BackFlow Prevention Information required from all Shareholders who are connected to the system

 

Owner Name  -

Date  

Address –

 

This letter is to get information about how water is used on your property. Here at Liberty Pipeline Company, we strive to provide clean and protected drinking water at every connection. On rare occasions when the water pressure drops in the main line due to construction or a water leak, a back siphonage situation may occur and pull water backwards, this is called backflow. To prevent contaminated water from backflowing, LPC’s Bylaws 2019 Article XIV and the International Plumbing Code Chapter 6 with coordinating Utah Administrative code R309-105-12 require all cross connections to be protected with backflow protection.

 

Yes	No
		Do you water your lawn with a conventional sprinkler system?
		If yes, is it connected to the culinary/drinking water (even as a backup)?
		If yes, do you currently have a backflow preventer on your sprinkler system?
		Do you have a water softener?
		Do you have a private well on their property?
		Do you have a hobby farm or greenhouse?
		If yes, do you inject fertilizer or other chemicals into the irrigation system?
		Do you have a swimming pool or pond?
		Do the outdoor faucets have a backflow preventer (see examples below)?

 Completed by (printed name):  

Signature:

Date:

Sincerely,

Liberty Pipeline Company

801-745-2088

Email Jodi@LibertyPipelineCompany.com with any questions.