Discolored Water Report Form

2. Based on resident feedback, we have simplified the form so you can fill out faster. If you would like to speak with a staff member please call 978-897-1317 or email dpw@townofmaynard.net 

4. Name (optional)
6. Location Address Number *
7. Street Name: (example Main St)*
9. Date/Time
   Date/Time

   Date/Time
11. Type of Water*

    1. Hot Water
    2. Cold Water

    Defaulted to both

12. Location *

    1. Kitchen
    2. Bathroom
    3. Other source
16. Upload image of discolored water*

    we prefer your kitchen sink but understand that you may want to show us a different location

Leave This Blank:


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

    This field is not part of the form submission.

20. Submit

* indicates a required field