You are correct that the unit is loud. You can hear that it is running from inside the house if you listen for it but it is not distracting. I let my do the weekly test at 2am and no one has complained and I do not hear it. When the power is out I think your neighbors should be a little more understanding about the noise and I think the noise will be notice by those who are outside. See if you can locate the generator away from where your neighbor might have an open window.
You also have some maintenance and checking to do each month and when it is running for an extended period of time at least daily maintenance checks.
I would go with natural gas if you can. Propane presents a storage problem in my mind. Gasoline might be hard to get so I guess I would put that down as number 3. The inverter generator was a good suggestion if you only need to run medical equipment. But be sure the generator is away from the house.
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