HomeMy WebLinkAboutMiscellaneous - 21 FRENCH FARM ROAD 4/30/2018WA ERS HED RES
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1. Name �-� /
2. Street Address TI t\ �c,
ENTS QUESTIONNAIRE
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3. How many members are in your household.
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4.
What type of sewage disposal system do you have?
❑ cesspool
❑ septic tank and leaching area
Z-- 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?
L ---Yes ❑ no ❑ do not know
6. How old is your sewage disposal system? ®�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 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
9. Have you had any problems with your sewage disposal system? Zl_--yes ❑ no
If yes, what problems?
❑ repeated pump -outs needed
❑ system clogs, backs up, or drains slowly
)K_�k odors
EJ1 sewage surfaces through ground
10. How many of each appliance are connected to your sewage disposal system?
washing machine dishwasher 4_ garbage disposal
dehumidifier drain sump pump toilet_
roof/pavement drains shower/bathtub
11. Please state the bra and type (liquid or powder) of detergent you use for:
dishwasher �.��K'N
clotheswasher
12. Does your property have a lawn? [ yes ❑ no
If yes, approximately what size?
❑ less than 1/4 acre ❑ 1/4 a ❑ 1/z acre ❑ 3/4 acre ❑ 1 acre
more than 1 acre (Specify), acres
13. How often do you fertilize your 1 7
No. of applications per year
Season(s) of the year
14. Please state the brand and pe (liquid or granular) of lawn fertilizer you use:
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0 Check here if your lawn is maintained by a professional landscape contractor.
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