Holden Customer Water Service Line Form

Holden Water Service Line Form

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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
Does mailing address differ from Service Address*

YesNo
Mailing Address*

Street Address

Street Address Line 2

CityState

Zip Code
Please upload 1-3 photos of the scratched water service line. Examples are shown below.*

Browse Files

Cancelof
Service Material*
Service Diameter*
Other Service Diameter*
Date or year of water service install
(If known)
Do you have any point-of-entry or point-of use treatment on your cold-water kitchen or bathroom taps (softening, filter, or other treatment)?

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

YesNoUnknown
If you are unable to determine the material type or cannot submit the inspection form, would you be interested in scheduling a basement inspection conducted by water system staff and/or their subcontractor to document the material type and size of your water service line?”

YesNo
The Holden Water Department will have a limited number of appointments for home visits to determine the material of your service line for you. If you anticipate needing a site visit, then please submit this form to be added to the waitlist. A representative from the Town’s Engineering Consultant (Tighe & Bond) will contact you with additional details on how to schedule an inspection appointment.
Any additional comments or questions?
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Holden Water Service Line Form