What is this form?

This form is for use by local, state or federal agencies receiving calls from individuals experiencing problems with their domestic wells.

How is this information going to be used?

This information is intended to inform and coordinate state response to mitigate drought impacts and better organize information about where domestic wells are having problems. Data collected is considered confidential and access to it is restricted. Collection of data is not to be construed as application for local, state or federal assistance. Individuals interested in financial assistance can be directed towards appropriate state and federal resources.

Attachment Size
Domestic Dry Well Call Sheet (304.46 KB) 304.46 KB

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