Vandalia Water Department Cross-Connection Control Survey

The purpose of this survey is to determine whether a cross-connection may exist at your home or business. A cross-connection is an unprotected or improper connection to the public water distribution system, that may cause contamination or pollution to enter the system. Click here to learn more about the survey.

This survey is required by the IEPA, and must be completed by all water customers. If you have any questions, please call the Vandalia Water Plant at 618-283-0111.

Choose From The Following

Please indicate if any of the following are present on the property.

	Kitchen Sink Faucet with Sprayer		Bathtub
	Garbage Disposal		Hot Tub/Whirlpool/Jacuzzi
	Ice Maker		Portable High-Pressure Washer
	Dishwasher		Boiler Heat
	Washing Machine		Floor Drain
	Toilet		Lawn Fertilizer System
	Bathroom Sink		Fertilizer or Weed Control Attached to Garden Hose

Please Provide the Following Information:

Name/Title of Person Submitting the Form:		*required
Email:		*required
Name of Water User or Business Name:		*required
Address of Property Owner:		*required
State of Property Owner		*required
Zip Code of Property Owner		*required
Phone:		*required
Alternate Phone:		*required
Address of Surveyed Property:		*required
Who is the Property Owner:		*required
Property Owner's Phone:		*required

Please Select From The Following

Do you have another source of water on the property such as a well, lake or cistern?	Yes No
Is the source connected to the public water system?	Yes No

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