HomeMy WebLinkAboutMiscellaneous - 102 BEAR HILL ROAD 4/30/2018 (2)Y+
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WATERSHED RESIDENTS QUESTIONNAIRE
1. Name
2. Street Address :L
3. How many members are in your household. —
4. What type of sewage disposal system do you have?
❑ cesspool
❑ aseptic tank and leaching area
v connection to municipal sewer
❑ other (describe)
❑ do not know
5. Are the plans (drawings) or 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 rebuiit or repaired?
❑ yes �,j no do -got know
If yes, approximately how long ago? vears. What was done?
8. flow frequently is your sewage disposal system pumped out? ❑ annually
/ ❑ every 2-w years every 5-10 years ❑ over 10 ;ears ❑ never L
9. Have you had any problems with your sewage disposal system? ❑ yes ❑ no
If yes, what probiems?
❑ repeated pump -outs needed
system _logs, 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 drain , sump pump toilet
roof/pavement drains _ shower/bathtub _
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11. Please state the brand and tvpe (liquid or powder) of detergent you use for:
dishwasher-
clotheswasher
12. Does your property have a lawn? CI' yes ❑ no
If yes, approximately what size?
❑ less than 1/4 acre ❑ 1/4 acre1/} 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 `t
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Season(s) of the year
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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.