HomeMy WebLinkAboutMiscellaneous - 280 SALEM STREET 4/30/2018 (2)C.0 00
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WATERSHED RESIDENTS QUESTIONNAIRE
1. Name h;;-Av1 I? Vlkh.5
2. Street Address 7-M SA1;:M Gr
3. How many members are in your household?
4.
What type of sewage disposal system do you have?
kcesspool
El septic tank and leaching area
F-1 connection to municipal sewer
El other (describe)
El do not know
5. Are the plans (drawings) fo our sewage disposal system on file with the i0ard of Health?
[I yes El no Wy do not know
6. How old is your sewage disposal system? El 0-5 years El 6-10 years El 11-20 years
F-1 over 20 years jKdo not know
7. Has your sewage disposal system been rebuilt or repaired?
0 yes I El 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
E every 2-4 years El every 5-10 years El over 10 years never
9. Have you had any problems with your sewage disposal system? yes El no
If yes, what problems?
9 repeated pump -outs needed
El system clogs, backs up, or drains slowly
7 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 _Y_
11. Please state the brand and type (liquid or powder) of detergent you use for:
dishwasher
clotheswasher
12. Does your property have a lawn?
If yes, approximately what size?
F� less than 1/4 acre K 1/4 acre
0 more than 1 acre (Specify) —
13. How often do you fertilize your lawn?
o No. of applications per year — 0
Season(s). of the year to
X yes El no
El 1/2acre El 3/4acre El 1 acre
acres
14. Please state the brand and type (liquid or granular) of lawn fertilizer you use:
El Check here if your lawn is maintained by a professional landscape contractor.
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WATERSHED RESIDENTS QUESTIONNAIRE
P kloe ILS
2. Street Address ZM SAkM
3. How many members are in your household7
4. What type of sewage disposal system do you have?
cesspool
septic tank and leaching area
connection to municipal sewer
other (describe)
El do not know
V
5. Are the plans (drawings fo your sewage disposal system on file with the Board of Health?
El yes D no do not know
6. How old is your sewage jiposal system? El 0-5 years El 6-10years 11-20 years
El over 20 years do not know
7. Has your sewage disposal system been rebuilt or. repaired.?
El yes El 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
El every 2-4 years El every 5-10 years El over 10 years never
9. Have you had any problems with your sewage disposal system . ? JK yes El no
-If yes, what problems?
Aw/
repeated pump -outs needed
El system clogs, backs up, or drains slowly
El odors
El 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 ::Y,
11. , Please state the brand and type (liquid or powder) of detergent you use for:
dishwasher
clotheswasher
121. Does your property have a lawn? yes El no
If yes, approximately what size?
El less than V4 acre 1/4 acre EJ 1/2 acre El 3/4 acre El 1 acre
El more than 1 acre (Specify) - acres
.13. How often do you fertilize your lawn?
No. of applications per year 0
Season(s) of the year 0
14. Please state the brand and type (liquid or granular) of lawn fertilizer you use:
El Check here if your lawn is maintained by a professional landscape contractor.