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2. 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 twood@cityoffernley.org, or put it in the Utilities drop box. 

   Thank you!

   

   
   

4. First Name*
5. Last Name*
7. Address1*
8. Address2
10. City*
11. State*
12. Zip*
14. Phone Number*
15. Email Address

    Please enter your email address if you have one.

17. When did you start noticing issues with your well?

    Example: June 2020

18. Please describe issues:

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

20. How deep is your well now?

    Example: 59 ft.

21. Have you extended your well?
    -- Select One --YesNo
22. Date extended.
23. How deep was your well initially?

    Example: 40 ft.

25. Do you have plans to extend your well?
    -- Select One --YesNo
26. To what depth do you plan to extend it?

     Example: 65 ft.

28. Do you need to drill a new well on your property?
    -- Select One --YesNoIt will not help.
30. Additional comments:
Leave This Blank:


31. 1. Receive an email copy of this form.
32. Email address

    This field is not part of the form submission.

33. Submit

* indicates a required field