Residential Cross-Connection Survey

Please look over the plumbing in your home and answer the questions below. Thank you for helping meet this State of Idaho regulation.

Please submit by July 1, 2023

If you have any questions about cross connection contamination or backflow prevention, please call our office at (208) 522-1300. Further information can be obtained by contacting Adrianna Hummer with the Idaho Rural Water Association at 208-392-3576 or by contacting the Idaho Department of Environmental Quality.

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
















    First Name:

    Last Name:

    Phone Number:

    Email Address:

    Address:

    City:

    State:

    Zip Code:

    1. Is there any other source of water, such as a private well, at this address?
    YesNoDon't Know

    Is it protected by a testable backflow preventer?
    YesNoDon't Know

    2. Do you have a swimming pool or hot tub?
    YesNoDon't Know

    If you fill it with a hose, does a hose bib vacuum breaker protect it?
    YesNoDon't Know

    If you fill it by a direct water line, is it protected by a reduced pressure backflow preventer?
    YesNoDon't Know

    3. Do you have a lawn sprinkler system?
    YesNoDon't Know

    Is it protected by an approved backflow preventer?
    YesNoDon't Know

    4. Do you have a hot water or steam boiler (not a water heater)?
    YesNoDon't Know

    Is it protected by an approved backflow preventer? (All boilers are required to have a RP)
    YesNoDon't Know

    Are chemicals used in the water?
    YesNoDon't Know

    5. Do you have a photo lab, medical, biological, auto paint/repair, veterinarian or farm equipment, or any other chemical or medical labs or facilities at this address?
    YesNoDon't Know

    is it protected by a testable backflow preventer?
    YesNoDon't Know

    6. Do you have a hose aspirator for spraying chemicals?
    YesNoDon't Know

    (All hose connections should have a hose bib vacuum breaker)
    is it protected by a hose bib vacuum breaker?
    YesNoDon't Know

    Please list any and all backflow prevention devices or assemblies currently in use on your property. Include Manufacturer, Model Number, Type, Size, and Serial Number. If you aren’t sure just include as much information as you can.

    **Lawn sprinkler systems that have a connection to the drinking water service lines must have a backflow assembly installed which has to be tested every year. Check Idaho Public Drinking Water Rules or the Plumbing Code and its amendments as adopted by the State of Idaho for regulations.

     

    Falls Water Co., Inc. has an active Cross Connection Control Program in place which directs us to survey all of our water customers annually, keep records of all tests on testable backflow preventers, and issue a reminder notice when testing is due. The customer shall provide access for inspection and testing by water system personnel at all reasonable times to determine whether cross connections, sanitary hazards or other violations of the Cross Connection Control Program exist.

     

    Thank you. This survey will help prevent accidental contamination of our drinking water system.