HomeMy WebLinkAboutMiscellaneous - 10 BEAR HILL ROAD 4/30/2018 (2)11
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WATERSHED RESIDENTS QUESTIONNAIRE
1. Name'h%�
2. Street Address % �1
3. How many members are in your household?
4. What type of sewage disposal system do you have?
❑ cesspool
❑ septic tank and leaching area
UC 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
❑ over 20 years ❑ do not know
7. Has your sewage disposal system been rebuilt or repaired?
❑ yes ❑ no ❑ do not know
If yes, approximately how long ago? years. What was done?
8. 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 ❑ 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 connected to your sewage disposal system?
washing machine dishwasher f garbage disposal
dehumidifier drain 0 sump pump toilet
roof/pavement drains 0 shower/bathtub
11. Please state the ad d type (liquid or p di) of detergent you use for:
dishwasher
clotheswasher
12. Does your property have a lawn? [9 yes ❑ no
If yes, approximately what size?
❑ less than 1/4 acre ❑ 1/4 acre 1/z acre ❑ 3/4 acre ❑ 1 acre
❑ more than 1 acre (Specify) acres
13. How often do you fertilize your lawn?
No. of applications per ye r
Season(s) of the year
14. Please state the brand and type Uiqu dor granula7))of lawn fertilizer you use:
❑ Check here if your lawn is maintained by a professional landscape contractor.
•
WATERSHED RESIDENTS QUESTIONNAIRE
1. Name
2. Street Address
3. How many members are in your household?
4. What type of sewage disposal system do you have?
❑ cesspool,
❑ septic tank and leaching area
X1 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
❑ over 20 years ❑ do not know
7. Has your sewage disposal system been rebuilt or repaired?
❑ yes ❑ 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 ❑ 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 connected to your sewage disposal system?
washing machine dishwasher garbage disposal
dehumidifier drains sump pump toilet
roof/pavement drains shower/bathtub L
11. Please state the b3and d type (liquid or p wd r) of detergent you use for:
dishwasher <'.>. a�CtC�
clotheswasher
12. Does your property have a lawn? [1a yes ❑ no
If yes, approximately what size?
❑ less than 1/4 acre ❑ 1/4 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 ye r
Season(s) of the yeart��
14. Please state the brand and type (liquid or granula) of lawn fertilizer you use:
❑ Check here if your lawn is maintained by a professional landscape contractor.
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