HomeMy WebLinkAboutMiscellaneous - 23 APPLEDORE LANE 4/30/2018 J 23 APPLEDORE LANE
210/097.0-0078-0000.0
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WATERSHED RESIDENTS QUESTIONNAIRE
1. Name
2. Street Address
i
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 K 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? ❑ yes I 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 —
clotheswasher t
12. Does your property have a lawn? El yes ❑ no
If yes, approximately what size?
❑ less than 1/4 acre W 1/4 acre ❑ % 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
�1 Season(s) of the year
14. Please state the brand and type (liquid or granular) of lawn fertilizer you use:
7-7
❑ Check here if your lawn is maintained by a professional landscape contractor.
Address , -)-3 At°?0-4� POOP- ),A/ Title of File Page
of
Date File Open: Date file closed:
Doc Document/Action Title Date of Refer to other Purpose of Document/Action and notes
action Document/ document/
filum• Action Department
Board of Appeals — Board of Health -- -'Plan ning Board — Conservation Commission — Boildin Department