Commercial Cross-Connection Survey

If you have questions please contact 208-522-1300, email at fallswater@fallswater.com or visit the Falls
Water’s website at fallswater.com. Thank you for assisting in compliance with State of Idao public water supply
regulations and protecting Falls Water’s drinking water. 

Click here to see print-out version of this survey.

    First name:

    Last Name:

    Phone number:

    Email Address:

    Company name:

    OwnerTenantBoth

    Account Number:

    Water Service Address:

    Water Service City:

    Water Service State:

    Water Service Zip Code:

    Phone Number:

    Date: (Required)

    When completing the survey, please indicate if the listed cross connection is present and if
    it is protected with a backflow device. Thank you for assisting in compliance with State
    regulations and protecting Falls Water’s drinking water.

    1. Auxiliary water source water such as a well used for irrigation
    Is Connection Present?
    YesNo

    Is Connection Protected with backflow?
    YesNo

    2. Auxiliary water source used for geothermal heating or cooling
    Is Connection Present?
    YesNo

    Is Connection Protected with backflow?
    YesNo

    3. Underground lawn irrigation system
    Is Connection Present?
    YesNo

    Is Connection Protected with backflow?
    YesNo

    4. Lawn irrigation system using chemicals, fertilizer, or has a booster pump

    Is Connection Protected with backflow?
    YesNo

    5. Swimming pool or hot tub
    Is Connection Present?
    YesNo

    Is Connection Protected with backflow?
    YesNo

    6. Cooling tower

    Is Connection Protected with backflow?
    YesNo

    7. Boiler or steam system

    Is Connection Protected with backflow?
    YesNo

    8. Water cooled compressors

    Is Connection Protected with backflow?
    YesNo

    9. Fire suppression system
    Is Connection Present?
    YesNo

    Is Connection Protected with backflow?
    YesNo

    10. Post mixed carbonator
    Is Connection Present?
    YesNo

    Is Connection Protected with backflow?
    YesNo

    11. Water cooled ice maker
    Is Connection Present?
    YesNo

    Is Connection Protected with backflow?
    YesNo

    12. Medical, dental or dialysis equipment
    Is Connection Present?
    YesNo

    Is Connection Protected with backflow?
    YesNo

    13. Laboratory or photo equipment
    Is Connection Present?
    YesNo

    Is Connection Protected with backflow?
    YesNo

    14. Mobile or stationary water tank filling
    Is Connection Present?
    YesNo

    Is Connection Protected with backflow?
    YesNo

    15. Water system booster pumps
    Is Connection Present?
    YesNo

    Is Connection Protected with backflow?
    YesNo

    Are there any other processes that are connected to Falls Water’s water supply?
    YesNo

    16.
    Is Connection Present?
    YesNo

    Is Connection Protected with backflow?
    YesNo

    17.
    Is Connection Present?
    YesNo

    Is Connection Protected with backflow?
    YesNo

    18.
    Is Connection Present?
    YesNo

    Is Connection Protected with backflow?
    YesNo

    19.
    Is Connection Present?
    YesNo

    Is Connection Protected with backflow?
    YesNo

    Please Indicate type of business activity (eg. Manufacturing, medical,
    restaurant, mechanic, office, etc)

    Please provide contact information for your business. Thank You.