Private Well Water Test Log
See how a private supply changes over years rather than judging it from one test, and keep the maintenance record alongside the results.
HS-05 2 pages
Home systems · HS-28
Lead Service Line and Tap Water Test Record
A free printable lead pipe and water test record: how the supply pipe was identified, the supplier's records, lab results as reported, and pipe or filter work.
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One page. Choose your paper size — both versions are laid out identically, so neither one gets shrunk to fit.
Print it and write on it
Fill it in type and save
The fillable versions have real form fields — open them in any PDF reader, type into them and save. Printing help.
What this sheet is for
Keep the evidence about lead in your supply pipe and your tap water in one place. How the pipe was identified, what the supplier says, every lab result as reported, and any pipe replaced or filter fitted.
Who it is for
Owners and tenants of older homes who want to know whether a lead pipe serves the house, and anyone keeping evidence for a water supplier, landlord or buyer.
How to use it
- Find where the pipe enters the house, usually near the inside stop tap, and record what a gentle scratch and a magnet showed, with a photo.
- Ask the water supplier what their records say about the pipe to your property, and write their answer and reference.
- Arrange a laboratory test, follow its sampling instructions, and copy each result, its units and the lab's reference value as reported.
- Record any section of pipe replaced and who did it, and any filter in use with its cartridge changes.
What is on the sheet
One page, top to bottom:
Printed under the title: How the water pipe into the house was identified, what the water supplier's records say, each laboratory test for lead with its result as reported, and any pipe replaced or filter fitted.
Results as the lab gives them. Only a laboratory test confirms lead in drinking water; a scratch or magnet test only suggests what a pipe is made of. No safe or action level is printed: copy each result, its units and the lab's reference value from the report, and ask the lab, your water supplier or your local health body what it means.
The service pipe — where it comes into the house, often near the stop tap
Write-on lines: Where the pipe enters · Pipe size or colour · House built · Scratch test: what showed · Magnet sticks? · Photo ref. · Checked on · Supplier's record says · Their reference · Inside pipes and solder
Laboratory tests — follow the lab's own sampling instructions
Table, 5 rows: Sampled · Tap · Sample · Unused for · Laboratory · Result · Units · Reference · Report no.
Pipe replaced and filter in use
Write-on lines: Pipe replaced on · Which section · By whom · Paperwork ref. · Filter make and model · Certified for lead to · Cartridges changed on
Questions
What level of lead in water is safe?
This sheet does not say, on purpose. Limits and action levels differ between countries and are revised, and what a result means for your household is a question for the laboratory, your water supplier or your local health body. Copy the result and the lab's reference value exactly as the report gives them.
Can a scratch test tell me if a pipe is lead?
It can suggest it. Lead is soft, scratches to a shiny silver, and a magnet does not stick to it, but paint, coatings and other metals can mislead. Only a lab test tells you whether there is lead in the water, which is why the sheet keeps the two apart.
Should I use a filter?
That is a decision for you and the advice where you live. If you do, check that the filter is certified for lead reduction to the standard used there and change cartridges as its maker says. The sheet has space for both; it does not recommend a product.
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