Cross Connection Questionnaire

  • All new commercial construction will require premise isolation at the water meter or prior to the first connection at a minimum.
  • Multi-story buildings (3 stories or more) will require premise isolation at a minimum.
  • Multi-unit homes (5 units or more) will require premise isolation at a minimum.
  • Please select all items that apply, if you are uncertain, please choose “Not Sure”. The backflow prevention requirement may be enforced as if it were, in fact, used.

1 Air Compressor *
2 Air Conditioning Systems *
3 Aspirators *
4 Autoclave *
5 Autopsy/Embalming Equipment *
6 Auxiliary Water Supply *
7 Boiler Feed Lines *
8 Water Pump/Booster *
9 Bottle Washing Equipment *
10 Car Washing Equipment *
11 Chemical Feed Equipment *
12 Chlorinators *
13 Commercial Dishwasher(s) *
14 Commercial Laundry Machines *
15 Computer Cooling Lines *
16 Cooling Towers *
17 CO2 Beverage Dispenser *
18 Degreasing Equipment *
19 Dental Equipment *
20 Dialysis Equipment *
21 Dye Vats/Tanks *
22 Etching Tanks *
23 Fermenting Tanks *
24 Film Processing *
25 Fire Sprinkler System *
26 Heat Exchanger *
27 Hot Tub (Chemical/Fill Lines) *
28 Hydrotherapy Baths *
29 Ice Makers (Commercial) *
30 Irrigation System *
31 Industrial Fluid System *
32 Janitor Sinks *
33 Laboratory Equipment *
34 Make Up Tanks *
35 Photo Developing Sinks/Tanks *
36 Pump Prime Lines *
37 Radiator Flushing Equipment *
38 Sewer Connected Equipment *
39 Spas (Chemical/Fill Lines) *
40 Steam Generating Equipment *
41 Sterilizers *
42 Stills *
43 Swimming Pools (Chemical/ Fill Lines) *
44 Trap Primers *
46 X-Ray Equipment *
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