Lead & Copper Survey

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ANY PAYMENTS MADE AFTER 4:00 PM ON THE 25TH OF EACH MONTH MUSTINCLUDE THE $50.00 SERVICE FEE
ONLINE PAYMENTS MADE AFTER 4 PM WILL NOT BE CREDITED TO YOUR ACCOUNT UNTIL THE FOLLOWING BUSINESS DAY.
THE FALL RIVER ROAD UTILITY DISTRICT IS NOT AFFILIATED WITH THE DOXO PAYMENT SYSTEM. IF YOU CHOOSE TO PAY WITH THIS METHOD, YOUR PAYMENT COULD TAKE UP TO 30 DAYS TO POST.

What type of plumbing materials are used within the home?

Phone Number *

Fall River Road Utility District 1054 Mattoxtown Rd., Lawrenceburg, TN 38478 Phone: (931) 762-9481

Check all that apply *

Lead (dull, dark gray, (Easily scratched with hard object, shine when scratched)

Copper (copper color, green tarnish)

Known to have lead solder

Galvanized Iron/Steel (Magnetic, black-dark gray, some reddish-brown rust, hard to scratch)

PVC (Plastic Pipe)

Other

Is a water softener installed in your home? *

Yes

Check all that apply: *

Lead (dull, dark gray. Easily scratched with hard object, shiny when scratched)

Copper (copper color, green tarnish)

Know to have lead solder

Galvanized Iron/Steel (Magnetic, black-dark gray, some reddish-brown rust, hard to scratch)

PVC (Plastic Pipe)

Other

Is a permanent water filter installed in your home? *

Yes

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.

All required fields are flagged with a red asterisk. Form will not submit without all these fields completed.

What type of service line connects the home to the water meter?

Customer Name: *

Mailing Address: *

Lead and Copper Plumbing Survey

Year of plumbing at main consumption tap: Typically the kitchen sink, if unknown, write UNKNOWN *

Your participation is this program helps protect the health of your community. Please contact us with any questions. Thank you for your assistance, Northeast Utility District

Physical Address: *

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