HomeMy WebLinkAboutMiscellaneous - 766 GREAT POND ROAD 4/30/2018 (2)N1
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SEPTIC SYSTEM INSPECTION FORM
ADDRESS i (p 1�a
DATE INSPECTED - A'(P
PROPERLY FUNCTIONING? b N
WEATHER CONDITIONS
COMMENTS: -
WATER QUALITY TESTED? RESULTS?
DYE TEST PERFORMED? Y .N
DATE?
SKETCH:
0
WATERSHED RESIDENTS QUESTIONNAIRE
1. Name A)o r -A4_V_^
2. Street Address 7616 6`l�'� Fd �°���
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
I it 6C. AJI
- R" t1'`.)
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 ❑ 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
9. Have you had any problems with your sewage disposal system?
If yes, what problems?
❑ repeated pump -outs needed
❑ system clogs, backs up, or drains slowly
❑ odors
❑ sewage surfaces through ground
❑ yes ❑ no
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 shower/bathtub
11. Please state the brand and type (liquid or powder) of detergent you use for:
dishwasher
clotheswasher
12. Does your property have a lawn? yes ❑ no
If yes, approximately what size?
❑ less than 1/4 acre ❑ 1/4 acre R"�1/2acre ❑ 3/4 acre ❑ 1 acre
❑ more than 1 acre (Specify) - acres
13. How often do you fertilize your lawn?
No. of applications per year
OSeason(s) of the year 50c"14 Sw.-MMA-r-
14.
.-MM' -r- 1
14. Please state the brand and type (liquid or granular) of lawn fertilizer you use:
aLL 09-
❑ Check here if your lawn is maintained by a professional landscape contractor.