Water Department - Cross Connection Control Survey

Dear water customer:

The Illinois Environmental Protection Agency (IEPA) requires that all water systems in the State of Illinois have an effective Cross Connection Control Program. Cross connections within the public water supply are a serious concern, as they can allow contaminants or pollutants to enter the public water system through what is called “backflow.” Backflow occurs when a drop in water pressure causes your water to flow in the opposite direction. This can allow contaminated or polluted water to flow back into your drinking water. Given IEPA regulations and the dangers that exist from unprotected cross connections, it is necessary to establish and maintain an effective cross connection control program to protect both the integrity of the Village of North Aurora’s water supply as well as to protect our water customers.

One necessary component in this program is a survey of the water system to determine where cross connections exist. Below is a survey for your service location that we are requesting you complete and submit to the Village of North Aurora.

The Village of North Aurora is proud of the water that we deliver to you every day. By working together and cooperating in this critical program, we can further protect our water from potential contamination. Should you have any questions, please contact the water department at (630) 897-2662 ext 229. Thank you for you assistance.

Sincerely,
Paul Young
Superintendent of Water Operations

Property Classification
Residential Commercial
Please choose whether or not you have the following:
Yes	No	Lawn irrigation system
Yes	No	Fire Sprinkler system
Yes	No	Boiler
Yes	No	Alternate water source (i.e. well, pond…) at your location
Yes	No	Does your business use any type of chemicals? (if applicable)
Yes	No	Do you have any equipment using water?
Are there any backflow prevention assemblies at your location?
Yes No
If yes, please list the following for each: Manufacturer, Model, Serial #, and Size

I affirm all of the above to be true and accurate to the best of my knowledge. *Required field
Name*
Service Address*
E-mail*
Phone Number*