Please click on the above “Take Survey” to get Adobe pdf fillable form of our
2023 Cross Connection / Backflow Prevention Survey.
The IEPA requires updated information on Cross Connection and Backflow Prevention every three years. It is mandatory that ALL WATER CUSTOMERS complete this SURVEY in its entirety. Customers who are responsible for more than one property must fill out this form for each owned property.
If you have any questions or concerns or if you need help in completing the survey, please call the Water Company and we will be happy to assist you.
PLEASE COMPLETE THIS SURVEY IN ITS ENTIRETY, DO NOT LEAVE ANY QUESTION UNANSWERED.
Please email completed and electronically digitally or hand signed form to: lori@bondmadison.com
or mail back to us with your next water payment to
P.O. Box 287, Pocahontas, IL 62275
or fax to 618-669-0222
Call 618-669-2861 with any questions or concerns.
