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1.
Please provide your contact information
Name
Company
Address
Address 2
City/Town
State/Province
AL Alabama
AK Alaska
AS American Samoa
AZ Arizona
AR Arkansas
CA California
CO Colorado
CT Connecticut
DE Delaware
DC District of Columbia
FM Federated States of Micronesia
FL Florida
GA Georgia
GU Guam
HI Hawaii
ID Idaho
IL Illinois
IN Indiana
IA Iowa
KS Kansas
KY Kentucky
LA Louisiana
ME Maine
MH Marshall Islands
MD Maryland
MA Massachusetts
MI Michigan
MN Minnesota
MS Mississippi
MO Missouri
MT Montana
NE Nebraska
NV Nevada
NH New Hampshire
NJ New Jersey
NM New Mexico
NY New York
NC North Carolina
ND North Dakota
MP Northern Mariana Islands
OH Ohio
OK Oklahoma
OR Oregon
PW Palau
PA Pennsylvania
PR Puerto Rico
RI Rhode Island
SC South Carolina
SD South Dakota
TN Tennessee
TX Texas
UT Utah
VT Vermont
VI Virgin Islands
VA Virginia
WA Washington
WV West Virginia
WI Wisconsin
WY Wyoming
ZIP/Postal Code
Email Address
Phone Number
2.
Was your house built prior to 1987?
Yes
No
3.
Was your household water connected to the Blacksburg Water System prior to 1987?
Yes
No
4.
What type of material is used for your outside water service line from your water meter to the point of entry into your home?
Lead Pipe
Copper Pipe with Lead Solder
Plastic or PVC or Pex
Galvanized Iron
Cast Iron
Steal
I am not sure
5.
What color is your outside water service line from your water meter to the point of entry into your home? (scratch test - you can use a key or coin to scratch you service line where it enters your home and to determine the color)
Gold
Copper
Silver
White or Blue Plastic
Other
Other (please specify)
6.
What type of pipe is your house plumbed with?
Lead Pipe
Copper Pipe with Lead Solder
Plastic or PVC or PEX
Galvanized Iron
Cast Iron
Steel
I'm not sure