* 1. Do you know what products are considered household hazardous waste?

• Yes
• No

* 2. If you answered yes to the above question, in what way do you dispose of your household hazardous waste?

• Pour down the drain
• Pour on the ground/ditch
• Pour down the storm drain
• Put them in the trash
• Use them until finished
• Take them to the Johnson County Tox Box
• Other

* 3. How do you dispose of your unwanted medications?

• Flush down the toilet
• Pour down the drain
• Put them in the trash
• Bring them to a pharmacy
• Bring them to a pharmaceutical take back day
• Other

* 4. In your opinion, how much does what people do on the land affect nearby bodies of water?

• Great Deal
• Somewhat
• Not too much
• Not at all
• Don’t know

* 5. How much do shrubs and trees left along the banks of creeks, streams and lakes protect water quality?

• Great Deal
• Somewhat
• Not too much
• Not at all
• Don’t know

* 6. Inspection and routine clean out of septic tanks is necessary to protect the water quality of nearby bodies of water.

• Strongly Agree
• Agree
• Disagree
• Strongly Disagree
• Don’t know

* 7. Pet waste can be a source of bacteria for nearby streams and bodies of water.

• Strongly Agree
• Agree
• Disagree
• Strongly Disagree
• Don’t know

* 8. Even if you don’t live right next to a river or lake, fertilizers and pesticides used can harm local bodies of water.

• Strongly Agree
• Agree
• Disagree
• Strongly Disagree
• Don’t know

* 9. In most cities and towns, water that goes down storm drains is treated at a water treatment plant before it is released into the nearest river.

• True
• False
• Don’t know

* 10. In Johnson County, runoff from farms and cities causes more water pollution than industrial facilities.

• True
• False
• Don’t know

* 11. When it rains in your neighborhood, do you know which body of water the runoff from rainwater flows?

• Yes
• No

* 12. Has your yard been fertilized in the past twelve months? If No Skip to question 13.

• Yes
• No

12A . How many times has your yard been fertilized in the past twelve months?

• 1
• 2
• 3
• 4
• 5
• 6
• 7
• 8
• 9
• 10 Or More
• Don’t know

12B. Have you ever used any of the following in deciding how much fertilizer to apply?

• Label Information
• Consulting with the garden or home center
• The recommendations of the Purdue Extension Service
• Fertilize your lawn until it is green.
• Utilize some other method to decide.

* 13. Is your home served by a septic system? If NO skip to question 14.

• Yes
• No

13A . How many years has it been since your septic system was last inspected?

• 1
• 2
• 3
• 4
• 5
• 6
• 7
• 8
• 9
• 10 Or More
• Don’t know

13B. Have you ever gotten any advice on how to maintain a septic system?

• Yes
• No

13C. From which of the following have you gotten advice on how to maintain a septic system?

• The Local Health Department
• Some other Government Agency
• Friends and neighbors
• • The septic service company
• The internet
• Other

* 14. Do you own a dog? If NO skip to question 15.

• Yes
• No

14A. When your dog is on your property, do you clean up after them?

• All of the time
• Most of the time
• Occasionally
• Rarely
• Never

14B. When you walk your dog, do you clean up after them?

• All of the time
• Most of the time
• Occasionally
• Rarely
• Never

* 15. Listed are several methods for distributing information to the public on how you can protect water quality. Please choose the three best options.

• Brochures mailed to your home.
• Supplements in the local newspaper.
• Community newsletter articles.
• Free educational videos
• Public Service announcements on television or radio.
• A training workshop.

* 16. Which of the following would you classify yourself as (check all that apply)?

• Resident
• Visitor
• Public Service Employee
• Commercial Facility Employee
• Industrial Facility Employee
• Construction Site Personnel

* 17. What is your Zip Code?