Water Survey

FDWD Code (enter the code included on the letter sent to you or leave blank):

Name:

Street Address

City / State / Zip:

Email:

Phone:

Name of Occupant (if different from homeowner):

How many people live in the home? (include part-time residents):

Do you have a water softener?

Yes

No

Do you have any farm animals, horses, or livestock?

Yes

No

If yes, type and number:

How is animal waste disposed?

Do you have a septic tank?

Yes

No

If yes, when was it last cleaned?

Do you have a swimming pool?

Yes

No

Do you have a fuel tank?

Yes

No

If yes, what type? check all that apply:

Propane

Oil

Other

If Other, please list type:

If yes, where is the location? check all that apply:

Indoor

Outdoor

Above Ground

Below Ground

Do you have any questions or concerns we can help you with?

Water Survey

Survey

Contact Us

M – F: 7:30 AM – 4:00 PM

excluding holidays

203-847-7387

info@firstdistrictwater.org

Address
12 New Canaan Avenue, Norwalk, CT 06851

Water Survey

Survey

Contact Us

M – F: 7:30 AM – 4:00 PM

excluding holidays

203-847-7387

info@firstdistrictwater.org

Address12 New Canaan Avenue, Norwalk, CT 06851

Address
12 New Canaan Avenue, Norwalk, CT 06851