HomeMy WebLinkAboutMiscellaneous - 128 DALE STREET 4/30/2018 128 DALE STREET
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Board of Appeals - Board of Heal h Planniing Board - C
onseryatiion—CO mmt—ss ion — Boil;dingy Department -�—
1�,ESIDENTS QUESTIONNAIRE
2. Street Address
3. low many members are in your household? S
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. A.re 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. Peas your sewage disposal system been rebuilt or repaired?
❑ yes no ❑ do not know
ifY es, approximately how long ago? years. What was done?
8. Hoiv frequently is your sewage disposal system pumped out? ❑ annually
❑ every 2-4 years ❑ every 5-10 years ❑ over 10 years ❑ never
3. Have you had any problems with your sewage disposal system? ❑ yes DI no
If yes, what problems?
❑ repeated pump-outs needed
❑ system clogs, backs up, or drains slowly
❑ odors
❑ sewage surfaces through ground
10. How ma; y of each appliance are connected to your sewage disposal system?
washing Aachine ✓ dishwasher garbage disposal
dehumic ler drain sump pump; toilet �—
recf/pay. lent drains shower/bathub _3C
11. Please s e the brand and type (liquid or'�owder) of detergent you use for:
dishwa€. L-
clothesv, 'ter 00
1.2. goes ye property have a lawn? M, yes ❑ no
If yes, a oximately what size?
❑ less n 1/4 acre �A 1/4 acre ❑ 1/2 acre ❑ 3/4 acre ❑ 1 acre
❑ mor, an 1 acre (Specify) acres
13. How oft o you fertilize your lawn?
:.do. of a -ations Per year
5casont, the year
14. :'!ease s 7-he brand and type (liquid or granular) of lawn fertilizer you use:
❑ Dere if your lawn is maintained by a professional landscape contractor.