HomeMy WebLinkAboutMiscellaneous - 185 SUTTON HILL ROAD 4/30/2018 (2)SEPTIC SYSTEM INSPECTION FORM
ADDRESS I ( S sbt"t K L
DATE INSPECTED
PROPERLY FUNCTIONING? C)N
WEATHER CONDITIONS
COMMENTS:
�I ? i ER A L I Ty TES
DYE TEST PERFORMED? Y N
DATE?
SKETCH:
WATERSHED RESIDENTS QUESTIONNAIRE
1. Name �� tS �r C_
I I-
2. Street Address
las 4�ux- �p .
3. How many members are in your household? 3
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? El 0-5 years El 6-10 years ❑ 11-20 years -::z
❑ 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 -yea rs Elover 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 3
roof/pavement drains shower/bathtub
11. Please state the brand and type (liquid or powder) of detergent you use for:
dishwasher C&'sCk0G , PaW0 Z_
clotheswasher VIZ JA S �A_ c ta0ZY2_
12. Does your property have a lawn? 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? VGLI
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.