HomeMy WebLinkAboutMiscellaneous - 96 MARBLERIDGE ROAD 4/30/2018SEPTIC SYSTEM INSPECTION FORM
ADDRESS
DATE INSPECTED <�'1�t
PROPERLY FUNCTIONING? 6 N
WEATHER CONDITIONS 5o r
COMMENTS:
d
DYE TEST PERFORMED? Y N
DATE?
SKETCH:
WATERSHED RESIDENTS QUESTIONNAIRE
1. Namee'lic
a 2. Street Address 7
3. How many members are in your household? %0
0
�tdus,&s) 6- s ystems)
4. What type of sewage disposal system do you have?
R' cesspool (12-)
❑ septic tank and leaching area
❑ connection to municipal sewer +
❑ other (describe) /0lttA &h
❑ do not know k�'c hev� s��k �( �v�) e�'( tet" e�� �ti��e 10 cess��d
every rA,.* � 2isie 5"'C -'s to dry cerci 1
5. Are the plans (drawings) for your sewage disposal system on file with the Board of Health?
❑ yes ❑ no C- do not know –
6. How old is your sewage disposal system? ❑ 0-5 years ❑ 6-10 years
0 over 20 years ❑ do not know
tcTo �p,(-v x leo C5.
7. Has your sewage disposal system been rebuilt or repaired?
❑ yes %J no ❑ do not know
hurin 5'V,;ws of VV,
If yes, approximately how long ago? years. What was done?
❑ 11-20 years .
.~ S. How frequently is your sewage disposal system pumped out? 5211, annually /e ss if Vers
❑ every 2-4 years ❑ every 5-10 years ❑ over 10 years ❑ never `aJeT s eL;- s e h
9. Have you had any problems with your sewage disposal system? [r' yes ❑ no
If yes, what problems? — -
R' repeated pump -outs needed
system clogs, backs up, or drains slowly ju zd �4 (_L
Ca'
odors�t,�
CY sewage surfaces through ground u.d wt_,:LJ
10. How many of each appliance are eonneeted to your sewage disposal system?
washing machined dishwasher garbage disposal
dehumidifier drain sump pump toilet
roof/pavement drains shower/bathtub�(, �/ f l� e1i s� n l� ,✓
11. Please state the brand and type (liquid or powder) of detergent you use for:
dishwasher
clotheswasher y6 w i s 1, A L -L
+4.0 duvr-ps iHr a dry wel�
12. Does your property have a lawn? C yes ❑ no
If yes, approximately what size?
❑ less than 'A acre ❑ '/4 acre ❑ 1/7 acre ❑ % acre Q' 1 acre
❑ more than 1 acre (Specify) acres
13. How often do you fertilize your lawn?
No. of applications per year #10 h e
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.