Cross-Connection Questionnaire

Nebraska Department of Environment and Energy Title 179 requires the completion of a Cross-Connection Survey for all water connections to a public water system every 5 years. We ask for your assistance in completing this survey. To meet the state requirements, 100% of City of Papillion water customers must return the survey. If you need assistance in filling out this form, or if you have any questions about cross connections, please call 402-597-2007. Thank you for your cooperation.

Please complete your Cross-Connection Questionnaire using one of the following applicable links:

Residential - Cross-Connection Questionnaire


Commercial - Cross Connection Questionnaire