HomeMy WebLinkAboutMiscellaneous - 70 JOHNSON CIRCLE 4/30/2018 (2) r
70 JOHNSON CIRCLE
210[03=01100.0
WATERSHED RE IDENTS QUESTIONNAIRE
1. NameZX
2. Street Address
f
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 the plans (drawings) for your sewage disposal system on file with the Board of Health?
❑ yes ❑ no COY do not know
6. How old is your sewage disposal system? ❑ 0-5 years EN-16-40 years ❑ 11-20 years
❑ over 20 years ❑ do not know
7. Has your sewage
isposal system been rebuilt or repaired?
❑ yes Ll K no ❑ do not know
If yes, approximately how long ago? years. What was done?
i
I
O 8. How frequently is your sewage disposal system pumped out? ❑ annually
❑ every 2-4 years ❑ every 5-10 years ❑ over 10 years ❑ never
9. Have you had any problems with your sewage disposal system? ❑ yes 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 appliazlee are connected to your sew�ge disposal system?
washing machine dishwashers garbage disposal C--
dehumidifier drain sump pump �� toilet
roof/pavement drains shower/bathtub
11. Please state thebrand afid type (liquid or powder) of detergent you use for:
dishwasher
clotheswasher T
12. Does your property have a lawn? yes ❑ no
If yes, approximately what size?
❑ less than 1/4 acre ❑ 1/4 acre ❑ 1/2 acre El/l 3/4 acre ❑ 1 acre
❑ more than 1 acre (Specify) acres
13. How often do you fertilize your lawn?
No. of applications per year
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.
T 7
1. Na—Re
:2 Zx_
2. Street Address
3. How many members are in your household.7
4. Vi at type of sewage disposal system do you have?
cesspool
septic tank and leaching area
[_".connection to municipal sewer
F, other (describe)
El do not know
5. Are the plans (drawings) for your sewage disposal system on file with the Board of Health?
El yes El no k"do not know
6. How old is your sewage disposal system? El 0-5 years Eil6-�10 years .0 11-20 years
ED over 20 years El do not know
7. Has your sewage
fiisposal system been rebuilt or repaired?
El yes Lno El do not know
If yes, approximately how long ago? years. What was done?
8. Huw frequently is your sewage disposal system pumped out? El annually
71❑ every 2-4 years El every 5-10 years El over 10 years El -never
9. Fliave you had any problems with your sewage disposal system? El yes 9--n--'o
If yes, what problems?
El repeated pump-outs needed
El system dogs, backs up, or drains slowly
El odors
El sewage surfaces through ground
10. How many of each applia are connected to your sewa e disposal system?
washing machine dishwasher garbage disposal
dehumidifier drain sump-pump toilet
roo,f/pavement drains shower/bathtub
11. Please state the brand afid type (liq4id or powder) of detergent you use for:
dishwasher
clotheswashe r
12. D6es your property have a lawn? nYes El no
If yes, approximately what size?
R less than 'Aacre El 1/4 acre El 1/2acre V13/4acre El 1 acre
F-1 more than I acre (Specify) — acres
13. How often do you fertilize your lawn?
No. of applications per year
Season(s) of the year
14. Please state the brand and type (liquid or granular) of lawn fertilizer you use:
0
I❑ Check here if your lawn is maintained by a professional landscape contractor.