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HomeMy WebLinkAboutMiscellaneous - 33 FRENCH FARM ROAD 4/30/2018G 4-- 0 I WTT V, LL T3 O U Q) 0 A U- 4- 0 - 4— O (1) • I }r f 8 I m }_0 V Q i W E O © I w o � 4 ' o ' a. L 1 7 i d c c t O � O !a rx EAG Z3 ® C C .f C a C w y O C i a o 'G a rOGQ _ c �a c m i= v c o_ n n Q � a w o 414 E o m U O D C 0 (a Z WATERSHED RESIDENTS QUESTIONNAIRE 1. Name t,� ate- nri. � �•� << �S r 2. Street Address 33 +�='��►� `�"��������� 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? ❑ yes ❑ no C9 do not know 6. How old is your sewage disposal system? [✓]`• 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 Y 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 ❑ never 9. Have you had any problems with your sewage disposal system? ❑ yes P' 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 dishwasher 1 garbage disposal dehumidifier drain sump pump toilet roof/pavement drains showeribathtub _,_ 11. Please state the brand and type (liquid or powder) of detergent you use for: dishwasher Ps P� .: � ��a► ciotheswasher 12. Does your property have a lawn? [J1 yes If yes, approximately what size? / ❑ less than 1/4 acre ❑ 1/4 acre �a ❑ more than 1 acre (Specify) acres 13. How often do you fertilize your lawn? i No. of applications per year t— Season(s) of the year Ni–i-- ❑ no 1/2 acre ❑ 3/4 acre ❑ 1 acre 14. Please state the brand and type (liquid or granular) of lawn fertilizer you use: 1�Gtha.At�l� Q Check here if your lawn is maintained by a professional landscape contractor. C 2. Stref•t Address 3. FLcv,7 many members are in your household? 4. 'V h? type of sewage disposal system do you have? ❑ ' esspool [, . s:r.t3tic tank and leaching area [_ c r•anection to municipal sewer ier (describe) not know 5. A~; :x.e plans (drawings) for your sewage disposal system on file with the Board of Health? [, Ve3s ❑ no C do not know 6. h. i - old is your sewage disposal system? V" 0-5 years ❑ 6-10 years ❑ 11-20 years F, aver 20 years ❑ do not know 7. I l . s your sewage disposal system been rebuilt or repaired? ❑ yes no ❑ do not know If I -cu, approximately how long ago? years. What was done? 8. Htlw frequently is your sewage disposal system pumped out? ❑ annually D every 2-4 years ❑ every 5-10 years ❑ over 10 years ❑ never 9. Hl ewe you had any problems with your sewage disposal system? ❑ yes ►R no if s, what problems? ❑ repeated pump -outs needed ❑ system clogs, backs up, or drains slowly ❑ odors ❑ sewage surfaces through ground 10. 1--'o v.- many of each appliance are connected to your sewage disposal system? v, _=4',ing machine ✓ dishwasher ✓ garbage disposal d _i,u,nidifier drain sump pump toilet `pavement drains shower/bathtub 11. Pease state the brand and type (liquid or powder) of detergent you use for: d:s i -,,usher t(IeL I ^� cl^nheswasher 12. '. = your property have a lawn? yes yes, approximately what size? less than 1/4 acre ❑ '/a acre more than 1 acre (Specify) acres 13. i= w often do you fertilize your lawn? applications per year zscn(s) of the year ��-�- ❑ no '/z acre ❑ 3/4 acre ❑ 1 acre 14. . Er a stz to the brand and type (liquid or granular) of lawn fertilizer you use: t \. { \_ '.. ;!- here if your lawn is maintained by a professional landscape contractor.