Cross Connection Control Program Survey
Water Use Survey - Cross Connection Control Program

Per the OEPA, we are required to perform a “survey” of all water customers every few years to help protect the public water systems. This survey is required by the OEPA and is not optional. PLEASE COMPLY AS IT IS VERY IMPORTANT!

THANK YOU for your cooperation and assistance in keeping our water safe!

Please note: The owner of the property is responsible to have all backflow prevention devices inspected every twelve months. Failure to do this may result in your water service being turned off. If more information is needed, please call Wadsworth Backflow Division at 330-335-2831.
Sign in to Google to save your progress. Learn more
Email address *
Service Address *
Business Name (if applicable)
Property Owners Name *
Property Owners Phone Number *
Type of Service? *
Indicate which of the following will be used at the service address: (Please check all that apply) *
Do you have a backflow preventer on your property now? *
If yes, where:
Have you installed any of the items listed above in the last 12 months?
Clear selection
If yes, explain:
If you answered other in the items list above please list the other water-using equipment on your property which was not mentioned above.
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of wadsworthcity.org. Report Abuse
Google Forms