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Residential Cross-Connection Survey

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

By submitting this survey you certify under penalty of law, that the following information is, to the best of your knowledge and belief, true, accurate, and complete.
1
Contact Information
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Contact Information
2
Does the property have auxiliary water such as Wenatchee Reclamation Irrigation Water or a private well?
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Does the property have auxiliary water such as Wenatchee Reclamation Irrigation Water or a private well?
3
Does the property have an underground lawn sprinkler system?
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Does the property have an underground lawn sprinkler system?
4
Does the property have a sprinkler system using both City and Reclamation water?
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Does the property have a sprinkler system using both City and Reclamation water?
5
Does the property have a swimming pool or hot tub with an automatic water fill?
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Does the property have a swimming pool or hot tub with an automatic water fill?
6
For any questions with a "yes" answer - is that plumbing connection protected with a backflow assembly?  Please list in the comment section below.
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For any questions with a "yes" answer - is that plumbing connection protected with a backflow assembly? Please list in the comment section below.
7
Comments:
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