Questionnaire

* 1. Address

* 2. What year was your well installed?

* 3. How deep is your well in feet?

* 4. How was your well constructed? (select all that apply)

* 5. What kind of formation does your well tap into? (e.g. granite bedrock, gravel, confined aquifer, unconfined aquifer, etc.)

* 6. What water treatment systems do you have? (select all that apply)

* 7. How would you describe you well's water quality? (e.g. taste, color, odor)

* 8. Do you have any well water test records that you'd be willing to share with us?

* 9. May we obtain the location of your well using a GPS unit?

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