HomeMy WebLinkAboutMiscellaneous - 85 MARBLERIDGE ROAD 4/30/2018 (3)m
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SEPTIC SYSTEM INSPECTION FORM
ADDRESS ro ° Cirri
DATE INSPECTED
PROPERLY FUNCTIONING? N
.WEATHER CONDITIONS
COMMENTS:
DYE TEST PERFORMED? Y N
DATE?
SKETCi::
i'WATERSHED RESIDE -NTS QUESTIONNAIRE
/iName
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<' 2. Street Address
3. How many members are in your household?
4. What type of sewage disposal system do you have?
❑ cesspool
fd 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 do not know
6. How old is your sewage disposal system? ❑ 0-5 years ❑ 6-10 years ❑ 11-20 years
f� 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? lX years. What was done?
SFC'TIG a Ictr3K ReF Pr A
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 appliance are connected to your sewage disposal system?
washing machine o dishwasher ON garbage disposal 0
dehumidifier drain O sump pump O toilet rt W o
roof/pavement drains showerlbathtub -I" u; 0
11. Please state the brand and type (liquid or powder) of detergent you use for:
dishwasher MCin o A a S
clotheswasher -7;
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 ❑ 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
NEVI ev'_ AN d \
14. Please state the brand and type (liquid or granular) of lawn fertilizer you use:
No NE
❑ Check here if. your lawn is maintained by a professional landscape contractor.