Countryside Service Line Survey
PLEASE ANSWER ALL QUESTIONS TO THE BEST OF YOUR ABILITY
1.
Date
2.
ADDRESS
3.
OWNERS NAME
4.
OWNERS PHONE
5.
OWNERS E-MAIL
*
6.
ADD my e-mail to the City's E-MAIL NOTIFICATION DATABASE for important notifications.
(Required.)
Yes
No
To help identify the pipe material, scratch the service line with a coin in the scratch area shown on the image.
*
7.
Type of Water Pipe (inlet side) (check one)
(Required.)
Lead – shiny silver color
Galvanized – dull gray color
Copper – tarnished penny color
PVC – gray or white color
*
8.
Type of Water Pipe (outlet side) (check one)
(Required.)
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?
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.