HomeMy WebLinkAboutMiscellaneous - 32 LISA LANE 4/30/2018 (2) U LIJA LMI'm
J210/098.A-0036-0000.0
WATERSHED RESIDENTS QUESTIONNAIRE
1. Name �� v� Gh JK ,/
2. Street Address _ 32— &.cfto L�
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
❑ other (describe)
❑ do not know
5. Are the plans (drawings) for your sewage disposal system on file with the Board of Health?
X yes ❑ no ❑ do not know
6. How old is your sewage disposal system? X _ 0-5 years ❑ 6-10 years ❑ 11-20 years
❑ over 20 years ❑ do not know
7. Has your sewage disposal system been rebuilt or repaired?
❑ yes ® 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
❑ every 2-4 years ❑ every 5-10 years, ❑ over 10 years X never
9. Have you had any problems with your sewage disposal system? ❑ yes l no
If yes, what problems?
❑ repeated pump-outs needed
❑ system clogs, backs up, or drains slowly
❑ odors
❑ sewage surfaces through ground
10. How many of each appliance are connected to your sewage disposal system?
washing machine I dishwasher garbage disposal O
dehumidifier drain sump pump toilet _
roof/pavement drains 0 shower/bathtub �-
11. Please state the brand and type (liquid or powder) of detergent you use for:
dishwasher
clotheswasher T i ip 61'
12. Does your property have a lawn? C"yes ❑ no
If yes, approximately what size?
❑ less than 1/4 acre [Z 1/4 acre % acre ❑ . 3/4 acre ❑ 1 acre
❑ 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
14. Please state the brand and type (liquid or granular) of lawn fertilizer you use:
( . - - - I J,
0 Check here if your lawn is maintained by a professional landscape contractor.
- D' -S QUES"IONNAT
ZLD IRE
1. Name
{� 2. Street Address + 1.
i
3. flow many members are in your household?
4. type of sewage disposal system do you have?
`I cesspool
septic tank and leaching area
connection to municipal sewer
other (describe)
do not know
5. Are the plans (drawings) for your sewage disposal system on file with the Board of Health? i
.; yes ❑ no ❑ do not know t
6. Flow old is your sewage disposal system? I] 0-5 years ❑ 6-10 years ❑ 11-20 years
❑ over 20 years ❑ do not know
7. 11as your sewage disposal system been rebuilt or repaired?
C. yes ® no ❑ do not know
yes, approximately how long ago? years. What was done?
1 8. How frequently is your sewage disposal system pumped out? ❑ annually
every 2-4 years ❑ every 5-10 years ❑ over 10 years ($1 never
9. i-lave you had any problems with your sewage disposal system? ❑ yes no
if yes, what problems?
❑ repeated pump-outs needed
❑ system clogs, backs up, or drains slowly
❑ odors
❑ sewage surfaces through ground
10. :low many of each appliance are connected to yqur sewage disposal system?
.washing machine I dishwasher garbage disposal O
c e'umidifier drain sump pump toilet
oof/pavement drains D shower/bathtub _
R. ''lease state the brand and type (liquid or powder) of detergent you use for: `
dishwasher CPAIC& If
_lotheswasher T 1'D
11. Does your property have a lawn? Pill yes ❑ no
f yes, approximately what yysize?
Jess than 1/4 acre LCI 1/4 acre 1/2 acre ❑ 3/4 acre ❑ 1 acre
more than 1 acre (Specify) acres
13. How often do you fertilize your lawn?
U� No. of applications per ear
Season(s) of the year
14. lease state the brand and type (liquid or granular) of lawn fertilizer you use:
En Check here€your lawn is maintained by a professional landscape contractor.