Anomalous groundwater changes started three months before the 2011 M9.0 Off the Pacific coast of the Tohoku Earthquake (Tohoku EQ), Japan. Groundwater level and temperature decreased almost simultaneously in a 2000-m well at a spa, Goyo-onsen, in Iwate Prefecture, 155 km northwest of the epicenter. Since the source of Goyo-onsen, located above the edge of a coseismic rupture area of the Tohoku EQ fault, is probably confined, the observed anomalies were caused probably by preseismic crustal deformation. Preseismic groundwater anomalies have been observed prior to similar large subduction EQs such as the 1946 M8.1 Nankai EQ. Thus, monitoring confined groundwater may be useful to identify precursors of large subduction EQs.