HomeMy WebLinkAboutMiscellaneous - 82 LISA LANE 4/30/2018r
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WATERSHED RESIDENTS QUESTIONNAIRE
1. Name ^
2. Street Address- Qz L2.
3. How many members are in your household.
4. What type of sewage disposal system do you have?
❑ cesspool
❑ septic tank and leaching area
C connection to municipal sewer
❑ other (describe)
❑ do not know
5. Are the plans (drawings) for your sewage disposal system on file h thelBoard of Health?
❑ yes ❑ no N 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
#0
7. Has your sewage disposal system been rebuilt or repaired?
yes L 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
O9. 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 appliance are connected to your sewage disposal system?
washing machine —A_ 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 42'
12. Does your property have a lawn?
If yes, approximately what size?
❑ less than 1/4 acre ❑ 1/4 acre
❑ more than 1 acre (Specify)
13. How often do you fertilize your laws ?
No. of applications per year
Season(s) of the year
yes ❑ no
❑ 1/2 acre 3/4 acre ❑ 1 acre
acres
14. Please state thg brand and type (liquid or granular) of lawn fertilizer you use:
❑ Check here if your lawn is maintained by a professional landscape contractor.