Cross Connection Survey

Dear Water Customers,

The purpose of this survey is to determine whether a cross-connection may exist at your home or business. 

What is a Cross Connection?
A Cross Connection is any actual or potential connection between your drinking water and any non-potable source that results in contamination of the water distribution system.

What is Backflow?
Backflow occurs when the water in your pipes goes in the opposite direction of normal flow. There are two conditions that cause backflow:

  • Backpressure - when the pressure in your pipes is greater than the pressure in the water distribution system.
  • Backsiphonage - when there is a sudden reduction of pressure in the water distribution system that causes fluids (water, chemicals, etc.) from your pipes to be sucked into the water distribution system.

The Illinois Environmental Protection Agency (IEPA) and the Illinois Department of Public Health (IDPH) are responsible for enforcing cross-control regulations.

This survey is required by the IEPA, and must be completed by all water customers.  We thank you for your cooperation on this matter.  If you have any questions, please contact City Hall at (618) 533-7625.

The PDF below may be completed and emailed into our office, or the open form fields may be filled out and will be submitted directly to our office.

2024_Cross-Connection_Control_Survey

Location Information
Types of Use
Do you have any other source of water such as private well, pond, lake, tank, bay, cistern, reclaimed water?
If yes, does it connect to the City's system?
Are there backflow prevention devices installed on the premises?
If yes, please provide a copy of the test results by fax to (618) 532-4534 or by email to kaenke@cityofcentralia.org
Is there an outdoor hydrant and/or outdoor faucet on the property?
All threaded hose connections are Required by the Illinois Environmental Protection Agency and the Illinois Plumbing Code to have a Hose Vacuum Breaker. These are available at most hardware and plumbing supply dealers.
If yes, which one?
Do you have any of the equipment listed below on the premises? - Please check all that apply:
What type of pipe do you have coming into your house?
The city is required to provide an inventory of our customer''s water service line type. We are asking you to provide the below information so we can begin tracking the different service line types for the EPA
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