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Permission
Yes, MPCA and/or its contractors have permission to sample my well.
No, MPCA does not have permission to sample my well (we will not contact you again)
I do not have a well.
Name
Property address
Unique well number
Is your home connected to city water?
Yes
No
Property status
Own
Rent
Manage
Email
Phone number
Mailing address (if different from well address)
Name, phone number, and address for the property owner
Are your outside taps on?
Yes
No
Unknown
Are your outside taps filtered?
Yes
No
Unknown
Do you have a water softener?
Yes
No
Unknown
Are your outside taps softened?
Yes
No
Unknown
Do you have a copy of your well log?
Yes
No
Unknown
When was your well drilled?
How many feet deep is your well?
Describe location of exterior tap
Submit
Leave this field blank