FOR Watershed Ground Water Survey
1. What is your water supply? [ ] Well, [ ] Spring, [ ] Public, [ ] Other
2. How deep is the well? _____________________________________________________
3. Are you concerned about the depth of your well? [ ] Yes [ ] No
4. What is the well=s storage capacity? ___________________________________________
5. What is the flow rate (gallons/minute)? 0-3 _____ 3-8 _____ 8-20 _____ 20+ ____
6. Has the flow rate changed in recent years? [ ] Yes [ ] No
7. What is your water pressure like? ____________________________________________
8. Are you having any supply problems? [ ] Yes [ ] No
9. Do you have good water quality? [ ] Yes [ ] No
10. When was the well last tested? _______________________________________________
11. What were the results? _____________________________________________________
12. Do you have sediment in your water? [ ] Yes [ ] No
13. Do you have a water treatment system? [ ] Yes [ ] No
14. If so, why are you treating your water? __________________________________________
15. Where is the water treatment system located? ___________________________________
16. What kind of treatment system is it? __________________________________________
17. How old is the treatment system? ____________________________________________
18. Who drilled/dug your well? _________________________________________________
19. When was your well drilled/dug? _____________________________________________
20. What is the well=s diameter? _________________________________________________
21. What casing material was used? ______________________________________________
22. How deep is the casing? ____________________________________________________
23. What repairs and maintenance have been done? _________________________________
________________________________________________________________________
24. How often have repairs been made? ___________________________________________
25. Who did the repairs? ______________________________________________________