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2. The Illinois Environmental Protection Agency (IEPA) requires that all water systems in the State of Illinois have an effective Cross Connection Control Program. Cross connections are a serious concern as they can allow contaminants to enter the public water system through “backflow”. Backflow occurs when a drop in water pressure causes water to flow in the opposite direction. This can allow contaminated water to flow back into your drinking water. Given IEPA regulations and the dangers that exist from unprotected cross connections, an effective cross connection control program is necessary to protect our customers as well as the integrity of the Village of Roselle’s water supply. One necessary component of our program is a survey to determine where cross connections may exist. We are requesting that you complete the survey below. By working together and completing the survey, we can further protect our water from potential contamination. If you have any questions regarding this survey, please contact the water division at (630) 671-2368. Thank you for your assistance.
4. Street Address*
   Roselle, IL 60172
6. Indicate which of the following are present at the address indicated above.*

   Please check all that apply.

   1. Lawn Irrigation System
   2. Swimming Pool
   3. Fire Sprinkler System

   1. Boiler Used as Heat Source
   2. Alternate Water Source - Private Well
   3. Equipment Containing Chemicals Connected to the Village Water System
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8. 1. Receive an email copy of this form.
9. Email address

   This field is not part of the form submission.

10. Submit

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