Feb 0416 12159;) JASPER GAS 8: WATER 812-482-9827 [32

Service Line Information

 

Public Water System Name5115049?

 

StreetAddress: gal; 551?,an gym.

 

 

City: T4 59-6 z"

 

State: 

 

Zip code: (L,

 

PWS Contact Name: 0 Sam,

 

Contact Phone Number: a; ?3213);?

 

 

 

 

 

Contact Email Address: {and (dank cw, 

I. Service Line Inventory Information
A. List irgformation sources or records checked by utility for sewice line information:
A) ml 
TMST fizz-31L {mg-?From above list, speci?: all sources or records that contain service line information:

1
2.
3,
4
5

Received Time Feb. 4? 2016 No.6911

 

 

Feb 041812159p

p.13

JASPER GAS WATER 812482-9827

I C. Sen?ice Line Almeria!

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Con?dence in Records
Number of Plumber or Estimates
Service Line Material Service Esmated (E) or (Insert $131 1 1?9ng
Connections from Records no confidence :11 records or
(R) estimate and 10 being very
con?dent)
I. No lead portion ?1 5 7, 0 
2, Service line material is
unknown if) (a
3. Lead gooseneck only  #1 co (3  i 
4. Entire service line is 
lead from the water main
to home 0 cl
5. Lead only ?rom the water
main to external senrice
shut-off; curb or to ext 
line 0 (3 3
6. Lead only from the
external shut-off valve to
the home 0 ?1
Total number of service
connections (add 1 through a,
6) (9532: 
Total number of service lines
with lead ortions add 3 
through '2 a a 2
11. Service Line Ownership
1. Specify who owns the portion of the service line from the water ma ..- external shut-of?
curb or property line. Municipality (M), Public Water System (P) 
Unknownfnot sure 
2.

Specify who owns the portion of the service line from the petty line or shut-off to
the home. Municipality (M), Public Water System (P) csident( or Unknown/not sure



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.

Colt-?flex E) (?ma?x 

3. What is the legal citation of the State or local ordinance that establishes and speci?es the

ownership of the service lines?



dale?F  (mt-tacL

Received Time Feb. 4. 20l6 No.69ll

 

 

 

 

812-482-9827

  0416 12:59p JASPER GAS WATER

  

TIM DOERSAM
FILTRATION PLANT FOREMAN 

i

812-482-2010
81244826252

. 812?482-9827 FAX

 

 

Date: 01 

. a, 

Cl Urgent For Review Please Comment



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Received Time Feb. 4. 2016 No.6911