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HomeMy WebLinkAboutMiscellaneous - 67 GLENNCREST DRIVE 4/30/2018 67 GLENNCREST DRIVE e 210/104.C-0053-0000.0 Form No.4 Town of North Andover, Massachusetts BOARD OF HEALTH November 6 19 97 CERTIFICATE OF COMPLIANCE This is to certify that the Individual Soil Absorption Sewage Disposal System constructed ( ) or repaired (X ) D— Box Only I by Tnaa Bateson r INSTALLER at 191 F LOCA has been installed in accordance with Board of Health Regulations as described in the Design Approval Site System Permit No. NSA dated 19 . The issuance of this certificate shall not be construed as a guarantee that the system will function satisfactorily. BOARD OF HE)TETH i Address A(c_k s Ok 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 — Planaing Board — Conservation Commission — Building Department ClIx COMMOMArEALTH OF MASSACIiL;SETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS �--� DEPARTMEIT OF ENVIRONMENTAL PROTECTION ONE HINTER STREET. BOSTON. NIA 02108 61-t-292-5500 WILLIAM F.WELD TRUDY CORE Saretan• Govemo: ARGEO PAUL CELLUCCI DAVID B.STRUHS Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioner PART A /�1y _,j'CERTIFICATI(O�NN Property Address:(O / �� POV "" ( gess of Owner: Date of Inspection: 4C7 7 Of different) Name of Inspector: 1 am a D ppr ved system inspeqtor pursuant to 1S.340 of Title 5 (310 CMR.15.000) Company Name: Mailing Address: L Telephone Number: t _ L4-7 Ar6; CERTIFICATION STATEMENT 1 certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete*as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: pa onditionally Passes N s Fu her Evaluation By the Local Approving Authority Inspector's Signature: - i Date: 10 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 go or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the'system owner and copies sent to the buyer, if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, or A] SYSTEM PASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined.in 310 CMR 15.303. Any failure criteria not evaluated are indicated below. COMMENTS: 81 SYSTEM CONDITIONALLY PASSES: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the repll5merll-.Qr repair, as approveo by the Board of Health, will Indicate yes, no, or not determined (Y, N,or ND). Describe basis of detetmina ion in all instances. If"not determined, explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty(20)years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. A. (revised 04/2S/97) Page I of 10 DEP on the World Wide Web: httpJhvww.rnsg, ltate.ma.usldep >d Printed on Recycled Paper SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A y . CERTIFICATION (continued) Property Address: /JO Owner: ^- CJI�cWes-- /` At V)C Date of Inspection: 61 SYSTEM CONDITIONALLY PASSES(continued) .__ Sewage backup or breakout or high static'water level observed in the distribution box is due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. The system will pass inspection if(with approval of the Board of Health). Describe observations: broken pipe(s) are replaced obstruction is removed distribution box is le.veiled or replaced _ The system required pumping more than four times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s) are replaced obstruction is removed C1 FURTHER EVALUATION IS REQUIRED BY THE BOARD OF HEALTH: Conditions exist which require further evaluation by.the Board of Health in order to determine if the system is failing to protect the public health, safety and the environment. 1) SYSTEM WILL,PASS UNLESS BOARD OF HEALTH DETERMINES THAT THt SYSTEM IS NOT FUNCTIONING IN A MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ Cesspool or privy is within 50 feet of a•surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh. 2) SYSTEM WILL FAIL UNLESS THE BOARD-OF HEALTH (AND PUBLIC WATER SUPPLIER, IF APPROPRIATE) DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECTS THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT: _ The system has a septic tank and soil absorption system (SIS)and the SAS is within 100 feet to a surface water supply or tributary to a surface water supply. _ The system has a septic tank and soil absorption system and the SAS is within a Zone I of a public water supply well. _ The system has a septic tank and soil absorption system and the SAS is within 50 feet of a private watei supply well. The system has a septic tank and soil absorption system and the SAS is less than 100 feet but 50 feet or more from a private water supply well, unless a well water analysis for coliform bacteria and volatile organic 'compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm. Method used to determine distance (approximation.not valid). 