HomeMy WebLinkAboutMiscellaneous - 380 BEAR HILL ROAD 4/30/2018a
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WATERSHED RESIDENTS QUESTIONNAIRE
1. Name ff-e� ',��,� S� Z
2. Street Address L1=f°% )4/4�
3. How many members are in your household?
4.
What type of sewage disposal system do you have?
❑ cesspool
❑ septic tank and leaching area
Vconnection to municipal sewer
❑ other (describe)
❑ do not know
5. Are the plans (drawings) for y ur sewage disposal system on file with the Board of Health?
El yes El no for
not know
Z"
6. How old is your sewage disposal system? En 0-5 years ❑ 6-10 years ❑ 11-20 years
❑ over 20 years ❑ do not know
7. Has your sewa disposal system been rebuilt or repaired?
Elyes 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 en
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 _
roof/pavement drains shower/bathtub
11. Please state the brad and type (11 aid or powder) of detergent you use for:
dishwasher
clotheswasher
12. Does your property have a lawn? yes ❑ no
If yes, approximately what size?
❑ less than 1/4 acre ❑ 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?
f No. of applications per year -
Season(s) of the year . t""
14. Please state the brand and type (liquid or granular) of lawn fertilizer you use:
0
❑ Check here if your lawn is maintained by a professional landscape contractor.
_RC ENT
2. Street Address_ -
3. How many members are in your household? y
4.
�Vlnat type of sewage disposal system do you have?
❑ cesspool
septic tank and leaching area
V connection to municipal sewer
❑ other (describe)
do not know
5. Are the plans (drawings) for y ur sewage disposal system on file with the Board of Health?
`] yes El no for
not know
6. H ow old is your sewage disposal system? K.""o-5 years ❑ 6-10 years ❑ 11-20 years
D; over 20 years ❑ do not know
7. Has your sewagoldisposal system been rebuilt or repaired?
❑ yes [ ' no ❑ do not know
If yes, approximately how long ago?
years. What was done?
S. Ii.ow frequently is your sewage disposal system pumped out? ❑ annually
❑ every 2-4 years ❑ every 5-10 years ❑ over 10 years Elnever
9. 131ave you had any problems with your sewage disposal system? ❑ yes eno
If yes, what problems?
❑ repeated pump -outs needed
❑ system clogs, backs up, or drains slowly
❑ odors
❑ sewage surfaces through ground
10. Hui^ many of each appliance are connected to your/
disposal system?
; -ashing machine dishwasher / garbage disposal
-ehumidifier drain sump pump toilet
roof/pavement drains shower/bathtub_
11. Pic ase state the bend type (li uid or powder) of detergent you use for:
dishwasher��-
elotheswasher
12. Does your property have a lawn? yes ❑ no
If yes, approximately what size?
❑ less than 1/4 acre ❑ 1/4 acre
❑ more than 1 acre (Specify)
�'/z acre El3/4 acre El1 acre
acres
1a. How often do you fertilize your lawn?
No. of applications per dear -3
Season(s) of the year \f ,�a - 1'�sn`%• �i'tc
14. P;'e se state the brand and type (liquid or granular) of lawn fertilizer you use:
ci- Dere if your lawn is maintained by a professional landscape contractor.