Colden, Holland, and Wales Water Well Survey

Responses to this survey will be confidentially sent to the NY Rural Water Association.

1. Please enter your street address and town (e.g. 100 Somewhere Road, Wales). This information is necessary and information on your well's water quality and quantity will be kept strictly confidential.

2. To research data with local well contractors, it is helpful to have the last name of the person who paid to have the well drilled. If you know who this may have been, please indicate the last name of that individual below. Note that this question is optional.

3. When was your well drilled?

4. What type of well do you have?

5. Which drilling contractor installed your well (you can check the well cap if you are not sure).

6. Please enter the information below if you have a copy of your well report or can remember it.

7. Have you ever had any of the following problems with your well?

8. If you have any comments or questions, please state them below.