HomeMy WebLinkAboutMiscellaneous - 22 APPLEDORE LANE 4/30/2018 22 APPLEDORE LANE
J 210/098.A-0072-0000.0
' 1
WATERSHED RESIDENTS QUESTIONNAIRE
1. Name �PoER R E A
2. Street Address 2-2- A PZ-
�-1
3. How many members are in your household?
4. What type of sewage disposal system do you have?
❑ cesspool
❑ septic tank and leaching area
N 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 AtIA
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 SIA
If yes, approximately how long ago? years. What was done?
8. How frequently is your sewage disposal system pumped out? ❑ annually ^t�.4
❑ every 2-4 years ❑ every 5-10 years ❑ over 10 years ❑ never
9. Have you had any problems with your sewage disposal system? ❑ yes 2q- 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 dishwasher garbage disposal
dehumidifier drain ✓ sump pump toilet
roof/pavement drains shower/bathtub
11. Please state the brand and type (liquid or powder) of detergent you use for:
dishwasher G ASc��E
clotheswasher 5e-ARS
12. Does your property have a lawn? A 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
N Season(s) of the year
14. Please state the brand and type (liquid or granular) of lawn fertilizer you use:
7 Check here if your lawn is maintained by a professional landscape contractor.
Address ,At Title of File Page of
Date File Open: Date fele closed:
Doc Document/Action Title Date of Refer to other Purpose of DocumeEnt/Action and notes
action Document/ document/
Num. Action Department
Board of Appeals — Board of Health — Planniting Board — Conservation Commission — B�flding Departrnerxt