HomeMy WebLinkAboutMiscellaneous - 680 GREAT POND ROAD 4/30/2018 (2) 680 GREAT POND ROAD ad
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WATERSHED RESIDENTS QUESTIONNAIRE
1. NameC
n �
2. Street Address ��` ° R T �y�'d (� 0 1q t�
O3. 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 disposal system on file with the Board of Health?
❑ yes ❑ no X do not know
6. How old is your sewage disposal system? ❑ 0-5 years ❑ 6-10 years ❑ 11-20 years
Aover 20 years ❑ do not know
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
OK every 2-4 years ❑ every 5-10 years ❑ over 10 years ❑ never
9. Have you had any problems with your sewage disposal system? ❑ yes I 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 yo r sewage disposal system?
washing machine _ dishwasher garbage disposal
dehumidifier drain sump pump toilet
roof/pavement drains showeribathtub
11. Please state the b nd and t (liquid or ppowder) of etergent you use f : PJt.
dishwasher L&C S U L - �h to /
clotheswasher L- L_ o e k-
12. Does your property have a lawn? X yes ❑ no
If yes, approximately what size?
❑ less than 1/4 acre Nf 1/4 acre ❑ 1/2 acre ❑ 3/4 acre ❑ 1 acre
❑ more than 1 acre (Specify) acres
13. How often do you fertilize your laxvn7
No. of applications per year ��---
OSeason(s) of the year S P I ly L L.
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.
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SEPTIC SYSTEM INSPECTION FORM
1
ADDRESS 10L CgQ�- 1
DATE INSPECTED �
PROPERLY FUNCTIONING? N
WEATHER CONDITIONS
COMMENTS:
WATER QUALITY TESTED? RESULTS?
DYE TEST PERFORMED? Y N
DATE?
SKETCH:
E 'er ` ❑ ' E � ETA: . . i
R � � c A-
2. S t-reet Address � Y a Ck e ffi l
3. E;ow many members are in your household? oL
4. Vwhat 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 disposal system on file with the Board of Health? f
❑ yes ❑ no X do not know
p
6. 1`ow old is your sewage disposal system? ❑ 0-5 years ❑ 6-10 years ❑ 11-20 years
over 20 years ❑ do not know
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?
E, F1 frequently is your sewage disposal system pumped out? ❑ .annually
I every 2-4 years ❑ every 5-10 years ❑ over 10 years ❑ never
9. .a.<�e you had any problems with your sewage disposal system? EJ yes IA no d
h" yes, what problems?
❑ repeated pump-outs needed
❑ system clogs, backs up, or drains slowly
❑ odors
❑ sewage surfaces through ground
i
10. How many of each appliance are connected to yo r sewage .disposal system?
ivashing machine dishwasher garbage disposal
cls. ,,urnidifier drain sumr'zpump Aoilet
Foo:/pavement drains showerlbathtub a
11. Please state the b nd and�y (liquid or powder) of�etergent yo use r:
dishwasher L C S U L /-I a) ijY :W
clotheswasher L Ls o e
12. Does your property have a lawn? J yes El no
1f 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 In?
No. of applications per year off- L
eason(s) of the year �'P+� I o' L
14. Please state the brand and type (liquid or granular) of lawn fertilizer you use:
1LyC ,9 Al ► 7— c,°RAnrwLfile-
El Check here if your lawn is maintained by a professional landscape contractor.