Water Service Line Survey

    First Name:

    Last Name:

    Phone Number:

    Email Address:

    Address:

    City:

    State:

    Zip Code:

    Do you own or rent this building?
    OwnRent

    What year was this building built?

    To your knowledge, has the water service line for your building ever been replaced?
    YesNoNot Sure

    What year was it replaced?

    What material is your water service line? You may choose more than one.

    LeadCopperSteel (ductile iron pipe, galvanized)Plastic (HDPE, PVC)UnknownCannot locate service line

    How did you determine the material?
    Scratch testVisualPlumber or other qualified professionalCannot locate service line