State of Indiana Ground Water Monitoring Network Application

The Indiana Department of Environmental Management (IDEM) is conducting a statewide ground water quality survey. We are currently seeking residential well owners to participate in this survey.

The water well sampling will be free of charge to residents who participate and copies of the analytical results will be provided. Your mailing address, and specific well location, will not be available in publications as part of this sampling effort. Any additional annual sampling of your well will occur at no expense to you.

If you are interested in participating in this program, please complete the enclosed application and return it in the provided prepaid envelope. The samples need to be collected from an outside spigot that is easily accessible to our samplers and is not connected to a softener or other filtration system. IDEM will call prior to visiting, but the resident does not need to be present at the time of sampling.

If you have questions, please call Kevin Spindler at (317) 234-3243 or kspindle@idem.in.gov.

Questions marked with a * are required.

 
*1. Name (First, Last):
 
*2. Street Address:
 
*3. City, State, and ZIP:
 
*4. Phone Number (Including Area Code):
 
*5. County:
 

Yes, I would like to participate in this water quality survey. I understand that my well will be sampled at no expense to me and that I will receive copies of the sampling results. I also understand that any future resampling of my well will also occur at no expense to me.

 
*6. I confirm my participation in this water quality survey.
Confirm
 
*7. Do you have an accessible non-softened outside spigot?
Yes
No
 
8. Where is the spigot located?
 
*9. A convenient time to contact you at the above phone number is:
 
*10. The most convenient time on a weekday to collect a water sample is:
 
11. Additional Comments or Information: