Island Lake, IL · Lake County
Cross Connection Survey
This survey records water-related systems and backflow prevention devices at a location for the person completing it and affirming the information.
What this form is
The Cross Connection Survey records whether a location has lawn irrigation, fire sprinklers, a boiler, a hot tub, spa, pool, or other equipment, and whether it has backflow prevention devices. The signer provides account and address information, affirms the answers, and signs and dates the survey; if backflow devices are present, the form asks for their manufacturer, model, serial number, and size.
Who needs it
A person completing the survey for a location with water-related systems or backflow prevention devices can use it to report the requested details.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This document is signed without a notary; the signer just signs and dates it on the form.
How to submit this form
- 1
Download The Survey
Download the Cross Connection Survey for Island Lake.
- 2
Complete The Survey
Provide the account name and address, then answer the questions about systems and backflow prevention devices.
- 3
Add Device Details
If backflow devices are present, provide the manufacturer, model, serial number, and size.
- 4
Sign And Date
Affirm that the information is accurate to the best of your knowledge, then sign and date the survey.
- 5
Submit To The City
Submit it to the city department named on the form; check the city website for current contact details.
Frequently asked questions
- What information does the Cross Connection Survey ask for?
- It asks about systems such as lawn irrigation, fire sprinklers, boilers, and pools or spas, and whether backflow prevention devices are present. If they are, it requests device details.
- Who completes the Cross Connection Survey?
- A person reporting information about a location completes the survey, provides the account name and address, and affirms that the answers are accurate to the best of their knowledge.
- Do I need a notary for the Cross Connection Survey?
- No. The signer signs and dates this survey without a notary.
- How do I submit the Cross Connection Survey?
- The document does not provide submission details. Submit it to the city department named on the form; check the city website for current contact details.
Need something notarized?
This Cross Connection Survey doesn’t need a notary — but Illinois residents can notarize other documents online with a commissioned online notary.