HomeMy WebLinkAboutMiscellaneous - 70 FRENCH FARM ROAD 4/30/2018 (2) 0000-0600-0 CJCQ/G2 ,
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WATERSHED RESIDENTS QUESTIONNAIRE
1. Name /'✓EAL S/lFeffl �i�#/
2. Street Address 73 F1P7,F✓cH )r- i 1`7 rte(
3. How many members are in your household?
4. What type of sewage disposal system do you have?
❑ cesspool
❑ septic tank and leaching area
C2 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 ❑ 11-20 years .
❑ over 20 years ❑ do not know
7. Has your sewage disposal system been rebuilt or repaired?
❑ yes M 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
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9. Have you had any problems with your sewage disposal system? ❑ yes X❑ 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 showerlbathtub
11. Please state the brand and type (liquid or powder) of detergent you use for:
dishwasher P_Na .war f'owpE�'
clotheswasher J>yl9/�7 o t-/4f
12. Does your property have a lawn? Q' yes ❑ no
If yes, approximately what size?
❑ less than 1/4 acre ❑ 1/4 acre ❑ 1/2 acre ❑ 3/4 acre [J 1 acre
❑ more than 1 acre (Specify) acres
13. How often do you fertilize your lawn?
No. of applications per year 3 -
Season(s) of the year YP)ejAfG - FAa-
14. Please state the brand and type (liquid or granular) of lawn fertilizer you use:
0-FOPaUf f kIVE 7-ufFff&1A-M P G-P141vv'-ftor
❑ Check here if your lawn is maintained by a professional landscape contractor.