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2. Background
   The Senate Bill 550 law signed by Illinois Governor Rauner on January 17, 2017 adds a new section 17.11 titled “Drinking Water Notifications and Inventories”.  In summary, this additional section requires owners and operators of community water systems to create a comprehensive lead service line inventory and to submit documentation of the inventory to IEPA.  This is so that information on all lead service lines in the state that pose the risk of increased lead exposure in drinking water is collected and made publicly available.
4. Water Service Survey
   Use this form to self-report your water service material type as copper, lead, galvanized steel, or plastic. The majority of water services in the Village are made of copper or lead. It is important to check the pipe material as it comes into the home, as often a home will have copper plumbing from a remodel but still have a lead service line. This location is generally close to your water meter and located in a basement, crawl space, or utility closet. Apartment or condominium units may not have water meters in their unit and if so can disregard this notice. Lead pipes are gray in color, shiny when scratched, and often include molten joints. Galvanized pipes are gray in color and are dull when scratched. Copper pipes are brown colored and include soldered or threaded fittings. If you are unsure use a metal tool to clean the pipe and compare the pipe color with a penny. After reviewing your service pipe material, complete the survey below to the best of your knowledge.
6. For additional information on how to identify your service pipe material,
   visit www.vniles.com/servicematerialID.
8. My water service is made of:

   (Select one)

   1. Copper
   2. Lead
   3. Plastic
   4. Galvanized Steel
   5. I don't know.
10. Service Address and Contact Information
    Please provide the service address and contact information for which the above response applies:
12. Name
14. Service Address*
15. Street Name*
    -- Select One --W ALBION AVEW AMELIA DRN ASHLAND AVEN AUSTIN AVEW BALLARD RDN BELLEFORTE PLW BETTY TERW BIRCHWOOD AVEW BREEN STW BRUCE DRN CALDWELL AVEN CALLERO DRN CANAVAN CTW CAROL AVEW CAROL CTW CAROL STW CATINO TERW CEDAR LNCENTER FOR THE ARTS DRCIVIC CENTER DRGOLF MILL CTRW CHASE AVEW CHERRY AVEN CHESTER AVEW CHURCH STW CHURCH TERW CHURCHILL AVEN CHURCHILL CIRCIVIC CENTER DRW CLARA CTW CLARA DRW CLEVELAND STN CLIFTON AVEN CONCORD LNW CONRAD AVEW COURTE DRN COURTLAND DRW CRAIN STN CRONAME RDN CUMBERLAND AVEW DAVIS STN DAYS TERN DEE RDN DELPHIA AVEW DEMPSTER STW DOBSON STW EBERT PLW EBINGER DRW ELIZABETH AVEN ELMORE STW ELMWOOD DRW EMERSON STW FARGO AVEN FARNSWORTH DRN FIELD DRN FOREST VIEW LNW FOSTER LNN FOX GLEN DRN FRANKS AVEW GEORGIA DRN GLENDALE LNN GLENDALE RDW GOLF RDGOLF MILL CTRN GRACE AVEN GRAND CTN GRAND STW GREENDALE AVEW GREENLEAF STW GREENVIEW AVEN GREENWOOD AVEW GREGORY LNW GRENNAN PLW GROSS POINT RDW HAMILTON DRN HAMLIN AVEN HARLEM AVEW HARRISON STW HARTS RDW HARVARD STW HEATHWOOD CIRW HEATHWOOD DRW HOWARD STN HUBER LNN HUBER OVALW JARVIS AVEW JARVIS STN JOEY DRW JOHANNA DRW JONQUIL TERW KATHY LNW KAY STW KEDZIE STW KEENEY STW KIRK DRW KIRK STN KNIGHT AVEW LAKE STN LAUREN LNW LAWLER AVEW LEE STN LEHIGH AVEN LEXINGTON LNW LILL CTW LILL STN LINCOLN AVEN LORAS LNW LYONS STW MADISON CTW MADISON DRW MADISON STW MAIN STN MARYLAND STW MAYNARD DRW MAYNARD OVALW MAYNARD RDN MAYNARD TERN MEACHAM CTN MELVINA AVEN MENARD AVEN MERRILL AVEN MERRILL STN MERRIMAC AVEN MILWAUKEE AVEW MONROE CTW MONROE STW MULFORD STN NATCHEZ AVEN NATIONAL AVEN NEVA AVEN NEW ENGLAND AVEN NEWARK AVEN NEWCASTLE AVEN NEWLAND AVEW NILES AVEW NILES TERN NORA AVEN NORDICA AVEW NORMA CTW NORMAL AVEW NORMAL CTN NORMANDY AVEW NORTH TERN NOTTINGHAM AVEW OAK AVEW OAK LNN OAK PARK AVEW OAKTON CTW OAKTON STN OCONTO AVEN OCTAVIA AVEN ODELL AVEN OKETO AVEN OLCOTT AVEN OLEANDER AVEN ORIOLE AVEN OSCEOLA AVEN OTTAWA AVEN OVERHILL AVEN OZANAM AVEN OZARK AVEW PARK AVEW PARK LNW PETER TERW PROSPECT CTN PROSPECT STN RIVERSIDE DRW RIVERVIEW AVEN ROBIN RDN ROOT CTN ROOT STN ROSEMARY LNW ROSEVIEW DRN RUSCH DRN SCHOOL STW SEWARD STN SHERMER RDW STOLTING RDW SUNSET RDN SUSAN CTW TERRACE DRW TOUHY AVEN WARREN OVALN WARREN RDN WASHINGTON STN WAUKEGAN RDN WENDY WAYN WESTERN AVEN WILLOW LNN WISNER STW WOOD RIVER DRN WOODLAND DRW WRIGHT TER
16. Unit/Apartment
18. Water Account Number
20. Phone Number
22. E-mail
24. Need a Public Works Department appointment? (Check only if needed)

    If you are not able to locate your water service or not comfortable making this determination, the Public Works Department is willing to visit your home to determine your pipe material. To schedule an appointment, check the box below or call (847) 588-7900.

    1. Yes, I am in need of an appointment
Leave This Blank:


26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

* indicates a required field