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2. Owner Information
4. First and Last Name*
6. Street Address*
8. Phone Number*
9. Email Address
11. Account Number (On Water Bill)
15. Building Information
17. Building Type
    -- Select One --Single Family ResidenceMulti-Family ResidenceResidential With In Home Child CareNon-Residential No School or Child CareMixed Residential & Non-Residential With No School or Child CareSchool or Child CareOther
19. Estimated Year Built
21. Point-Of-Entry or Point-Of-Use Treatment Present?

    1. None
    2. Water softener

    1. Filtration system
    2. Osmosis
23. Estimated Year the Majority of the Plumbing Was Installed
27. Pipe Material Information

29. Identify where your water service pipe is located and determine the pipe material using this website.

31. Inlet Side (From Street) Water Pipe Type

    1. Lead – shiny silver color and magnet will not stick to material
    2. Galvanized – dull gray color and magnet will stick to material
    3. Copper – tarnished penny color
    4. Plastic – gray, white, blue, clear or black in color
    5. Other
33. If other, please list type here.
35. Inlet Side Water Pipe Size
    -- Select One --1 inch3/4 inchOther
37. Outlet Side (To Home) Water Pipe Type

    Check all that apply

    1. Lead – shiny silver color and magnet will not stick to material
    2. Galvanized – dull gray color and magnet will stick to material
    3. Copper – tarnished penny color
    4. Plastic – gray, white, blue, clear or black in color
39. Inside Building Plumbing Material

    Check all that apply

    1. Lead – shiny silver color and magnet will not stick to material
    2. Galvanized – dull gray color and magnet will stick to material
    3. Copper – tarnished penny color
    4. Plastic – gray, white, blue, clear or black in color
    5. Other
43. Attach a Photo of Your Service
45. Questions, Comments, or Requests?
Leave This Blank:


47. 1. Receive an email copy of this form.
48. Email address

    This field is not part of the form submission.

49. Submit

* indicates a required field