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Customer-side Lead Survey
Customer Information
First Name
*
Last Name
*
Service Address
*
City
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Zip Code
*
Phone Number
*
Customer Service Line Data
Customer Service Line Material:
*
Plastic/ PVC
Copper
Galvanized
Lead
Other
Customer Service Line Install Date:
*
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
Customer Service Line Size:
*
1/2"
3/4"
1"
1 1/2"
2"
2 1/2"
3"
4"
Building Data
Building Type:
*
Single Family Residence
Multiple Family Residence
School or Child Care Center
Child Care (In-Home)
Business
Point-of-Entry or Point-of-Use Treatment Present? (Water Filtration System)
*
Yes
No
Building Plumbing Material (Inside Structure):
*
Plastic/ PVC
Copper
Galvanized
Lead
Other
Building Plumbing Material Install Date:
*
< 1960
1960 - 1988
1989 - 2014
> 2014
Data Verification
Verification Source:
*
Customer Inspection
Plumber Inspection
Builder Inspection
Customer Records
BRRWC Inspection
Please click submit and you will be redirected to Blue Ridge Rural Water Company's website.
Thank you for your time.
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