HomeMy WebLinkAboutMiscellaneous - 21 HEATH ROAD 4/30/2018 (2)I
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WATERSHED RESIDENTS QUESTIONNAIRE
1. Name A-9,q/-3F)e _ 1)
2. Street Address �..I/ /6F'o f/ 4 p
3. How many members are in your household?
4. What type of sewage disposal system do you have?
❑ cesspool
❑peptic tank and leaching area
connection to municipal sewer
❑ other (describe)
❑ do not know
3
5. Are the plans (drawings) for your sewage disposal system on file with the Board of Health?
❑ yes ❑ no P;"do not know -
6. How old is your sewage disposal system? ❑ 0-5 years ❑ 6-10 years 2/11-20 years
❑ over 20 years ❑ do not know
7. Has your sewage disposal system been rebuilt or repaired? 14n
❑ 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 til
❑ every 2-4 years ❑ every 5-10 years ❑ over 10 years ❑ never—/
9. Have you had any problems with your sewage disposal system? F-1yesL� 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 ppl,l�ance are connected to you sewage disposal system? �
washing machine Il dishwasher �garbage disposal ,
dehumidifier drain sump pump toilet
roof/pavement drains shower/bathtub(41Z
11. Please state the brand and type (liquid or powder) of detergent you use for:
dishwasher
clotheswasher�-
12. Does your property have a lawn? M_ 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 ye -21
Season(s) of the year
14. Please state the brand and type (liquid or granular) of lawn fertilizer you use:
S - X14
0 Check here if your lawn is maintained by a professional landscape contractor.