Customer Material Questionnaire

The Town of Woodworth Water System is required to update our lead and copper sample plan and complete an inventory of the service line materials in our distribution system by October 16, 2024.  To assist with this endeavor, we are asking our customers to complete the brief survey below.

We understand that you may not be aware of your plumbing or service line materials and that is okay. However, we ask that you complete the questionnaire to the best of your ability and return it to us using the instructions provided at the end of the survey. We thank you for your cooperation in helping us comply with the Federal requirement.  If you have any questions, you can reach us at: (318) 442-1198 or .

Customer Information:

Property Information:

Use a separate sheet for each property

Service Line Schematic:

As shown in the figure, a service line is the section of pipe that runs from the water main to the structure served. The system-owned portion of the service line runs from the water main to the meter. The customer-owned portion of the service line runs from the meter to the structure served. For the purposes of this inventory, we are only asking for the material of the customer-owned service line and the water piping materials inside of the home or building.

Material Questionnaire:

I attest that, to the best of my knowledge, the information provided above is true and accurate:

Thank you for submitting your customer material questionnaire.

Town of Woodworth - Town Hall