ABCDEFGHIJKLMNOPQRSTUVWXYZ
1
2
Lead Service Line Inventory Template
3
*Please enter information in the empty box next to each sectionWater System NameVillage of GolfSystem ID Number:IL 0311080Current Inventory Date:4/15/2025
4
*Please enter totals in the empty box next to each categoryTotal Service lines:173
Total Lead:
29Total Non-Lead:144Total Galvanized Requiring replacement:0Total Unknown:0Website link to Material Inventory:
5
6
7
Service AddressLead and Copper Sample site number. Is this a high-risk Facility or Area?Service Line Newly Identified Since Last Submitted InventoryYear PWS-Owned Service Line was InstalledYear Customer Side Service Line was InstalledSource of Information Used for Service Line IdentificationGooseneck/ PigtailPWS-Owned Service Line MaterialCustomer Side Service Line MaterialClassification for Entire Serivice LineWas Galvanized Service Line Material ever downstream of Lead?Date Customer Notified of Lead Service LineWas a Lead Service Line Previously Replaced at this Location?Date Lead Service Line ReplacedMaterial of Service Line Replacement Has the customer refused access to the property?Date of customer waiver or IDPH notification, if customer refused access to property
8
Lead and Copper Sample site number is the 7 digit number starting with "LP" or " LA". / If address is not a lead and copper sample site mark "N/A"EXAMPLES:Yes (Y) or No (N)What year was the PWS-Owned service line installed, if known?What year was the customer side service line installed, if known?How was the Material of this Service Line Identified? EXAMPLES: Construction Records, Visual Inspections, Survey Response, Maintenance Records, etc...EXAMPLES:EXAMPLES:EXAMPLES:EXAMPLES:If any galvanized service line material was ever downstream of a Lead section, mark Yes (Y). If the galvanized service line material was never downstream of any Lead section, mark No (N). / If Yes, that section of service line should be marked as Galvanized Requiring Replacement in the appropriate immediately preceding column(s).Enter date customer was notified of Lead Service Line. / If Service Line is not Lead put N/RYes (Y) or No (N)If previous column was marked (Y), provide date the Lead Service Line was replaced. / Leave blank if previous column was (N).EXAMPLES: Yes (Y) or No (N)IF customer refused access to property, date waiver obtained by PWS or date PWS notified IDPH of refusal to sign waiver. / Leave blank if customer has not refused access.
9
Group Homes, Parks, Playgrounds, Special Care Facilities, Hospitals, Clinics, Child Care FacilitiesCopper - No Lead Solder (C)Copper - No Lead Solder (C)Copper - No Lead Solder (C)Lead (L)Copper - No Lead Solder (C)
10
Copper - Lead Solder (CLS)Copper - Lead Solder (CLS)Copper - Lead Solder (CLS)Galvanized Requiring Replacemnt (GRR)
11
Galvanized (G)Galvanized (G)Galvanized (G)Unknown (U)Galvanized (G)
12
Lead (L)Galvanized Requiring Replacemnt (GRR)Galvanized Requiring Replacemnt (GRR)Non-Lead (NL)Plastic - PVC, HDPE, PEX (P)
13
Cast/Ductile Iron or Transite (O)Lead (L)Lead (L)Cast/Ductile Iron or Transite (O)
14
Yes (Y) or No (N)Plastic - PVC, HDPE, PEX (P)Cast/Ductile Iron or Transite (O)Cast/Ductile Iron or Transite (O)Leave blank if no Lead Service Line was replaced.
