We Need Your Help!
  The Shellsburg Water Department is updating its records of water service lines. A service line is the connection between the water distribution pipes in the street and the water meter in your home or business. An updated citywide inventory is required under the Environmental Protection Agency (EPA)'s recently revised Lead-Copper rule.

Any citywide inventory can be a costly undertaking. Customer participation can reduce the expense of the inventory required by the EPA and reduce inconveniences associated with potential home or office visits. 

To better manage resources and costs, the Shellsburg Water Department is asking for help from residents and business owners to identify private service line material. Please fill out our short survey to help us complete our inventory in an efficient manner. Residents are encouraged to complete the survey, regardless of the age of their home or business.

We thank you for your cooperation in helping us continue to serve clean and safe drinking water to our customers.

If you have any questions about this survey, please contact:
Operator Name: Rick Robertson
Phone: 319-436-2954 Opt. #2
Email: rickr@shellsburg.com

Or:

Clerk: Barb Tracy
Phone: 319-436-2254 Opt. #1
Email: barbt@shellsburg.com

Sign in to Google to save your progress. Learn more
Name of Person filling out this form. *
Phone Number should we have questions.
*

Property Address
 (use separate form for each property)
*
Property Type
*
Year Built *
What material is your service line (1) made of?
*
Captionless Image
When was the service line going into your home or business installed? *
What material are the pipes in your house or business made of (2)?  (Check all the apply)
*
Captionless Image
Required
How old are the pipes inside your home or business? *
Do you have a water softener or a whole home water purification system or any other treatment device installed in your home or business? *
If you answered yes to the previous question. Do you have an untreated, cold-water kitchen or bathroom faucet?
*
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy