HomeMy WebLinkAboutMiscellaneous - 153 DALE STREET 4/30/2018 (2) 153 DALE STREET
210/037.6-0019-0000.0
WATERSHED RESIDENTS QUESTIONNAIRE
1. Name 242 1ja P
2. Street Address -6-7
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 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
El over years ❑ do not know _ _ _ _ , . ;
7. Has your sewage disposal system been rebuilt or repaired? rt=
❑ 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 i
❑ sewage surfaces through ground
10. How many of each appliance are connected to your sewage disposal system?
washing machine �f dishwasher V_ 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 <-
clotheswasher s
12. Does your property have a lawn? LR` 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 } . = K_
Season(s) of the year (::--V -
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.