Clay County PWSD#3 Water Service Line Inventory Survey

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Are You The*

OwnerTenantProperty ManagerOther
Building Type*

Single FamilyMulti FamilySchool / ChildcareBusinessOther
What year were your water lines connected to the building, if known?
What is the water line material where the water line enters your home?*

LeadCopperGalvanizedPlastic - PVCPlastic - PEXPlastic - HDPE
Has your portion of the water line between the meter and home/building been replaced?

YesNoI don't know
If possible, upload a photo of the water line entering your home

Cancelof
If you cannot upload a photo

You can email a picture of the water line entering your home to pwsdclay3@gmail.com
Should be Empty:

If you cannot upload a photo