HomeMy WebLinkAboutMiscellaneous - 30 JOHNSON CIRCLE 4/30/2018 (2)K)
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WATERSHED RESIDENTS QUESTIONNAIRE
1. Name PANIEL 12 /21519 -rl*
2. Street Address 0 '-rO 9A)�SQAJ
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
M 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?
Nt yes 0 no El do not know
6. How old is your sewage disposal system? El 0-5 years 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 El do not know
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If yes, approximately how long ago? — ars. What was done?
8. How frequently is your sewage disposal system pumped out? F-1 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? El yes [I 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 —I
dehumidifier drain — sump pump toilet
roof/pavement drains — showerlbathtub
11. Please state the brand and type (liquid or powder) of detergent you use for:
dishwasher — V,4 44),S
clotheswasher
12. Does your property have a lawn? yes El no
If yes, approximately what size?
El less than 1/4acre GK 'Aacre El %acre 0 3/4acre F-1, 1 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 ULa q .4
V 1)
14. Please state the brand and type (liquid or granular) of lawn fertilizer you use:
EE
1. NF-ne L24411FL' 1-21-- 46-17271
2. Street Address 3 Q C, 4
3. How many members are in your household?
4. What type of sewage disposal system do you have?
cesspool
septic tank and leaching area
connection to municipal sewer
17 other (describe)
7 do not know
5. Are the plans (drawings) for your sewage disposal system on file with the Board of Health?
X,, yes El no El do not know
6. How old is your sewage disposal system? El 0-5 years 6-10 years El 11-20 years
Ej_ over 20 years El do not know
Has your sewage disposal system been rebuilt or repaired?
yes El no F-1 do not know
jc;4�'-O'u 0/1f, P401��'('dj 6 t4 /"O'V
If yes, approximately how long ago? , ars. What was done?
How frequently is your sewage disposal system pumped out? El annually
0 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? El yes 0 no
1f 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 __L dishwasher __L_ garbage disposal
debumidifier drain sump pump toilet
rooll/pavement drains showeribathtub --_I-
11. Please state the brand and type (liquid or powder) of detergent you use for:
dishwasher — V4 4.'o,s
clotheswasher �AQ i,;,
12. Does your property have a lawn? IX yes El no
If yes, approximately what size?
F1 less than 1/4 acre 9 'Aacre El 1/2acre El %acre El acre
7-1 more than 1 acre (Specify) — acres
13. How often do you fertilize your lawn?
No. of applications per year
Season(s) of the year Slikiz,,
14. Please state the brand and type (liquid or granular) of lawn fertilizer you use:
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117 Check here if your lawn is maintained by a professional landscape contractor.