HomeMy WebLinkAboutMiscellaneous - 337 MARBLERIDGE ROAD 4/30/2018E.
WATERSHED RESIDENTS QUESTIONNAIRE
1. Name �, / K
a 2. Street Address
O3. How many members are in your household?
4. What type of sewage disposal system do you have?
❑ cesspool
❑ septic tank and leaching area
D4 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 ❑ do not know...
6. How old is your sewage disposal system? V" 0-5 years ❑ 6-10 years ❑ 11-20 years
❑ over 20 years ❑ do not knov�,/
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 ❑ never
9. Have 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. How many of each appliance are connected to your sewage disposal system? .,
washing machine dishwasher garbage disposal
dehumidifier drain sump pump toilet -3
roof/pavement drains shower/bathtub
11. Please state the brand and a (Ii uid or powder) of detergent you use for:
�-I
dishwasher CA ®
clotheswasher 4/i -5,k
12. Does your property have a lawn? yes ❑ no
If yes, approximately what size?
❑ less than 1/4 acre A 1/4 acre ❑ 1/z acre ❑
❑ more than 1 acre (Specify) acres
13. How often do you fertilize your lawn?
No. of applications per year
OSeason(s) of the year
3/4 acre ❑ 1 acre
14. Please state the brand and type (liquid or granular) of lawn fertilizer you use:
Check here if your lawn is maintained by a professional landscape contractor. 1