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222 West Main Street, Suite 100
Somerset, PA 15501

814-443-1319

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Water Service Line Survey

Full Name

Please enter your full name.

First Last

Phone

Please enter a valid phone number where we can reach you.

Email(Required)

Please List your Email Address

Address(Required)

Please provide the house number and street for this residence.

Street Address City ZIP / Postal Code

Residence Type(Required)

Select the type of residence this address represents.

Single Family Residence

Multi-Family Residence

Building/Other

School

Childcare Facility

Contains Lead Solder(Required)

Indicate if the plumbing in this residence contains lead solder.

Yes

Not Sure

Point-of-Entry Treatment System(Required)

Select if there is a Point-of-Entry (POE) treatment system installed.
Point-of-Entry (POE) treatment is any unit installed to treat the water entering a house or building. Most often a filtration system installed close to the where the service enters the building. Filters installed underneath sinks or on taps are NOT considered POE treatment.

Yes

Not Sure

Service Line Details - Customer Owned

Material (Customer)(Required)

Select the material of the service line owned by the customer.

Lead

Galvanized Steel

Plastic

Copper

Not Sure

Other (Please Describe)

Material (Customer Described)(Required)

Pipe Size (Customer)(Required)

Select the size of the customer-owned service line.

1/2"

3/4"

Not Sure

Other (Please Describe)

Pipe Size (Customer)(Required)

Lead (Customer)(Required)

Select if this service line owned buy the customer previously contained lead.

Yes

Not Sure

Exact Install Date (Customer)

Enter the exact installation date if known.

MM slash DD slash YYYY

Approximate Install Date (Customer)

Enter an approximate installation date if the exact date is unknown.

MM slash DD slash YYYY

System Owned Details

System-Owned Portion(Required)

Do you have knowledge of your system from the curb stop to water main?

Service Line Details - System Owned

This section is ONLY if you have knowledge of the system from the Curb stop to water main.

Material (System)

Select the material of the service line owned by the customer.

Lead

Galvanized Steel

Plastic

Copper

Not Sure

Other (Please Describe)

Material (System)

Pipe Size (System)

Select the size of the customer-owned service line.

1/2"

3/4"

Not Sure

Other (Please Describe)

Pipe Size (System)

Lead (System)

Select if this service line owned buy the customer previously contained lead.

Yes

Not Sure

Exact Install Date (Customer)

Enter the exact installation date if known.

MM slash DD slash YYYY

Approximate Install Date (Customer)

Enter an approximate installation date if the exact date is unknown.

MM slash DD slash YYYY

Additional Info

System Photos

If photos are provided they may assist in identifying/validating the pipe material, however photos are not required.

Drop files here or

Max. file size: 50 MB, Max. files: 5.

Have a Project?

Don’t hesitate to contact us for more information about our company and services.

Company

Somerset Engineering
222 West Main Street, Suite 100 Somerset, PA 15501
P: 814-443-1319

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