Cross-Connection Control Survey

Walk-through inspection of a property to identify cross-connections, assess backflow risks, and document required backflow prevention assemblies for the public water system.

Inspection Details

• Property address and account information recorded
• Inspection date and time recorded
• Inspector name and organization recorded
• Survey scope confirmed with property representative
• Access to all relevant areas granted for walk-through

Water Service Entry and Meter Area

• Main service entry and meter location identified
• Visible piping, valves, and fittings at service entry are labeled or traceable
• Evidence of unauthorized bypass, tee, or unapproved connection at service entry
• Meter pit, vault, or enclosure is accessible and free of flooding or contamination
• Service entry area supports safe inspection and maintenance access

Cross-Connection Identification

• Irrigation, fire suppression, process, or auxiliary water connections identified
• Potential cross-connection points observed during walk-through
• Cross-connection hazards isolated from potable supply where observed
• Auxiliary water sources identified and protected from backflow
• Any temporary hoses, hose bibbs, or submerged outlets present

Backflow Prevention Assemblies

• Required backflow prevention assembly installed where indicated
• Assembly type matches the hazard level and service application
• Assembly is accessible for testing, maintenance, and AHJ review
• Assembly shows no visible leaks, damage, corrosion, or tampering
• Assembly is installed with adequate clearance and orientation for inspection

Documentation, Compliance, and Corrective Actions

• Deficiencies documented with location and description
• Immediate public health risk present
• Corrective action deadline assigned
• Follow-up testing, repair, or reinspection required
• Inspector signature captured