Marissa, IL · St. Clair County
Cross Connection Survey
Marissa water customers complete this survey every two years to provide information about their water service, plumbing, and property.
What this form is
The Village of Marissa uses this survey to gather information from water customers about their service, water use, plumbing, and property. The document says the survey is required every two years and asks for customer and premise details, service type, water connections, household information, and water service line material. It says nonresponding customers may receive an inspection by a licensed plumber certified by the E.P.A.
Who needs it
Marissa water customers should complete the survey, which asks about their household or business and the property receiving water service.
How to submit it
Complete the survey and return it to the Village office with your next payment, as directed on the form. Call (618) 295-2351 with questions.
About notarization
This document is signed and dated without a notary; it mentions no notarized or sworn attachment, so the signer just signs and dates it.
How to submit this form
- 1
Download the Survey
Download the Cross Connection Survey for Marissa water customers.
- 2
Complete the Survey
Provide the requested customer, premise, water use, plumbing, and service line information.
- 3
Review and Sign
Review your answers, then sign and date the survey. No attachment is specified.
- 4
Return It to the Village
Return the completed survey to the Village office with your next payment.
Frequently asked questions
- Do I need a notary for the Cross Connection Survey?
- No. The survey has a signature and date line but no notary block or notarized attachment; the signer just signs and dates it.
- How do I submit the Cross Connection Survey?
- Complete it and return it to the Village office with your next payment, as directed on the survey. Call (618) 295-2351 with questions.
- What information does the survey ask for?
- It asks for customer and premise details, service type, water use, plumbing and water connections, household information, and water service line material.
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.