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WATERSHED RESIDENTS OUESTIONNAIRE
1. Name
2. Street Address
LY4�511 TP1161
0
3. How many members are in your
household?
4--
4. What type of sewage disposal system do you have?
�ce ool
ss '
eptic tank and leaching area
El connection to municipal sewer
El other (describe)
El do not know
5. Are the plans (drawings) for your sewage disposal system on file with the Board of Health?
El yes El no M.� �onot know
6. How old is your sewage disposal system? El 0-5 years 6-10 years Z�- �11-20 years
El over 20 years 0 do not know
7. Has your sewage d�jWsal system been rebuilt or repaired?
El yes L;--Ifio El do not know
If yes, approximately how long ago?
years. What was done?
8. How frequently is your sewage disposal system pumped out? 0�- �annually
El every 2-4 years [I every 5-10 years El over 10 years El never
9. Have you had any problems with your sewage disposal system? El yes Z,-�no
If yes, what problems?
El 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 67-
11. Please state the brand and tvpg (I d or powder) of detergent you use for:
dishwasher ___pEN 0 Ul-A-V - Zoi WV ��
clotheswasher DaIVOOLAS _Z /!;-,'Q/0
12. Does your property have a lawn? &-�yes F1 no
If yes, approximately what size? �3
El less than 'Aacre El 1/4 acre El %acre /4acre El 1 acre
0 more than 1 acre (Specify) — acres
13. How often do you fertilize your lawn?
No. of applications per year
Season(s) of the year S PA146C S
0 2--
14. Please state the brand and type (liquid or granular) of lawn fertilizer you use:
Z_n
&,-�heck here if your lawn is maintained by a professional landscape contractor.
i
�.