HomeMy WebLinkAboutMiscellaneous - 112 FOXHILL ROAD 4/30/2018 112 FOX HILL ROAD
21D/037.C-0010-0000.0 --- - - -- - �" --
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WATERSHED RESIDENTS QUESTIONNAIRE
1. Name ? U-e, S C O
2. Street Address l a xi �\/U . ��.t ca�o f ✓' J�/�SS,
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O3. How many members are in your household?
4. What type of sewage disposal system do.you have?
❑ cesspool
❑ 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 L;-'-d'o not know. /
6. How old is your sewage disposal system? 2;-'1-5 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 TT—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 5710 years ❑ over 10 years ❑ never
O9. Have you had any problems with your sewage disposal system? ❑ yes [`t`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 drain sump pump toilet
roof/pavement drains showeribathtub
11. Please state the brand and type (liquid or powder) of detergent you use for:
dishwasher e 0-1 c 'Rd e-
clotheswasher L t a u ; d Tide..
12. Does your property have a lawn? LJ' yes ❑ no
If yes, approximately what size? �/�, -
❑ less than 1/4 acre El 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 year _ _
OSeason(s) of the year 11
14. Please state the brand anda (liquid typ ( q or granular) of lawn fertilizer you use:
�2+vc. k p� vt fib JK e S C 0. re DE z Lv vt
e---Check here if your lawn is maintained by a professional landscape contractor.