Moffat Water Supply Corporation Water Service Line Material Survey

Please complete the form to submit the material of your water service line.

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* 1. First Name

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* 2. Last Name

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* 3. Phone Number

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* 4. Email

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* 5. Property Address

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* 6. Account Number - Please enter the account number found on your water bill.

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* 7. Type of Occupancy

Owner

Renter/Tenant

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* 8. What type of material is used for the water service lines? -The water line that runs from the meter to your home or building.

PVC (white plastic)

Lead (blue grey color)

PEX (red or blue tubing)

HDPE (black or blue hard plastic tubing)

Copper (bronze or green color)

Galvanized Iron/Steel (dull silver/grey color)

Other

Unknown

Unknown, but installed after lead state ban - 1988

Unknown, but not lead

Unknown, but could contain lead

Combination, but could contain lead

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* 9. Please provide the install date of your water service line. If you do not know the install date, please provide the year the home was built.

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* 10. Is there a lead connector where your service line is connected to the water meter?

Yes

Unknown

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* 11. Is there lead solder in the service line?

Yes

Unknown

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* 12. Does the interior home or building plumbing contain copper pipes with lead solder installed before July 1, 1988

Yes

Unknown

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* 13. Source of Information - How did you determine the material of your water service line?

Visual Inspection

Lead Test Kit

Plumbing Records

Scratch Test

Other

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* 14. Add a Photo (optional)

Please provide a photo of your water service line.

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