15
Unknown (U)Plastic - PVC, HDPE, PEX (P)Plastic - PVC, HDPE, PEX (P)
16
Unknown Not Lead (UNL)Unknown (U)Unknown (U)
17
Unknown Not Lead (UNL)Unknown Not Lead (UNL)
18
29 Logan TerrLC1T001NNUnknown1942Historical Record- Water System Record/Investigation- Visual Inspection (professional)LLLL 5/14/2024N
19
48 Briar RdLC1T021NNUnknown1942Historical Record- Water System Record/Investigation- Visual Inspection (professional)LLLL5/14/2024N
20
9 Orchard LnLC1T017NNUnknown1951Historical Record- Water System Record/Investigation- Visual Inspection (professional)LLLL5/14/2024N
21
20 Dover LnLC1T002NNUnknown1947Historical Record- Water System Record/Investigation- Visual Inspection (professional)LLLL5/14/2024N
22
31 Briar RdN/ANNUnknown1948Historical Record- Water System Record/Investigation- Visual Inspection (professional)UULL5/14/2024N
23
5 Overlook DrLC1T003NNUnknown1939Historical Record- Water System Record/Investigation- Visual Inspection (professional)LLLL5/14/2024N
24
26 Briar RdN/ANNUnknown1930Historical Record- Water System Record/Investigation- Visual Inspection (professional)UULL5/14/2024N
25
8 Briar RdLC1T004NNUnknown1940Historical Record- Water System Record/Investigation- Visual Inspection (professional)LLLL5/14/2024N
26
3 Briar RdN/ANNUnknown1953Historical Record- Water System Record/Investigation- Visual Inspection (professional)UULL5/14/2024N
27
13 Overlook DrLC1T005NNUnknown1941Historical Record- Water System Record/Investigation- Visual Inspection (professional)LLLL4/14/2024N
28
47 Overlook DrN/ANNUnknown1940Historical Record- Water System Record/Investigation- Visual Inspection (professional)UULL5/14/2024N
29
11 Dover LnLC1T006NNUnknown1926Historical Record- Water System Record/Investigation- Visual Inspection (professional)LLLL5/14/2024N
30
18 Briar RdLC1T007NNUnknown1943Historical Record- Water System Record/Investigation- Visual Inspection (professional)LLLL5/14/2024N
31
49 Park LnN/ANN20162016Historical Record- Construction or Plumbing CodeCCCNLN/RN
32
75 Park LnN/ANN20012001Historical RecordsCCCNLN/RN
33
25 Briar RdN/ANNUnknown1953Historical RecordsCCCNLN/RN
34
18 Blossom LnN/ANNUnknown1973Historical RecordsCCCNLN/RN
35
63 Overlook DrN/ANNUnknown1986Historical RecordsCCCNLN/RN
36
32 Briar RdN/ANN20212021Historical Record- Construction or Plumbing CodeCCCNLN/RN
37
54 Park LnN/ANN20012001Historical Record- Construction or Plumbing CodeCCCNLN/RN
38
17 Briar RdN/ANN19971997Historical Record- Construction or Plumbing CodeCCCNLN/RN
39
14 Dover LnN/ANN20032003Historical Record- Construction or Plumbing CodeCCCNLN/RN
40
50 Overlook DrN/ANNUnknown1918Historical RecordsCCCNLN/RN
41
18 Park LnN/ANNUnknown1950Historical Record- Water System Record/Investigation- Visual Inspection (professional)CCCNLN/RN
42
28 Park LnN/ANNUnknown1957Historical RecordsCCCNLN/RN
43
34 Briar RdN/ANNUnknown1952Historical RecordsCCCNLN/RN
44
10 Henneberry LnN/ANNUnknown1989Historical Record- Construction or Plumbing CodeCCCNLN/RN
45
10 Briar RdN/ANNUnknown1941Historical Record- Water System Record/Investigation- Visual Inspection (professional)CCCNLN/RN
46
15 Blossom LnN/ANNUnknown1897Historical Record- Water System Record/Investigation- Visual Inspection (professional)CCCNLN/RN
47
40 Briar RdN/ANN20012001Historical Record- Construction or Plumbing CodeCCCNLN/RN
48
44 Briar RdN/ANNUnknown1955Historical RecordsCCCNLN/RN
49
2 Clyde RdN/ANNUnknown1949Historical RecordsCCCNLN/RN
50
11 Henneberry LnN/ANNUnknown1959Historical RecordsCCCNLN/RN
51
