Purpose:
The U.S. Environmental Protection Agency (EPA) requires public water systems to identify and prioritize sampling locations based on the materials in plumbing systems. Your participation will help us classify your home for possible inclusion in our Lead and Copper sampling program.
Instructions:
Please complete the following questionnaire. Your responses will help us determine your home’s eligibility for sampling based on the LCR Tier guidance.
Section A: Property Information

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* 1. Name of Accountholder/Resident

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* 2. What island is your property located?

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* 3. Physical Property Address

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* 4. Mobile Phone Number

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* 5. Email Address

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* 6. Water Account Number

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* 7. Year Home Was Built

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* 8. Type of Property (Check One)

Section B: Service Line Material

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* 9. To the best of your knowledge, what is the material of the water service line (the pipe from the street to your home)?

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* 10. Was your service line ever replaced?

Section C: Interior Plumbing Materials

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* 11. What is the material of the interior plumbing in your homer? (Check all that apply.)

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* 12. If copper is present, was it installed before 1986?

Section D: Additional Information

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* 13. Has any plumbing work been done in the past 10 years (e.g. re-piping, renovations, etc.)

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* 14. Are you interested in participating in WAPA's free Lead and Copper tap sampling program?

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* 15. I certify that the information provided is true to the best of my knowledge.

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