HomeMy WebLinkAboutMiscellaneous - 292 SALEM STREET 4/30/2018 (2)0
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Please forward us as much of the followIng. information that is possible;
1. Type of system
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2. A,!ze
3. Location,
4- Maintenance records and date Of last pumping out
771,
Documentation of repairs an
d reconstruction
6. Site conditions
7. Builder of system
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8* Enzineer who approved;
—Site
M .9
— System J- rell 49 'f4'
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9. Installation Proced-ure
1.0. Problems
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WATERSHED RESIDENTS QUESTIONNAIRE
1. Name
2. Street Address
IWATMARM
3. How many members are in your household?
4.
What type of sewage disposal system do you have?
El cesspool
septic tank and leaching area
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 Board of Health?
El yes EJ no 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 do not know
7. Has your sewag� disposal system been rebuilt or repaired?
0 yes _NK 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? E] annually
El every 2-4 years every 5-10 ye ars El over 10 years ;<never
9.
Have you had any problems with your sewage disposal system? yes no
If yes, what problems?
El repeated pump -outs needed
El system clogs, backs up, or drains slowly
[I odors
El sewage surfaces through ground
10.
How many of each appliance are connected to your sewage disposal system?
10100e,_
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 At ETZ,
clotheswasher X�E4 a /Q'1� e R'__
12.
Does your property have a lawn? e s El no
If yes, approximately what size?
Z0003/
D less than 1/4 acre El 1/4 acre 1/2acre 4 acre El 1 acre
more than 1 acre (Specify) - acres
13.
How often do you fertilize you I n?
No. of applications per year 'd'M tv
Season(s) of the
year
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.