HomeMy WebLinkAboutMiscellaneous - 51 JOHNSON CIRCLE 4/30/2018 (2) 51 JOHNSON CIRCLE
210/097.0-0060-0000-0
WATERSHED RESIDENTS QUESTIONNAIRE
1. Name 1'/ChLf P Z�_ P 61 Cc.1 E__)�S
2. Street Address Q&::�Zf e// C //f C
3. How many members are in your household? 0/7/E-
4. What type of sewage disposal system do you have?
❑ cesspool
❑ septic tank and leaching area
Ill 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 JZ' 11-20 years _.
❑ over 20 years ❑ do not know j
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 years ❑ over 10 years ❑ never
9. Have you had any problems with your sewage disposal system? ❑ yes 01 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 _
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 Cff SC_A,-p F
clotheswasher 7-1,04--
12. Does your property have a lawn? lj�, yes ❑ no
If yes, approximately what size?
If
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? .3
No. of applications per year
Season(s) of the year S ��l �� G S�✓ 1,,, rn c!c
14. Please state the brand and type (liquid or granular) of lawn fertilizer you use:
S c G �-7 S r i F19 n V4- rte)
❑ Check here if your lawn is maintained by a professional landscape contractor.
WATERSHED RESIDENTS QUESTIONNAIRE
1. Name / C H ��� S -Z 6b N 0/
2. Street Address :YG N S a1-4 c YZ CL
3. How many members are in your household? Z
4. What type of sewage disposal system do you have?
❑ cesspool
❑ septic tank and leaching area
P�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?
N/A ❑ yes ❑ no ❑ do not know-
6. How old is your sewage disposal system? ❑ 0-5 years ❑ 6-10 years ❑ 11-20 years _
M/A ❑ over 20 years ❑ do not know
7. Has your sewage disposal system been rebuilt or repaired?
HIA ❑ yes ❑ no ❑ do not know
If yes, approximately how long ago? years. What was done?
N)A
8. How frequently is your sewage disposal system pumped out? ❑ annually
H/A ❑ every 2-4 years ❑ every 5-10 years ❑ over 10 years ❑ never
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 I dishwasher l_ garbage disposal t
dehumidifier drain sump pump toilet Z
roof/pavement drains shower/bathtub
11. Please state the brand and type (liquid or powder) of detergent you use for:
dishwasher La,SOADS 02 5\3Q\-AAY1 aCiaD�R
clotheswasher 2 0\10 K R - A Qm t \MA Svmnk: O9- F
12. Does your property have a lawn? yes ❑ no
If yes, approximately what size?
&?' less than 1/4 acre ❑ '/4 acre ❑ % 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 S? Svc M-0,
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.