HomeMy WebLinkAboutMiscellaneous - 29 BEAR HILL ROAD 4/30/2018N
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17 -SHED 1 65 QUESTiONNAIRE
1. Nime OL P 24 R E
2. Street Address A b
3. How many members are in your household?
4. What type of sewage disposal system do you have?
El cesspool
0 septic tank and leaching area
IWI-`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?
D yes F1 no [�� do not know
6. How old is your sewage disposal system? [j?"' 0-5 years El 6-10 years El 11-20 years
El over 20 years El do not know
7. Has your sewage disposal system been rebuilt or repaired?
El yes El no ELI 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
Ll every 2-4 years El every 5-10 years El over 10 years El never
9. "iave you had any problems with your sewage disposal system? El yes U/ no
f yes, what problems?
El repeated pump -outs needed
El system clogs, backs up, or drains slowly
El odors
El sewage surfaces through ground
10. many of each appliance are connected to your sewage disposal system?
VI-lastung machine (J) dishwasher f garbage disposal
sump pump toilet
arnidifier drain —
f/pavement drains shower/bAhtub
11. Nease state th� brand and type (liquid or powder) of detergent you use for:
ef-chwasher
cletheswasher
12. ljoes your property have a lawn? yes no
yes, approximately what size? 113 ej'<.'t'U
less than 'Aacre 1�1/ 1/4 acre El 1/2acre El 3/4acre acre
more than I acre (Specify) — acres
13. f.ov-.7 often do you fertilize your lawn?
T o. of applications per year =4,,,* � a-- --j
en�sor.(s) c;f the year
14. lkc;-se EtatE the brand and type (liquid or granular) of lawn fertilizer you use:
hero if your lawn is maintained. by a professional landsca e contractor.
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WATERSHED RESIDENTS QUESTIONNAIRE
1. Name �4,,q leQ) Y 4 / Al ga ? /I /'� E
2. Street Address A
3. How many members are in your household?
4. What type of sewage disposal system do you have?
El cesspool
El septic tank and leaching area
E�,`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 L] no [;?- do not know
6. How old is your sewage disposal system? 0-5 years E] 6-10 years El 11-20 years
L1 over 20 years El do not know
7. Has your sewage disposal system been rebuilt or repaired?
E] yes El no D/ do not know
If yes, approximately how long ago? — years. What was done?
8. How frequently is your sewage disposal system pumped out? LJ annually
El every 2-4 years F-1 every 5-10 years El over 10 years E] never
9. Have you had any problems with your sewage disposal system? El yes no
If yes, what problems?
El 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 6", (1) garbage disposal
dehumidifier drain sump pump — toilet 0
roof/pavement drains shower/bathtub -1-
11. Please state the brand and type (liquid or powder) of detergent you use, for:
dishwasher
clotheswasher /Tz�� 0
12. Does your property have a lawn? Ell -yes El no
If yes, approximately what size? , t,'�,30-*Vv
El less than 'Aacre [2' 1/4 acre 0 1/2 acre F-1 3/4 acre E] acre
El more than 1 acre (Specify) — acres
13. How often do you fertilize your lawn?
No. of applications per year a,
Season(s) of the year
14. Please state the brand and type (liquid or granular) of lawn fertilizer you use:
— - _ "� - " ) — _'/_ I - . — f -P - . -
t El Check here if your lawn is maintained by a professional landscape contractor.