Countryside Service Line Survey

PLEASE ANSWER ALL QUESTIONS TO THE BEST OF YOUR ABILITY

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* 1. Date

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* 2. ADDRESS

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* 3. OWNERS NAME

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* 4. OWNERS PHONE

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* 5. OWNERS E-MAIL

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* 6. ADD my e-mail to the City's E-MAIL NOTIFICATION DATABASE for important notifications.

Yes

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To help identify the pipe material, scratch the service line with a coin in the scratch area shown on the image.

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* 7. Type of Water Pipe (inlet side) (check one)

 Lead – shiny silver color

 Galvanized – dull gray color

 Copper – tarnished penny color

 PVC – gray or white color

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* 8. Type of Water Pipe (outlet side) (check one)

 Lead – shiny silver color

 Galvanized – dull gray color

 Copper – tarnished penny color

 PVC – gray or white color

If known, has the plumbing been replaced or renovated in your home?

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* 9. IF yes, what year was the plumbing replaced?

NEED HELP? If you need help identifying your service line, you can contact the Countryside Water Department at (708) 354-8827 to schedule an appointment to have your service line identified.