Get the free Cross-Connection Control Survey - breese

This form is to be used by water department personnel and/or by customers of the City of Breese water supply to assess plumbing installations and determine the need for preventive inspections against

How to fill out cross-connection control survey

How to fill out Cross-Connection Control Survey

1. Obtain a copy of the Cross-Connection Control Survey form from your local water authority.
2. Start by filling out your contact information, including name, address, and phone number.
3. Identify the type of property (residential, commercial, industrial) and describe its use.
4. List all water sources connected to your property, including public water supply, wells, and any other sources.
5. Provide information on all plumbing fixtures and appliances, such as sinks, toilets, irrigation systems, and fire protection systems.
6. Detail any potential cross-connections, which are plumbing configurations where water from a non-potable source could flow back into the drinking water supply.
7. Indicate any backflow prevention devices installed on your property, including their locations and maintenance records.
8. Review the completed survey for accuracy and completeness.
9. Submit the completed survey to your local water authority as per their submission guidelines.

Who needs Cross-Connection Control Survey?

1. Property owners and managers responsible for maintaining safe drinking water standards.
2. Commercial properties, including restaurants and industrial facilities, where there are potential cross-connections.
3. Residential homes with irrigation systems or swimming pools.
4. Local government agencies and municipalities monitoring water safety.

People Also Ask about

What is a cross-connection control device?

A cross connection control device is a mechanical device that stops the backflow of water into public drinking water.

What is meant by cross connection?

A cross connect is a point-to-point connection between two endpoints in a data center. These could be two devices, networks, or data center environments within a facility. The aim is to create private network connectivity between these two entities.

What is the most common form of cross connection?

The ordinary garden hose is used to create the most common form of cross connection. A hose can be easily connected to the drinking water supply and used for a variety of potentially dangerous applications.

What is an example of a cross connection in food service?

A common example of an indirect cross-connection is a hose connected to the water supply in a utility closet with its end submerged in a dirty mop bucket. A cross-connection occurs when the potable — or drinking — water supply comes in contact with a source of contamination.

What is a cross-connection control survey?

Cross-connection surveys are a comprehensive inspection of a facility (new or existing) to determine whether connections exist between potable water outlets and a source of contamination or pollution. If any such connection exists, then a backflow prevention device will need to be installed.

What are some examples of a cross connection?

Common examples of cross-connections include a garden hose submerged in a pesticide mixture, a piped connection providing potable feed water to an industrial process, such as a cooling tower, or a submerged outlet of an irrigation system. Connections to firefighting equipment are other very common cross-connections.

How do you prevent cross connection?

Tips for Protecting Your Home or Business from Cross-connections Learn how to eliminate or control cross-connections with backflow preventers. Do not submerge hoses or place hoses where they could become submerged, such as sinks, tubs, or pools. hose bib vacuum breakers on hose spigots.

What is an example of a cross connection?

Common examples of cross-connections include a garden hose submerged in a pesticide mixture, a piped connection providing potable feed water to an industrial process, such as a cooling tower, or a submerged outlet of an irrigation system. Connections to firefighting equipment are other very common cross-connections.

For pdfFiller’s FAQs

What is Cross-Connection Control Survey?

A Cross-Connection Control Survey is an assessment conducted to identify potential cross-connections within a water system that could lead to contamination, ensuring safe drinking water.

Who is required to file Cross-Connection Control Survey?

Typically, property owners, business managers, or facility operators who have potential cross-connections in their plumbing systems are required to file a Cross-Connection Control Survey.

How to fill out Cross-Connection Control Survey?

To fill out a Cross-Connection Control Survey, individuals typically need to provide details about their plumbing systems, identify any cross-connections, and document any existing backflow prevention devices. Specific forms and guidelines are usually provided by local water authorities.

What is the purpose of Cross-Connection Control Survey?

The purpose of the Cross-Connection Control Survey is to assess and mitigate the risk of backflow and contamination of potable water sources, protecting public health.

What information must be reported on Cross-Connection Control Survey?

The information that must be reported typically includes the property's address, details of the plumbing system, identification of all cross-connections, types of backflow prevention devices installed, and any existing maintenance records.