Lead and Copper Plumbing Survey

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Thank you for interest in protecting your health and the health of your community. To maintain complete records and estimate your home's lead-exposure risk, we ask that you complete this survey.

Customer Name *

Phone Number *

Physical Address *

Mailing Address *

Years of plumbing at main consumption tap: (Typically the kitchen sink, if unknown, type UNKNOWN)

Year Home Constructed (If unknown, type UNKNOWN):

Is a permanent water filter installed in your home?

Yes

Is a water softener installed in your home?

Yes

What type of service line connects the home to the water meter?

Service line material can be verified by viewing the water line at the point where it connects to the meter (usually outside in a boxed pit) and where it enters the home (usually in the basement or foundation crawl spaces. NPR has developed an interactive plumbing identification guide: https:apps.npr.org/find-lead-pipes-in-your-home/en/ and there is a representative pictorial example of types of plumbing materials included below.

Check all that apply:

Lead (dull, dark gray. Easily scratched with hard object, shiny when scratched)

Copper (copper color, green tarnish)

Known to have lead solder

Galvanized Iron/Steel (Magnetic, black-dark gray, some reddish-brown rust. Hard to scratch)

Plastic/PVC/PEX

Other

Blank

What type of plumbing materials are used within the home?

Plumbing material can be verified by viewing the lines connecting to your water heater. NPR has developed an interactive plumbing identification guide: https://apps.npr.org/find-lead-pipes-in-your-home/en/ and there is a representative pictorial example of types of plumbing materials included above.

Check all that apply:

Lead (dull, dark gray. Easily scratched with hard object, shiny when scratched)

Copper (copper color, green tarnish)

Known to have lead solder

Galvanized Iron/Steel (Magnetic, black-dark gray, some reddish-brown rust, hard to scratch)

Plastic/PVC/PEX

Other

Blank

Your participation in this program helps protect the health of your community. Please contact us with any questions. Fill out the survey and return it to Paris BPU by April 30th and be entered to win a
$250 Visa Gift Card or a set of Beats Studio Buds! The drawing will be held on May 1!

Thank you for your assistance.

Paris BPU

731-642-1322

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