3) OTHER (revised 04/29/97) Page 2 of 20 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address:, I 6�"Cx �$ - lb(—�r'�`1 Owner: l�^a1" Date of Inspection: ��^ I 9r7 DJ SYSTEM FAILS: You must indicate either "Yes"or"No" as to each of the following: I have determined that the system violates one or more of the following failure criteria as defined in 310 CMR 15.303. The basis for this determination is identified below. The Board of Health should be contacted to determine what will be necessary to correct the failure. Yes No _ Backup of sewage into facility or system component due to an overloaded or clogged SAS or cesspool. Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool. _ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool. liquid depth in cesspool is less than 6"below invert or available volume is less than 1/2 day flow. Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. Any portion of the Soil Absorption System, cesspool or privy is below the high groundwater elevation. f Any.portion of a cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. _ Any portion of a cesspool or privy is within a Zone I of a public well. Any portion of a cesspool or privy is within 50 feet of a private water supply well. Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. If the well has been analyzed to be acceptable, attach copy of well water analysis for coliiorm bacteria, volatile organic compounds, ammonia nitrogen and nitrate nitrogen. El LARGE SYSTEM FAILS: You must indicate either "Yes" or"No" as to each of the following: The following criteria apply to large systems in addition to the criteria above: The system serves a facility with a design flow of 10,000 gpd or greater (Large System)and the system is a significant threat to public health and safety and the environment because one or more of the following conditions exist: Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area-IWPA)or a mapped Zone'll of a public water supply well) The owner or operator of any such system shall bring the system and facility into full compliance with the groundwater treatment program requirements of 314 CMR 5.00 and 6.00. Please consult the local regional office of the Department for further information. (rovittd 04/25/97) Pana 3 of 16 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: Owner: cG^'�`Q,,M.,( /��A�n�t�J� \ � /T v l Date of Inspection: �" Check if the following have been done: You must indicate either"Yes"or"No"as to each of the following: Yes o Pumping information was provided by the owner, occupant, or Board of Health. None of the system components have been pumped for at least two weeks and the system has been receiving normal flow rates during that period. Large volumes of water have not been introduced into the system recently or p� as part of this inspection. As built plans have been obtained and examined. Note if they are not available with N/A. The facility or dwelling was inspected for signs of sewage back-up. The system does not receive non-sanitary or industrial waste flow. The site was inspected for signs of breakout. _ All system components, excluding the Soil Absorption System, have been located on the site. The septic tank manholes were uncovered, opened, and the interior of the septic tank was inspected for condition of baffles or tees, material of construction, dimensions, depth of liquid,depth of sludge,depth of scum. The.size and location of the Soil Absorption System on the site has been determined based on: The facility owner (and occupants, if different from owner) were provided with information on the proper maintenance of Sub-Surface Disposal System. Existing information. Ex. Plan at B.O.H. Determined in the field (if any of the failure criteria related to Part C is at issue, approximation of distance is unacceptable) [15.302(3)(b)) k. (zaviaed 04/25/97) Page 4 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C ' J SYSTEM INFORMATION Property Address:�p Owner: Inspection. : Date of `^ -9r7 FLOW CONDITIONS