Emerging Issues for Private Wells - Word

Attachment A: Instrument (Word Version)

Form Approved

OMB No. 0920-0879

Expiration Date 04/30/2017

This assessment is directed to members of the Council of State and Territorial Epidemiologists (CSTE) or their delegates who have responsibility for private residential wells and public health. This project is funded through a Cooperative Agreement with the Centers for Disease Control and Prevention.

This assessment was developed to identify emerging public health issues facing private residential well owners, gaps in private well knowledge or stewardship practices, tools and resources needed to address these gaps, and any anticipated changes in policies or legislation impacting private residential wells and private residential well users.

The anticipated respondent is the person within your state health department or in your state environment department, who knows the most about private residential wells and works with private residential well owners. If this is someone other than yourself, please forward this assessment to that person. We also encourage you to involve other potential stakeholders/partners (National Ground Water Association, Water Systems Council, etc.) when answering these questions, as they work closely with private residential well owners.

The information obtained from this assessment will provide data needed to inform future activities conducted by 1) the Health Studies Branch, Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention; 2) CSTE Private Wells Workgroup; and 3) other public health partners to address private well­related public health issues. Identifiable information about the respondent (name, position, agency, phone, and email) will be removed when the results of this assessment are aggregated for analysis. Individually identifiable state responses will be kept secured and will not be shared with the Workgroup or any other entity without permission.

This assessment is estimated to require an average of 60 minutes of your time.

Thank you for completing this assessment by MONTH DAY, 2015. Please contact Jennifer Lemmings ([email protected] or 770­458­3811) if you have any questions. We appreciate your time and attention to this matter.

Follow the directions accompanying each question.

Public reporting burden of this collection of information is estimated to average 60 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing information. 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 Office of Management and Budget control number. Send comments regarding this burden estimate, or any other aspect of this information collection, including suggestions for reducing this burden to CDC/Agency for Toxic Substance and Disease Registry Information Collection Review Office, 1600 Clifton Road NE, MS D74, Atlanta, Georgia 30333; Attention: PRA (0920-0879).

1. *Please enter the following information about the primary respondent to this assessment

Name:

Position:

Agency:

State/Province:

Email Address: Phone Number:

2. What types of private well programs exist in your state and what aspects of private well stewardship does each program address? In the text boxes below, please write the name of the program followed by a 1 line description of the stewardship it addresses. (e.g., Private Well Testing Funds ­ well water quality testing; Newsletter ­ private well water maintenance)

3. Is your State Health Department involved in designing and implementing these private well programs?

• Yes, all of them

• Yes, some of them

• No, another group is responsible for these programs

• Unsure

• Other (please specify)

4. Does the state provide guidance regarding treatment options for private well water?

• Yes

• No

• Unsure

• Other (please specify)

5. *What (other) programs, if any, are in place for private wells in your state?

6. Select the top three (3) contaminants of concern you think have a substantial public health impact due to exposure to private well water within your state. Select only three (3) options below

• Arsenic

• Cadmium

• Chemicals (e.g., runoff, industrial discharge)

• Chromium

• Chloride

• Copper

• Fluoride

• Hardness

• Iron

• Lead

• Manganese

• MBTE and other gasoline additives

• Nitrates

• Pathogens including bacteria, viruses and/or protozoa

• Pesticides

• pH

• Radium

• Radon

• Selenium

• Sulfate

• Total dissolved solids

• Uranium

• Volatile Organic Compounds (VOCs)

• Other (please specify)

Questions 7­18 are about the most pressing concerns currently within your state regarding private well water for drinking water. Each of the questions regards a subcategory within the larger topic of drinking water.

7. Please select the most pressing concerns about private well water for drinking water within your state related to water quality. Select all that apply.

Water quality

1. Agricultural practices

2. Biological

3. Chemical

4. Testing

5. Regulations

6. Source

7. Not Applicable

8. Other (please specify)

8. Please select the most pressing concerns about private well water for drinking water within your state related to water quantity. Select all that apply.

Water quantity

1. Agricultural practices

2. Depleting water source

3. Regulations

4. Not applicable

5. Other (please specify)

9. Please select the most pressing concerns about private well water for drinking water within your state related to climate change. Select all that apply.

Climate change

1. Water quantity due to periods of long periods of drought

2. Changing weather patterns, more/less frequent periods of drought/flooding

3. Devastation from natural disasters

4. Not applicable

5. Other (please specify)

10. Please select the most pressing concerns about private well water for drinking water within your state related to industrial activities. Select all that apply.

Industrial activities

1. Mineral extraction

2. Superfund Sites

3. Emerging chemicals

4. Persistent chemicals

5. Not applicable

6. Other (please specify)

11. Please select the most pressing concerns about private well water for drinking water within your state related to staffing. Select all that apply.

Staffing

1. Not enough agencies working on private wells

2. Not enough staff to support private well testing demand

3. Not enough staff to analyze private well testing data

4. Not enough training/education of staff

5. Coordination

6. Not applicable

7. Other (please specify)

12. Please select the most pressing concerns about private well water for drinking water within your state related to development. Select all that apply.

