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Dear Dentist




Following is a series of questions used by our representatives to help them identify possible problems with your water supply. Can you answer all of these about your water?

Is your water supplied by the City? If so which city?

 Is your water supplied by the County? If so which county?

 Are you on City Sewage or Septic Tank. If other, please describe.


Have you noticed any interruptions in your water flow? How long were the interruptions (seconds, minutes, hours, days)? How often do they occur. Once a day, once a month…? When they occur does the water change odor, color, taste, or turbidity (cloudiness)?


Have you ever had a film, residue, powder-like material, or other discoloration appear on your pots, pans, dishes, glassware or silverware? Do you know what it is? 


Are your fixtures stained, corroded, etched, discolored, or accumulating a residue? If so, do you know what it is?


Is there any discoloration on sinks, bathtubs, showers or toilets? If so, do you know what is causing it?


Do you have a well?

Is your well bored or drilled?

How deep is your well?

What (in gallons per minute = GPM) is the flow rate from the well?


If your well is drilled does the jacket (lining, casing) extend the entire depth of the well? If not, how far does it extend and where is the casing located (at or near the top of the well, at or near the bottom of the well)?


Does any of your water come from surface sources such as springs, streams, ponds, and lakes? If so, which of these sources provide your water. Is this water source continuous or is it interrupted at times?


Do you have a tank or reservoir in which your water is stored? If so, where is it located? Is it opaque or translucent, or transparent? Is it plastic or metal? How many gallons of water does the tank / reservoir hold? Does the reservoir have a liner. Is the liner plastic or metal?


Is the plumbing between your water source and faucet plastic (PVC), lead, copper, or some other material? If other than one of the above, or if some sections are made of one material and others of a different material, please describe the material. Ex. Iron from pumphouse to home.


Do you have a water purification system installed? If so please describe the system and the purpose of the system. Who installed the system?

Where is your water purification system located?

Filters? Softeners?

What is your water purification system designed to do? How much contamination can enter the system before it is overloaded and the contaminants pass through into your drinking water?

Have you had the water coming from your purification system tested to see if it is pure and the system is working properly? How long has it been since you replaced the cartridges in your system?


Do you add anything to your water? If so what do you add?


Do you regularly boil your water? Yes or No.


If your water has a taste, odor, color, or turbidity does it change after boiling?


Do you use any treatment of the water, which has not already been identified? If so, please describe it briefly.


Does your tap water have an odor? If so please describe the odor. What does it smell like? Is it weak, strong, very strong? Does it cause irritation of the eyes, nose or throat? How long has this odor been present?


Is the odor always there or does it come and go?

Does it get worse or better when it rains? Does it change when it rains or has been dry for a long time?

When the odor gets stronger or weaker does the water’s color or turbidity change at the same time?


Does your tap water have a taste? Is it metallic, salty, sweet, bitter, sour? If so, how strong is the taste?


Is your tap water normally clear or cloudy? Slightly cloudy, very cloudy, extremely cloudy?


Is your tap water usually colored? If so, what color would you call it? Is the color light or dark? Does the color change when it rains or is dry for a long period of time?


Do you know any neighbors who are using the same water supply you use? If so, please give their names, addresses, and location with respect to your home (if you know).


Have neighbors who have the same water supply had complaints similar to yours?


Has there been any unusual activity in the area near your water source recently? Has there been new construction, a chemical spill, logging operation, installation or removal of tanks, underground lines, septic systems, sewer systems, water lines, flooding, heavy storms, bulldozing?


Can you think of any other possibly relevant information we should know while considering your concerns and analyzing your water? 


Where (drawing please) is your septic system (drainage field) located with respect to the well. How far apart are they?


Toll free:  1-866-626-1716

Office:        1-706-219-3349

Postal address
P.O. Box 3364
Cleveland, Georgia USA
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General Information:
Customer Support: 706-219-3349


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Last modified by Dr. Eberhard Essich 03/22/17