Service Line Information

 

Public Water System Name:

CHM 01L N??r

 

PWSID:

safe (a o;

 

Street Address:

(71 AJJ 2nd 57L.

 

 

 

 

 

 

 

 

City: g: (IQ-fa 
State: TN 0/ 4
Zip Code: 4 4, 7 5? 3
PWS Contact Name: LJ {l I Am 
Contact Phone Number: 6 0 -- 7/ J) 
Contact Email Address:

 

 

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Service Linc Inventory Information

A. List information sources or records checked by utitity for service line information:

wugmewwe

Ne ff?jrc/S 0N Siren-Cf

AME m?f?r: 

B. From above list, specify all sources or records that contain service line information:



 

C. Service Line Material

 

Con?dence in Records

 

 

 

 

 

 

Number of Is Number or Estimates
Service Line Material Service Esnmated (E) or (Insert 1'10, With 1 being
Connections from Records no confidence in records or
(R) estimate and 10 being very
con?dent)
1. No lead portion a a 0 
2. Service line material is
unknown I. 0' ?3 5;
3. Lead gooseneck only C) 5?
4. Entire service line is
lead from the water main ?2 6, 
to home
5. Lead only from the water
main to external service .
shut-off, curb or property ?2 0 (C 71
line
6. Lead only from the
external shut-off valve to a 5 2

the home

 

Total number of service
connections (add 1 through 

6)

4/900



 

 

Total number of service lines
with lead portions (add 3
through 6)

 

23650

 

 

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II.

Service Line Ownership

. Specify who owns the portion of the service line from the water main to the external shut-off,

curb or property line. Municipality (M), Public Water System (P) Resident (R) or

Unknown/not sure 



Specify who owns the portion of the service line from the curb, property line or shut?off to
the home. Municipality (M), Public Water System (P) Resident (R) or Unknown/not sure

,6

For questions 2 and 3 above, please provide any additional information that may be relevant to

the issue of ownership of the service line segments.

o@nat establishes and speci?es the

{ma?a ?l?o cpl/ESfW
Curl-astray? home:

3. What is the legal citation of the State
ownership of the service lines?

5?3 ,os?d

3'3, 05"!