Residential Customer Water User

Cross-Connection Control Program Follow Up - Compliance

Your public water supplier has contracted with HydroCorp of Troy, MI to assist in acquiring this information as a part of the water provider's Cross-Connection Control Program. Part 14 of the Michigan Safe Drinking Water Act, 1976 PA 399, as amended, (Act 399) and the Administrative Rules (R325.11401-11407) contain the cross connection rules that public water systems must follow regarding cross connection control.

Any program questions can be directed to HydroCorp | 800.690.6651

If you are having difficulties uploading photos via this form, you can email them to photo@hydrocorpinc.com (be sure to include your full address information, including city, in the body or header of your email.)

Thank you for helping to protect the drinking water system. For more information, video overview and resources, Click Here.

After entering your name, address, email, please upload your photos/information in section below.

First Name *

Last Name *

House/Address Number * 🛈

Street Name: *

Community * 🛈

Community (Other)

State *

Zip Code *

Email Address *

Phone Number

We ask for your email address in case we need to respond to you with questions as it relates to the information you provide on this form. We will not utilize your email or phone number for any other purpose. Your email address, name and any other information you provide, such as address and phone number are held in strict confidence. We do not sell or share your information with anyone else.

Property Owner Name & Address if different from above: 🛈

Please complete the information below. Click on YELLOW "SUBMIT BUTTON" at bottom of form once you have entered your information.

Verify that all outside faucets are equipped with an ASSE #1011 approved hose bibb vacuum breaker or an integrated vacuum breaker (ASSE #1019 or ASSE #1052 approved) that prevents anything connected to your hose from entering your water system.

Once this has been verified and an approved hose bibb vacuum breaker (HBVB) has been installed, please submit/upload a photo of the faucet with the approved ASSE #1011 device attached.

You can purchase these approved ASSE #1011 vacuum breakers and anti-frost hose bibb vacuum breakers at most retail hardware stores for approximately $10-$20. Make sure it has the ASSE #1011 certification symbol stamped on the vacuum breaker.

Upload photo of anti-frost hose bibb vacuum breaker attached to your faucet. If you have more than one requirement, please use a separate button for each photo. Maximum photo upload size 10MB.

Upload photo of anti-frost hose bibb vacuum breaker attached to your faucet. Maximum photo upload size - 10MB

Comments/Notes:

Homeowner has verified that they have performed the installation requirements outlined in the notification letter and have performed necessary corrections. Please initial indicating that you have completed the necessary requirements.

The City, Village, Township, Water Provider and HydroCorp are not responsible for improper draining or freezing of device(s) that may cause damage to homeowner’s plumbing system. Homeowner should properly drain/winterize any plumbing system and components subject to freezing.

Initials: *

Brochure 10-15-2014 front page copy(1) <p>This page includes frames, and your browser does not work with it.</p>