Town of Brownville Water District #1 and #2 – Lead Service Lateral Inventory

Property Address

Your name

Phone Number of Person Completing this Form

Email of Person Completing this Form

Interior Service Line Material (Please describe your method(s) of Verification)

Exterior Service Line Material (WD#2 Only) (Please describe your method(s) of Verification)

Lead Solder Present (Please describe your method(s) of Verification)
YesNoUnknown

Photos taken of pipe, solder and verification method provided to Town
YesNo

POU and/or POE Treatment System
YesNo

If Yes, please describe and provide the location of the system

Upload photos