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:   ____________________________________________    

  ____________________________________________