RESIDENTIAL• Design flow: J Q.p.dJbedroom for S.A.S. Number of bedrooms:-1— Number edrooms:Number of current residents: _._/ Garbage grinder (yes or no):WO Laundry connected to s1' em (yes or no):, Seasonal use (yes or no):'=V VIA,Water meter readings, if v ilable (last two (2)year usage (gpd): Sump Pump (yes or no): Last date of occupancy: COMMERCIAUI NDUSTRIAL: Type of establishment: Design flow: gallons/day Grease trap present: (yes or no)_ Industrial Waste Holding Tank present: lyes or no)_ Non-sanitary waste discharged to the Title i system: (yes or no)_, Water meter readings, if available: Last date of occupancy: . OTHER: (Describe) Last date of occupancy: GENERAL INFORMATION PUMPING RECORDS and source of information: System pumped as part of inspection: (yes or no) If yes, volume pum It�0 �lioni�- - '- Reason for pumping:i K-MC� l - TYPE OF STEM Septic tank/distribution box/soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes,attach previous inspection records, if any) VA Technology etc. Copy of up to date contracts' Other APPROXIMATE AGE of all components, date installed (if known)and source of information: -�, s D Sewage odors detected when arriving at the site: (yes or no), (revised 04/33/97) Digi 3 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: &q bc- AjQ(tW ✓-Q� Owner: Date of Inspection: BUILDING SEWER: (Locate on site plan) 1 Depth below grade: Material of construction: �iron_40 PVC_other (explain) Distance from private water supply well or suction hr-e Diameter 4 It Comments: I nditi n of'oinu, venting, evidence of leakage, etc.) �-es' SEPTIC TANK:.. (locate on site plan) Depth below grade: "' Material of construction: _ on�crete _metal _Fiberglass _Polyethylene _other(explain) If tank is metal, list age_ is age confirmed by Certificate of Compliance _(Yes/No) Dimensions: r K 4•(� a 3, 1 Y (3)a 4 Sludge depth: (r Distance from top of trudge to bottom of outlet tee or baffle: vAd Scum thickness:_ t( Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bott m f utlet tee or baffle: i C �—\ ` 0 How dimensions were determined: u � ' A Comments: (recommendation for pumping, cond( f inle and o tle s or ba es, de h of liq 'd level in rel ion t out( invert, ictegrity, evidence of leakage, etc. vIm— rU t �Vf U.zt '�v1 !Rilt�T RAP (locate on site plan) Depth below grade: Material of construction: _concrete _metal _Fiberglass _Polyethylene _other(explain) Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments: (recommendation for pumping, condition of inlet and outlet tees or baffles, depth of liquid level in relation to outlet invert,structural integrity, evidence of leakage, etc.) (revised 04/2S/97) Paye 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: Owner: �..t�• �–�i OUr��a V1Q Date of Inspection: TIGHT OR HOLDING TANK: (Tank must be pumped prior to, or at time, of inspection) (locate on site plan) Depth below grade: Material of construction: _concrete _metal Fiberglass _Polyethylene other(explain) Dimensions: Capacity:_gallons Design flow: gallons/day Alarm level: Alarm in working order Yes; _ No Date of previous pumping: Comments: (condition of inlet tee, condition of alarm and float switches, etc.) DISTRIBUTION BOX:_v (locate on site plan) ,(� _ 1 b� invert: 6u .— --3�rJ l�1 Depth of liquid levet above outlet e Comments: (n ifkvel and distribution is ual, vidence ofsolid rry er, evidence of lea ge into or outf bo etcuct .) > > 1 a PUMP CHAMBER:Nie -�((�u v SL ��M" (locate on site plan) v Pumps in working order: (Yes or No) Alarms in working order(Yes or No) Comments: (note condition of pump chamber, condition of pumps and appurtenances, etc.) (zavisad 04/25/97) Page 1 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address:6 1"' .� Owner. RL Max-ked AMY\c, R�`C© Date of Inspection. 0 —!