2023 Private Well Testing Registration (South Jersey)

Contact Information

What township do you reside in?

For how many years have you lived at your property with a private well?

How did you learn about this well testing opportunity? (Please select all that apply)

Flyer/Pamplet

Social Media (e.g. - Facebook)

Township Website

Word-of-mouth

Other

Has your well water been tested for gross alpha (radioactivity) before?

Yes - during real estate transaction when we bought or rented the house

Yes - during a community event

Yes - for a previous outreach sponsored by the New Jersey Department of Health

No

I don't know

Other

Do you have water treatment for your well water?

Yes

No

I don't know

Who maintains your water treatment?

We do (e.g. - myself, spouse, relative)

Treatment professional

Laboratory professional

No one (water treatment is not maintained)

Not Applicable (do not have water treatment or don't know if there is water treatment present)

Other

2023 Private Well Testing Registration (South Jersey) - Sponsored by NJDOH