The New Hampshire Department of Environmental Services (NHDES) has been testing private water wells in southern New Hampshire for perfluorooctanoic acid (PFOA). The following form is provided to help us know who is located within the area of interest and would like their well tested. NHDES will contact you regarding sampling your well prior to any testing. Please note that filling out this form does not guarantee that NHDES will test your well. We are currently testing wells in several defined areas. Once you complete the form, you will receive an email from NHDES that will let you know if you are in an area where we are currently collecting samples. If you are not selected for sampling, we will keep your request on file and will contact if you if our investigation expands to include your address. If you have issues completing this form, please call (603) 271-3710. More information on NHDES’ PFOA investigation is available at

Please limit responses to one submission per household.

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