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2020 Town of Chilton Well Testing Program - Free Homeowners Kit Sign Up - NEW DATES

  1. Important Update! The date of the program has changed to SEPTEMBER 21, 2020. Please note this on your flyer or print off the confirmation email for your records. As dates for bottle pick up are confirmed, registrants will be notified. Thank you for your patience and flexibility

  2. Please include both spouse names (if applicable)

  3. To be notified of any program changes

  4. If different from mailing address.

  5. The Town of Chilton provides the bacteria and nitrate test for free. Do you wish to add on other tests at an additional cost?*

  6. By registering, you understand that this is a self sample program. The sample must be drawn on and returned on September 21*

  7. Preferred Kit Pick Up Time and Location*

  8. Payment must be submitted via check made out to Calumet County when you pick up kits (if doing optional tests)*

  9. Preferred Drop Off Time and Location*

  10. Leave This Blank:

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