2026 Cross-Connection Survey
This mandatory survey form needs completed per Illinois EPA regulations prior to September 4, 2026 to prevent further action from the Commission.
Account #: (If your account # does not start with a 1, then STOP this survey does not apply to you, this is only for Otter Lake Water Commission's actual customers only)
*
Do not include the ending dash and number
Customer Name:
*
Service Address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Phone Number Listed on Mailing Needs Changed:
*
Yes (then provide new phone # on next line)
No
Primary Phone Number:
-
Area Code
Phone Number
Please check Yes or No on the following items:
In-Ground Lawn Irrigation System?
*
Yes
No
In-Ground Swimming Pool?
*
Yes
No
Private Fire Protection & Lines?
*
Yes
No
Boiler Heat System?
*
Yes
No
Water Cooled HVAC System?
*
Yes
No
Food and/or Chemical Processing Equipment?
*
Yes
No
Laboratory Facility (Lab/Chemical Facility Not A Restroom)?
*
Yes
No
Private Well System Plumbed to Existing Commission Water?
*
Yes
No
Private Well System Separately Plumbed From Commission Water?
*
Yes
No
Submit
Should be Empty: