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Well Complaint Form

This form is provided to the public to report freeze related well complaints.

DO use this form to provide information regarding the well, its location, and a description of the issue.

DO NOT use this form if your complaint is not related to a well issue. Non-well related freeze complaints can be submitted to info@watermatters.org.

Once you have completed this form, your complaint will be assigned to staff for investigation. You will be notified of the outcome of the investigation. The District encourages you to obtain potable water for consumption.

The District advises citizens with wells for potable water supply to equip their wells with automatic switches that will turn off the pump when water levels and pressure drop. This method can help to prevent the pump from overheating and irreversible damage.

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* Required Fields

- Contact Information
- Name*
- First Name*
- Last Name*
- Email
- Confirm Email*
- Send me a copy of this form* Yes No
- Phone* - -
- Well Address
- Address*
- City* State* ZIP*
- County*
- What is the general location
  of the impacted well?*
- Mailing Address
- Same as above
- Address*
- City* State* ZIP*
- Well Information
- What is your relationship
  to the property?*
  
  (Explain other)*
- When was the problem with
  the well noticed?*
- Is the well producing any water?* Yes No
- What is the problem with the well?*
  Low Pressure
  Poor Water Quality
  Air in Line
  Other
  
  (Explain other)*
- Have you had problems with
  the well previously?* Yes No
- What were the previous problems?*
- When did your previous problems occur?
- Was the well repaired or replaced?* Yes No
- When was the work done?
- In what year was your well constructed?
- In what year was your house constructed?
- Do you know the approximate depth of your well in feet?* Yes No
- What is the depth of your well?* feet
- Do you know the approximate depth of your casing in feet?* Yes No
- What is the depth of your casing?* feet
- Do you know the approximate depth of your pump in feet?* Yes No
- What is the depth of your pump?* feet
- Do you know the approximate diameter of your well in inches?* Yes No
- What is the diameter of your well?* inches
- Have you performed any repairs
  in response to this problem?* Yes No
- Provide details about the repair.*
- Other information
  (100 char limit)

Well Complaint Form

Contact Information

Well Address

Mailing Address

Well Information