Application: Leak Repair Pilot Program

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please complete the survey below to help us determine your eligibility for the Waterway NC Leak Repair Pilot Program. If deemed eligible, candidates will be served on a first come, first serve basis until funding is no longer available. Thanks to our partnership with the New Hanover Community Endowment, approved participants in this program will receive a leak repair or appliance replacement at no cost.

To learn more about this program and our partnership with Wilmington Area Rebuilding Ministry (WARM NC) and the New Hanover Community Endowment, please follow this link.

If you have any questions, please email Waterway NC at info@waterway-online.com. You may also call us at 910-859-2811.

Do you currently have an active leak in your home? *

Yes

Maybe

What evidence do you have for an active leak? Check all that apply. *

I received a "High Water Use" letter from Cape Fear Public Utility Authority.

I can see damage from the leak on my wall, ceiling, or floor.

My water use is much higher than is typical (More than 12,000 gallons per month).

Other:

Required

What is the address for the home with the suspected leak?

At this time, you must live in New Hanover County, North Carolina in order to be eligible for the leak repair program

What is the name of the Cape Fear Public Utility Authority account holder? *

Do you own the home or do you rent the home? *

Homeowner

Renter

How many adults live at this address on a regular basis? How many children? *

What is the typical monthly income for this household? *

How often do you struggle to afford your water bill? *

Never

1-2 times per year

3+ times per year

I would rather not answer

How much is a typical water bill for this household? *

$75-$100

$101-$150

$150-$200

$200-$250

More than $250

I'm not sure

What language do you feel most comfortable speaking in? *

English

Spanish

Mandarin

Other:

Please provide the best contact information we can use to reach you (email and/or phone number to call or text) *

If you qualify for this Leak Repair Pilot Project, do you consent to sharing your water consumption data with the Waterway NC team for up to 12 months after the repair work is completed? *

Yes

If you qualify for this Leak Repair Pilot Project, do you consent to participate in the project and to permit WARM NC’s Community Partners Program to make repairs at your home? (warmnc.org)
*

Yes

Clear form

Never submit passwords through Google Forms.

This form was created inside of CFPUA Assist Inc. (DBA: WATERway NC). Report Abuse

Forms