Thank you for taking the time to complete this survey. Your responses will help guide health education activities for private well owners across North Carolina.
This survey is intended for private drinking well owners in North Carolina or their representatives who may be familiar with the maintenance of their wells. The respondent to this survey should be the person within your household who knows the most about your well.
This survey asks about a well that was constructed at your address and water quality testing that was conducted for that well. If you did not live at your address at the time the well was constructed and tested, then you may not have received a copy of the results from the well water testing that was done. A copy of those test results was included in the survey package mailed to you.

Taking part in this survey is completely voluntary. You may skip any question or stop at any time. A summary of participants' aggregated responses will be published on the NC Department of Health and Human Services (NC DHHS) website. The survey and responses received may be considered public records.

The survey questions are divided into five sections:
  • Background about Your Private Well
  • Private Well Testing and Results
  • Actions Taken with Your Private Well
  • Your Concerns about Your Private Well
  • Demographics
We estimate that this survey will take about 20 minutes to complete. You may skip any question you do not want to answer.

We will award $25 gift cards to 500 survey participants, using a random drawing. This survey ends December 7, 2020. Any surveys received after this date will not be considered for the $25 gift card award.
→ By proceeding, you indicate that you are 18 years of age or older and consent to participate in this survey.
Loading... Loading...
You have selected an option that triggers this survey to end right now. To save your responses and end the survey, click the button below to do so. If you have selected the wrong option by accident and do not wish to leave the survey, you may click the other button below to continue, which will also remove the value of the option you just selected to allow you to enter it again and continue the survey.
The response has now been removed for the last question for which you selected a value. You may now enter a new response for that question and continue the survey.