HomeMy WebLinkAboutMiscellaneous - 47 SUTTON HILL ROAD 4/30/2018 47 SUTTON HILL ROAD id
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RESID T QUESTIONNAIRE
1. Name a-
2. Street Address
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3. How many members are in your household?
4. What type of sewage disposal system do you have?
❑ cesspool
❑ septic tank and leaching area
connection to municipal sewer
❑ other (describe)
❑ do not know
5. Are the plans (drawings) for your sewage disposalsystem on file with the Board of Health?
[I yes El no EJ do
do not know I
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6. How old is your sewage disposal system? ❑ 0-5 years ❑ 6-10 years ❑ 11-20 years
❑ over 20 years ❑ do not know /1
7. Has your sewage disposal system been rebuilt or repaired?
❑ yes El no F1 do not know J],�
If yes, approximately how long ago? Iyears. 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 ❑ nevkd/h
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9. Have you had any problems with your sewage disposal s stem? ❑ yes ❑ no
If yes, what problems?
❑ repeated pump-outs needed 6�
❑ 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 -a�-
11. Please state the an and type (liquid or powder) of detergent you use for:
dishwasher
clotheswasher
12. Does your property have a lawn? V-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 law ?
No. of applications perear.
Season(s) of the year v%
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
rtTIONNAIRE
2. Street Address
3. I.-low many members are in your household?
f�
4. `v 'hat type of sewage disposal system do you have?
C E'sspool
septic tank and leaching area
connection to municipal sewer
❑ other (describe)
❑ do not know
5. A re the plans'(drawings) for your sewage disposal sys em on file with the Board of Health?
❑ yes O no ❑ do not know }
t
6. H ow old is your sewage disposal system? ❑ 0-5 years ❑ 6-10 years ❑ 11-20 years
❑ over 20 years ❑ do not know (�
f-1
7. Has your sewage disposal system been rebuilt or re aired?:
❑ yes ❑ no ❑ do not know
If yes, approximately how long ago? years. What was done?
r
S. How frequently is your sewage disposal system pumped out? ❑ annually
❑ every 2-4 years ❑ every 5-10 years ❑ over 10 years ❑ ne
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9. Have you had any problems with your sewage disposal s stem? ❑ 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 I
dehumidifier drain sump pump toilet
—
roof/pavement drains shower/bathtub J_
11. Please state theerno and typ (liquid or powder) of detergent you use for:
dishwasher L
clotheswasher
12. Does your property have a lawn? ryes ❑ 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 law ?
No. of applications per ear
Season(s) of the year
14. Blease 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.