Summary of Lead Service Line Inventory - Town of Champlain W.D. (NY0930006)

I. System Information

Water System Name Town of Champlain W.D.
PWS ID Number NY0930006

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

Contact Name Christopher M. Matott
Contact Phone Number 518-534-0323
Contact Email Address codeofficer@townofchamplain.com

III. Summary of Inventory

Total Number of Service Lines in the Distribution System 171
Total Number of Identified Service Lines 171
Total Number of Lead Service Lines 0
Total Number of GSLRR 0
Total Number of Non-LSL 171
Total Number of Unknown Service Lines 0
Service Lines Lead GSL or GSLRR Non-Lead Unknown
PWS - Side Service Lines 0 0 GSL 171 0
Customer - Side Service Lines 0 2 GSL 169 0
Total Number of Service Lines in the Distribution System 0 0 GSLRR 171 0
Service Line Identification Methods
Identification Methods PWS- Side SLs Customer-Side SLs
Historical Records 171 126
Field Inspection 0 21
Customer Identification with Photo or other Verification NA 17
Excavation 0 0
Sequential Sampling 0 0
Statistical Analysis/Predictive Model 0 7

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:10729 Route 9, Champlain. NY 12919
If under 50,000 customers: Explain how to access the inventory Go to www.townofchamplain.com or contact the town office at 518-298-8160

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.

Christopher M. Matott
Name
Water Operator
Title
06/17/25
Date