Water Needs Assessment

Section 1: Domestic/Drinking Water (Non-Agricultural)

	Bottled	Well	City/Community water system	Private water system
Drinking	Drinking Bottled	Drinking Well	Drinking City/Community water system	Drinking Private water system
Cooking	Cooking Bottled	Cooking Well	Cooking City/Community water system	Cooking Private water system
Brushing teeth	Brushing teeth Bottled	Brushing teeth Well	Brushing teeth City/Community water system	Brushing teeth Private water system
Bathing	Bathing Bottled	Bathing Well	Bathing City/Community water system	Bathing Private water system
Cleaning the house	Cleaning the house Bottled	Cleaning the house Well	Cleaning the house City/Community water system	Cleaning the house Private water system
Washing clothes	Washing clothes Bottled	Washing clothes Well	Washing clothes City/Community water system	Washing clothes Private water system
Other (please specify in text box below)	Other (please specify in text box below) Bottled	Other (please specify in text box below) Well	Other (please specify in text box below) City/Community water system	Other (please specify in text box below) Private water system

"Other" water use

Yes