction? YES NO UNK Does the landfill/dump have an all weather road or boardwalk? [ ] [ ] [ ] YES NO UNK Does the landfill/dump have any type of heavy equipment to [ ] [ ] [ ] compact or cover the solid waste? If so, what kind?________ YES NO UNK Does the village landfill/dump have an operator? If so, who? [ ] [ ] [ ] _________________________________________________________ YES NO UNK Does the village landfill/dump have a fence around it? [ ] [ ] [ ] YES NO UNK If there is a fence, is it in good condition? [ ] [ ] [ ] YES NO UNK Is there uncontrolled access to the landfill/dump? [ ] [ ] [ ] YES NO UNK Is there uncontrolled open burning at the landfill/dump? [ ] [ ] [ ] YES NO UNK Is there a burn box at the landfill/dump? If so, who [ ] [ ] [ ] operates it?______ YES NO UNK Are there other burn boxes in the village (such as the [ ] [ ] [ ] village school or store)? If so, who operates them?________ YES NO UNK Are the health clinic medical wastes or veterinarian [ ] [ ] [ ] disposed of at the landfill? If not, how and/or where are they disposed of?________ YES NO UNK Is there windblown litter around the landfill? If so, how [ ] [ ] [ ] much and how far does it go?________ YES NO UNK Is there a lot of plastic in the windblown litter? If so, [ ] [ ] [ ] what is the predominant color?________ YES NO UNK Does the landfill/dump have uncrushed tin cans from the [ ] [ ] [ ] school lunch program? YES NO UNK Does the landfill/dump have a lot of aluminum cans? [ ] [ ] [ ] YES NO UNK Does the landfill/dump have cardboard or other paper wastes [ ] [ ] [ ] from the village store? If so, in general terms, how much?___ YES NO UNK Is there a "No Dumping of Hazardous Materials" warning [ ] [ ] [ ] sign at the landfill/dump entrance. YES NO UNK During the inspection of the landfill, were paint cans, [ ] [ ] [ ] used oil containers, ead acid batteries or other hazardous materials observed? If so, in general terms, what and how many?________ YES NO UNK Is there a lead acid battery collection point at the [ ] [ ] [ ] landfill/dump? If so, where and how are the batteries contained?________ YES NO UNK Is there a community salvage yard at the landfill/dump or [ ] [ ] [ ] at some other location in the village? If so, where?________ YES NO UNK Is the landfill/dump in a tundra pond or setting in water [ ] [ ] [ ] most of the time? YES NO UNK Is the landfill/dump generating leachates, or runoff, that [ ] [ ] [ ] stain the ground downstream of the landfill? YES NO UNK Are there animals scavenging through the garbage at the [ ] [ ] [ ] landfill/dump. If so, what kind of animals?________ YES NO UNK Are there old, or other, landfill/dumps in and/or around [ ] [ ] [ ] the village. If so who operated them and where are they? _________________________________________________________ YES NO UNK Does the village landfill/dump have a DEC Class III Landfill [ ] [ ] [ ] Permit or a DEC letter of non-objection? POLLUTION PREVENTION YES NO UNK Are environmental pollution problems an issue with the [ ] [ ] [ ] village councils and/or residents? If so, who and what environmental issues?________ YES NO UNK Does the village school have an environmental or pollution [ ] [ ] [ ] prevention education program? If so, what grade levels?____ YES NO UNK Are aluminum cans being recycled? If so, by whom?__________ [ ] [ ] [ ] ___________________________________________________________ YES NO UNK Are lead acid batteries being collected and/or recycled? If [ ] [ ] [ ] so, by whom?_______________________________________________ YES NO UNK Is waste oil being recycled? If so, by whom?________ [ ] [ ] [ ] YES NO UNK Is the power plant operator correctly disposing of the [ ] [ ] [ ] waste oil generated by the electrical generator? If so, how?________ If not, what is happening to the waste oil?___________ YES NO UNK Do the village stores recycle the white plastic shopping [ ] [ ] [ ] bags or offer rebates for reuse of the white plastic shopping bags? If so, which store(s)? YES NO UNK Do the village stores have paper or canvas bags as an [ ] [ ] [ ] alternative to plastic bags? YES NO UNK Does the village have a village cleanup program? If so, [ ] [ ] [ ] are the recyclables separated from the other trash? YES NO UNK Is there a village awareness of the importance of preventing [ ] [ ] [ ] fuel oil spills at their homes? YES NO UNK Do the village "gas" stations have containment containers [ ] [ ] [ ] to place gas cans in while filling them? TANK FARMS How many tank farms are there in the village and who owns them? Which tank farms have berms or dikes, and which do not?________ YES NO UNK Do any of the tank farm owners have a SPCC (Spill Prevention [ ] [ ] [ ] Control or Clean Up) or C (Contingency) Plan? Who does and does not?________ YES NO UNK Do any of the tanks farms have active or ongoing leaks, of [ ] [ ] [ ] any size? If so, who?________ YES NO UNK Do any of the tank farms have fuel oil spill clean up [ ] [ ] [ ] materials on hand. If so, who and in general terms, how much?________ YES NO UNK Have there been any tank farm fuel oil spills of more than [ ] [ ] [ ] 50 gallons in the last five years? ______________________ YES NO UNK Have the tank farm fuel oil river "headers" ever been [ ] [ ] [ ] pressure tested? If so, when?________ AIR YES NO UNK Can the smoke from the burning garbage at landfill/dump [ ] [ ] [ ] be smelled in the village? YES NO UNK Is burning plastic the predominant odor smelled? If not, [ ] [ ] [ ] what is the predominate odor?__________________________ YES NO UNK If village residents use burn barrels, does the smell of [ ] [ ] [ ] burning plastic create complaints from the other village residents? YES NO UNK Is there an awareness in the village that the smokes from [ ] [ ] [ ] burning plastic can be very toxic? YES NO UNK Do the village residents consider cigarette smoke and wood [ ] [ ] [ ] stove smoke as sources of indoor air pollution? YES NO UNK Do village residents use wood stoves to heat their homes? [ ] [ ] [ ] If so, how many?_________________________________________ YES NO UNK Have village residents notice an increase of indoor air [ ] [ ] [ ] pollution related problems after their houses have been weatherized? For more information, contact: Bill Stokes, Rural Environmental Quality Specialist State of Alaska Department of Environmental Conservation 555 Cordova Street Anchorage, AK 99501 Toll Free: 1-800-510-2332 Phone: (907) 269-7580 e-mail: bstokes@envircon.state.ak.us