HomeMy WebLinkAboutMiscellaneous - 219 FRENCH FARM ROAD 4/30/2018 l
III FRENCH FARM ROAD Rd.
210/062.0-D068-0000.0
AddressL! M -2D Title
_ ,� of Fl:k gage of
Date File Open: Date file closed:
Doc Document/Action Title Date of Refer to other Purpose of Documernt/Action and notes
action Document/ document/
Mum. Action Department
Board of Appeals — Board of Health — Planning Board — Conservation Commission — Building Department
WATERSHED\RESIDENTS QUESTIONNAIRE
1. Name c N P,�;��-s • o v i.,�z
2. Street Address
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 do not know ,
6. How old is your sewage disposal system?;!�,0-5 years ❑ 6-10 years ❑ 11-20 years Y .
❑ over 20 years ❑ do not know
7. Has your sewage disposal system been rebuilt or repaired?
❑ yes �91 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 C91, never
O9. 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 sewage disposal system?
washing machine _I'>-,- dishwashers garbage disposal
dehumidifier drain sump pump toilet >L
roof/pavement drains shower/bathtub
q ry
11. Please state the brand and type (liquid or powder) of detergent you use for:
dishwasherh�--
clotheswasher
12. Does your property have a lawn? JW, 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
Season(s) of the year
14. Please state the brand and type (liquid or granular) of lawn fertilizer you use:
PrP w� — �Pc�J PJ
Y-Check here if your lawn is maintained by a professional landscape contractor.