Request edit access
JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
West Shore Well Survey
Sign in to Google
to save your progress.
Learn more
Name
Your answer
Address
Your answer
Telephone/Cell Number
Your answer
Email Address
Your answer
Do you have a beach well?
Your answer
Do you use municipal water?
Your answer
Do you have any drilled wells on your property?
Your answer
If yes, how many and how deep?
Your answer
If yes, how many yards is it from the lake shore?
Your answer
If yes, is the well(s) still in use?
Your answer
Have you noticed any ground subsidence on your property? Subsidence could cause cracks in your foundation or even a very slight lean of the building or trees towards the lake
Your answer
Would you like to be on the CLEAN listserve? We send about 6 newsletter emails per year.
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. -
Terms of Service
-
Privacy Policy
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report
