Service Line Inventory

Service Line Inventory
The United States Environmental Protection Agency (EPA) is conducting a copper and lead service line inventory on all public water supply systems. This inventory requires Cooper County Consolidated Public Water Supply District #1 to submit information on all lines in our district. We assure you CPWSD's lines are not now, nor have they ever been copper based.

We are sending out this survey in our efforts to obtain information about the privately owned (customer side) service lines within the system. Please submit one form per service address and contact us if you have any questions.

Thank you for being a customer of Consolidated Public Water Supply District #1.
Customer Name*

First NameLast Name
Service Line Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Visual Inspection

Please check the following boxes regarding the method used to identify the service line entering the residence/building.

*Only answers under "Witnessed Installation" OR "Interior Self-Identification" can be selected
Witnessed Installation
Witnessed installation of the service line

LeadCopperGalvanized SteelPlasticOther
Self-Identification
Interior Self-Identification

LeadCopperGalvanized SteelPlasticOther
Location of Self-Identification

FoundationBasement wallFloor slabOther
Self-identification method

Located a wipe lead jointPerformed a scratch testPerformed a magnet testVisual Confirmation
If galvanized; with the water flow being from the water main to the residence/building, has lead pipe ever been used ahead of the galvanized pipe?

YesNo
What year was the customer owned service line installed?
Year
In order to support your identification, please provide photographic evidence. The photo must show the location used to perform the self-identification and be labeled with the address for the service line identified.
By signing this form I am stating to the best of my knowledge all information contained on this form is accurate.
Date*

MonthDayYear
Date
Customer Signature*

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