Cross Connection Survey

Thank you for completing the survey online. If you are a tenant, please have the property owner complete the survey.

The Utah State Plumbing Code R309-105-12. states: … (1) The water supplier shall not allow a connection to his system which may jeopardize its quality and integrity.  Cross connections are not allowed unless controlled by an approved and properly operating backflow prevention assembly or device.  The requirements of the International Plumbing Code and its amendments as adopted by the Department of Commerce shall be met with respect to cross connection control and backflow prevention.

In compliance with that Code and the Utah State Division of Drinking Water, Timber Lakes Water Special Service District (TLWSSD) carries out a program of Cross Connection Control that helps protect your drinking water from contamination.  A cross connection is any actual (or potential) physical connection between a potable (drinking) water pipe and any other pipe, system, or machine that contains non-potable (non-drinkable) fluids or that have the possibility of containing non-potable substances, and where possible for those substances to find their way into the drinking water system.  Such an event is called a “Backflow.”

A Backflow is a reverse flow from the normal direction of fluid in a piping system.  It can occur when systems lose pressure such that non-potable water or fluids flow from the customer pipes back into the drinking water system at lower pressure.  Backflows can occur due to either back-siphonage or backpressure and are preventable.  Fire sprinkler systems are the most common residential hazard in Timber Lakes.

An essential part of our cross-connection control program is an assessment to determine the degree of hazard, if any, posed by each customer’s plumbing system(s).  Please fill out and return the following survey to help us assess any hazards that could threaten your safe drinking water.

If you have any questions, please call Monday – Friday, 9 am to 5 pm
Jody 385-450-0750 or Vince 435-503-7926

Helpful links:

Please enter a number where we can contact you to clarify any questions or issues.
Please enter your Lot # then Street Address (City, State, and Zip are not necessary)
If you have any of the previous mentioned appurtenances at your residence, you probably need, or already have, a backflow assembly installed that needs to be tested yearly. If you have or need backflow assemblies installed or tested, testing and installation needs to be completed within 120 days from the date printed at the top of this survey (April 1, 2020). Failure to test assemblies or privide adequate protection against cross connections can result in termination of water service. Please see the links above the survey for the District's Cross Connection Policy, a list of certified testing professionals, and other helpful information.
If you indicated other above, please specify. Or you can add comments about any of the above items here.
If yes, please provide the following:
in inches
Please submit a copy of the test form to timberwaterssd@msn.com with your Name, Timber Lakes lot # and Address
By checking this box, you are electronically signing this form and verifying that you are the owner of the property.

Customers who do not return or submit the survey by July 30, 2020 will be required to install the appropriate check valve assembly on their side of the water meter within 120 days of the date noted on the survey (April 1, 2020) to prevent possible disruption of water service.

For more information on Cross Connection Control and Backflow control visit the Utah State Division of Drinking Water web page.
https://rules.utah.gov/publicat/code/r309/r309-105.htm#T12