HomeMy WebLinkAboutMiscellaneous - 95 SANDRA LANE 4/30/2018 (2)N
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WATERSHED RESIDENTS QUESTIONNAIRE
1. Name /���G 1�,0495`r
2. Street Address tF7�A , /!/ • '414ft
3. How many members are in your household?
4. What type of sewage disposal system do you have?
❑ cesspool
❑ septic tank and leaching area
X connection to municipal sewer /
❑ other (describe) i4G�!' .
El do not know j'
5. Are the plans (drawings) for your sewage disposal system on file with the Board of Health?
❑ yes no ❑ do not kn6w _`
6. How old is your sewage disposal system? ❑ 0-5 years ❑ 6-10 years
❑ over 20 years ❑ do not know 4u,404W4--.amatt.
7. Has your sewage disposal system been rebuilt or repaired?
[Iyes Elno EJdo not know Ajli ` t. '
If yes, approximately how long ago? years. What was done?
�0 "O�e�
8. How frequently is your sewage disposal system pumped out? ❑
❑ every 2-4 years ❑ every 5-10 years ❑ over 10 years
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
❑ 11-20 years-
annually
ears
annually
❑ never
❑ yes Pr no ._ :
10. How many of each appliance are connected to your sewage disposal system?
washing machine dishwasher �_ garbage disposal -3-
dehumidifier drain sump pump toilet a►
roof/pavement drains shower/bathtub
11. Please state the b nd, and pe (liquid or powder) of detergent you use for:
dishwasher
clotheswasher
12. Does your property have a lawn? yes ❑ no
If yes, approximately what size?
Jam- less than % acre ❑ % acre ❑ 1/z acre ❑ % acre ❑ 1 acre
❑ more than 1 acre (Specify) acres
13. How often do you fertilize your 1 wn?
No. of applications per y ar
Season(s) of the year
IF
14. Please state the brand and type (liq id or granular) of lawn fertilizer you use:
�' Check here if your lawn is maintained by a professional landscape contractor.