HomeMy WebLinkAboutMiscellaneous - 157 SUTTON HILL ROAD 4/30/2018 I ; 157$UTTpN HILL ROAD dC�
210/060.0-0093-0000.0
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WATERSHED RESIDENTS QUESTIONNAIRE
1. Name _T/'1C/ C C L(Yj i d
2. Street Address �4/ 76L A // `�C✓
3. How many members are in your household.
4. What type of sewage disposal system do you have?
cess ool
eptic tank and leaching are
❑ 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. w old is your sewage disposal system? El0-5 years El 6-10 years El 11-20 years
7 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 seiyage disposal system pumped out? ❑ annually
❑ every 2-4 years f every 5-10 years ti ❑ over 10 years ❑ never
9. Have you had any problems with your sewage disposal system? ❑ yes A 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 �LZ dishwasher ✓ 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 cfva S >�
clotheswasher
12. Does your property have a lawn? X yes ❑ no
If yes, approximately what size?
❑ less than 1/4 acre ❑ 1/4 acre >t/% 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
Season(s) of the year —5PM'Y7 g Q ��
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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2. Street Address
3. Hova.' inany members are in your household?
4. "V1j-,a14 type of sewage disposal system do you have?
cep; on)
ta -n
1 and leaching ar
connection to municipal sewer
(OrDer (describe)
d o not k n 0 W
5. Ar'- the plans (drawings) for your sewage disposal system on file with the Board of Health?
1 ves El no do not know
6. 1 w old is your sewage disposal system? El 0-5 years El 6-10 years El 11-20 years
over 20 years El do not know
7. Has your se-wage disposal system been rebuilt or repaired?
El V/ no FI do not know
ye , approximately how long ago? years. What was done?
8. liov; frequently is your se age disposal system pumped out? El annually
E every 2-4 years every 5-10 years El over 10 years El never
9. Have you had any problems with your sewage disposal system? El yes no
C , what problems?
El repeated pump-outs needed
Ej- system clogs, backs up, or drains slowly
El odors
El sewage surfaces through ground
10. Ho-- mane of each ap VIi*an e are connected to your sewage disposal system?
wits--ing machine dishwasher ✓ garbage disposal
6'elrunnidifier drain \-surnp pump toilet
roof'-navernent drains showerlbathtub
11. Ple<! e state the brand and type (liquid or powder) of detergent you use for:
disi,vcasher _'FlecNi, 5'__'1
clo, ,_sSwasher 411
12. Does: your property have a lawn?
X yes ❑ no
If yes, approximately what size?
0 less than 1/4 acre El 1/4 acre )</1/2 acre El 3/A acre El 1 acre
El more than 1 acre (Specify) - acres
13. Hovy often do you fertilize your lawn?
14o. of applications per year 12
Season(s) of the year TZ
14. Please state t1he brand and type (liquid or granular) of lawn fertilizer you use:
Check here if your lawn is maintained by a professional landscape contractor.