City of Carthage Residential Cross Connection Survey

City of Carthage Residential Cross Connection Survey
Name

First NameLast Name
Address Number
Street Name
Email
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Do you have any other sources of water, such as a private well or tank that is connected to the water system?
Do you have a permanent in-ground lawn irrigation system installed on your property?
Do you have a swimming pool?
Is the pool filled by a permanent connection to the water supply?
Is your building heated by a boiler?
Are there any backflow prevention devices installed on the premises?
Has the device been tested?
What type of water service line do you have coming into your home? (Service line before the water meter)
Take a photo of your meter and service line.
What type of water lines do you have running throughout your home?
Do you have a sump pump?
Is is connected to the sewer system?
Do you have down spouts from the gutters connected to the sewer system?
Next steps after survey completion:

The water system is required by the EPA to have a Cross Connection Control Program in place. Part of the program is a mandatory Tri-Annual Cross Connection Control Survey. This survey must be filled out by all residents and businesses connected to the water system.

If you do have a backflow prevention device installed it has to be tested/inspected annually by a plumber with a backflow prevention certification
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