Balranald Shire Council Residents' Questionnaire Survey for Private Domestic Water Providers: Water Sources, Water Treatment and Land Usage

This survey relates to domestic water use ONLY. Domestic water means tap water supplied via plumbing fittings to your home and used for drinking, cooking, washing , laundry, sanitation and other household purposes. The survey takes approximately 7 minutes

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* 1. Please specify how many people in the relevant age groups currently live at your residence.

Under 1

1-4

5-9

10-19

20-54

55+

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* 2. Does anyone at your residence identify as having a chronic health condition or immunocompromised such as transplant patients, cancer patient dialysis patients or other? Check the appropriate.

Yes

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* 3. Approximately how much water is used in total at your residence for domestic purposes each day?

Less than 10 Litres

10-99 Litres

100-199 Litres

Greater than 200 Litres

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* 4. Where is your domestic watersourced from? Please check the applicable boxes.
Rainwater: Collected from roofs and stored within a tank for future use.

Yes

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* 5. If yes to rainwater,please check the following that apply:

Trees overhang the roof

First flush device installed

Bitumen or lead items on the roof

Animal droppings (bats, birds, reptiles, mammals) on roof

Aerial spraying occurs on nearby lands

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* 6. Surface Water: Drawn from rivers, creeks, and dams which may or mayn't be stored in a tank prior to use.

Yes

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* 7. If yes to surface water, please check the following that apply.

Intake distant from septic tanks

Surface water restricted from livestock

Stored in tank

Not stored in tank

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* 8. Shallow groundwater: Drawn from bores, wells or springs that are 1-20 metres deep which may or may not be stored in a tank prior to use.

Yes

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* 9. If yes to shallow groundwater, please check the following that apply.

Bore distant from septic tanks

Bore cover secure

Bore protected from contaminated seepage from rubbish or agricultural run-off

Bore restricted from livestock

Stored in tank

Not stored in tank

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* 10. Deep groundwater: drawn from bores, wells or springs that are greater than 20 metres deep, which may or may not be stored in a tank prior to use.

Yes

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* 11. If yes to deep groundwater, please check the following that apply.

Bore distant from septic tanks

Bore cover secure

Bore protected from contaminated seepage from rubbish or agricultural run-off

Bore restricted from livestock

Stored in tank

Not stored in tank

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* 12. Carted Water: from mains or town water supply transferred by tanker and stored in a tank prior to use.

Yes

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* 13. If yes to carted water, please check the following that apply.

Tanker is purpose built and maintained for drinking water transportation

Tanker hose appears clean and does not come in contact with water in your tank

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* 14. If you use a tank to store your domestic water, which of the following best describes your tank? Check the most apropriate.

Above ground tank with screens or is totally sealed.

Above ground without screens or is unsealed

Below ground tank

Use both above and below ground tanks

I don't use a tank to store domestic water

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* 15. Which best describes the type (s) of water treatment used on your domestic water supply? Check all that apply.

Untreated - no treatment ( e.g. filtration, disinfection) used on site

Filtered - using a sand and/or activated carbon filter

Disinfection - using commercial compounds such as chlorine ( Sodium hypochlorite)

Ultra - violet (UV) - short wave length ultra violet light

Boil water

Other treatment method not listed above. (please specify)

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* 16. What part of your residence is supplied treated water? Check the most appropriate answer.

None - no taps supply treated water. All water available is untreated

One outlet - only one tap supplies treated water ( e.g. kitchen sink only)

Multiple outlets - a number of taps supply treated water

All outlets - all taps throughout the residence supply treated water

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* 17. Specify if domestic water used for the following activities at your residence is treated. Please check yes or no for each.

Drinking water - Yes

Drinking water - No

Food preparation - Yes

Food preparation - No

Bathing - Yes

Bathing - No

Washing clothes and dishes - Yes

Washing clothes and dishes - No

Brushing teeth - Yes

Brushing teeth - No

Watering gardens - Yes

Watering gardens - No

Children's play - Yes

Children's play - No

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* 18. Is private domestic water provided to a business? Check all appropriate.

Accommodation

Food and beverage

Service station, transport hub

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* 19. On a scale of one to ten how satisfied are you with the quality of your domestic water supply. Where one is very dissatisfied and ten is very satisfied Check the most appropriate answer.

1 Very dissatisfied

10 Very satisfied

1 Very dissatisfied

10 Very satisfied

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* 20. On a scale of one to ten how concerned are you about the safety of your domestic water supply? Where one is very concerned and ten is not concerned at all.Check the most appropriate answer.

