HomeMy WebLinkAboutMiscellaneous - 236 JOHNSON STREET 4/30/2018 236 JOHNSON STREET a
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WATERSHED RESIDENTS QUESTIONNAIRE
1. Name VY � ; —!l I�' '1 C le � '�I
2. Street Address 2--3 �.�oasd 11 --S
3. How many members are in your household? 0�4--
4. What type of sewage disposal system do you have?
❑ cesspool
❑/septic tank and leaching area
R 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.
now 6. How old is your sewage disposal system? ❑ 0-5 years ❑ 6-10 years 11-20 years -
El over 20 years ❑ do not know
7. Has your sewage disposal system been rebuilt or repaired?
❑ yes ❑ no R 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 CK'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 V
roof/pavement drains showeribathtub
11. Please state the brand and type (liquid or powder) of detergent you use for:
dishwasher S u n L l' 9 h f"
clotheswasher V ; aAl
12. Does your property have a lawn? L9' 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:
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❑ Check here if your lawn is maintained by a professional landscape contractor.