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Cross-Connection Control Survey

Cross-Connection Control Survey

Dear Water Customer,

The below form must be completed and sent to the City of East Peoria' s Water Department by all water services connected to our public water supplyThis survey will help us prevent accidental contamination of our drinking water system.  The purpose of this survey is to determine whether a cross-connection may exist at your home or business. This survey will be included in your next water billing, and can be filled out and submitted online.

This does not affect Northern Tazewell Public Water District users.

If filling out the paper survey included in your water bill, please return it to 100 S. Main St., East Peoria, IL 61611. You may include this with your water bill or fax it to 309-698-4730 within 30 days. If you have any questions, call (309) 698-4716 between 8 a.m.-4 p.m. Monday-Friday.

EPA Cross Connection Control Manual

A cross-connection is an unprotected or improper connection to the public water system that may cause contamination or pollution to enter the system. The Illinois Environmental Protection Agency (IEPA) and the Illinois Department of Public Health (IDPH) are responsible for enforcing cross-connection regulations. This is a three-step process. The City of East Peoria must pass a Cross-Connection Control Ordinance. This has been done, and the ordinance has been approved by the IEPA. Every customer served by this system must be surveyed. This survey includes identifying what plumbing fixtures are present in the home or business. After we receive this survey back, we shall review the data and determine whether an inspection of your plumbing is needed. If this is the case, you will be notified by phone or mail.  

This survey is required by the Illinois Environmental Protection Agency, and must be completed by all water customers. Most modern plumbing systems have backflow devices built in (toilets, sinks, modern hose connections). Please be assured this is not necessarily an indication of any problems, but is required by the IEPA. Thank you for your cooperation.

Required fields are marked with a

Property Classification

Residential Commercial

Name (or name of business)


Characters remaining:
 

Street Address


Characters remaining:
 

Phone

 

Please check whether or not you have the following:

Lawn irrigation system

Yes No

Fire sprinkler system

Yes No

Boiler - for heat (not water heater)

Yes No

Is there an alternate water source (i.e. well, pond) at your location which is connected to city water?

Yes No

Does your business use any type of equipment with chemicals that is connected to city water?

Yes No

Do you have any equipment other than household appliances using water?

Yes No
 

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