Water Service Line Survey Full NamePlease enter your full name. First Last PhonePlease enter a valid phone number where we can reach you.Email(Required)Please List your Email Address Address(Required)Please provide the house number and street for this residence. Street Address City ZIP / Postal Code Residence Type(Required)Select the type of residence this address represents. Single Family Residence Multi-Family Residence Building/Other School Childcare Facility Contains Lead Solder(Required)Indicate if the plumbing in this residence contains lead solder. Yes No Not Sure Point-of-Entry Treatment System(Required)Select if there is a Point-of-Entry (POE) treatment system installed. Point-of-Entry (POE) treatment is any unit installed to treat the water entering a house or building. Most often a filtration system installed close to the where the service enters the building. Filters installed underneath sinks or on taps are NOT considered POE treatment. Yes No Not Sure Service Line Details - Customer OwnedMaterial (Customer)(Required)Select the material of the service line owned by the customer. Lead Galvanized Steel Plastic Copper Not Sure Other (Please Describe) Material (Customer Described)(Required)Pipe Size (Customer)(Required)Select the size of the customer-owned service line. 1/2" 3/4" 1" Not Sure Other (Please Describe) Pipe Size (Customer)(Required)Lead (Customer)(Required)Select if this service line owned buy the customer previously contained lead. Yes No Not Sure Exact Install Date (Customer)Enter the exact installation date if known. MM slash DD slash YYYY Approximate Install Date (Customer)Enter an approximate installation date if the exact date is unknown. MM slash DD slash YYYY System Owned DetailsSystem-Owned Portion(Required)Do you have knowledge of your system from the curb stop to water main?Select OneYesNoService Line Details - System OwnedThis section is ONLY if you have knowledge of the system from the Curb stop to water main.Material (System)Select the material of the service line owned by the customer. Lead Galvanized Steel Plastic Copper Not Sure Other (Please Describe) Material (System)Pipe Size (System)Select the size of the customer-owned service line. 1/2" 3/4" 1" Not Sure Other (Please Describe) Pipe Size (System)Lead (System)Select if this service line owned buy the customer previously contained lead. Yes No Not Sure Exact Install Date (Customer)Enter the exact installation date if known. MM slash DD slash YYYY Approximate Install Date (Customer)Enter an approximate installation date if the exact date is unknown. MM slash DD slash YYYY Additional InfoSystem PhotosIf photos are provided they may assist in identifying/validating the pipe material, however photos are not required. Drop files here or Select files Max. file size: 50 MB, Max. files: 5.
