HomeMy WebLinkAboutMiscellaneous - 27 KIERAN ROAD 4/30/2018 (2)N
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'Plense forward us as much of the follow i.niz information that is possible;
1. Type of system
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2. A Q,e 1-� �
3, T:-�)ca t, i on 14,� C',
M,,iintenance records and date of last pumping out
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Documentation of repairs and reconstruction
6. Site conditions
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7. Biiilder of system
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8. Engineer who approved,
— Site
— System
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9. Installatilon Procedure
10. Problems
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SEPTIC SYSTEM INSPECTION FORM
ADDRESS
DATE INSPECTED g - % (o
PROPERLY FUNCTIONING? N
WEATHER CONDITIONS
COMMENTS:
W A Tl E: IZ aU A L I T Y TE S TiEb '?ft -R ES u LTS
DYE TEST PERFORMED? Y N
DATE?
SKETCH:
WATERSHED RESIDENTS QUESTIONNAIRE
1. Name
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2. Street Address 4V
3. How many members are in your household.?
4. What type of sewage disposal system do you have?
El cesspool
2' septic tank and leaching area
El connection to municipal sewer
[I other (describe)
El do not know
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5. Are the plans (drawings) for your sewage disposal system on file with the Board of Health?
Z' yes El no 0 do not know..
6. How old is your sewage disposal system? 0 0-5 years El 6-10 years 11-20 years.. --,--
El over 20 years El do not know
7. Has your sewage disposal system been rebuilt or repaired?
0 yes le -no El do not know
If yes, approximately how long ago?
years. What was done?
8. How frequently is your sewage disposal system pumped out? El annually
�0 21, every 2-4 years El every 5-10 years El over 10 years El never
9. Have you had any problems with your sewage disposal system? El yes Er no
If yes, what problems?
0 repeated pump -outs needed
El system clogs, backs up, or drains slowly
El odors
0 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 Ln
12. Does your property have a lawn? Z�yes El no
If yes, approximately what size?
El less than 'Aacre 0 1/4 acre 1/2 acre 0 3/4acre El 1 acre
El more than 1 acre (Specify) - acres
13. How often do you fertilize your lawn?
No. of applications per year IL
Season(s) of the year It
14. Please state the brand and type (liquid or granular) of lawn fertilizer you use:
_s' #' Iller
El Check here if your lawn is maintaine d by a professional landscape contractor.