1. What is the texture of the soil around your well?
2. At the well site, is the water table or bedrock less than 20 feet from the ground surface?
3. Is there a depression or sign of soil settlement near or around your well?
4. Does surface runoff ever reach your well?
5. Is the water well upslope from all potential pollution sources?
6. What is the separation distance between the water well and each of the following? (Skip items not present on your farm)
a) Sewer/drain inlet:
b) Septic tank:
c) Outdoor privies
e) Manure pit:
f) Nearest stream, lake, pond or ditch:
g) Nearest property line:
h) Nearest storage:
i) Chemical storage
7. How was your well constructed?
8. How old is your well?
9. How deep is your well?
10. Does the well have a casing?
11. Does the casing extend the full depth of the well?
12. Are there any holes or tears in the casing?
13. How far does the well casing extend above the ground surface?
14. Are there any cracks or holes in your well cap?
15.Describe the fit of the well cap.
16. Does the well have a vent?
17. Are there any cross connections between your water supply line and potential souces of contaminated water?
18. How many faucet and hose connections have anti-backflow devices?
19. Are there any unused or abandoned wells on your property that have not been capped or plugged using a procedure approved by the Indiana Department of Natural Resources?
20. Do you have your water tested on a regular basis?
21. Does your water meet state and federal quality standards?
22. Does one or more of the following indicators of your drinking water quality change during wet periods or following a storm: color, clarity, odor or taste?