Aquarion Water Company Basement Inspection Booking Form

Service Line Inventory Survey

Aquarion Water Company
How would you like to provide your water service material information?

I will provide service line information myself in this form.I would like someone to come and inspect my water service.
If you have any questions or concerns regarding the Service Line Inventory, or need to change your selected appointment, please call Tighe & Bond at 413-408-4021
Do you consent to having 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
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Water Account Number
(If known)
Email*
example@example.com
Address*

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.*

Cancelof
Service Material*
Service Diameter*
Other Service Diameter*
Date or year of water service install
(If known)
Is the pipe magnetic?

YesNoUnknown
What color is the pipe when scratched?

Bright CopperShiny SilverDull GrayGreenOther
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
Any additional comments or questions?
Please select all of the dates/times that an adult 18 years or older would be available (at the water service address) to accompany Water System Staff or their subcontractor during an inspection of your water service line (select all that apply):

Morning: between 8:00am and 12:00pm

Afternoon: between 12:30pm and 2:30pm
Select your town*
Select all dates/times you are available (Please choose multiple)*

Thursday, December 12th (Morning)Thursday, December 12th (Afternoon)Please describe the best days of the week and time of day for scheduling an inspection if more dates become available:
Select all dates/times you are available (Please choose multiple)*

Wednesday, December 4th (Morning)Wednesday, December 4th (Afternoon)Please describe the best days of the week and time of day for scheduling an inspection if more dates become available:
Select all dates/times you are available (Please choose multiple)*

Tuesday, December 3rd (Morning)Tuesday, December 3rd (Afternoon)Please describe the best days of the week and time of day for scheduling an inspection if more dates become available:
Select all dates/times you are available (Please choose multiple)*

Please describe the best days of the week and time of day for scheduling an inspection if more dates become available:
Select all dates/times you are available (Please choose multiple)*

Wednesday, December 18th (Morning)Wednesday, December 18th (Afternoon)Please describe the best days of the week and time of day for scheduling an inspection if more dates become available:
Any Special Instructions
Please consider providing your water service information by conducting your own basement inspection and uploading the photo to the water department.

Customer Self-Inspection

Click here for more information on Lead and the Water Service Line Inventory Program.
Should be Empty:

Service Line Inventory Survey