HomeMy WebLinkAboutMiscellaneous - 45 FRENCH FARM ROAD 4/30/2018 45 FRENCH FARM ROAD
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Board of Appeals — Board of Health — Planning Board — Conseruat on Commission — Building Department
WATERSHED RESIDENTS QUESTIONNAIRE
1. Name
2. Street Address
3. How many members are in your household?
4. What type of sewage disposal system do you have?
❑ cesspool
❑ septic tank and leaching area
Y 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 /L;I
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?
El yes �T' no ❑ do not know
If yes, approximately how long ago? years. What was done?
8. How frequently is your sewage disposal system pumped out?,;1 El 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 Q( 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 r garbage disposal
dehumidifier drain sump pump toilet _
roof/pavement drains (, shower/bathtub L_
11. Please state the brand and type (liquid or powder) of detergent you use for:
dishwashers
clotheswasher �` J
12. Does your property have a lawn? R' 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?
No. of applications per year
Season(s) of the year 5p
14. Please state the brand and type (liquid or granular) of lawn fertilizer you use:
S, 6_11PNV L/Vf7__
❑ Check here if your lawn is maintained by a professional landscape contractor.
t'�s � 17i °3:.L • �� 1� ` 0i``+vT4? t'1�
1. 114ar.r
2. Street Address r r' i/' ' % _ • '..`
3. Hfo-�- many members are in your household?
Z/
4. What type of sewage disposal system do you have?
.esspQol
C septic tank and leaching area
al sewer connection to municipal p
L other (describe)
❑ do not know
5. ire 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?�I� 0-5 years ❑ 6-10 years � ❑ 11-20 years
❑ over 20 years ❑ do not know
7. 1-1. ; Vaur sewage disposal system been rebuilt or repaired?
yes no ❑ do not know
If yes, approximately how long ago? years. What was done?
S. How frequently is your sewage disposal system pumped out? �/} Elannually
17 every 2-4 years Elevery 5-10 years Elover 1 years ❑ never
9. Have you had any problems with your sewage disposal system? ❑ yes no
`.' ves, what problems?
❑ repeated pump-outs needed
❑ system clogs, backs up, or drains slowly
❑ odors
❑ sewage surfaces through ground
10. i jov: many of each appjiance are connected to your sewage disposal system?
wa_sriiing machine / dishwasher , t garbage disposal
c,ehunli ;jfier drain 1 sump pump d toilet
rocJpavement drains G shower/bathtub L—
11. Ple ,,e state the'brand and type (liquid or powder) of detergent you use for:
hwasher Rc c.�,•
rloiheswasher -IT
12. ',,aoes your property have a lawn? yes ❑ no
If yes, approximately what size?
less than 1/4 acre El1/4 acre El1/2 acre 3/4 acre El 1 acre
❑ more than 1 acre (Specify) acres
13. :�oiv often do you fertilize your lawn?
No. of applications per year R J
Sc-zson(s) of the year
'S E
14. P ease state the brand and type (liquid or granular) of lawn fertilizer you use:
- ? -may t..;ilii.�, . i•_.�.
Ell;(cl: here if your lawn is maintained by a professional landscape contractor.