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Today is Thursday, August 11, 2022.
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:
Daytime Phone: (
* Address:
* City:
* State:
* ZIP:

* Do you currently have any of the following at the above mentioned address? (check all that apply)

If other, please specify:
* Backflow Assembly Manufacturer:
* Backflow Assembly Model:
* Backflow assembly Serial #:
* Size:
* 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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Check here to have email confirmation of this submission.

* Information is required.


If you send us a message, you will receive a Tracking Number allowing you to follow-up with your request, at your convenience.

Internal Use Only, Leave Blank:
Please leave this field blank and remove any values that have been populated for it.

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