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Welcome to the Village of Antioch, IL, Action Line
Today is Sunday, February 16, 2025.
Backflow Device Survey

Notice to Property Owners with Backflow Devices
IEPA Title 35 Section 653.801 requires all property owners with backflow devices to complete a survey. To complete the survey, please answer the questions below, or contact the Public Works Department at 847-395-1881 if you have any questions.

* Information is required.

Contact Information

* First Name:
* Last Name:
Business Name:
Email:
Daytime Phone: (
* Address:
* City:
* State:
* ZIP:

* If you have a RESIDENTIAL property, please check whether or not you currently have any of the following at the above mentioned address? (check all that apply)






7
 
If other, please specify:
 
If you have a COMMERCIAL property, please check whether or not you currently have any of the following at the above mentioned address? (check all that apply):















16
 
* Backflow Assembly Manufacturer:
 
* Backflow Assembly Model # (909, 975, 825, etc.):
 
* Backflow assembly Serial # (found on plate):
 
* Size (1", 2", 6", etc.):
 
Type (RP, DC, PVB, SVB)
 
On Line To:
 
* I affirm the information above to be accurate to the best of my knowledge.

 
Attach a Picture or File (max size: 30MB):
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Notes:

If you send us a message, you will receive a Tracking Number allowing you to follow-up with your request, at your convenience. Responses may be delayed dependent on staffing. If this is an urgent matter, please call Village offices at 847-395-1000.

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