* 1. Do you get your water from a well or from a spring?

* 2. How far, in feet, miles, or portions of a mile, is the proposed route of the ACP from your water source?  Please give your best estimate but if you have no idea, please indicate that.  Be sure to indicate the units (feet or miles).

* 3. How far, in feet, miles, or portions of a mile, is the proposed route of the ACP from your home.  Please give your best estimate.  Be sure to indicate the units (feet or miles).

* 4. Is your home on a road that would be blocked in if the ACP should explode, blocking your or any of your neighbors' escape?

* 5. Please provide your contact information.

* 6. How far in feet, miles, or portions of a mile is the proposed route of the ACP from other important structures on your property (barn, workshop, shed)?  Please indicate in your answer the type of structure you are referring to.  Be sure to indicate the units (feet or miles).

* 7. Does the proposed route of the ACP go within a 1/4 mile (1320 feet) of any of your neighbor's water sources, homes, or other structures (WHO ARE NOT ACTUALLY ON THE ROUTE - in other words, only answer "Yes" if the ACP is proposed to be near, but not ON your neighbor's property)?

* 8. If you answered "Yes" to Question 7, please fill out the information you know below:

* 9. Which route is your property on or nearest to?  If you are not sure, please consult the map here: http://friendsofnelson.com/wp-content/uploads/2015/02/Nelson-Alt-overview-map23feb2015.pdf

* 10. Have you received a notice from Dominion "requesting" permission to survey?

* 11. Have you written to deny permission to survey via certified, return receipt mail?

T