HomeMy WebLinkAboutMiscellaneous - 53 FRENCH FARM ROAD 4/30/2018 53 FRENCH FARM ROAD
210/035.0-0092-0000.0
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AAressC � Title of File Page of
Date File Open: Date file closed:
Doc Document/Action Title Date of Refer to other Purpose of Document/Action and notes:
action Document/ document/
Num. Action Department
Board of Appeals.— Board of Health — Planniing Board — Conservation Commission — Building Department
WATERSHE�Dj R/ESIDENT/S QUESTIONNAIRE
1. Name M12
2. Street Address c,53 1�z7, dhrM
lm 13,29.
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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
I17 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- , N,,4-f _
6. How old is your sewage disposal system? ❑ 0-5 years ❑ 6-10 years ❑ 11-20 years
❑ over 20 years ❑ do not know l,.. .
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 AP.
9. Have you had any problems with your sewage disposal system? ❑ yes Cg--'no
If yes, what problems?
❑ repeated pump-outs needed
❑ system clogs, backs up, or drains slowly
❑ odors /4%•
❑ 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
clotheswasher
12. Does your property have a lawn? li? yes ❑ no
If yes, approximately what size?
❑ less than 1/4 acre El 1/4 acre El1/2 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 -1 -
Season(s) of the year
14. Please state the brand and type (liquid or granular) of lawn fertilizer you use:
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❑ Check here if your lawn is maintained by a professional landscape contractor.