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HomeMy WebLinkAboutMiscellaneous - 183 FRENCH FARM ROAD 4/30/2018N u w WT Ln X Q m z on = W T � D O � S 0 O D z Q i 8 0 Q ' v E u 0 G 0 c v o � a I L 7 I a ' L v s ( � � ° c v o E s v mCL° ovG '°v 0 ` `s f � O v o E C a D D Q C t L R C cc v U ~ C O � Q Q yL 'D E m 3 U O C 0 m Z WATERSHED RESIDENTS QUESTIONNAIRE 1. Name 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 Q' 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 EP' do not know 6. How old is your sewage disposal system? M/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 O 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 f' 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? r chitrg machine ! dishwasher garbage disposal tumidifier drain sump pump toilet I-p-Avement drains shower/bathtub 11. Please state the brand and type (liquid or powder) of detergent you use for: dishwasher 4 D &� clotheswasher f?c aJ b &kS 1, e . /-4,& 90e_ E) %t vc ETc �/F. 12. Does your property have a lawn? [7 yes ❑ no If yes, approximately what size? ❑ less than 1/4 acre El 1/4 acre El1/2 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 �l 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. %i�ri..,g fc � d AIRF 2. Street Address 3. How Many members are in your household? 4. V;h-at type of sewage disposal system do you have? ❑ cesspool ❑ r septic tank and leaching area connection to municipal sewer ❑ other (describe) ❑ do not know 5. A --re. the plans (drawings) for ydur sewage disposal system on file with the Board of Health? "-es ❑ no Cir do not know 6. how old is your sewage disposal system? P/0-5 years ❑ 6-10 years ❑ 11-20 years ❑ over 20 years ❑ do not know t`- ?. 1 t_ s your sewage disposal system been rebuilt or repaired? ❑ ves © no ❑ do not know r If yes, approximately how long ago? years. What was done? 8. frequently is your sewage disposal system pumped out? ❑ annually V114 = every 2-4 years ❑ every 5-10 years ❑ over 10 years ❑ never 9. _F f -e you had any problems with your sewage disposal system? ❑ yes V__`no what problems? ❑ repeated pump -outs needed ❑ system clogs, backs up, or drains slowly ❑ odors ❑ sewage surfaces through ground 10, l v. many of each appliance are connected to your sewage disposal system? dishwasher _� garbage dis o?;al�-"-/ hia�g machine $ g l� 2 i� is idisier drain sump pump toilet ri ement drains showerlbathtub 11. N'ease state the brand and type (liquid or powder) of detergent you use for: cish�a°ashen 1b�!1/Z� %0� lc �7�- clatheswasheT Ill/�;c'� %�R�Lii1�C�IeS /• �. /�%t� ; 1.2. Does your property have a lawn? al yes ❑ no J, tees, approximately what size? 11_1 less than '/4 acre El% acre ❑ 1/2 acre 3/4 acre ❑ 1 acre ❑ more than 1 acre (Specify) acres 13. I -;civ ofte=n do you fertilize your awn? cif am plications per year of the year - 14. r ea w e s tz ; :e the brand and type (liquid or granular) of lawn fertilizer you use: i hete if your lavin is main.tamed by a professional landscape contractor.