The Safety of McCook’s drinking water is very important. With that in mind the Nebraska Department of Health and Human Services requires each public water system in Nebraska to have residents conduct an inspection of the plumbing in their home. The inspection is to determine the potential for cross connections with the public water supply and ensure these connections are properly protected against backflow or backsiphonage.

To help understand cross connection we have included a brochure that explains some of the common situation that cause backflow and backsiphonage. Please take a few minutes complete the survey below then return it to the City of McCook. Surveys may be dropped off at the city office, mailed, or put in the after hours payment drop box or the survey can be completed online at www.cityofmccook.com click the cross connection survey button and follow the online instructions.

McCook Municipal Ordinance § 52.28 Unsafe Connection; Backflow Hazard requires that once each 5 years customers shall complete the survey supplied by the municipality. Failure to do so may result in fines or interruption in service.

Customer Full Name:*

Customer Address:*

Do you have underground lawn irrigation system? *

YES

NO

If yes, is it protected by a testable backflow device?

YES NO

UNKNOWN

Do you have a swimming pool or hot tub? *

YES

NO

If yes, is it protected by a testable backflow device?

YES NO

UNKNOWN

Do you have photo, chemical medical or other lab facilities?*

YES

NO

If yes, is it protected by a testable backflow device?

YES NO

UNKNOWN

Do you have a private well or other source of water?*

YES

NO

If yes, is it protected by a testable backflow device?

YES NO

UNKNOWN

Do you have boiler heat or water to air heat pump?*

YES

NO

If yes, is it protected by a testable backflow device?

YES NO

UNKNOWN

Do you use your garden hose to apply lawn chemical?*

YES

NO

If yes, is it protected by a hose bib vacuum breaker?

YES NO

UNKNOWN

Do you have a water softener?*

YES

NO

If yes, is waste line going to the sewer protected by an air gap?

YES NO

UNKNOWN

If you have any questions please contact the City of McCook Water Department at 308-345-2022, ext. 222.