Study on Arsenic and Uranium in Bedrock Wells of East Central Massachusetts (MASSWELL)

OMB Control Number 1028-00XX

Expiration Date

USGS Study of Bedrock Wells of East Central Massachusetts

In Parts 1 and 3 of the survey we want to know a little about your water and where it comes from. In Part 2, there are instructions about how to collect a water sample. Please use the zip-lock bag (provided) to protect your water sample in the mail. When you are done, please use the enclosed self addressed envelope to mail your survey and water sample back to the USGS.

Your participation is completely voluntary and we would like to thank you for taking the time to participate in this important study. If you have any questions, please do not hesitate to contact the project leader John Colman at: (508) 490 5027.

____________________________________________________________________________________

PART 1 - Water Sources and Supplies

The majority of residential water supply wells in east-central Massachusetts are bedrock wells that tap ground water aquifers in fractured bedrock formations. These wells are relatively unaffected by drought and, when properly constructed, provide maximum protection from surface contaminants. We are really interested in wells that are supplied by bedrock sources. In the first part of this study, we would like to ask you a few questions about your water source and supply.

1. Is your home supplied with water from a private bedrock well?

• Yes (go to question 2)

• Unsure. Please explain. ____________________________________________

__________________________________________________________________

• No. My house supply is town water or another source other than bedrock well.

Please STOP here and return the survey in the attached envelope. You do not have to mail back bottles or a water sample.

2. Is your well water treated?

• Yes

What is the treatment? ______________________________

• No

3. How many people are in your household? (Please write in the number of people currently living in your home in the space provided below)

______ People live in this household

4. Have you had your water tested for arsenic or uranium? (Please indicate month and year of your most recent test and the concentration level of the water tested.)

Arsenic	Uranium
No	No
Yes, but don’t have the results	Yes, but don’t have the results
Yes, and here are the results Date (mm/yyyy) ___________ Concentration _____________	Yes, and here are the results Date (mm/yyyy) ___________ Concentration _____________

5. Do you use your well water for drinking water or cooking?

• Yes

• No, because of water quality issues (Select all that apply):

Arsenic	Uranium
Iron	Sediment
Manganese	Taste
Other___________________________________________________________

Part 2 - Water Sampling Instructions

Although collecting a water sample is a relatively simple task, there are several steps that must be taken to ensure accurate results. Please follow the instructions in steps 1-8 below to complete the next section of the survey.

Instructions

1. Collect your water sample in the sample container provided by the USGS. Samples collected in any other container will not meet lab standards and cannot be processed. If you do not have a water sampling container please contact the USGS and we will send you one right away.

2. Choose a location to sample your water. If you do not have any water treatment devices, such as a water softener or a reverse osmosis filter, take the sample from a cold water tap where you get your drinking water. If possible, choose a non-leaking, non-swivel, non-mixing faucet. If you do have treatment devices on your water system, please locate a faucet which is attached to the water line before the treatment system.

3. Remove any faucet attachments and aeration screens.

4. Please wash your hands, to prevent contamination of your sample, before sampling and do not touch the inside of the bottle or lid.

5. Turn on the cold water and let it run for 1 to 2 minutes to flush the water out of the pipes. Turn the faucet down to a pencil size stream of water and fill the sample container.

6. Place the container in the zip-lock bag (provided).

7. Place the zip-lock bag and your completed survey in the self addressed envelope.

8. Mail the envelope to the USGS on the same day.

PART 3 - Location and Time of Water Sample

Please tell us where and when you collected the water for this sample.

Which faucet did you use to take the sample?

• Basement Faucet

  • Before the filter

  • After the filter

• Outside Spigot

• Bathroom Faucet

• Kitchen Faucet

• Other __________________________________

Date and time of sampling_____________________________________

Once this survey is done, we will send the results to the Massachusetts Department of Health. We may conduct a follow-up study. If that is the case we may need to collect additional water samples from a small segment of the people we contacted for this study. Would you be willing to participate in the follow-up study if necessary?

• Yes, I would like to participate in a follow-up study.

Please contact me by phone: _____________________________________

Or by email: ____________________________________________________

• No, I would not like to participate in a follow-up study.

P APERWORK REDUCTION ACT STATEMENT: The Paperwork Reduction Act of 1995 (44 U.S.C. 3501 et. seq.) requires us to inform you that this information is being collected to inform a study on arsenic and uranium in bedrock wells of east central Massachusetts. The estimated burden for this collection of information is estimated to average 10 minutes per response, including the time for reviewing instructions, answering questions, collecting water samples. The response to this request is voluntary. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB Control Number. Comments regarding the burden estimate or any other aspect of this collection of information should be directed to: John Coleman at (508) 490 5027

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