AEM Tier I

Ontario County
Agricultural Environmental Management
Tier 1 Survey



Watershed Identification __________________________________________________			Date______________
Farm Name ____________________________________________________________
Owner's Name ________________________________		Operator's Name ________________________________
Address _____________________________________		Address _______________________________________
Phone ________________	Fax _________________	Phone ________________	Fax ________________
e-mail ___________________________________		e-mail ___________________________________
Preferred Contact Person ______Owner ______Operator

1) Future Status of the Farm:
Do you anticipate any major modifications to your farm within the next 5 years?		______Yes ______No
If yes, please circle the condition(s) that best describe the modification(s):
Business structure	Expansion	Retirement
Operation type	Diversification of farm business	Sale of farm

2) Basic Farm Information:
What Primary Farm Type best describes your operation? (Please circle only one)				Land Use	Owned	Rented
Dairy	Beef	Poultry	Vineyard	Tillable Acres	_______	_______
Swine	Horses	Orchard	Vegetables	Grazed Land Acres	_______	_______
				Hay Land Acres	_______	_______
Cash crop (Please specify) _________________________				Woodland Acres	_______	_______
Other (Please specify) ____________________________				Total Acres	_______	_______
Animal Numbers for your Primary Farm Type
Average Weight: _______ Number ________				Average Weight: _______ Number:_________
Average Weight: _______ Number ________				Average Weight: _______ Number:_________

3) Management Questions : (Please check Yes or No)	Yes	No
Do you grow specialty crops? (eg. fruits, vegetables, grapes, etc.)	_____	_____
Do you spread and/or store manure?	_____	_____
Is there a barnyard or feedlot on your farm?	_____	_____
Do you store silage on the farm?	_____	_____
Do you utilize pastureland on your farm?	_____	_____
Do you use fertilizer?	_____	_____
Do you use pesticides (herbicides, insecticides, fungicides) on your farm?	_____	_____
Do you store and or mix pesticides (herbicides, insecticides, fungicides) on your farm?	_____	_____
Does your operation utilize cropland?	_____	_____
Is the water supply on your farm from a well or spring?	_____	_____
Is there a defined stream within or adjacent to your farm?	_____	_____
Do you presently or do you plan to harvest timber on your farm?	_____	_____
Do you store petroleum products on your farm?	_____	_____