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CrossConnection Control ManualOffice of Water (4606M) EPA 816R03002 www.epa.gov/safewater February 2003Printed on Recycled PaperCrossConnection Control Manual United States Environmental Protection

How to fill out cross-connection

How to fill out cross-connection

1. To fill out a cross-connection form, follow these steps:
2. Identify the cross-connection: Determine where two different water sources may come into contact, such as a residential drinking water line and a lawn irrigation system.
3. Obtain the cross-connection form: Contact your local water utility or regulatory agency to obtain the appropriate form for reporting cross-connections.
4. Provide contact information: Fill out your name, address, and contact information at the top of the form.
5. Provide details about the cross-connection: Describe the specific cross-connection situation, including the types of water systems involved and the potential health hazards.
6. Date and sign the form: Provide the date and your signature to validate the accuracy of the information.
7. Submit the form: Submit the completed cross-connection form to the appropriate water utility or regulatory agency.
8. Follow up: If necessary, follow up with the agency to ensure that the cross-connection is addressed and appropriate protective measures are implemented.

Who needs cross-connection?

1. Anyone who has multiple water systems that could potentially cross-contaminate each other needs to be aware of cross-connection concerns.
2. This includes homeowners with plumbing systems connected to irrigation systems, swimming pools, or wells, as well as businesses with industrial water processes or fire suppression systems.
3. Additionally, water utilities and regulatory agencies need to be aware of cross-connections in order to enforce proper regulations, ensure public safety, and prevent contamination of the public water supply.

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What is cross-connection?

Cross-connection is a physical connection between a potable water supply and a non-potable source, such as a contaminated water supply.

Who is required to file cross-connection?

Property owners, businesses, and facilities that have potential cross-connections are required to file cross-connection reports.

How to fill out cross-connection?

Cross-connection reports can be filled out by providing detailed information about potential cross-connections and implementing backflow prevention devices.

What is the purpose of cross-connection?

The purpose of cross-connection is to protect the public water supply from contamination by ensuring that potential cross-connections are properly identified and prevented.

What information must be reported on cross-connection?

Information such as the location of potential cross-connections, types of contaminants, and actions taken to prevent backflow must be reported on cross-connection reports.