HomeMy WebLinkAboutMiscellaneous - 361 MARBLERIDGE ROAD 4/30/2018r
s
0
0
w
PO
Q
0
0
0
6
0
0
0
0
L
SEPTIC SYSTEM INSPECTION FORM
ADDRESS Q Q � 04
DATE INSPECTED
PROPERLY FUNCTIONING? N
WEATHER CONDITIONS
COMMENTS:
WA E- P, 4Z;ALILi��
DYE TEST PERFORMED? Y N
DATE?
SKETCi:
WATERSHED RESIDENTS QUESTIONNAIRE
1. Name
2. Street Address 3 G � M P�cRb LF I? -S G E
3. How many members are in your household? 3
4.
What type of sewage disposal system do you have?
❑ cesspool
❑ aseptic 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 ❑ do not know'-" t-�/#, -,
6. How old is your sewage disposal system? er"o-5 years ❑ 6-10 years ❑ 11-20 years`
❑ over 20 years ❑ do not know
7. Has your sewlage disposal system been rebuilt or repaired?
ElL
yes [kno ❑ do not know
If yes, approximately how long ago? years. What was done?
8. How frequently is your sewage disposal system pumped out? ❑ annually Nii/�►
El every 2-4 years El every 5-10 years El over 10 years El never
_ ce'''
9. Have you had any problems with your sewage disposal system? Elyes [+ no
Ifyes, 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 1 dishwasher garbage disposal I
dehumidifier drain O sump pump _1L_ toilet
roof/pavement drains o shower/bathtub —_
11. Please state the brand and type (liquid or powder) of detergent you use for:
dishwasher
clotheswasher S e -h- -S 6le_A'� _D
12. Does your property have a lawn? N yes ❑ no
If yes, approximately whatsi e?
❑ less than 1/4 acre 1/4 acre ❑ 1/2 acre ❑ 3/4 acre ❑ 1 acre
❑ more than 1 acre (Specify) acres
r 13. How often do you fertilize your lawn?
O No. of applications per year
Season(s) of the year
14. Please state the brand and type (liquid or granular) of lawn fertilizer you use:
V
Check here if your lawn is maintained by a professional landscape contractor.