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Please complete the following short survey for the Knox County Health Department to confirm the presence of a residential well on your property. This information is vital for the protection and safety of your well water in the event of an emergency in your neighborhood. Information provided to us will be kept strictly confidential and will only be used by the Knox County Health Department.

The Knox County Health Department appreciates your time, cooperation, and assistance. Please fill in or respond to the statements below best describing your property.

* 1. Neighbors on my street have wells.

* 2. I have a well on the property where I live.

* 3. My address is:

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