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Cross Connection Control Requirements
R309-105-12 requires every public drinking water system to establish and actively enforce a cross connection control program.

An effective program includes key components designed to prevent contamination from entering your water distribution system.

The five core components are outlined below.

The Five Elements of a Cross Connection Control Program

Explore templates, forms, and tools that support each core part of a strong CCC program.
1. Local Authority Statement
Ordinance Template Example Policy Template Example
2. Public Awareness
Public Awareness Tracking Form WATTS Backflow Informative Packet Thermal Expansion Education Letter CCC Protect Your Drinking Water Supply Flyer Video: Welcome to Backflow City Chemical Dispensers Cross Connection Information Packet Landscaping Backflow Postcard - Simple Landscape Postcard - You Have Options Video: Hose Bibb Vacuum Breaker Demo
3. Trained Staff
Trained/Certified Staff Tracking Form Upcoming CCC Program Administrator Certification Courses Upcoming CCC CEU Trainings for Renewal DDW Certification Renewal Form DDW Payment Portal for Annual Renewal ($150)
4. Record Keeping
Inventory Spreadsheet Template Containment Protection Spreadsheet Assembly Test Notification Letter Backflow Assembly Test Report Form
5. On-Going Enforcement Program
Cross Connection Hazard Assessments
Assembly Test Notification Letter Hazard Assessment Survey Form (1) Hazard Assessment Survey Form (2) Hazard Assessment Survey Form (3) Hazard Assessment Survey Spreadsheet Hazard Assessment Follow Up Letter Residential Customers Cross Connection Survey
Additional Enforcement Tools
Database of Certified Backflow Assembly Testers Backflow Incidents Reporting Template
Rural Water Association of Utah

Contact

14572 South 790 West
A203
Bluffdale, Utah 84065
United States

(801) 756-5123

RESOURCES

Division Of Drinking Water Division Of Water QualityEnvironmental Protection Agency EPAUTWARNNational Rural Water Association
Novi AMS
Association Management Software

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