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2. SCSA#3 Annual Backflow Certification Sign Up

   Silver Creek residents who want SCSA#3 to perform their annual backflow certification must complete this application form.

4. Email*
6. First Name*
7. Last Name*
9. Physical Address*
11. Where is the backflow preventer valve located?*

    1. Indoor
    2. Outdoor
    3. I don't know
13. By submitting this form I understand that a charge for the backflow certification will appear each September on my water bill.*

    1. Agree
15. I understand that SCSA#3 will continue to perform my annual backflow inspection and that I will be charged for this service until I notify SCSA#3 to discontinue this service.*

    1. Agree
17. If there is anything more you would like to share please let us know.
Leave This Blank:


19. 1. Receive an email copy of this form.
20. Email address

    This field is not part of the form submission.

21. Submit

* indicates a required field