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HomeMy WebLinkAboutMiscellaneous - 21 JOHNSON CIRCLE 4/30/2018 (2)WATERSHED RESiI)FNTS QUESTIONNAIRE 1. Name IV", [,(_I• --C-1 11.1``'( 0 2. Street Address Z( d - � j Q �,, �� j 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 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 Ordo 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? ❑ yes J11f 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'7 washing machine dishwasher garbage disposal dehumidifier drain sump pump toilet roof/pavement drains shower/bathtub �-- 11. Please state the brand arul type (liquid or powder) of detergent you use for: dishwasher clotheswasher `k 12. Does your property have a lawn? yes ❑ no If yes, approximately whYcify) ze? El less than 1/4 acre 1/4 acre El 1/2 acre ❑ 3/4 acre El acre F-1morethan 1 acre (Sp acres 13. How often do you fertilize your lawn? 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. 2. Street Address 21 6 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 sewer ❑ other (describe) ❑ do not know 5. r x_ the plans (drawings) fo our sewage disposal system on file with the Board of Health? 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 se a disposal system been rebuilt or repaired? ❑ yes no ❑ do not know 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, low many of each appliance are cortnected to your sewage disposal system? washing machine 1 dishwasher ( garbage disposal dehumidifier drain sump pump toilet roof/pavement drains shower/bathtub 11. Please state the brand anJ ('quid or powder) of detergent you use for: dishwasher clotheswasher 12. Does your property have a lawn? yes ❑ no If yes, approximately wha size? ❑ less than 'A acre 1/4 acre ❑ % acre ❑ 3/4 acre ❑ 1 acre ❑ more than 1 acre (Sp cify) acres 13. How often do you fertilize your lawn? 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.