City of Lexington Backflow Prevention Survey Question Title * 1. Name OK Question Title * 2. Address that is on the postcard or letter... OK Question Title * 3. Account Number OK Question Title * 4. What color is the paper survey you received in the mail? Lime Green Postcard Yellow paper Orange Postcard White paper OK Question Title * 5. Is there a backflow prevention assembly at this address? I don't know Yes No OK Question Title * 6. If yes, when was the device installed? OK Question Title * 7. If there is a backflow prevention device, when was it last tested and who tested it? OK Question Title * 8. Do you have a private well on the property? Yes No OK Question Title * 9. Is your private well used for drinking water? Yes No I don't have a private well OK Question Title * 10. Do you use a water source heat pump for heating your home? Yes No OK Question Title * 11. If you use radiator/steam heating in your home, are any chemical additives used? No, I do not have additives Yes, I have additives I do not have steam heat OK Question Title * 12. Do you have any chemical or lab facilities on the property? (medical, biological, veterinary, etc.) Yes No OK Question Title * 13. Do you have any hose aspirators for spraying chemicals on the property? Yes No OK Question Title * 14. Do you have any soft drink dispensers or bar carbonation on the property? Yes No OK Question Title * 15. Do you have any hose bib connections on the property? (garden hose faucet) Yes No OK Question Title * 16. Do you have any swimming pools or hot tubs on the property? Yes No OK Question Title * 17. Do you have any soap injectors on the property? Yes No OK Question Title * 18. Do you have any truck or tank water filling stations on the property? Yes No OK Question Title * 19. Do you have an underground lawn sprinkler system on the property? Yes No OK Question Title * 20. Do you have any water cooled equipment on the property? Yes No OK Question Title * 21. Do you have a water softener on the property? Yes No OK Question Title * 22. Do you have any water storage tanks on the property? Yes No OK Question Title * 23. Are there any pumps hooked to your plumbing? If yes, what kind? Pressure booster Fountain Boiler Circulator Sewage I do not have any pumps hooked to my plumbing Other (please specify) OK DONE