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In order to protect the City of Edwardsville's water supply from potential cross-connections, we are conducting a survey, as required by the Illinois Environmental Protection Agency, to determine if there are any hazardous conditions that could affect our drinking water. Answering "yes" to any of the survey items below indicates that a cross-connection may be present. The Illinois Department of Public Health requires annual inspections of all active backflow devices to protect from contamination. The City of Edwardsville is taking an active role in protecting the water supply.If you have had an inspection, please attach it with this survey if it has not already been submitted. Please be aware that this survey is for the current calendar year. Previous year survey submissions will not be considered as compliance. Non-compliance may result in your water being shut off until this survey is submitted.We appreciate you taking the time to complete the survey.If you have questions regarding the survey please contact the City of Edwardsville Public Works Department at 618-692-7535.
Check All That Apply
This does not include devices installed on the City water meter or outside water/garden hose.
May also be faxed to 618-692-7505, or mailed to 200 E Park StreetEdwardsville, IL 62025
This does not include lawn water devices attached to a garden hose.
This section should only be filled out by Commercial Properties. Please skip this section if you are a single family residential location.
The Illinois Environmental Protection Agency and the Illinois Department of Public Health require hose vacuum breakers to be attached to all outdoor faucets. These devices protect the plumbing system from being contaminated by any substance which might enter the water hose (lawn fertilizer, herbicide, soap, ect.). Hose vacuum breakers are available at most hardware stores or through your local plumbing contractor.
Your comments are important in the cross-connection control program. Use this space for any comments or address corrections.
Please type your name as confirmation of the person completing the survey.
This field is not part of the form submission.
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