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Residential Well Survey

Residential Well Questionnaire- Potter Hill Ecological Restoration Study

The Southern Rhode Island Conservation District is partnering with the Town of Westerly, the Wood-Pawcatuck Watershed Association, the Nature Conservancy, NOAA, RIDEM, USFWS, and others to conduct a feasibility study to identify the best alternative for improving public safety, reducing flood risks, and improving ecological function of the Pawcatuck River at the Potter Hill Mill site on the Westerly-Hopkinton border.  Detailed information and updates about the project can be found at      www.westerlyri.gov/PotterHill

We are using this survey to gather additional information needed to complete our study.  Your participation is greatly appreciated.  Any information collected will be held strictly confidential by the partner team, will not be distributed or used for other purposes than to assess potential impacts from the project, and will be destroyed upon the completion of our study. 

If you have any questions or concerns regarding this survey, please contact Gina Fuller at (401) 661-5761 or gfuller@sricd.org .
1.What is your first name?
2.What is your last name?
3.What is the property address?(Required.)
4.Is this the same as the mailing address?
5.What is  your mailing address?  (If your answer to # 4 was "NO")
6.Are you the property owner?
7.Phone Number
8.Email Address
9.Date of well installation
10.Depth of well below ground (in feet)
11.Type of well 
12.Well installer (if known)
13.Do you have a well completion report?
14.Well Test Yield in gallons per minute  (if known)
15.What was the month and year of the test?
16.Has your well been fracked?
17.Have you experienced any issues with your well's performance due to drought conditions?
18.If your answer to #16 was "YES", please tell us more about these issues.  Be sure to include dates, months,  and year in your response.
19.How long have you lived at this address?
20.Do you provide permission for a member of the project team to contact you to schedule a visit to observe the well and measure its depth?  
21.Is this a year round residence?