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This bi-annual survey form is to be completed and submitted to the Village of Palos Park Water Department to assess potential cross-connections in plumbing systems. The data collected will help determine

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How to fill out cross-connection control survey

01

Gather necessary materials, including the survey form and any relevant plumbing records.

02

Identify all water supply sources for the property, including public water systems and private wells.

03

Locate and document all cross-connections, such as hoses or equipment that connect potable water to non-potable water sources.

04

Assess the risk level of each cross-connection, determining if a backflow preventer is required.

05

Ensure all details are filled out accurately, including property address and contact information.

06

Review local regulations regarding cross-connection control to ensure compliance.

07

Submit the completed survey to the appropriate authority, such as the local water utility or health department.

Who needs cross-connection control survey?

01

Property owners, especially those with irrigation systems or large plumbing installations.

02

Businesses that have potential for cross-connections, such as car washes or food processing facilities.

03

Municipalities and public water systems to ensure compliance with safety regulations.

04

Plumbers and contractors working on new installations or renovations.

05

Homeowners wanting to maintain safe drinking water by preventing contamination.

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What is cross-connection control survey?

A cross-connection control survey is an assessment conducted to identify and evaluate potential cross-connections in a plumbing system, which can lead to the contamination of potable water supplies.

Who is required to file cross-connection control survey?

Typically, property owners, facility managers, or licensed plumbers are required to file a cross-connection control survey as part of compliance with local regulations regarding water safety.

How to fill out cross-connection control survey?

To fill out a cross-connection control survey, one should accurately provide information about the plumbing system layout, identify all potential cross-connections, and specify the type of backflow prevention devices in use or recommended.

What is the purpose of cross-connection control survey?

The purpose of a cross-connection control survey is to protect public health by preventing contamination of the drinking water supply through the identification and mitigation of potential cross-connections.

What information must be reported on cross-connection control survey?

The information reported on a cross-connection control survey typically includes the location and type of cross-connections, existing backflow prevention devices, the hazard levels of the connections, and any corrective actions taken or recommended.

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