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2. Please follow the instructions on our website (www.concordnh.gov/waterservicelines) to complete a proper inspection of your water service line and then report your findings to the City of Concord's Water Treatment Facility by completing and submitting this form. Thank you!

4. First Name:*
5. Last Name:*
7. Address:*
9. City:*
10. State:*
11. Zip Code:*
13. Phone Number:*
14. Email:
16. I am the:*

    1. Property Owner

    1. Renter / Tenant
18. Does a magnet stick to your service line?*

    1. Yes

    1. Unsure

    1. No
20. What color is the pipe of your service line?*

    1. Copper (with or without Green/Blue)

    1. Gray or Silver

    1. White or Black

    1. Other
22. Upload a photo of your service line:*

    Photo must show the material of your service line after completing the scratch test. The scratched surface (on the section of pipe between where the pipe enters your property and the water meter) should be visible in your photo.

24. What year was your property built in?*

    If you are unsure, make your best guess and include a comment that your answer is a guess.

26. Comments / Concerns:

    If you have any comments, questions, or concerns, feel free to write it in this space provided.

Leave This Blank:


28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

* indicates a required field