This form will help identify potential cross connection hazards. Please complete this form by September 1, 2025. This form will help identify potential cross connection hazards. It is important that we receive your completed form, and that you answer questions honestly. We appreciate your time and cooperation.


What is a Cross Connection?

Plumbing cross-connections are defined as actual or potential connections between a potable and non-potable water supply. This may cause a backflow condition or a serious health hazard to occur.

What is Backflow?

Backflow is when the water in your pipes (the pipes after the water meter) goes backwards (the opposite direction from normal flow). There are two situations that can cause a backflow condition.

“Back Pressure” – a pressure greater than the supply pressure that may cause backflow.
(High-pressure boiler or pressure washer)

“Back Siphonage” – the creation of a backflow as a result of negative pressure.
(Water main break or use of fire hydrants)

Along with the required backflow preventers and their regular maintenance, site inspections or surveys may be performed at properties that present a potential hazard to our water system:

* External (“site”, or “containment”) – to protect the water supply from cross connections on the customer’s premises.

* Internal (“hazard”, or “isolation”) – to protect the customer from potentially hazardous cross-connection in their own system.

Cross Connection Control Program

Corbett Water District’s Cross Connection Control Program is designed to safeguard public health. We ask for your cooperation with our program and its enforcement.

All plumbing within buildings served by the Water District must be installed, and all plumbing fixtures constructed, so as to prevent pollution of water supply by back siphonage or back pressure.