LEAD SERVICE LINE INVENTORY

The Manchester Municipal Water Department is required to make a Lead Service Line inventory of the water distribution system. To compile a database of the materials used in our customer's service lines and plumbing, please take a few minutes to complete this questionnaire.

We thank you for your cooperation in helping us with this to continue to serve clean and safe drinking water to our customers.

Sign in to Google to save your progress. Learn more
Contact Information
Name of person filling out questionnaire: 
(First name)
 *
(Last name) *
Phone Number should we have questions:  *
Property Information
Address (fill out a separate form for each property):
(House Number)
 *
Street Name *
Type of Home: *
Year Built: *
How to identify your service line material 
Materials List
Use the above information to help you answer the following questions. 

What material is your service line (the portion coming into the building before the meter) made of? (Check all that apply)

When was the service line going into your house or business installed?

Clear selection

What materials are the pipes in your house or business made of? (Check all that apply)

How old are the pipes inside your home?
Clear selection

Do you have a water softener or a whole home water purification system, or any other treatment device installed in your house or business?

Clear selection

If you answered yes to the above question, do you have an untreated, cold-water kitchen or bathroom faucet?

Clear selection

If your home or business meets the criteria for lead and copper sampling, would you be willing to participate in this testing? During testing, a Water Supply Employee would bring an empty bottle to your house, provide you with documentation and instructions on collecting the sample, and pick it up the next morning. Sampling frequency is typically every three years.

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