Lead and Copper Plumbing Survey
Thank you for your interest in protecting your health and the health of your community. To maintain complete records and estimate your home's lead-exposure risk, we ask that you complete this survey. 
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Customer Name:  *
Phone Number:  *
Physical Address:  *
Mailing Address:  *
Years of plumbing at main consumption tap: 
(Typically the kitchen sink; if unknown, type UNKNOWN)
 *
Is a permanent water filter installed in your home? *
Is a water softener installed in your home?  *
What type of service line connects the home to the water meter? Please check all that apply:
Service line material can be verified by viewing the water line at the point where it connects to the meter (usually outside in a boxed pit) and where it enters the home (usually in the basement or foundation crawl spaces). NPR has developed an interactive plumbing identification guide: https://apps.npr.org/find-lead-pipes-in-your-home/en/ and there is a representative pictorial example of types of plumbing materials included below.
 *
Required
Types of plumbing materials
What type of plumbing materials are used within the home? Please check all that apply:
Plumbing material can be verified by viewing the lines connecting to your water heater. NPR has developed an interactive plumbing identification guide: https://apps.npr.org/find-lead-pipes-in-your-home/en/ and there is a representative pictorial example of types of plumbing materials included above. 
 *
Required
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