The GWMN is a statewide groundwater quality study. We typically get our samples from private residential drinking water wells. Your assistance will help us get the best possible data for this study. Unfortunately, not everyone that signs up will be able to be sampled. If you are selected for sampling, we will notify you prior to our visit and provide you with a copy of the sampling results at the end of the sampling season. We appreciate your participation in our study by initially completing this survey to the best of your knowledge.

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* Name

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* Address

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* Phone Number

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* Is texting of this number okay?

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* Do you have an outside spigot that does not go through a water softener or other treatment?

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* If 'Yes', where is this spigot located?

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* Can you attach a standard garden hose to the outside spigot without any adapter?

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* Is the spigot accessible to our samplers? (i.e. no locked gates or pets)

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* Do you have a water softener or iron removal system?

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* Do you have a treatment system that you use to treat your drinking water such as reverse osmosis?

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* If you answered 'Yes' to the Previous question, what type of system is it? (Please include the brand and model number of the system)

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* Would it be possible for IDEM to test a sample of this treated drinking water (if someone is available while our sampler is there)?

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* Do you have a copy of the Well Record form showing the depth and construction of the well and the geologic materials encountered by the driller during well installation?
If you do not have this form, IDEM will attempt to locate it in the Department of Natural Resources (DNR) database. This information is required for inclusion into this project.

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* Has your water ever been tested?

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* If you answered 'Yes' to the previous question, was there anything notable about the results?

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