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Water Needs Assessment
Section 1: Domestic/Drinking Water (Non-Agricultural)
Please select the primary source for each of the domestic water uses that apply to your household.
Bottled
Well
City/Community water system
Private water system
Drinking
Bottled
Well
City/Community water system
Private water system
Cooking
Bottled
Well
City/Community water system
Private water system
Brushing teeth
Bottled
Well
City/Community water system
Private water system
Bathing
Bottled
Well
City/Community water system
Private water system
Cleaning the house
Bottled
Well
City/Community water system
Private water system
Washing clothes
Bottled
Well
City/Community water system
Private water system
Other (please specify in text box below)
Bottled
Well
City/Community water system
Private water system
"Other" water use
Do you ever use/drink water from a domestic well?
Yes
No
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