HomeMy WebLinkAboutMiscellaneous - 195 FRENCH FARM ROAD 4/30/2018 195 FRENCH FARM ROAD ad -
210/062.0-0070-0000.0
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AddU ss PQeA, l� a Title of File Page of
Date File Open: Date file closed:
Doc Document/Action Title Date of Refer to other Purpose of Document/Action and notes.
action Document/ document/
Num. Action Department
Board of Appeals — Board of Health — Planning Board — Conservation Commission — Building Department
WATERSHED RESIDENTS QUESTIONNAIRE
1. Name In1Y1Q,3( i c avid 1ee
2. Street Address I_ �/'�+��- ' / •
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 sew r
[� other (describe) Y
❑ 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?X 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 A no ❑ do not know
If yes, approximately how long ago? years. What was done?
S. 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 ewage disposal system? Y
washing machine — dishwasher garbage disposal
dehumidifier drain sump pump toilet _
roof/pavement drains shower/bathtub
11. Please state the j2rand and type (li uid or powder) of detergent you use for:
dishwasher
clotheswasher
12. Does your property have a lawn? Lv� 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 O
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
j-5TTONNAIRE
1. Name,
2. Streell Address
3. -1 o"V many members are in your household?
4. Vt7 rh a t- type of sewage disposal system do you have?
D, cesspool
p
tic tank and leaching area
Ej connection to municipal sewer
FU- u-.her (describe) Sew 'Sotm
El do not know
5. -C "he plans (drawings) for your sewage disposal system on file with the Board of Health?
yes El no D do not know
E. �cqvv old is your sewage disposal system? 0-5 years El 6-10 years El 11-20 years
I L over 20 years EJ do not know
7. F, your sewage disposal system been rebuilt or repaired?
❑ es no El do not know
f _-.s, approximately how long ago? years. What was done? J
nv.- frequently is your sewage disposal system pumped out? El annually
El every 5-10 years ❑ over 10 years El never
every 2-4 years
7ve you had any problems with your sewage disposal system? ❑ yes no
yl�s, what problems?
El repeated pump-outs needed
El system clogs, backs up, or drains slowly
El odors
El sewage surfaces through ground
10. i, -,vj many of each appliance are connected to yo age disposal system?
Ing machine AK dishwasher garbage disposal
l
-urnidifier drain - sump pump toilet
navement drains - shower/bathtub
TM
V. I ;ease state the rand and type (li�Uic or powder) of detergent you use for:
.kAkLP^AP Pd%.QA A&
c 2:iwasheir
C .Aheswasher -
T .-es your property have a lawn? yes El no
approximately what size?
Lj less than 1/4 acre EJ 1/4 acre El 1/2 acre EJ 3/4 acre El 1 acre
❑ rnore than 1 acre (Specify) - acres
13. T often do you fertilize your lawn?
V,i,). of appiica.tions per year 0
Season(s) of the year
14. "PI e.:se state the brand and type (liquid or granular) of lawn fertilizer you use:
Ci,< ck- here if your lawn is maintained by a professional landscape contractor.