Hello, Treasure Island Country Club members:
As a first step in developing a state-mandated cross-connection control plan, your water distribution team is surveying its customers. Simply put, a cross connection is a point in the piping system where the potable water is connected directly or the possibility exists of being connected to a source of contamination, pollution, or non-potable substance. We need all members to fill out the questionnaire below.
In the questionnaire, indicate whether the special plumbing or activities listed apply to your premises.
Mail completed questionnaires by July 10, 2004, to: Water Distribution Team, Box 44, Grapeview, WA 98546. Or drop them off at the annual membership meeting on July 10, 2004, at the Grapeview Fire Hall.
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Yes |
No |
Plumbing or Activity Present on Customer's Premises |
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Underground sprinkler system |
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Water treatment system (e.g., water softener) |
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Solar heating system |
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Residential fire sprinkler system |
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Other water supply (whether or not connected to plumbing system) |
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Sewage pumping facilities or grey water system |
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Boat moorage with water supply |
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Swimming pool or spa |
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Greenhouse |
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Decorative pond |
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Photo lab or dark room |
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Home-based business. If Yes, list type/describe (e.g., beauty salon, machine shop, etc.): ___________________________________________________________________________________________________________________________________________________________________________ |
_____________________________
_______________________________________
(Print Name)
(Treasure Island address)
_____________________________ __________
______________________
(Signature)
(Date) (Best phone number
to reach you)
Questions: Call Skip Beahm (xxx-xxxx) or Rod Wilkinson (xxx-xxxx).