PRIVATE WELL SAMPLE
  The Department will take a sample of the water from your well and test it for bacteriological contamination. This application is for a single well.

  We do not test private wells for any minerals, bacteriological contamination. We do not test private wells
  for any minerals, chemicals, or other contaminants. If you wish to have your well tested for these things, you will
  need to contact a private lab. Below is a link to a list of in-state private labs that participate in MSDH’s Drinking Water Lab Certification Program:
   In-State Private Labs

  NOTE: The Division of On-site Wastewater WILL NOT take any water samples for homes connected to public water systems. Please contact the  
              Bureau of Public Water Supply with any concerns regarding your public water system:   Bureau of Public Water Supply
    * Required fields 
 
Site Information
Site Address * 
Zip *   
County * 
City * 
State * 
Acreage *    (>0 acres)  
       
Contact Information
Name * 
Mailing Address * 
Zip * 
City * 
State *   
Email Address *    Re-Enter Email Address
Phone #1 * 
Phone #2 * 
Provide any necessary directions to property or location of well. Please indicate if there is a locked gate or pets to be aware of. 
         
Notes/Directions   
 
  An Invoice of $10 + a processing fee will be emailed within one(1) business day.