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System Name P.O. Box 999 Mayberry, TN 99999WELL USER AGREEMENT In accordance with System Names cross connection control program, a private well or auxiliary water source may not be connected in any
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How to fill out cross connection control

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How to fill out cross connection control

01
To fill out a cross connection control form, follow the steps below:
02
Start by obtaining a cross connection control form. This form can usually be obtained from your local water utility or health department.
03
Read the instructions provided on the form carefully. These instructions will guide you on how to correctly fill out the form and provide necessary information.
04
Begin filling out the form by providing your personal information, such as name, address, and contact details.
05
Identify the specific cross connection that needs to be controlled. This could be a connection between the potable water supply and a non-potable source, such as a reclaimed water system or a swimming pool.
06
Describe the types of backflow prevention devices or methods that are currently in place to control the cross connection.
07
Evaluate the overall risk level associated with the cross connection. This may involve assessing the potential hazards and consequences if backflow were to occur.
08
Determine the appropriate level of backflow protection required for the specific cross connection.
09
Answer any additional questions or provide any other necessary information as requested on the form.
10
Review the completed form to ensure all information is accurate and complete.
11
Submit the form to the designated authority or entity as instructed on the form.
12
Keep a copy of the completed form for your records.

Who needs cross connection control?

01
Cross connection control is needed by various individuals, businesses, and organizations who have potential cross connections between potable and non-potable water sources. This includes:
02
- Residential properties with alternative water sources like wells or rainwater harvesting systems.
03
- Commercial buildings and businesses that use non-potable water for their operations, such as restaurants with dishwashers or irrigation systems.
04
- Industrial facilities that have water treatment processes or use chemicals in their operations.
05
- Municipal water utilities and agencies responsible for maintaining the public water supply.
06
- Healthcare facilities like hospitals and dental clinics that require strict water quality standards.
07
- Recreational facilities with swimming pools, spas, or other water features.
08
- Educational institutions with science laboratories or research facilities.
09
It is important for these individuals and entities to implement and maintain proper cross connection control measures to prevent backflow and ensure the safety and integrity of the potable water supply.

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Cross connection control is a system of policies and procedures designed to prevent contaminated water from entering the potable water supply through cross connections.
All water users with potential cross connections, including residential, commercial, and industrial facilities, are typically required to file cross connection control.
To fill out a cross connection control form, you must provide information about the property, the type of water supply, and details regarding any identified cross connections and the measures in place to prevent contamination.
The purpose of cross connection control is to safeguard public health by preventing the contamination of the drinking water supply through improper connections or plumbing practices.
The report should include the location of the cross connection, type of device used for control, maintenance records, and any incidents of backflow.
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