NC Private Well User Questionnaire
Are you one of the more than 3 million+ private well users in NC? Most wells have never been inspected or tested for more than bacteria, even when state and local agencies knew of nearby contamination sites.

The below survey is designed to better understand the barriers private well users may face when considering steps to protect the safety of their drinking water.

*All responses are anonymous and will only be shared with Clean Water for NC (CWFNC), a statewide environmental health nonprofit, to better inform their Well User Protection campaign area. No personal information is being collected.

Visit www.cwfnc.org if you'd like to contact staff regarding questions or concerns with the quality of your private well.
Sign in to Google to save your progress. Learn more
Section 1: The below questions are related to testing for contaminants
All responses are completely anonymous.
When was your private well drilled? (The state only began requiring licenses & testing for new wells drilled after July 2008) *
Has your well ever been tested for any type of contaminant? *
How often do you have your well tested for Total Coliform Bacteria?
Clear selection
How often do you have your well tested for Arsenic?
Clear selection
How often do you have your well tested for Lead?
Clear selection
How often do you have your well tested for Zinc?
Clear selection
How often do you have your well tested for Nitrate/Nitrite?
Clear selection
How often do you have your well tested for Chromium?
Clear selection
How often do you have your well tested for Pesticides?
Clear selection
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms