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2021 Town of Chilton Well Testing Program - Free Homeowners Kit Sign Up

  1. Please include both spouse names (if applicable)
  2. To be notified of any program changes
  3. If different from mailing address.
  4. The Town of Chilton provides Homeowner's Package (Bacteria and Nitrate) for free. Do you wish to add on other tests at an additional cost?*
    HOMEOWNER'S PACKAGE: includes Bacteria, Nitrate, pH, Alkalinity, Hardness, Chloride, Conductivity, Corrosivity Index ... METALS PACKAGE: includes 11 metals, including an arsenic screen...... DACT SCREEN: tests for Atrazine and its byproducts
  5. Kit Distribution (Pick Up Kits)*
  6. Preferred Drop Off Time and Location*
  7. Leave This Blank:

  8. This field is not part of the form submission.