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526 Oak Ave., Springdale, AR 72762
479-751-5751
Office 8am - 4:30pm | Drive thru 8am - 4:15pm
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FAQ
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E-Statements
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Commission Agendas
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Employment
West Side Water Project
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Bulky Waste Pickups
Arkansas 811 (call before you dig)
Beaver Water District
Leak Repair Form
Seasonal Meter Form
Pool Adjustment Form
S.T.E.P. System
Impact Fees
Services
Engineering & Mapping
Water Quality/Backflow
Wastewater
Trash & Recycling
GIS Mapping
About
Contact
Customer Information
New / Transfer Service
Cancel Service
Payments
Rates & Fees
FAQ
Online Forms
E-Statements
Impact Fees
Resources
Commission Agendas
Current Projects
Employment
West Side Water Project
Bids
Surplus
Bulky Waste Pickups
Arkansas 811 (call before you dig)
Beaver Water District
Leak Repair Form
Seasonal Meter Form
Pool Adjustment Form
S.T.E.P. System
Impact Fees
Services
Engineering & Mapping
Water Quality/Backflow
Wastewater
Trash & Recycling
GIS Mapping
About
Contact
Pay My Bill
RESOURCES
Commission Agendas
Current Projects
Employment
West Side Water Project
Bids
Surplus
Bulky Waste Pickups
Arkansas 811 (call before you dig)
Beaver Water District
Leak Repair Form
Seasonal Meter Form
Pool Adjustment Form
S.T.E.P. System
Impact Fees
Contact
Customer Cross Connection Survey
Home
Customer Cross Connection Survey
Customer Cross Connection Survey
Company Name:
Email:
Phone Number:
Service Address:
Address Line 1
Address Line 2
City
State
Zip Code
Mailing Address:
Address Line 1
Address Line 2
City
State
Zip
Does this property have a fire sprinkler system?
Yes
No
If yes, what type of system?
Wet Pipe
Dry Pipe
Antifreeze
Does this property have an underground irrigation system?
Yes
No
Has it been used within the last year?
Yes
No
Is there a backflow installed for the irrigation system?
Yes
No
Is there a backflow installed on the domestic water system?
Yes
No
Has it been tested within the last year?
Yes
No
How many backflows (domestic only) are on this property?
Does this property use fats, oils, or grease to cook with?
Yes
No
Is this facility a single or multi-tenant building?
Single
Multi
What kind of disposal system is installed?
Grease Trap
Grease Interceptor
Dedicated Grease Bin
Does one meter feed all suites?
Yes
No
Are there any pumps, pressure boosters, or storage tanks connected to the water system?
Yes
No
Are there any decorative fountains, ponds, or pools supplied by the domestic water?
Yes
No
Do you have a carbonated fountain drink machine connected to the water system?
Yes
No
Please Check Your Business Type – Check All That Apply
Automotive
Church/Religious
Hospital/Medical Facility
Administrative Office
Dental Facility
Manufacturing Plant
Hotel/Motel/Apartment
Doctors Office
Mortuary/Funeral Home
Barber/Beauty Salon
Distributing Plant
Retail Sales & Service
Car/Truck Wash
Fabricating Plant
Restaurant
Convenience Store
Food Processing
School/College
Chemical Plant
Gas Station
Warehouse
Other Type of Facility Not Listed:
Does this property also include a paint booth?
Yes
No
Does this property have a pool, spa or hot tub?
Yes
No
Does this property utilize a commercial kitchen?
Yes
No
Does this property use a cooling tower?
Yes
No
Does your facility operate a cooling tower or evaporative condenser that is connected to the water supply?
Yes
No
Does your facility use any chemical feed or mixing stations that connect to the water supply?
Yes
No
Does your facility have a boiler?
Yes
No
Does your facility use any chemical feed or mixing stations that connect to the water supply?
Yes
No
Does your facility have a boiler?
Yes
No
Does your facility use any chemical feed or mixing stations that connect to the water supply?
Yes
No
Does your facility have a boiler?
Yes
No
Does this property have a baptistry?
Yes
No
Is the faucet located above the fill line of the baptistry?
Yes
No
What is it filled by?
Hose
Faucet
Is there any x-ray processing or laboratory equipment on site that requires a water connection?
Yes
No
Is there any x-ray processing or laboratory equipment on site that requires a water connection?
Yes
No
Does your facility use any diagnostic or treatment equipment (such as sterilizers, autoclaves, suction units, or patient rinse stations) that is supplied by water?
Yes
No
Does your facility use any chemical feed or mixing stations that connect to the water supply?
Yes
No
Does your facility operate any sterilizers or autoclaves that are connected to the water supply?
Yes
No
Does your facility have a boiler?
Yes
No
Does your facility operate any dialysis machines or water treatment systems connected to the water supply?
Yes
No
Does this property have a car wash?
Yes
No
Does your facility operate any embalming machines or preparation equipment that are connected to the water supply?
Yes
No
Completed By:
Date:
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