Austerlitz Residential Water Well Survey
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1
. Please enter your street address (e.g. 100 Somewhere Road). This information is necessary and information on your well's water quality and quantity will be kept strictly confidential.
Please enter your street address (e.g. 100 Somewhere Road). This information is necessary and information on your well's water quality and quantity will be kept strictly confidential.
2
. What type of well do you have?
What type of well do you have?
Drilled (6 to 8 inch diameter casing with sanitary well cover)
Driven (1 to 3 inch diameter pipe with attached point)
Dug (2 to 8 foot diameter constructed of concrete or stones)
Not Sure
3
. When was your well drilled?
When was your well drilled?
Since 2000
1990-1999
Before 1990
Not Sure
4
. Which drilling contractor installed your well (you can check the well cap if you are not sure).
Which drilling contractor installed your well (you can check the well cap if you are not sure).
Hanson Well Drilling & Pump Co.
Keyser Drilling Co.
Smith Well Drilling
W Gordon Goold Inc.
Other
Not sure
Other (please specify)
5
. If you have a copy of your well completion report (well log), please enter the information below:
If you have a copy of your well completion report (well log), please enter the information below:
Well Depth
Casing Depth
Depth to Bedrock
Well Yield
6
. Have you ever had any of the following problems with your well?
Have you ever had any of the following problems with your well?
Not enough water
Hardness (scale, soap scum, poor lathering, white/tan particles)
Reddish, yellowish, or blackish water or staining
Bluish-green water or staining
Rotten-egg odor
Methane gas odor
Salty taste
Metallic taste
Sediment
Coliform bacteria
Elevated nitrate
Other
No problems
Other (please specify)
7
. If you have any comments or questions, please state them below.
If you have any comments or questions, please state them below.
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