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Cross-Connection Control Questionnaire

An "*" marks a field as required.

Information

Dear Water Customer:

Our records indicate that you have an existing backflow prevention assembly that is tested annually. New regulations allow some backflow prevention assemblies to be tested every two years.

To find out if your assembly qualifies for a two-year testing frequency, please complete the questionnaire.

  • Is this a residential property?*



Please select any of the following items that apply to your property.*
Does your property have...

  • a lawn irrigation system?
  • a fire sprinkler system?
  • a booster pump serving or within the premise?
  • an alternative water source (e.g. well) at your location?
  • any type of equipment that uses chemicals and is connected to City water (excluding house-hold appliances)?
  • five or more stories high?

 

Signature*

I acknowledge all the information on this form is true to the best of my ability.