Marshall Municipal Utilities

Customer Name:

Address:

Customer Phone#:

Customer Email:

Water Service Account#:

Please answer the questions below using the provided pictures to help:

1. Type of Structure: (click one)
a. Single family home
b. Multi-family home
c. Business
d. Hospital/medical facility
e. School/childcare facility
f. Nursing home

2. Water Service Line Material, from the Water Meter to Your Structure, see images below: (click one)
a. Copper
b. Galvanized Steel
c. PVC
d. Other Non-Lead
e. Asbestos-Cement
f. Lead

3. How did you identify your Water Service Line? (click one)
a. Performed a scratch test
b. Performed a magnet test
c. Located a wipe lead joint

Visit the Links below to DNR’s video/webpages for assistance in Identifying your Water Service Line:
https://www.youtube.com/watch?v=1JUGIpuH9a4
https://dnr.mo.gov/document-search/do-you-have-lead-service-line-pub3046/pub3046
https://dnr.mo.gov/document-search/how-identify-your-water-service-line-material-pub3052

4. Size of Customer Water Service Line: (click one)
3/8"
1/2"
5/8"
3/4"
1"
1 1/4"
1 1/2"
1 3/4"
2"
3"
4"
6"
8"
10"
12"
14"
16"

5. What year was the Customer-owned Water Service Line (meter to structure) installed (Example: 1994)?

6. If your water service line (water meter to your structure) is Galvanized steel; with water flowing from the MMU Water Main to your structure, has lead pipe ever been used ahead of the galvanized steel pipe? (see above image) (click one)
a. Yes
b. No
c. Unknown

7. Are You or Have You Been, a Lead & Copper Sample Site? (click one)
a. Yes
b. No
c. Unknown

8. Is there a private Point-of-Entry or Point-of-Use Treatment present (like a water filtering/softener unit)? (click one)
a. Yes
b. No
c. Unknown

9. What is Your Structures Primary Plumbing Material (Inside the building)? (click one)
a. Copper
b. Galvanized steel
c. PVC
d. Other Non-lead
e. Copper Pipe with Lead Solder
f. Lead
g. Unknown

10. What Year was Your Structure’s Plumbing installed, inside the building (Example: 1994)?

          OR

What Year Range was Your Structure’s Plumbing installed, inside the building? (click one))
a. Before 1989
b. Between 1989 and 1-4-2014
c. After 1-4-2014
d. Unknown

11. In order to support your service line self-identification, MMU is required to ask for photographic evidence. The photo must show the location used to perform the self-identification, and be labeled with the address for the water service line being identified. Locations may include: Structure's foundation wall, basement wall, shut off valve, or floor slab.See the images below for examples of where the water service line may enter your structure/home.

To the best of my knowledge all information contained in this online questionnaire is accurate.
Please type your name and date in the space below. Doing so will serve as your signature

E-Signature and Date

This concludes MMU's Water Service Line Questionnaire, Thank You!!

Pressing the above button will open your email program with an email already written and addressed to us. Please go ahead and send it. Sometimes this form fails to upload your picture required for question 11 properly to your email. Please make sure it is attached before sending the email.