HomeMy WebLinkAboutMiscellaneous - 200 MARBLERIDGE ROAD 4/30/2018¢� I
'Qeu Oi. 1(06
SEPTIC SYSTEM INSPECTION FORM
ADDRESSV1,
DATE INSPECTED �` o
PROPERLY FUNCTIONING? Y N
WEATHER CONDITIONS
COMMENTS:
8,6 -e
s F ,.
si-r-pe GL vv\- 1n &s 0. 6 r v .
14A i E R a V A L I T y 'f ES -P-
DYE
LDYE TEST PERFORMED? Y N
DATE?
SKETCh:
j -9- 8
i�Urd 1 �S o�
O26g
�-z
1 �Vrnl �a�- �dQ✓ ���e �
M
WATERSHED RESIDENTS QUESTIONNAIRE
1. Name
2. Street A
3. How many members are in your household?
4. What type of sewage disposal system do you have?
❑ cesspool
V' 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 Ind' do not know
6. How old is your sewage disposal system? ❑ 0-5 years ❑ 6-10 years ❑ 11-20 years
V over 20 years ❑ do not know
7. Has your sewag disposal system been rebuilt or repaired?
El yes no ❑ do not know
If yes, approximately how long ago?
years. What was done?
8. frequently is your sewage disposal system pumped out? ❑ annually
7every 2-4 years - ❑ every 5-10 years ❑ over 10 years ❑ never
9. Have you had any problems with your sewage disposal system? ❑ yes Vlno
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
roof/pavement drains shower/bathtub lz:�
11. Please state the brand and ty a (liquid or powder) of detergent you u"se for:
dishwasher
clotheswasher /
12. Does your property have a lawn? Er yes ❑ no
If yes, approximately what size?
less than 1/4 acre F9 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?%u
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:
-ti.6�';tfi''$a`.��+yE�eek���9
J
maintained by a "professional landscape contractor.
,jL