56 Overlook DrN/ANNUnknown1914Historical Record- Water System Record/Investigation- Visual Inspection (professional)CCCNLN/RN
52
26 Park LnN/ANNUnknown1926Historical RecordsCCCNLN/RN
53
33 Park LnN/ANNUnknown1951Historical RecordsCCCNLN/RN
54
21 Park LnN/ANNUnknown1963Historical RecordsCCCNLN/RN
55
2 Elm CirN/ANNUnknown1962Historical RecordsCCCNLN/RN
56
77 Overlook DrN/ANN20162016Historical Record- Construction or Plumbing CodeCCCNLN/RN
57
55 Overlook DrN/ANN20162016Historical Record- Construction or Plumbing CodeCCCNLN/RN
58
49 Briar RdN/ANN20012001Historical Record- Construction or Plumbing CodeCCCNLN/RN
59
8 Henneberry LnN/ANN20072007Historical Record- Construction or Plumbing CodeCCCNLN/RN
60
37 Briar RdN/ANNUnknown1941Historical RecordsCCCNLN/RN
61
47 Park LnN/ANNUnknown1965Historical RecordsCCCNLN/RN
62
55 Park LnN/ANNUnknown1923Historical RecordsCCCNLN/RN
63
4 Clyde RdN/ANN20092009Historical Record- Construction or Plumbing CodeCCCNLN/RN
64
70 Golf RdN/ANNUnknown1977Historical RecordsCCCNLN/RN
65
43 Briar RdN/ANNUnknown1954Historical RecordsCCCNLN/RN
66
64 Park LnN/ANN20042004Historical Record- Construction or Plumbing CodeCCCNLN/RN
67
8 Orchard LnN/ANNUnknown1963Historical RecordsCCCNLN/RN
68
59 Park LnN/ANNUnknown1912Historical RecordsCCCNLN/RN
69
27 Park LnN/ANNUnknown1972Historical RecordsCCCNLN/RN
70
4 Orchard LnN/ANNUnknown1988Historical RecordsCCCNLN/RN
71
39 Briar RdN/ANNUnknown1942Historical RecordsCCCNLN/RN
72
25 Logan TerN/ANNUnknown1957Historical RecordsCCCNLN/RN
73
20 Park LnN/ANNUnknown1945Historical RecordsCCCNLN/RN
74
5 Orchard LnN/ANNUnknown1967Historical RecordsCCCNLN/RN
75
31 Park LnN/ANNUnknown1952Historical RecordsCCCNLN/RN
76
35 Logan TerN/ANN20182018Historical Record- Construction or Plumbing CodeCCCNLN/RN
77
5 Henneberry LnN/ANNUnknown1964Historical RecordsCCCNLN/RN
78
7 Orchard LnN/ANNUnknown1995Historical RecordsCCCNLN/RN
79
30 Briar RdN/ANNUnknown1940Historical Record- Construction or Plumbing CodeCCCNLN/RN
80
29 Park LnN/ANNUnknown1963Historical RecordsCCCNLN/RN
81
50 Park LnN/ANNUnknown1957Historical RecordsCCCNLN/RN
82
50 Briar RdN/ANNUnknown1943Historical RecordsCCCNLN/RN
83
47 Briar RdN/ANN20082008Historical Record- Construction or Plumbing CodeCCCNLN/RN
84
35 Overlook DrN/ANNUnknown1928Historical RecordsCCCNLN/RN
85
26 Logan TerN/ANNUnknown1939Historical RecordsCCCNLN/RN
86
1 Elm CirN/ANNUnknown1962Historical RecordsCCCNLN/RN
87
58 Overlook DrN/ANNUnknown1944Historical RecordsCCCNLN/RN
88
52 Briar RdN/ANNUnknown1959Historical RecordsCCCNLN/RN
89
1 Orchard LnN/ANNUnknown1981Historical RecordsCCCNLN/RN
90
27 Logan TerN/ANN20061928Historical Record- Construction or Plumbing CodeCCCNLN/RN
91
51 Briar RdN/ANN20152015Historical Record- Construction or Plumbing CodeCCCNLN/RN
92
17 Clyde RdN/ANNUnknown1953Historical RecordsCCCNLN/RN
93
62 Park LnN/ANN20062006Historical Record- Construction or Plumbing CodeCCCNLN/RN
94
2 Orchard LnN/ANNUnknown1918Historical RecordsCCCNLN/RN
95
44 Park LnN/ANNUnknown1960Historical Record- Water System Record/Investigation- Visual Inspection (professional)CCCNLN/RN
96
25 Park LnN/ANNUnknown1963Historical RecordsCCCNLN/RN
97
2 Henneberry LnN/ANNUnknown1965Historical RecordsCCCNLN/RN
98
17 Blossom LnN/ANNUnknown1987Historical Record- Water System Record/Investigation- Visual Inspection (professional)CCCNLN/RN
99
40 Park LnN/ANNUnknown1957Historical RecordsCCCNLN/RN
100
61 Overlook DrN/ANNUnknown1996Historical Record- Water System Record/Investigation- Visual Inspection (professional)CCCNLN/RN