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Cross- Connection Control Reporting Form

August 20, 2019

Under Nebraska Department of Health & Human Services regulations Title 179 Chapter 22 we are required to conduct an on-going program for the detection and elimination of cross connections.

We are conducting this survey to assist customers in reporting potential backflow hazards and comply with this regulation.

This must be completed at least every five years and we must have 100% response.

Please complete the cross-connection control reporting form by December 31, 2019. You may come into the Village Office to complete a form or you may click on the following link to complete the form, print and return to the office by mail, email or leaving in the drop box at the Village Office.

Failure to complete the form puts your water system in violation of State Health Department Regulation Title 179 and therefore subject to disconnect from services.

The following link provides the form and more information. http://www.nerwa.org/cccsurvey.pdf

Please contact the Village Office or Utilities Superintendent League or Grier with any questions.



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