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In order to protect the water supply from being contaminated, we are conducting a survey to determine if there are any hazardous conditions that could affect our drinking water.
 
We appreciate you taking the time to complete this survey.
 
If you have any questions regarding this survey please contact:

Wayne Dotson, Water Superintendent (217) 864-5656

                                                                                                                                                                                            
The information provided is an accurate and current description of your water system at this address.  Please print your information below and sign your name as confirmation of the person completing this survey.   
                                                                                                                                                                                            
 

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* 1. Customer Information

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* 2. What type of water service line do you have coming into your home?

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* 3. Other Sources of Water?

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* 4. Part 1
 Are there any backflow prevention devices installed on the premises?

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* 5. Part 2
Has the device been tested?

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* 6. Do you have a permanent in-ground lawn irrigation system installed on your property?

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* 7. Do you have a swimming pool?

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* 8. Is the pool filled by a permanent connection to the water supply?

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* 9. Is your building heated by a boiler?

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* 10. Do you have a sump pump?

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* 11. Is it connected to the sewer system?

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* 12. Do you have a water powered back up sump pump?

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