Lanark Lead Service Line Replacement Program Survey Question Title * 1. Name of the Property Owner and Property Address Question Title * 2. Telephone Number and email Address of Owner Question Title * 3. Name and Phone Number of Renter (If Applicable) Question Title * 4. Approximate Year That the House was Constructed Question Title * 5. Type of Water Pipe Material Entering the Home (Select Only One) Plastic Pipe Lead Pipe Copper Pipe Galvanized Pipe Question Title * 6. Type of Water Piping Inside the House Plastic Pipe Lead Pipe Copper Pipe Galvanized Pipe Question Title * 7. Is There a Water Shutoff Valve on the Pipe Coming into the Home? Yes No Question Title * 8. Does Your Home Have a Water Softener? Yes No Question Title * 9. Which Wall is your Waterline Coming in from? North Wall East Wall South Wall West Wall Center of Floor or Similar Question Title * 10. Does Your Home Have a Water Filtration System? Faucets Yes Faucets No Whole House Yes Whole House No Done