HomeMy WebLinkAboutMiscellaneous - 135 FRENCH FARM ROAD 4/30/2018 135 FRENCH FARM ROAD
210/035.0-0085-0000.0 ,
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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 - Planniing Board - Conservation Commission - Building Department
WATERSHED RESIDENTS QUESTIONNAIRE
1. Name
2. Street Address
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\ 3. 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 y ur 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 Cdo 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
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9. Have you had any problems with your sewage disposal system? ❑ yes C1 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 dishwashery garbage disposal
dehumidifier drain sump pump toilet
roof/pavement drains shower/bathtub `
11. Please state the brand and type (liquid or powder) of detergent you use for:
dishwasher eA--- C R�
clotheswasher
12. Does your property have a lawn? C1 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 year Z--
f ,
Season(s) of the year
14. Please state the brand and type (liquid or granular) of lawn fertilizer you use:
heck here if your lawn is maintained by a professional landscape contractor.