HomeMy WebLinkAboutMiscellaneous - 67 SANDRA LANE 4/30/2018 (2) 67 SANDRA LANE
J210/097.0-0075-0000.0
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WATERSHED RESIDENTS QUESTIONNAIRE
1. Name W\A 1Ls'�1
2. Street Address
b-1 �c�,c l..a.
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 theg P lans (drawings) for our sewageP 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 El 11-20 years"='
r ❑ over 20 years ❑ do not know
7. Has your sewa 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. ❑ annually
❑ every 2-4 ears every 5-10years. . ❑ over 10 years never
9. Have you had any problems with your sewage disposal system? ❑ yes Xno =
- 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 3
roof/pavement drains showerlbathtub -
11. Please state theeand and type (liquid or powder) of detergent you use for:
dishwasher 0-5 c i.�Q,.
clotheswasher E CC,-
12.
C12. Does your property have a lawn? yes ❑ no
If yes, approximately what size?
❑ less than 1/4 acre ❑ 1/4 acre ❑ 1/z acre ❑ 3/4 acre OM-&r-e
f more than 1 acre (Specify) acres
13. How often do you fertilize your 1 n?
No. of applications per Zpr 4
Season(s) of the year el S ! w.NALr -
14. Please state the brand and type (liquid 'oriranular) of lawn fertilzer ou use:
Z
❑ Check here if your lawn is maintained by a professional landscape contractor.