Town of Flaxville – Leadline Inventory Form

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Town of Flaxville – Water Service Line Inventory Test Form

Please read the entire form, test instructions, and examples carefully before filling out this form.

Your contact info is only required if you wish to schedule an inspection or would like the Town staff to contact you. If you have more than one water service line entering the building, please complete the test for each water service line.

Street Address *

What is the color of the scraped pipe on the upstream/street side of the water meter?

SilverCopperBrassGrayOther Color

(If Other: describe other color):

Does a magnet stick to the pipe? *YesNoSlightly

What is the material of the pipe? *LeadCopperBrassGalvanizedPlasticUnknown

If you are uncertain of your water service line material, please take a photo of the exposed and scratched service line where it enters the building and return it with this form.

Drag and Drop (or) Choose Files

What year was your building constructed?

What type of building is it?

Single Family ResidenceMultiple Family ResidenceSchoolChild Care CenterChild Care in HomeHospital/Nursing Home

Other

What size is your service line?5/8”3/4”1”1 ½”2”3”

Is there water treatment in the building?

Was the plumbing in your building ever remodeled?

YesNo

If yes, when:

The following information is optional:

Please provide your preferred method of contact information if you would like to schedule an inspection or be contacted by the Town of Flaxville.

Please enter the following information:

First Name

Last Name

Street Address/P.O. Box

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Phone

Email Address

Please do not fill in this field.

Town of Flaxville – Water Service Line Inventory Test Form

Please read the entire form, test instructions, and examples carefully before filling out this form.

Your contact info is only required if you wish to schedule an inspection or would like the Town staff to contact you. If you have more than one water service line entering the building, please complete the test for each water service line.

The following information is optional: Please provide your preferred method of contact information if you would like to schedule an inspection or be contacted by the Town of Flaxville.

Please enter the following information:

The following information is optional:

Please provide your preferred method of contact information if you would like to schedule an inspection or be contacted by the Town of Flaxville.