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Cross Connection Control Survey for Potable (Drinking) Water

  1. Please complete the survey below to update the Village's records about cross connections and/or backflow devices on your property. If you prefer to download and mail/email our form, you may do so here. Forms may be sent to

  2. Property Type*
  3. Occupancy*
  4. Type of building*
  5. Do you have any of the following on your property? (Check all that apply)
  6. Do you have a backflow preventer on your property now?*
  7. Leave This Blank:

  8. This field is not part of the form submission.