How to Fill Out the Residential Cross Connection Survey
- Customer address
- The address of the residential property being surveyed.
- Customer name
- The name of the person filling out the survey.
- Phone #
- The number where the customer can be reached.
- Answers
- Yes: This potential cross connection exists at this property.
- No: This type of cross connection does not exist at this property.
- Don't know: Water pipes may be concealed.
Question 1
- Underground Lawn Irrigation Systems
- Contaminated lawn surface water can be siphoned back into your plumbing system through an automated lawn irrigation system unless a proper backflow device is attached to your system. Either a Pressure Vacuum Breaker (PVB) or Reduced Pressure Zone (RPZ) device should be installed to protect from backflow. Both of these devices need to be tested annually. On all lawn irrigation systems installed since 1987, the contractor should have installed a PVB or RPZ device. Older systems equipped with an atmospheric vacuum breaker need to be re-plumbed with either a PVB or RPZ.
Question 2
- Swimming Pools or Hot Tubs
- Built in pools and hot tubs usually are connected with permanent water fill piping. An unprotected cross connection could draw disinfectant chemicals back into your household plumbing system. These should be protected by a testable device like a PVB or RPZ.
Question 3
- Photo, Chemical, Medical or other Lab Facilities
- Any in-home use of photographic chemicals, other process chemicals or medical or biological laboratory supplies could cause contamination due to an unprotected cross connection. Any of these in-home uses should be protected with a testable backflow preventer. You may wish to consult your plumber about these devices.
Question 4
- Private Wells and Secondary Water Service Lines
- Whenever two sources of water enter a property, the potential exists for the pressure in one to be greater than the other. A private well operating at 100 psi could force contaminated water back into the public water system operating at 80 psi.
Question 5
- Lawn and Garden Chemical Sprayers Attached to Hoses
- Anytime a garden hose is submerged in or connected to a container containing a potentially harmful substance, like lawn and garden chemicals, and there's a sudden drop in water pressure, contamination can occur unless a hose bibb vacuum breaker is used. This is a simple inexpensive device installed on the faucet to which the hose is attached. A vacuum breaker is built into all new hose bibbs installed in new housing since 1992.
Other potential cross connections:
Almost every bathtub and sink are equipped with the best known backflow prevention device -- an air gap, the space between the highest water level in the fixture and the outlet of the water from the faucet. However, care should be taken to avoid leaving attached hoses submerged in contaminated water.
A toilet flush valve without an anti-siphon device permits contaminated water to get into the household plumbing system and into the water you drink. Require an anti-siphon device when this valve need to be replaced.
Other possible cross connection locations include: boilers, fire protection systems, in-home water treatment systems, solar heating, car washes, decorative ponds and soaking tubs in laundry areas.
