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Lead & Copper Survey
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*
" indicates required fields
Service Address
*
Street Address
Address Line 2
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Customer Name
*
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*
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Customer Email
*
Because of recent updates to drinking water regulations, the Kansas Department of Health and Environment (KDHE) is requiring each public water system to gather data on their customer's plumbing. KDHE is requiring all water systems to identify each service line,including private home plumbing materials.The following information is needed about your home's plumbing.
Water Service Line Material
*
Lead
PEX
Copper
Asbestos - Cement
Galvanized Steel
Other Non-lead
PVC
HDPE
Water Service Line Size (in inches)
*
Service Line Installation Year
Building Type
*
Single Family Residence
Multi Family Residence
Building
Other
Water Softener, Filter, or Other Treatment?
Yes
No
Home Internal Plumbing Material
*
Lead
HDPE
Copper
PEX
Copper Pipe with Lead Solder
Other Non-Lead
Galvanized Steel
PVC
Secondary Internal Plumbing Material
Lead
HDPE
Copper
PEX
Copper Pipe with Lead Solder
Other Non-Lead
Galvanized Steel
PVC
Year (range) when plumbing was installed
*
Before 1989
Between 1989 and 2014
After 2014
Picture of Pipes
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Accepted file types: jpg, png, pdf, jpeg, Max. file size: 10 MB.
