Water and Utility Questionnaires

Water Well Testing

Name*
First Last
Email
Phone
Address
Street Address Address Line 2 City State ZIP Code
Do you have a private water well at your residence?*
If you answer No, please provide your digital signature at the bottom of the form.
- Yes
- No
Will you allow RH energytrans to test your water prior to and after pipeline construction?
- Yes
- No
If yes, what is the best time to contact you to arrange for testing?
What is the approximate distance of your well from a residence (in feet)?
Is your water well less than 200ft from the Risberg Line Right of Way?
- Yes
- No
Approximate distance if less than 200ft from Right of Way
Well Information, if Available:
When was the water well drilled?
What is the well depth?
Does your well have a casing?
- Yes
- No
What is the type of casing?
Digital Signature*
- Please sign this form electronically by checking this box, indicating that the person signing is the same as the name listed above
Name
This field is for validation purposes and should be left unchanged.

Name*
First Last
Do you have any underground utility lines such as cable TV, propane, water, electrical, sewer, drainage, etc. located on your property that you feel could be impacted by pipeline construction activities?*
If you answer No, please provide your digital signature at the bottom of the form.
- Yes
- No
Please list the type(s) of underground utilities:
If possible, please provide an image or drawing of your property that details the locations of any utility lines relative to your house.
Accepted file types: jpg, gif, png, tiff, pdf.
If you are unable to upload an image file, please describe your property as best you can.
Digital Signature*
- Please sign this form electronically by checking this box, indicating that the person signing is the same as the name listed above
Comments
This field is for validation purposes and should be left unchanged.