Development

1. Urban sprawl

2. New development of rural areas

3. Land preservation

4. Supporting population growth

5. Not applicable

6. Other (please specify)

13. Please select the most pressing concerns about private well water for drinking water within your state related to infrastructure. Select all that apply.

Infrastructure

1. Appropriately locating new or replacement wells

2. Older private well infrastructure

3. Infrastructure in place to protect groundwater

4. Not applicable

5. Other (please specify)

14. Please select the most pressing concerns about private well water for drinking water within your state related to regulations/legislation. Select all that apply.

Regulations/Legislation

1. Local ordinances regarding private well testing

2. State regulations

3. Not applicable

4. Other (please specify)

15. Please select the most pressing concerns about private well water for drinking water within your state related to availability of testing. Select all that apply.

Availability of testing

1. Testing methods

2. Limited access to a laboratory

3. Limited funds for testing

4. Limited availability of test kits that can be used by homeowners

5. Not applicable

6. Other (please specify)

16. Please select the most pressing concerns about private well water for drinking water within your state related to funding for testing. Select all that apply.

Funding for testing

1. At the state and local levels

2. Private residential testing

3. Access to home testing kits

4. Not applicable

5. Other (please specify)

17. Please select the most pressing concerns about private well water for drinking water within your state related to public education. Select all that apply.

Public education

1. Public knowledge of contaminants

2. Public knowledge of water sources

3. Public knowledge of quality/waterborne illnesses

4. Resources for public education

5. Not applicable

6. Other (please specify)

18. Please select the most pressing concerns about private well water for drinking water within your state related to location of wells. Select all that apply.

Location of wells

1. Data regarding location information

2. Finding/ adding new wells

3. Locating old wells

4. Real estate information regarding well quality

5. Not applicable

6. Other (please specify)

Questions 19-27 are about emerging issues within your state regarding private well water used for drinking water.

19. Rank the emerging private well water issues that you anticipate your state will have to address in the next 10 to 20 years

• Agriculture practices

• Appropriately locating new or replacement wells

• Availability of testing (including testing methods or access to a laboratory)

• Certification of oversight of the private well water treatment industry

• Changes in water quality (e.g., agricultural practices, biological, chemical, testing, regulations, source)

• Changes in water quantity

• Climate change

• Changes in water source

• Energy development

• Funding for testing

• Increase in water demand

• Industrial activity

• Old private well infrastructure

• Increased pressure from legislatures to revise or add regulations

• Urban sprawl

• Other

20. Indicate why your most important concern (indicated as #1 in Question 19) is of importance in your state. Select all options below that apply.

• Costs the most to address

• Costs the least to address

• Affects the most people or represents a barrier to improved public health for the largest number of people

• Poses the greatest overall health risk

• Disproportionately affects a vulnerable population

• Other (specify)

21. Indicate why your second most important concern (indicated as #2 in Question 19) is of importance in your state. Select all options below that apply.

• Costs the most to address

• Costs the least to address

• Affects the most people or represents a barrier to improved public health for the largest number of people

• Poses the greatest overall health risk

• Disproportionately affects a vulnerable population

• Other (specify)

22. Indicate why your third most important concern (indicated as #3 in Question 19) is of importance in your state. Select all options below that apply.

• Costs the most to address

• Costs the least to address

• Affects the most people or represents a barrier to improved public health for the largest number of people

• Poses the greatest overall health risk

• Disproportionately affects a vulnerable population

• Other (specify)

23. What are your recommendations for how to address the emerging issues you selected in Question 19?

24. *Do you currently have the resources to support your recommendations for plans to address these emerging private well water issues as answered in Question 19?

• Yes

• No

Please explain either your Yes or No answer.

25. What tools (e.g., access to data, geospatial mapping, effective outreach/education materials, improved tools to provide guidance regarding treatment, etc.) do you need to address the top 3 important concerns you selected in Question 19?

Please rank the tools you need in order of priority with “1” being the most important and “5” being the least important.

1.

2.

3.

4.

5.

26. Indicate your top three (3) types of information you anticipate will be most needed by people in your state due to these emerging private well water issues. Rank only 3 options below.

• Known common sources of well water contamination

• Potential health effects from using contaminated well water for drinking and food preparation

• Relative level of risk associated with various concentrations of contaminants

• Factors that make a private well susceptible to contamination

• Testing guidance and requirements

• List of certified testing laboratories

• Funds to pay for testing

• Understanding test results

• How to correct contamination problems (including how to choose from among treatment options)

• Preventing well contamination problems

• Information on how to choose a well constructor/driller (i.e., what questions to ask your well constructor/driller)

• Other (please specify)

27. Provide any additional comments you may have here regarding any part of the assessment:

Thank you for your participation.

Thank you for taking the time to answer these questions. Your responses are invaluable to our decision making and the planning of future activities.

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