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FREE PRIVATE WELL WATER TESTING Is the water in my well safe? To assess if your water is safe, you should have water samples collected from your well, and tested by a certified laboratory. Your drinking water may contain chemicals that you cannot see or smell. There is not one test that can detect every chemical, bacteria, or pathogen in existence. To know if a particular contaminant is in the water, you have to request that the laboratory test for that specific contaminant.
How can my well water become polluted? Groundwater pollution can originate from various sources including: fertilizers, pesticides, septic systems, livestock waste, chemical spills, fuel from leaking underground tanks, and naturally occurring chemicals.
Who is responsible for my private “domestic” well water? No government agency monitors the water quality of private wells. It is the responsibility of the owner or tenant to test and treat their water. Health agencies recommend that private domestic water well supplies be tested on an annual basis.
How are samples collected and how will I get the results? 1. The well owner/tenant assists Community Water Center staff to locate
the well and pressure tank. 2. Water from the well pressure tank may need to be drained by staff
before sampling. 3. Water samples are collected by staff from a faucet as close to the well
as possible. 4. Water samples are tested by a certified laboratory. 5. Well water test results are given to the well owner/tenant. 6. Well sampling and water testing are performed at no cost to the well
owner.
To have your domestic well water tested: Complete the participation agreement (other side of this form) by filling in the required information. We will contact you by telephone to schedule a time to collect samples from your well. CWC recommends that you provide your well construction information (Well Completion Report) to staff.
References: Please note that information on this flyer was adapted from a flyer used by the GAMA Domestic Well Project of the State Water Resources Control Board. Some parts of the GAMA flyer were quoted directly. Our program is independent of the GAMA program.
Contaminants Typically Tested Bacteria (Total Coliform and E. coli) Nitrate Arsenic Chromium Uranium Dibromochloropropane [DBCP] 1,2,3, Trichloropropane [123-‐TCP])
Contact Information: If you have any questions or concerns regarding this project, please do not hesitate to contact the Community Water Center at (559) 733-‐0219 or Gerardo Tinoco, Jr. at gerardo.tinoco@communitywatercenter.org (661) 345-‐9976.
By signing this agreement, I agree, as the owner or tenant in possession of the property referenced below, to participate in the private well testing program offered by the Community Water Center (CWC), a non-‐profit organization working for community water solutions in Tulare County (www.communitywatercenter.org). I understand that the well will be tested for one or more of these potential contaminants: Total coliform bacteria, E. coli, nitrate, Dibromochloropropane (DBCP), 1,2,3, Trichloropropane (TCP), Hexavalent Chromium, Arsenic, and Uranium. Depth to water may also be measured in my private well with a well sounder. A copy of the water quality report will be provided to me. I also acknowledge that the water quality report will be a public record and as such it may be used in water quality studies or planning. Any summary reports available for this program will be made available to me (as a participant). Purpose of program: The purpose of this program is to better understand water quality and water depth of private wells in this area. Nitrates and other contaminants have been found in nearby wells. Numerous private wells in the surrounding area have gone dry. The Community Water Center is running this program in order to help plan for future water solutions in my area. Cost: The private well testing program is offered by the Community Water Center at no cost to me, the owner or tenant.
Please indicate the address of the property where the private well is located here:
_____________________________________________________________
� YES, I am the well owner and would like to participate in Private Well Testing (Well Owner).
�
YES, I am the tenant and have permission from the well owner to participate.
� YES, I have well construction information (Well Completion Report).
� NO, I do not wish to participate at this time, but I would like to stay informed about water solutions.
Participation Agreement for Free Private Well Testing
Signature of Owner or Tenant
____________________________________________
Owner/Tenant’s Name (Please print): ____________________________________________
Daytime Phone: ____________________________________________
Email: ____________________________________________
Resident’s Mailing Address: ____________________________________________ ____________________________________________
Date: ____________________________________________
____________________________________________
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