|The Mississippi Department of Environmental Quality, Office of Land and Water Resources (OLWR) conducts an annual water-use survey in Mississippi. The survey is mailed out the first week of March to allow the water users being queried to have sufficient time to develop final pumpage data for the previous calendar year. Public water suppliers, industries, commercial, and private well owners are surveyed.|
|The annual water-use survey consists of two forms:|
| 1. Well Owner Information Form|
2. Well Data Form
|Well Owner Information Form|
|This identifies the well owner. Owners of commercial, industrial and private wells should fill out the first box on the form. Public water suppliers should fill out the larger second box which consists of the Public Water Suppliers Information and the System Information sections. Public suppliers please fill out a separate System Information section for each individual system as designated by the Mississippi State Department of Health. (Please photocopy this form if additional ones are needed). |
Everyone should sign the bottom of the Well Owner Information Form in the place provided.
|Well Data Form|
|This identifies all the wells owned by an individual, business or water supplier. It is important that each existing well is accounted for on this form (even if the well has been abandoned or does not have a permit number). If you have a well that is not included in this list of wells, please include the missing well(s) at the bottom of the page. Included on the Well Data Form is a space to enter the annual pumpage for each individual well. If your wells are not metered, please use the best estimate possible and indicate on the form that it is an estimate by writing a short sentence at the bottom of the form explaining how it was estimated.|
Two typical ways of estimating pumpage:
- Multiply the number of customers by 100 gallons per day.
- Determine the length of time the pump runs daily and multiply it by the pump output or rate.
If the well was inactive during the year, indicate so in the space provided for the pumpage data. Please be sure that this form is as complete and accurate as possible. Any errors noted on the form should be corrected before it is submitted to the OLWR. If all the information is correct, please fill in the corresponding pumpage and connection data for each well and return the completed form.
|The annual survey not only aids in the inventorying and identification of ground-water wells, but also enables us to track the following items:|
- annual pumpage
- updated well engineering data
- changes in well ownership
- changes in well status (active, standby, abandoned, unused, etc.)
|This questionnaire is designed to be completed quickly and easily by all well owners. Some questions apply only to the public water suppliers. Please skip those questions that do not apply to you as a private well owner. |
|This questionnaire should be completed and returned to the Mississippi Department of Environmental Quality, Office of Land and Water Resources. Please mail to:|
|Mississippi Department of Environmental Quality|
Office of Land and Water Resources
P.O. Box 2309
Jackson, MS 39225
|If you have any questions or need any assistance contact Casey Fitzgerald, 601-961-5209 or email at firstname.lastname@example.org.|
|Thank you for your cooperation.|