Red Rock Rural Community Association

Water Resource Assessment and Monitoring Program

Dear Resident:

Due to recent issues concerning the availability of water resources within the boundaries of the Red Rock Rural Community Association we have developed this voluntary program to assist in a local water resource data gathering and assessment effort. The result is to be a preliminary attempt to gather, map, and monitor area water activity.

Without a dedicated supply of water we could not survive in this desert environment and the need for data in conducting proper water management is essential. Your cooperation in answering the following questions, (to the best of your knowledge), is greatly appreciated.

Please complete the questionnaire, included on page 2 and 3, and return it to:

RRRCA

PO Box 3086

Sedona, AZ 86340

PLEASE NOTE: The RRRCA assumes no liability in the collection or accuracy of information provided by individual well owners; all efforts will be made to ensure a true analysis of data received and reported. Any information gathered during this assessment is for internal use only. The RRRCA will not make this information publicly available, and all information will be kept private, unless the well owner specifically authorizes disclosure of such information.

Thank you!

Red Rock Rural Community Association

Water Resource Assessment and Monitoring Program Questionnaire

*1. Well Owner’s Name:_________________________________________________________

Address:_________________________________________________________

Contact Phone:____________ Email:________________________________________

*2. Well Location/Description (from owner’s tax statement):

Township____________NS Range____________EW Section____________

Subsections__________1/4__________1/4__________1/4

10 acre 40 acre 160 acre

Lot or Parcel #___________________________________

*3. Well Information:

Year Drilled:________________________

Well Depth:_________________________

Depth to Water (static level):______________________

Primary Water Use: _ Residential _ Agricultural

(check one) _ Livestock _ other:____________________________

*4. Well is considered a: _ Private Well _ Community Well

(check one)

4A. If a community well – How many homes does it serve?____________

*5. Has the well ever been: _ Deepened _ Modified _ Relocated

*5A. If so - Year(s):____________ Depth:____________ Other modifications:________________

_______________________________________________________________________________________

6. Do you maintain a well log (written record) or other journal of information regarding this well: _ Yes _ No

7. Has the quality or quantity of your water ever varied or changed: _ Yes _ No

7A. If yes – please explain:_________________________________________________________

_______________________________________________________________________________________

8. Has your well ever been tested for the following?

_ Well Never Tested

_ (1) pH (date/results:______) _ (2) Alkalinity (date/results:______) _ (3) Hardness (date/results:______)

_ (4) Nitrite (date/results:______) _ (5) Nitrate (date/results:______) _ (6) Arsenic (date/results:______)

_ (7) Bacteria (date/results:______) _ (8) Giardia/Cryptosporidium (date/results:______)

_ (9) Heavy Metals [mercury/lead] (date/results:______)

9. Would you be willing to purchase a Well Test Kit ($8.00) to test for #1-5 above? _ Yes _ No

9A. Would you be willing to purchase a Well Test Kit ($16.00) to test for arsenic? _ Yes _ No

(Other test kits can be purchased from: Acustrip - PO Box 413, Mountain Lakes, NJ, 07046

Phone – 973 299-8237…Web – www.acustrip.com.)

10. Do you have any other water resources (irrigation ditch rights, rain barrels, pool, holding tank, pond)? _ Yes _ No

10A. If so – What other resources do you currently utilize? _________________________________

________________________________________________________________________________________

11. Would you be willing to participate in an ongoing well monitoring group? _ Yes _ No

12. If you had the option would you be in favor of establishing and connecting to a water supply provided by a local water district? _ Yes _ No

Comments:_____________________________________________________________________________

_______________________________________________________________________________________

* Denotes information of public record.