Drinking Water and Groundwater Bureau Complaint Form NHDES-W-03-053
RequiredRequired Question(s)
The NHDES Drinking Water and Groundwater Bureau (DWGB) regulates public water systems, NH accredited laboratories, and water use facilities; well construction, maintenance and decommissioning standards; and public water system certified operators. To submit a complaint to the Drinking Water and Groundwater Bureau, please fill out his form. For additional information, please visit the Drinking Water and Groundwater Bureau webpage. For questions, please contact the Drinking Water and Groundwater Bureau at 271-2513. Please consider completing each question so that we may contact you regarding your complaint.
 
1.
Contact Information (person submitting this complaint)

First Name:
Last Name:
Email Address:
emailaddress@xyz.com
Address 1:
City:
State/Province
(US/Canada):
Postal Code:
Phone:

2.

 Would you like your information to remain confidential? Please be advised that NHDES may be required to reveal this information if the case proceeds to an administrative trial or hearing. 

Yes
No
Required 3.

Type of Complaint/Incident. Please select the type of DWGB complaint.  

Public water system
NH certified water system operator
Registered water use facility
NH accredited laboratory
Well standard (construction, maintenance, decommissioning)
Other  
Required 4.

Complaint Against (please provide: Business/Water System/Individual Name; Mailing Address; Town; State; Zip; and Phone Number (if known))  

 

350 characters left.
Required 5.

 Provide a description/summary of the complaint or incident; including, when the incident occurred and if it's still occurring, and how you became aware of the situation.

 

350 characters left.
6.

 Have you contacted the facility/public water system/individual regarding your complaint? If so, please identify who you spoke with, when, and summarize the conversation. 

 

350 characters left.
7.

 Have you contacted or filed a similar complaint with another state agency or municipality? If so, please identify who you contacted, when, and the outcome.

 

350 characters left.
8.

 Have you been in contact with DWGB staff regarding your complaint before filling out this form? If so, please identify who from DWGB you've been in contact with and the outcome.

 

350 characters left.