Questionnaire & Registration Form

Please complete this questionnaire to Sign Up for a RiverWise Watershed Protection Assessment. Questions are related in some way to watershed protection and water quality. This information will help us determine how you can best reduce your impact on your watershed.

Address

Question Title

* 1. Address

Preferred method of contact:

Question Title

* 2. Preferred method of contact:

Are you currently a Pearl Home?

Question Title

* 3. Are you currently a Pearl Home?

Are you the property owner?

Question Title

* 4. Are you the property owner?

How did you hear about this program?

Question Title

* 5. How did you hear about this program?

Please choose the answer that most closely describes your practices.  You are welcome to provide additional comments or explanations. 
Do you have flooding or channeling of stormwater on your property? If so, where?

Question Title

* 6. Do you have flooding or channeling of stormwater on your property? If so, where?

Do you have a septic system on your property? If so, where is your drain/leach field?

Question Title

* 7. Do you have a septic system on your property? If so, where is your drain/leach field?

Is there an oil tank on your property?

Question Title

* 8. Is there an oil tank on your property?

If yes,where is the oil tank located?

Question Title

* 9. If yes,where is the oil tank located?

If yes, is the oil tank in use?

Question Title

* 10. If yes, is the oil tank in use?

If yes, is the oil tank full?

Question Title

* 11. If yes, is the oil tank full?

Do you use a lawn service and/or hire an outside source for your lawn care needs?

Question Title

* 12. Do you use a lawn service and/or hire an outside source for your lawn care needs?

If yes, who do you currently use for your lawn service needs?

Question Title

* 13. If yes, who do you currently use for your lawn service needs?

During the late spring when the grass grows most quickly, the lawn is usually mowed:

Question Title

* 14. During the late spring when the grass grows most quickly, the lawn is usually mowed:

Mower blades are at the:

Question Title

* 15. Mower blades are at the:

Grass clippings are:

Question Title

* 16. Grass clippings are:

Watering
Please check all that apply.

Question Title

* 17. Please check all that apply.

  Lawn Garden (vegetable garden, flower bed, or potted plants) Landscape Areas (shrubbery and trees)
I water on a regular schedule
I water only when the weather is very hot and very dry
I water when it has not rained for a couple of weeks
I water frequently, but for a short time
I water frequently, but for a long time
I use a sprinkler to water
I use a soaker hose to water
I water by hand with a garden hose
I water by hand with a watering can
I have an automatic sprinkler system to water
I use tap to water
I use rain water from a barrel (other collection device) to water
Fertilizers Herbicides, Pesticides, and Fungicides
Please check all that apply.

Question Title

* 18. Please check all that apply.

  Lawn  Garden (vegetable garden, flower bed, or potted plants) Landscaped Areas (shrubbery and trees)
I use chemical fertilizers if indicated by soil testing 
I use chemical fertilizers on a regular basis
I use "Weed & Feed" products
I use chemical fertilizers for certain plants
I do not use fertilizers
I use only organic materials (manure, compost, leaves mowed in)
Please check all that apply.

Question Title

* 19. Please check all that apply.

  Lawn Garden (vegetable garden, flower bed, or potted plants) Landscaped Area (shrubbery and trees)
I use pesticides/ fungicides occasionally
I use pesticides/ fungicides only when there is a significant problem
I use pesticides/ fungicides to keep plants looking their best
I use pesticides/ fungicides only after the problem has been identified
I use pesticides/ fungicides regularly to prevent potential problems
I use herbicides only to eliminate invasive plants
I never use pesticides/ fungicides on my...
I never use herbicides on my...
I use only natural product on my...
Do you (or your lawn service) take into account the weather forecast for rain in deciding when to apply fertilizers, pesticides or herbicides?

Question Title

* 20. Do you (or your lawn service) take into account the weather forecast for rain in deciding when to apply fertilizers, pesticides or herbicides?

Check all that apply. Autumn Leaves are:

Question Title

* 21. Check all that apply. Autumn Leaves are:

Check all that apply. Washing the car:

Question Title

* 22. Check all that apply. Washing the car:

When changing the car's oil..

Question Title

* 23. When changing the car's oil..

Purchasing Habits
Check all that apply. When purchasing household cleaners and chemicals...

Question Title

* 24. Check all that apply. When purchasing household cleaners and chemicals...

What is important to you when purchasing trees, shrubs, or flowers? (9 being most important and 1 being least important)

Question Title

* 25. What is important to you when purchasing trees, shrubs, or flowers? (9 being most important and 1 being least important)

When disposing of household cleaners, chemicals, paint, etc.

Question Title

* 26. When disposing of household cleaners, chemicals, paint, etc.

Dog Feces
If you have a dog, how do you clean up their feces on walks?

Question Title

* 27. If you have a dog, how do you clean up their feces on walks?

If you have a dog, how do you clean up their feces in your yard?

Question Title

* 28. If you have a dog, how do you clean up their feces in your yard?

What environmental issue do you consider the most important locally? (10 being most important and 1 being least important

Question Title

* 29. What environmental issue do you consider the most important locally? (10 being most important and 1 being least important

Urban landscapes have significant impact on water quality, either positive or negative.  How willing are you, on a scale of 1 to 5 (5 being the most willing), to put some time and effort into watershed friendly landscaping

Question Title

* 30. Urban landscapes have significant impact on water quality, either positive or negative.  How willing are you, on a scale of 1 to 5 (5 being the most willing), to put some time and effort into watershed friendly landscaping

What "Best Management Practices" are you interested in for your property?

Question Title

* 31. What "Best Management Practices" are you interested in for your property?

Rank your interest in the Best Management Practices. 

Question Title

* 32. Rank your interest in the Best Management Practices. 

What other practices are you interested in getting more information about?

Question Title

* 33. What other practices are you interested in getting more information about?

Please let us know if you would be interested in volunteering at any of the following activities/events

Question Title

* 34. Please let us know if you would be interested in volunteering at any of the following activities/events

We will be contacting you to set up a date and time soon. Thank you!

T