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HomeMy WebLinkAboutMiscellaneous - 41 BEAR HILL ROAD 4/30/2018 41 BEAR HILL ROAD 2101064.0.007&0000.0 Address �-ti 13�A y� ,�-,r �1,L �� Title of File Page 0-f Date File Open: Date file closed: aoc Document/Action Title Date of Refer to other Purpose of Documernt/Action and nates action Document/ documment/ N u m. Action De artment Board of Appeals — Board of Health — Plannii;ng Board — Con servation Commission ilding Departrnen7 G WATERSHED RESIDENTS QUESTIONNAIRE 1. Name1F?L'f hrI 2. Street Address i 3. How many members are in your household? 4. What type of sewage disposal system do you have? ❑ cesspool ❑ septic tank and leaching area KY 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? ❑ 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 vears ❑ over 10 years ❑ never i 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 __L_ dishwasher V garbage disposal dehumidifier drain sump pump toilet roof/pavement drains shower/bathtub 11. Please state the brand and.type (liquid or powder) of detergent you use for: dishwasher clotheswasher dcf s 12. Does your property have a lawp? U yes ❑ no If yes, approximately what size? ❑ less than 1/4 acre [V' 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? No. of applications peryear " Season(s) of the year -.-V=1 /Y1 4i r 14. Please state the brand and type (liquid or granular) of lawn fertilizer you use: elrL-i�; ©° Check here if your lawn is maintained by a professional landscape contractor. WATERSHED RESIDENTS QUESTIONNAIRE 1. Name 2. Street Address 3. How many members are in your household? 4. VVhat type of sewage disposal system do you have? ❑ cesspool i ❑ /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 ❑ 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 ❑ no ❑ do not know If yes, approximately how long ago? years. What was done? g. How frequently is your sewage disposal system pumped out? ❑ annually every 2-4 years ❑ every 5-10 years ❑ over 10 years ❑ never / 9. -lave you had any problems with your sewage disposal system? ❑ yes ® no t yes, what problems? ❑ repeated pump-outs needed ❑ system clogs, backs up, or drains slowly ❑ odors ❑ sewage surfaces through ground 10. Hv tv many of each appliagce are connected to your sewage disposal system? ' �f wa.shing machine ' dishwasher garbage disposal v i dehumidifier drain sump pump toilet roof/pavement.drains.. shower/bathtub ✓ 11. Please state the brand and-type (liquid or powder) of detergent you use for: Cisshwasher clotheswasher 4- P14"I'd A, Ci 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. fow often do you fertilize your lawn? k'c.. of applications per ear L<- ,easor►(s) of the year p-/F..:. �C- . `[ t J 14. >c,-a R state the brand and type (liquid or granular) of lawn fertilizer you use: PO t ;s 11 t. 1,...., ,.,.r -.«- 1 =� ,�,�.,�€eina.� ,x, ' -.rn€acQ;n,nad land rrnnfrartnr-