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Cross Connection & Backflow Prevention Program


    The Illinois Environmental Protection Agency (IEPA) requires every water supplier to develop and implement a cross-connection (backflow prevention) control program. One program requirement is to survey all residential water customers in the Village's service area every two years. All residential water customers are asked to complete the survey. For questions regarding the program or survey, contact the Water & Sewer Superintendent Tom Kopanski at 331-212-9042 or

    The Village of Montgomery Public Works Department - Water & Sewer Division provides quality and safe drinking water to all Montgomery residential and commercial users. The Village of Montgomery adopted a Cross Connection Control Program to ensure safe drinking water.

  2. Please list the full street address, including the apartment or unit number, if applicable.

  3. Please provide an email address for one person residing at the residence for which you are completing the survey.

  4. Is this address Residential or Commercial?*
  5. Do you have an underground lawn sprinkler system?*
  6. Do you have a swimming pool or hot tub?*
  7. Do you have a water treatment system other than a water softener?*
  8. Do you pull water from a source other than from the Village of Montgomery?*
  9. Do you have a boiler or steam heat?*
  10. Do you have a biological or chemical lab onsite?*
  11. Do you have dental or dialysis equipment onsite?*
  12. Leave This Blank:

  13. This field is not part of the form submission.