Questionnaire Text

Questionnaire form view entire document: text image

Only for private, occupied dwellings with people present (applies to questions 3 through 16)

6. The water used in this dwelling comes from:

[] 1 Public system
[] 2 Well or water wheel chain pump
[] 3 River, spring, stream, etc.
[] 4 ____ Other (specify)

Questionnaire instructions view entire document: text image

6. The water that this dwelling uses is from:

Fill in the circle that corresponds to the source of the water that the dwelling uses: 1. Public Network, 2. Well or Water Wheel [noria], 3. River, Runoff, Brook, 4. Other, specify its origin.

If the dwelling has more than one source of water, fill in the circle that corresponds to the one most used.

[The above directions refer to a picture of question 6 in this section of the enumeration form.]