Sanitary Sewer Survey

Backflow survey

Dear Water Customer,

The help of Hastings Utilities customers is needed.

The Nebraska Department of Health and Human Services public health regulations require us to survey all our customers every five years to determine if backflow conditions exist.

Included is a brief survey concerning potential backflow conditions at your residence. Based on the information provided, Hastings Utilities may contact the homeowner to conduct a backflow inspection, to evaluate and eliminate any backflow conditions.

What is backflow?

Backflow occurs when water pressure in a customer's service connection is greater than the pressure in the public's water supply pipe. Of greatest concern is backflow of toxic chemicals and wastewater that may contain pathogens. For example, chemically treated water from a boiler system being forced back through the service line into the public's drinking water supply.

Thank you for helping to protect the public drinking water supply. Please take a moment to look over the plumbing in your home and answer the questions.

1.Where do you live?(Required.)

Name

Address

Date

Phone

2.Do you have any other source of water, such as a private well at this address?

Yes

If yes, has a backflow prevention device been installed?

3.Do you have a well for a geothermal heating and cooling system for your home?

Yes

If yes, has a backflow prevention device been installed?

4.Do you have a boiler to heat your home?

Yes

If yes, has a backflow prevention device been installed?

5.Do you have an underground lawn sprinkler system?

Yes

If yes, has a backflow prevention device been installed?

6.Do you have outside garden hose faucets at your home?

Yes

If yes, has a vacuum breaker been installed on each faucet?

7.Do you have a swimming pool or hot tub?

Yes

If yes, do you fill it with a garden hose faucet?

8.Do you have a utility sink that a garden hose can be connected to the faucet?

Yes

If yes, has a vacuum breaker been installed on the faucet?