Lead and Copper Survey FormContact InformationName (required)Address (required)City/Town (required)State/Province (required)Zip/Postal Code (required)Survey InformationWhat year was your house built? (required)What type of construction is your home? (required)Stick BuiltManufacturedModularDo you have copper water pipes? (required)YesNoDon't knowDo you have any lead water pipes? (required)YesNoDon't knowDo you have galvanized water pipes? (required)YesNoDon't knowWould you be willing to take water samples for the District?YesNoThere was a problem saving your submission. Please try again later.Please wait while your submission is being saved...Submitting...SubmitThank you, your submission has been received.
