2020 New Kent DPU Cross Connection Survey

Thank you for taking a moment to complete the cross connection survey. The survey will help identify risks to drinking water quality and ensure proper protection is in place where those risks exists. Some common household risks include irrigation systems, hose-end lawn/garden applicators & hot tubs/swimming pools. Other risks are present in unique circumstances.

If you have questions about cross connections or backflow prevention please do not heistate to contact New Kent DPU at (804) 966-9678, or dpu.info@newkent-va.us.

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* 1. Name

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* 2. Service Address

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* 3. Please indicate any of the following which may be present at your premises:

Outside spigot without vacuum breaker

Frost-proof spigot without vacuum breaker

yard hydrant, yard spigot, standpipe

Shampoo bowl/sink

Private well, spring or cistern

Dark room/photo development

Mop sink, laundry sink, utility sink with hose bib threads

Baptismal pool

Dye vat

Carbonated drink machine

Swimming pool

Jacuzzi/hot tub

Solar heating system

Steam or hot water heating system

Lawn irrigation sprinkler system

Fire protection sprinkler system

Hose end sprayer for fertilizer or other chemicals

Pressure booster pump

Water storage tank

Dialysis equipment

2020 New Kent DPU Cross Connection Survey

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* 1. Name

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* 2. Service Address

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* 3. Please indicate any of the following which may be present at your premises:

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* 4. Please provide a brief description of any other items or treatment units connected to the water system on your property

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* 5. Please list any existing cross-control devices you have installed and if they appear to be working properly