-:30-97 SOIL ABSORPTION SYSTEM (SAS): (locate on site plan, if possible; excavation dot required, but may be approximated by non-intrusive methods) If not determined to be present, explain: Type: leaching pits, number._ leaching chambers, number: leaching galleries, number: �g leaching trenches, number,length: leaching fields, number, dimensions: overflow cesspool, number: Alternative system: Name of Technology: Comments: (note condition f soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) CESSPOOLS: Vllc� (locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater: inflow (cesspool must be pumped as part of inspection) Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.) PRIVY: �t? (locate on she plan) Materials of construction: Dimensions: Depth of solids: Comments: (note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation,etc.) F� (revised 04/25/97) Page 6 of 10 SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: �j �� � Or I v "Uac Owner: /� _ o Date of Inspection: �-�/ ��" `''eS \ (i r Icy —3o--9h SKETCH OF SEWAGE DISPOSAL SYSTEM: include ties to at least two permanent references landmarks or benchmarks locate all wells within 100' (Locate where public water supply comes into house) 0ckvt WAAI� A- as e " a = 3k"111 11 If 13 If 3 = a� `q ►f A. (revised 04/25/97) Page 9 of 10 • SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: ( `�^�� � Owner: Date of Inspection: Depth to Groundwater oQ Feet Please indicate all the methods used to determine High Groundwater Elevation: Obtained from Design Plans on record . L,-—Observation of Site (Abutting property, observation hole, basement sump etc.) Determine it from local conditions i,l Check with local Board of health Check FEMA Maps Check pumping records Check local excavators, installers Use USGS Data Describe in your own words how you established the High Groundwater Elevation. (Must be completed) r (revised 04/25/97) Paye 10 of 10 TEL: (508) 475-1474 a FAX: (508) 475-5451 > Q ATESON ENTERPRISESt INC. Excavating-Water&Sewer.Lines-Septic Systems & Pumping Service 1 11 Argilla Road Andover, Mass. 01810 Title 5 Inspection Report Property Address: ��-��-������ C kCLAj eS /)�A V\Q Owner : ----------------------------- Date Of Inspection : ------- My report contained herein does not constitute a guarantee of future usage and the functionality of the existing septic system. Such report issued herewith is merely based upon my observations , and I hereby disclaim any further operation current se of your c tic system. p Y P Neil J. Bateson Bateson Enterprises Inc. f,. 11 of 11 ti COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET. BOSTON. 61A 02108 617-292-5500 WILLIAM F.WELD TRUDY COXE Govemo: Secretary ARGEO PAUL CELLUCCI DAVID B.STRUHS Lt.Governor SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM Commissioner PART A y CERTIFICATION Property Address: of Owner. Date of Inspection: ttt` Of different) Name of Inspector: K �SO� I am a 139=1yed system ins ecto pursuant to Section 15.340 of Title 5 (310 CMR.1S.000) Company Name: Mailing Address: A'%% 1 �( ,OlQ'IV Telephone Number: _ CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete*as of the time of inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on-site sewage disposal systems. The system: ' asses Conditionally Passes Needl Furthjr Evaluation By the Local Approving Authority _ jFils �^r-� Inspector's Signature: Date: Ste` , / The System Inspector s aI submit a copy of this,inspection report to the Approving Authority within thirty(30)days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the Department of Environmental Protection. The original should be sent to the system owner and copies sent to the buyerr if applicable, and the approving authority. INSPECTION SUMMARY: Check A, B, C, or D: AI SYSTE ASSES: I have not found any information which indicates that the system violates any of the failure criteria as defined in 310 CMR 15.303. Any failure cri eria not evaluated a(� m i��ted below. 1�G COMMENTS: vk-<�:t�U F Aauj O a BI SYSTEM CONDITIONALLY PASSES: One or more system components as described in the "Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Indicate yes, no, or not determined (Y, N, or ND). Describe basis of determination in all instances. If"not determined", explain why not. The septic tank is metal, unless the owner or operator has provided the system inspector with a copy of a Certificate of Compliance (attached) indicating that the tank was installed within twenty (20) years prior to the date of the inspection; or the septic tank, whether or not metal, is cracked, structurally unsound, shows substantial infiltration or exfiltration, or tank failure is imminent. The system will pass inspection if the existing septic tank is replaced with a conforming septic tank as approved by the Board of Health. (revised 04/25/97) Page 1 of 10 DEP on the World Me Web: http:/hvww.mapnet.stete.me.ualdep >� Primed