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Well Occupancy Survey 

Milwaukee County Ordinance requires that residential sewer users who obtain their water from a private well submit an affidavit to the Superintendent of the Water Works declaring the number of people residing in the household by April 1 of each year. 


Service address associated with your Milwaukee Water Works account: 

Milwaukee Water Works account number: 

Phone number: 

Email address: 

Number of people residing at the property: 

Type of Property: 

Is the property at this address connected to City of Milwaukee drinking water? 

If you answered "No" to the question above, what is the source of water for the property at this address?  

If you anwered "Other" to the question above, please describe the source of drinking water for this property: 

How is wastewater at the above address processed: 

 I acknowledge that typing my name in the box below constitutes my signature and, by my signature, I hereby certify that I have read the instructions for the survey and that the information I have provided in this form is true, complete and correct to the best of my knowledge, information and belief.

Property owner name: 

After clicking submit, you will have the opportunity to check your responses and make any edits before your final submission.

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