[Dunn County, WI] Groundwater Sampling Form

Section 1 of 1 in this document

Full Name

First Name *

Last Name *

Well Address

Street Address *

City *

State *

Zip *

Township *

Mailing address (if it differs from the well address)

Street Address

City

State

Zip

Phone Number

Email

Preferred Contact Method

Phone

Email

Do you have a private well or a municipal water line?

Private Well

Municipal Water Line

Please select any treatment options that are applicable to your water.

Reverse Osmosis (RO)

In-line Iron/ Metals Filter

In-line Sediment Filter

Water Softener

None

Have you participated in any LWCD well sampling programs in the past

Yes

No

For questions, please contact:
Heather Wood - Water Resources Specialist
Dunn County Environmental Services Dept.
Land and Water Conservation Division
3001 US Highway 12 East, Suite 240 A
Menomonie, WI 54751
715-231-6532

disregard this