Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Fernley Private Well Questionnaire

  1. Private Well Questionnaire

    The City of Fernley is collecting data from Fernley residents regarding private well issues within City limits. The information gathered will help City, State, and Federal Officials gain a better understanding of aquifer level trends and private well performance from October 2022 to present. These responses will be used for informational purposes only and is not intended for any future residential regulatory policies. 

    If you would like to share your well issues, please fill out the form and select the submit button by October 20th, 2023. 

    A hard copy of this form can also be found at the Public Works counter in City Hall. You can submit the form in person,  online, via email to, or put it in the Utilities drop box. 

    Thank you!

  2. Please enter your email address if you have one.

  3. Example: June 2020

  4. Example: Pressure loss, no water, sand, etc.

  5. Example: 59 ft.

  6. Example: 40 ft.

  7.  Example: 65 ft.

  8. Leave This Blank:

  9. This field is not part of the form submission.