HomeMy WebLinkAboutMiscellaneous - 123 FRENCH FARM ROAD 4/30/2018 123 FRENCH FARM ROAD odd
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Pr3SAsLkkL CRM 12 fl Title of File
Page of
Date File Open: Date file closed:
Doc Document/Action Title Date of Refer to other Purpose of Document/Action and notes.
action Document/ document/
Num. Action Department
Board of Appeals - Board of Health - Planning Board - Conservation Commission - Building Department
WATERSHEDRESIDENTS QUESTIONNAIRE
1. Name gliJi-ja � ` 1 amsie D&4,4eA
2. Street Address 1.?3 VcoGA kloa I 1 . 4,claoce
3. How many members are in your household? "r
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 ❑ do not know
6. How old is your sewage disposal system?Y 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 ;K 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 �I 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 X dishwasher 1 garbage disposal
dehumidifier drain sump pump toilet
roof/pavement drains shower/bathtub
11. Please state the brand and type (liquid o? powder) of detergent you use for:
dishwasher C,45C 4 DE
clotheswasher
12. Does your property have a lawn? CX yes ❑ no
If yes, approximately what size?
❑ less than 1/4 acre ❑ 1/4 acre ❑ 1/2 acre ❑ 3/4 acre X 1 acre
F1 more than 1 acre (Specify) acres /
13. How often do you fertilize your lawn?
No. of applications per year
Season(s) of the year i P"
14. Please state the brand and type (liquid or granular) of lawn fertilizer you use:
XCheck here if your lawn is maintained by a professional landscape contractor.
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North Andover Board of Health
Town Hall, 120 Main Street
North Andover, MA 01845