Form Center

* indicates a required field

2. NOTE: This survey is a requirement of the Ohio EPA and Ohio Administrative Code Chapter 3745-95 and is required to be completed once every 5 years. Avon Utilities will be required to do an in person survey if property owners do not complete the survey themselves.
4. First & Last Name:*
5. Service Address*
7. Email Address*
8. Phone Number*
10. Do You Own The Property?*

    1. Yes
    2. No
11. Have any changes been made to your plumbing in the past 5 years? If yes, describe below.*

    1. Yes
    2. No
13. Indicate which of the following are used at this service address.*

    Check all the apply

    1. Underground Lawn Sprinkler
    2. Inground Swimming Pool
    3. Water Powered Sump Pump
    4. Frost Free Yard Hydrant
    5. Auxiliary Water System (Private Well)
    6. Any Type of Water Treatment System
14. Describe any plumbing changes.
16. I hereby certify that I am the owner of the above listed property or am the authorized renter and that all information provided is true, complete, and correct to the best of my knowledge

    1. Yes
Leave This Blank:


17. 1. Receive an email copy of this form.
18. Email address

    This field is not part of the form submission.

19. Submit

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.