Cross-Connection Control Survey

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Residential Survey

Help us protect your water system.

Please correct the field(s) marked in red below:

Please complete and submit this survey, regardless of your potential for cross-connections.

Many common household fixtures could cause a hazard to our drinking water.  Please check all the boxes pertaining to fixtures you have on your property and we will contact you to discuss what can be done to protect you and your neighbors!
  • For immediate assistance, call Public Works Operations & Maintenance at (360) 754-4150.
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Please complete and submit this survey, regardless of your potential for cross-connections. Many common household fixtures could cause a hazard to our drinking water. Please check all the boxes pertaining to fixtures you have on your property and we will contact you to discuss what can be done to protect you and your neighbors! For immediate assistance, call Public Works Operations & Maintenance at (360) 754-4150.

Common Outdoor Fixtures

Please select all that apply or "N/A" if no options apply.

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Common Outdoor Fixtures Please select all that apply or "N/A" if no options apply.

Common Indoor Fixtures

Please select all that apply or "N/A" if no options apply.

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Common Indoor Fixtures Please select all that apply or "N/A" if no options apply.

Other Fixtures

Please select all that apply or "N/A" if no options apply.

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Other Fixtures Please select all that apply or "N/A" if no options apply.

Comments, please provide detailed information about concerns or questions:

  1. To receive a copy of your submission, please fill out your email address below and submit.