Southwick Customer Water Service Line Form

Southwick Water Service Line Form

Submit your results
Full Name*

First NameLast Name
Water Account Number
(If known)
Phone Number

Area CodePhone Number
Email Address
example@example.com
Address of Water Service*

Street Address

Street Address Line 2

CityState

Zip Code
How would you like to provide your water service material information?
Please follow this guide to:
1. Find your water service line.
2. Determine the type of material.
When you have done that:

Measure the diameter of the service line with a ruler.
Take photos of the service line to upload with the survey.
Make a note of the answers and now you are ready to complete the survey.
Service Material*
Service Diameter*
Other Service Diameter*
Date or year of water service install
(If known)
Do you have any softeners, filter, or other treatment on your internal service line?

YesNoUnknown
Do your internal building plumbing materials include lead pipes or lead solder?

YesNoUnknown
Please upload 1-3 photos of the scratched service line.*

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Southwick Water Service Line Form