Kansas(KDHE) Customer Water System Service Line Inventory Questionnaire
Sign in to Google to save your progress. Learn more
Contact Information
Name of Person filling out this questionnaire:
 *
Property Street Address:
Structure Type:
Clear selection
Year Built:
Phone Number should we have questions:
Materials List (Check all that apply) See drawing on back of this paper for more information
1. What pipe material is the service line pipe entering your house, foundation or business made of?
2. What year was your service line installed?
(This may be the year structure was built)
3. What size pipe is the service line entering your house or business? (in inches)
4. What material are the plumbing pipes in your house or business mostly made of?
5. What is the second most common plumbing pipe material in your house or business?
6. How old are the pipes inside your house?
Clear selection
7. Do you have a water softener, a whole home water purification system, RO-System, faucet filter or any other treatment device installed in your house or business?
Clear selection
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms