Mora, San Miguel, and Taos County Private Well Sampling Form

Number of Groundwater Wells on Property(Required)

Please enter a number from 1 to 500.

If "Other" please describe usage

If "Other" please describe features

What is the well depth?(Required)

Please answer “unknown” if you do not know.

List any other information about the well or wells.(Required)

This includes (but is not limited to) information such as drill date, depth to groundwater, and New Mexico Office of the State Engineer ID Number (e.g., CR-12345)

Do you believe damage occurred to your private well or water supply during the 2022 Hermit's Peak-Calf Canyon Wildfire?

If so, please explain

Please provide results or other specifics of the sampling

Name

This field is for validation purposes and should be left unchanged.