Applicant Certification of Known Environmental Issues
Applicable for the 2023 and 2024 Multifamily Consolidated Request for Proposals (RFP)/2024 and 2025 Housing Tax Credits Funding Rounds
Instructions: It is not necessary at the time of initial application to have an Environmental Site Assessment (ESA); however, if an ESA of any type has been conducted, you are required to disclose all known environmental issues below.

Development Name	     	
Development Address	     	
Year Building(s) Built (first occupied)	     	
Previous uses of the site 	     	
Source of this information	     	

Section 1: Overview
Inquiry 	Response	
Has a Phase I Environmental Study been completed?	 Yes    No    Unknown	
Date of Report	     	
Summarize any recognized environmental conditions	     	

Section 2: Asbestos
Inquiry 	Response	
Has an Asbestos Containing Materials (ACM) test been completed?	 Yes    No    Unknown	
Date of Report	     	
Comments	     	
Is there any friable asbestos within the subject project?	 Yes    No    Unknown	
Attach a copy of ACM test results, and/or attach a copy of an existing asbestos management plan, if applicable.	 Attached    N/A	

Section 3: Lead Based Paint (LBP)
Inquiry 	Response	
If proposal includes rehabilitation of an existing building, was it constructed prior to 1978? 
If “Yes,” proceed with next LBP question.	 Yes    No    Unknown	
Is the building exempt from LBP requirements due to proposed scope of work or population being served?  
If “No” or “Unknown,” proceed with remaining LBP questions. 	 Yes    No    Unknown	
Has a visual assessment been conducted by a qualified individual?	 Yes    No	
If “Yes,” was any deteriorated paint identified?	 Yes    No	
Will the proposed scope of work involve disturbing any painted surface?	 Yes    No	
Has a lead hazard evaluation, including LBP inspection/risk assessment, been conducted?	 Yes    No	
If “Yes,” is there the presence of lead or lead hazards within the subject property?	 Yes    No	
If applicable, attach a copy of the lead hazard evaluation results.	 Attached    N/A	
If applicable, attach a copy of an ongoing LBP Maintenance Plan or Lead-Free Building Certification.	 Attached    N/A	
Comments	     	

Section 4: Mold
Inquiry 	Response	
Is there visual evidence of mold growth on any interior surfaces, or are there any known leaks on the building envelope that might contribute to concealed water damage or mold?  	 Yes    No    Unknown	
If “Yes,” explain where and identify any assessments completed	     	
Comments	     	

Section 5: Other Hazards and Toxic Materials
Inquiry 	Response	
Is the subject property adjacent to or located within ¼ mile of a Superfund, National Priority or CERCLIS or CERCLA site, or within 3000 feet of a toxic or solid waste landfill? 	 Yes    No    Unknown	
Comments	     	
Are there known or evidence of former methamphetamine (meth) manufacturing labs within the subject property?  	 Yes    No    Unknown	
If “Yes,” provide information	     	
Comments	     	
Are there any underground or above-ground fuel storage tanks present on the subject property?  Is the subject property located within 1 mile of any 100+ gallon above-ground tanks?	 Yes    No    Unknown	
If “Yes,” address the following: number of tanks, capacity, usage, location, age, date of last tank installation/removal and delivery system tightness test, and test results	     	
Comments	     	
If there are unused tanks or tanks that were removed and there was a soil test done, attach a copy of the test.	 Attached    N/A	
Is there a major roadway within 1,000 feet, a railroad within 3,000 feet, a civil airport within 2,500 feet, or a military airport within 15,000 feet of the subject property?	 Yes    No    Unknown	
If “Yes,” identify the roadway, railroad, or airport and the distance from the subject property	     	
Comments 	     	
Are the structures or proposed structures at least 10 feet from all gas line and power line easements? 	 Yes    No    Unknown	
Comments	     	
Are there any well(s) on site?  	 Yes    No    Unknown	
If “Yes,” address the following: the current usage, the location, and whether it has been capped under Minnesota Department of Health and local requirements (if well is unused)	     	
Comments	     	
Is any portion of the subject property near any power, television, or microwave tower(s)?	 Yes    No    Unknown	
If “Yes,” list the tower’s height is and the distance to the subject property.	Height:      
Distance:      	
Comments	     	
Is any portion of the subject property at or below the 100- or 500-year flood plain, or in a Floodway or Coastal High Hazard Area?	 Yes    No    Unknown	
Comments	     	
Is any portion of the subject property within 100 feet of a wetland?	 Yes    No    Unknown	
Comments	     	
If this is a new construction proposal, has there been any recent site preparation or other alteration to the site?  	 Yes    No    Unknown	
If “Yes,” has the project been given clearance from the State Historical Preservation Office (SHPO) that it will not have a significant adverse impact on any known historic preservation in the immediate area? 	     	
Comments	     	
If this is a new construction proposal, is the project’s county or air quality management district in nonattainment or maintenance status for any criteria pollutants according to the EPA Green Book? 	 Yes    No    Unknown	
Comments	     	
Is any portion of the subject property located on prime farmland, unique farmland, or farmland of statewide importance according to the USDA? 	 Yes    No    Unknown	
Comments	     	
Is any portion of the subject property within proximity to a National Wild and Scenic Rivers System (NWSRS) river according to the NWSRS or National Park Service?	 Yes    No    Unknown	
Comments	     	
Are any federally listed protected species or designated critical habitats present in the project area according to the US Fish and Wildlife Service (USFWS)?	 Yes    No    Unknown	
Comments