HomeMy WebLinkAboutMiscellaneous - 35 WOODBERRY LANE 3/14/2016 WATERSHED RESIDENTS QUESTIONNAIRE
1. Name " oH w
- LA-10A 3c,i c2Au)�,, 1,
2. Street Address a5- ( _Ax17 6Cd 1yY �`W'
3. How many members are in your household?
4. What type of sewage disposal system do you have?
❑ cesspool
'�Z septic tank and leaching area
❑ connection to municipal sewer
❑ other (describe)
❑ do not know
5. Are the plans (drawings) for your sewage disposal system on file with the Board of Health?
yes ❑ no ❑ do not know _
6. How old is your sewage disposal system? ❑ 0-5 years > 6-10 years ❑ 11-20 years 'F'
❑ over 20 years ❑ do not know
7. Has your sewage disposal system been rebuilt or repaired?
❑ yes YL no ❑ do not know
If yes, approximately how long ago? years. What was done?
. ` S. How frequently is your sewage disposal system pumped out? ❑ annually
' every 2-4 years ❑ every 5-10 years ❑ over 10 years ❑ never
9. Have you had any problems with your sewage disposal system? ❑ yes 1 no
If yes, what problems?
❑ repeated pump-outs needed
❑ system clogs, backs up, or drains slowly
❑ odors
❑ sewage surfaces through ground
10. How many of each appliance are connects t to your sewage disposal system?
washing machine dishwas- !r garbage disposal
dehumidifier drain sump p: ap toilet _
roof/pavement drains shower/ Zhtub
11. Please state the brand and pe (liquid c powder) of detergent you use for:
dishwasher Gciev/Tj� --
clotheswasher 6"w►
12. Does your property have a lawn? yes ❑ no
If yes, approximately what size?
less than 1/4 acre ❑ 'A acre ❑ 1/2 acre ❑ 3/4 acre ❑ 1 acre
❑ more than 1 acre (Specify) acres
13. How often do you fertilize your lawn?
No. of applications per year o�
Season(s) of the year
14. Please state the brand and type (liquid or granular) of lawn fertilizer you use:
Check here if your lawn is maintained by a professional landscape contractor.