1 Very concerned

10 Not concerned at all

1 Very concerned

10 Not concerned at all

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* 21. How would you describe the land use for the property on which your private water sources and residence are located? Check all that apply.

Dry land cropping

Dry land grazing

Dry land mixed uses

Irrigated pasture from surface sources ( e.g. river/stream/dam)

Irrigated pasture from shallow underground sources ( wells or springs that are one to twenty meters deep)

Irrigated pasture from deep underground sources ( wells or springs that are greater than twenty meters deep)

Irrigated horticulture/ viticulture from surface sources ( e.g. river/stream/dam)

Irrigated horticulture/viticulture from shallow underground sources ( wells or springs that are one to twenty meters deep)

Irrigated horticulture/viticulture from deep underground sources ( wells or springs that are greater than twenty meters deep)

Town allotment ( rainwater tank or private bore)

Bush block/acreage ( rainwater tank or private bore)

Business enterprise ( rainwater tank or private bore)

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* 22. When undertaking the land use activity for the property on which your private water sources and residence are located do you use any of the following? Check all that apply.

Fertiliser

Insecticides

Pesticides

Livestock dips/sprays

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* 23. Do you wish to make any additional comments relating to your private domestic water supply?

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* 24. Please provide your address for analytical purposes. This will be used in compliance with the Privacy Act.

Thank you for your participation. Please remember to return this survey.

Balranald Shire Council Residents' Questionnaire Survey for Private Domestic Water Providers: Water Sources, Water Treatment and Land Usage

Question Title

* 1. Please specify how many people in the relevant age groups currently live at your residence.

Question Title

* 2. Does anyone at your residence identify as having a chronic health condition or immunocompromised such as transplant patients, cancer patient dialysis patients or other? Check the appropriate.

Question Title

* 3. Approximately how much water is used in total at your residence for domestic purposes each day?

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* 4. Where is your domestic watersourced from? Please check the applicable boxes.Rainwater: Collected from roofs and stored within a tank for future use.

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* 5. If yes to rainwater,please check the following that apply:

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* 6. Surface Water: Drawn from rivers, creeks, and dams which may or mayn't be stored in a tank prior to use.

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* 7. If yes to surface water, please check the following that apply.

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* 8. Shallow groundwater: ﻿Drawn from bores, wells or springs that are 1-20 metres deep which may or may not be stored in a tank prior to use.

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* 9. If yes to shallow groundwater, please check the following that apply.

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* 10. Deep groundwater: drawn from bores, wells or springs that are greater than 20 metres deep, which may or may not be stored in a tank prior to use.

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* 11. If yes to deep groundwater, please check the following that apply.

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* 12. Carted Water: from mains or town water supply transferred by tanker and stored in a tank prior to use.

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* 13. If yes to carted water, please check the following that apply.

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* 14. If you﻿ use a tank to store your domestic water, which of the following best describes your tank? Check the most apropriate.

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* 15. Which best describes the type (s) of water treatment used on your domestic water supply? Check all that apply.

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* 16. What part of your residence is supplied treated water? Check the most appropriate answer.

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* 17. Specify if domestic water used for the following activities at your residence is treated. Please check yes or no for each.

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* 18. Is private domestic water provided to a business? Check all appropriate.

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* 19. On a scale of one to ten how satisfied are you with the quality of your domestic water supply. Where one is very dissatisfied and ten is very satisfied Check the most appropriate answer.

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* 20. On a scale of one to ten how concerned are you about the safety of your domestic water supply? Where one is very concerned and ten is not concerned at all.Check the most appropriate answer.

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* 21. How would you describe the land use for the property on which your private water sources and residence are located? Check all that apply.

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* 22. When undertaking the land use activity for the property on which your private water sources and residence are located do you use any of the following? Check all that apply.

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* 23. Do you wish to make any additional comments relating to your private domestic water supply?

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* 24. Please provide your address for analytical purposes. This will be used in compliance with the Privacy Act.

* 4. Where is your domestic watersourced from? Please check the applicable boxes.
Rainwater: Collected from roofs and stored within a tank for future use.

* 8. Shallow groundwater: Drawn from bores, wells or springs that are 1-20 metres deep which may or may not be stored in a tank prior to use.

* 14. If you use a tank to store your domestic water, which of the following best describes your tank? Check the most apropriate.