on Recycled Paper Form No.4 Town of North Andover, Massachusetts BOARD OF HEALTH - November 6 19 97 CERTIFICATE OF COMPLIANCE This is to certify that the Individual Soil Absorption Sewage Disposal System constructed ( ) or Xd repaired p (X) by D— Box Only at i LOCA I Up has been installed in accordance with Board of Health Regulations as described in the Design Approval Site System Permit No. N/A dated 19 The issuance of this certificate shall not be construed as a guarantee that the system will ..:. unction satisfactorily. - BOARD OF HEAL H��� ' 711 txm z'- +r r.:.. APPLICATION FOR DISPOSAL WORKS CONSTRUCTION PERMIT DATE: //--6-- /7 CURRENT INSTALLER'S LICENSE# ,LOCATION: LICENSED INSTAL ®so ��q �Sd�✓ SIGNATURE: TELEPHONE# CHECK ONE. REPAIR: v NEW CONSTRUCTION: IF NEW CONSTRUCTION, PLEASE ATTACH FOUNDATION AS-BUILT. Administrative Use Only $75.00 Fee Attached? Yes / No Foundation As-built? Yes No Floor plans on file? Yes No Approval Date: /.P/ Town of North Andover, Massachusetts Form No.3 :. NORTH BOARD OF HEALTH 19 DISPOSAL WORKS CONSTRUCTION PERMIT ,SSACMUSES Applicant E ADDs TELEPHONE Site Location Permission is hereby granted to Construct ( ) or Repair Kan Individual Soil Absorption Sewage Disposal System as shown on the Design Approval S.S. No. 0A 0OZA oat it 'j HEALTH Fee D.W.C. No. r.: SEPTIC SYSTEM INSPECTION FORM ADDRESS DATE INSPECTED U r� PROPERLY FUNCTIONING? � N . WEATHER CONDITIONS COMMENTS : A L i Ty T E S^► es 0 L DYE TEST PERFORMED? Y N DATE? SKETCH: WATERSHED RESIDENTS QUESTIONNAIRE 1. Name ��-� 2. Street Address e-',T f;A; 3. How many members are in your household? 4. What type of sewage disposal system do you have? ❑ cesspool a 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 5 do not know 6. How old is your sewage disposal system? ❑ 0-5 years ❑ 6-10 years ❑ 11-20 years ❑ over 20 years Ci do not know 7. Has your sewage disposal system been rebuilt or repaired? ❑ yes ❑ no ED do not know If yes, approximately how long ago? years. What was done? 8. How frequently is your sewage disposal system pumped out? ❑ annually [k7 every 2-4 years ❑ every 5-10 years ❑ over 10 years ❑ never 9. Have you had any problems with your sewage disposal system? ❑ yes d 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 l dehumidifier drain sump m toilet roof/pavement drains shower/bathtub 11. Please state the brand and type (liquid or powder) of detergent you use for: dishwasher fes- " 'P - clotheswasher -i z = ��s=� L � i 12. Does your property have a lawn? fb� 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 C Season(s) of the year 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. TS OUES9TIONNAlRE 1. Name 2. Street Address 3. How many members are in your household? 4. What type of sewage disposal system do you have? El cesspool septic tank and leaching area F-1 connection to municipal sewer .1 other (describe) ❑ 4 c-9. not know 7 5. Are the plans (drawings) for your sewage disposal system on file with the Board of Health? El yes El no N do not know 6. Row old is your sewage disposal system? El 0-5 years El 6-10 years 0 11-20 years over 20 years El do not know 7. lia -your sewage disposal system been rebuilt or repaired? D yes El no 11 do not know If yes,, approximately how long ago? years. What was done? 8. lRow frequently is your sewage disposal system pumped out? El annually every 2-4 years El every 5-10 years El over 10 years El never 9. e you had any problems with your sewage disposal system? El yes IN no what problems? ❑ repeated pump-outs needed El system clogs, backs up, or drains slowly F1 odors El sewage surfaces through ground 10. How, many of each appliance are connected to your-sewage disposal system? machine dishwashergarbageAdisposal c-zhurnidifier O-ain sump pump toilet roc-filpavement drains showerlbathtub 11. state ihe'brand and type (liquid or powder) of detergent you use for: 6.'s,-Avasher clofineswasher 12. Does your property have a lawn? Q yes F-1 no F yes, approximately what size? El less than 1/4 acre El 1/4 acre El 1/z acres] 3/4 acre El 1 acre F-1 more than 1 acre (Specify) - acres 13. -1.ow often do you fertilize your lawn? J'�T_ o. of applications per year G S-Iasons) of the year 14. 1'.e -:c state the brand and type (liquid or granular) of lawn fertilizer you use: Ct,eck here if your lawn is maintained by a professional landscape contractor.