You must have JavaScript enabled to use this form. Address Please enter the address of the property for which you are completing the survey. Account Number Your account number can be found on your paper bill, or you can contact City Hall at (316) 772-5151. Structure Type: Single Family Home Multi-Family (Duplex/Quadraplex) Apartment Commercial Building Industrial Facility Year Built Material Types Use this guide to help identify pipe materials for the following questions. Service Material What material is the water service pipe as it enters your home or business? Copper Plastic Galvinized Lead Not sure Other Enter other… What year was your service line installed? (This may be the year structure was build) What size pipe is the service line entering your house or business? Service Material Photo Number of files allowed: 1-3 Maximum 3 files.256 MB limit.Allowed types: gif, jpg, jpeg, png. Plumbing Material What material or materials is the plumbing in your home or business? Select all that apply. Copper Plastic Galvanized Lead Not sure Other Enter other… Plumbing Material Photo One file only.256 MB limit.Allowed types: gif, jpg, jpeg, png. Optionally include a photo of the plumbing in your home or business. Has your property had a major renovation or plumbing replacement since it was built? Yes No Not sure If so, when? Has your service line been replaced? Yes No Not sure If so, when? How old are the pipes inside your house? Installed before 1989 Installed after 1989 Sampling Volunteer Information If you are willing to participate in our water quality sampling program, please fill in the fields below provide contact information and answer two brief questions. Thank you! Contact Name Enter the name of the individual who will serve as the contact for the sampling program. Contact Phone Number Enter the phone number (XXX-XXX-XXXX) at which the contact can be reached. Call or Text Would you prefer a call or text? Call Text Either Contact Email Enter the email at which the contact can be reached. Do you have a whole-house or point-of-source water filtration system? Yes No Not sure Do you have a water softener? Yes No Not sure Leave this field blank Print