Kansas Customer Water System Service Line Inventory Questionnaire
Allen County Rural Water District 15

Dear Water Customer:

The U.S. Environmental Protection Agency (EPA) recently issued regulations requiring all public water supply (PWS) systems to develop a Lead Service Line Inventory (LSLI) of both water system owned and your privately owned service lines. Your PWS system must submit this inventory to the Kansas Department of Health and Environment (KDHE) by October 16, 2024. If the required information cannot be gathered from the homeowner, KDHE may require the water supplier to excavate private lines in order to identify them. That would be very time consuming and expensive.

While these contaminants are not in the source water, they can enter tap water through the corrosion of service line piping and older household plumbing materials. Your water system is sending this survey to all customers asking that you complete and return the form below. We thank you for your cooperation in helping us with this to continue to serve clean and safe drinking water to our customers. Please take a few minutes to complete this questionnaire to the best of your ability and return to the address at the end of the questionnaire.

Additional information on the Lead and Copper Rule and identifying lead pipes and plumbing can be found on the KDHE website at: kdhe.ks.gov/547 or at the EPA Website at: epa.gov/dwreginfo/lead-and-copper-rule

Your help is needed to complete this requirement. Please complete this survey by July 20th.
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Name of Person filling out this questionnaire *
Phone Number should we have questions *
Property Street Address *
Structure Type *
Year Built *
Do you own your home or rent?
 *
If renting, who is the landlord/owner and their contact phone number?
What pipe material is the service line pipe entering your house, foundation or business made of?  (check all that apply)
 *
Required

What year was your service line installed? (This may be the year structure was built)

 *
What size pipe is the service line entering your house or business? (in inches) *
What material are the plumbing pipes in your house or business mostly made of?
 *
What is the second most common plumbing pipe material in your house or business? *
How old are the pipes inside your house? *
Do you have a water softener, a whole home water purification system, RO-System, faucet filter or any other treatment device installed in your house or business? *
If your home or business meets the criteria for lead and copper sampling, would you be willing to participate in this testing? During testing, a Water Supply Employee would bring an empty bottle to your house, provide you with documentation and instructions on collecting the sample, and pick it up the next morning. *
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