Drought Economic Impact Survey for Institutional, Commercial, Industrial, Public Water System and Agricultural Water Users

Last Update: June 2018

As part of the state's emergency response efforts to the drought, New Hampshire Department of Environmental Services (NHDES) is gathering information related to private well water availability and drought related economic impacts. The information requested in the below survey will assist the state in identifying the location and severity of drought impacts for assessing drought response needs.

Who should submit this form?

Industrial, commercial, institutional and agricultural water users on private wells experiencing problems with water supply due to the ongoing drought or who were experiencing problems, but made repairs to mitigate water supply issues. (This does not include water users solely on public water systems.)

Why is the information needed?
-To identify and assess drought response needs of those not served by public water systems.

-To identify where adverse impacts associated with drought are occurring.

-To quantify the specific economic impacts associated with drought to support potential disaster assistance requests.

Additional Information:
Collection of data is not to be construed as application for local, state or federal assistance.

NHDES intends to use this information for the reasons stated above. Please note that information submitted to the NHDES is considered to be part of the public record. NHDES will not publish your information, but other entities conducting Right-to-Know requests may be able to access the information you provide.

Thank you in advance for your time.

Question Title

* 1. Contact Information

First Name:

Last Name:

Company/Organization Name:

Public Water System ID (if applicable):

Water User ID (if applicable):

Phone Number:

E-mail:

Question Title

* 2. Please describe the water issue that you had/are having? (Check all that apply.)

Well is dry and no longer producing water.

Well pump is intermittently sucking air. Need to wait for the well to recharge to be able to pump again.

Well is pumping sand and/or muddy water.

Water pressure is low and/or you are experiencing lower flows out of fixtures or equipment.

Water quality has been reduced.

Stream/river flow is too low to pump water.

Lake/pond level is too low to pump water.

Other (please specify)

Question Title

* 3. What is the approximate date that the above problem started?

Date

Question Title

* 4. Has the problem been solved? (Check all that apply.)

Yes, the well pump was lowered.

Yes, the well was deepened.

Yes the well was hydrofractured.

Yes, the well has been replaced.

Yes, we are withdrawing from an alternative surface water sources.

No, water is being trucked in.

No, we are getting water from our neighbors with a hose.

No, we are on the drilling wait list.

No, we cannot afford to finance the solution.

Other (please specify)

Question Title

* 5. If you tried to repair the problem, but the solution did not work, please describe what happened.

Question Title

* 6. What was the cost of the repair ($)?

If this does not apply to you, enter "X":

Question Title

* 7. Who completed the repair work?

If this does not apply to you enter "X":

Question Title

* 8. Outside of the cost of repair, what do you estimate the economic impact has been to your business and how did you come to this estimate?

Economic Impact ($):

Explanation of how economic impact was estimated:

Question Title

* 9. What are the primary uses of this well or surface water?

Commercial

Industrial

Institutional

Public Water Supply

Mining

Snowmaking

Dust Control

General Irrigation

Golf Course Irrigation

Athletic Field Irrigation

Domestic

Bottle / Bulk Water

Logging / spraying timber

Agricultural - Field Crop Irrigation

Agriculture - Greenhouse Irrigation

Agriculture - Nursery Stock Irrigation

Agriculture - Livestock

Agriculture - Aquaculture

Agriculture - Cleaning Produce

Agriculture - Cleaning Equipment

Power - Biomass

Power - Fossil Fuel

Power - Geothermal

Power - Hydroelectric

Power - Nuclear

Other/More Information:

Question Title

* 10. Does the water user own or rent the property that the water use occurs on?

Own

Rent

Other:

Question Title

* 11. What type of surface water has been impacted by the drought?

Stream/River

Lake/Pond

Does not apply as the water source is a well.

Name of Surface Water:

Question Title

* 12. What type of well has been impacted by the drought? (For well definitions, click here.)

Bedrock well

Dug well

Point well

Well drilled in sand and gravel

Does not apply as the source is a surface water.

I do not know.

If more than one well has been impacted, please specify the number of wells and type of wells:

Question Title

* 13. Well Information: (If you do not know this information, please leave blank. If your well was drilled after January 1, 1984, the below information may be found on the DES OneStop Data search. Click on "Water Well" and type in street address information.

Depth of well:

Year well was drilled:

If more than one well was impacted, please provide information for other wells:

Question Title

* 14. Well/Surface Water Location:

Street Number:

Street Name:

City:

Zip:

Two nearest crossroads:

If more than one water source has been impacted, please provide any additional location information of all sources:

Question Title

* 1. Contact Information

Question Title

* 2. Please describe the water issue that you had/are having? (Check all that apply.)

Question Title

* 3. What is the approximate date that the above problem started?

Question Title

* 4. Has the problem been solved? (Check all that apply.)

Question Title

* 5. If you tried to repair the problem, but the solution did not work, please describe what happened.

Question Title

* 6. What was the cost of the repair ($)?

Question Title

* 7. Who completed the repair work?

Question Title

* 8. Outside of the cost of repair, what do you estimate the economic impact has been to your business and how did you come to this estimate?

Question Title

* 9. What are the primary uses of this well or surface water?

Question Title

* 10. Does the water user own or rent the property that the water use occurs on?

Question Title

* 11. What type of surface water has been impacted by the drought?

Question Title

* 12. What type of well has been impacted by the drought? (For well definitions, click here.)

Question Title

* 13. Well Information: (If you do not know this information, please leave blank. If your well was drilled after January 1, 1984, the below information may be found on the DES OneStop Data search. Click on "Water Well" and type in street address information.

Question Title

* 14. Well/Surface Water Location:

Question Title

* 15. Comments