Summary of Lead Service Line Inventory - Berne-Knox-Westerlo CSD PWS (NY0115885)

I. System Information

Water System Name Berne-Knox-Westerlo CSD PWS
PWS ID Number NY0115885

II. Contact Information for Owner / Licensed Operator of Record Completing the Form

Contact Name Keith Domermuth
Contact Phone Number 518-872-0946
Contact Email Address keith.domermuth@bkwcsschools.org

III. Summary of Inventory

Total Number of Service Lines in the Distribution System 4
Total Number of Identified Service Lines 4
Total Number of Lead Service Lines 0
Total Number of GSLRR 0
Total Number of Non-LSL 4
Total Number of Unknown Service Lines 0
Service Lines Lead GSL or GSLRR Non-Lead Unknown
PWS - Side Service Lines 0 1 GSL 3 0
Customer - Side Service Lines 0 1 GSL 3 0
Total Number of Service Lines in the Distribution System 0 0 GSLRR 4 0
Service Line Identification Methods
Identification Methods PWS- Side SLs Customer-Side SLs
Historical Records 2 0
Field Inspection 1 2
Customer Identification with Photo or other Verification NA 1
Excavation 1 1
Sequential Sampling 0 0
Statistical Analysis/Predictive Model 0 0

IV. Inventory Availability - The inventory must be available to public

If 50,000 customers or greater: Posting the inventory online water system's website. Address:
If under 50,000 customers: Explain how to access the inventory Keith.Domermuth@bkwschools.org

V. Certifications

By submitting this form, I have verified and certify the information listed in this form is true and accurate to the best of my knowledge and belief.

Keith Domermuth
Name
Director Of Facilities 1
Title
09/01/24
Date