HomeMy WebLinkAboutMiscellaneous - 141 DALE STREET 4/30/2018 141 DALE STREET
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210/037.B-0018-0000.0
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Address
Title of File
Page of
Date file Open:
Date file Closed:
Doc Document/Action Title Date of T� __
action Refer to other Purpose of l�ocuMent/Action and note
Num. Document/ document/ --_
Action De artment
Board of Appea�is - Board of Heal h PlannM.g Board _ dans
eruatiionCommission - Buil-din Departnlen;t -�—
Please forward us as much of the follow?ng information that is possible;
1. Type of system
2 . Age
3. Location , f
4 - Maintenance records and date of lost pumping out .
5. Bocumentation of repairs and reconstruction
6. Site conditions
7. Builder of system
8. Engineer who approved%
— Site
— System
9„ Installation Procedure
10. Problems
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WATERSHED RESIDENTS QUESTIONNAIRE
1. Name
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2. Street Address
3. How many members are in your household?
4. What type of sewage disposal system do you have?
❑ cesspool
❑ septic tank and leaching area
C� 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? ❑ 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 ❑ 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 5-10 years ❑ over 10 years ❑ never
9. Have you had any problems with your sewage disposal system? ❑ yes � 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 L__ —
roof/pavement drains shower/bathtub ✓
11. Please state the brand and type (liquid or powder) of detergent you use for:
dishwasher
clotheswasherU
12. Does your property have a lawn? yes ❑ no
If yes, approximately what size?
❑ less than 1/4 acre ❑ 1/4 acre ❑ 1/z acre ET 3/4 acre ❑ 1 acre
❑ more than 1 acre (Specify) acres
13. How often do you fertilize your lawn?
No. of applications per year
Season(s) of the year
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.
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