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Stormwater Pollution Reporting Form
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Steps
1.
Step One
This section is complete
This section is incomplete
2.
Contact Information
This section is complete
This section is incomplete
Step One
Date Pollution was Observed
Date Pollution was Observed
Street Address
*
City
State
Zip Code
*
Weather Conditions at the Time
*
-- Select One --
Clear
Drizzling
Heavy Downpour
Overcast
Partly Cloudy
Raining
Snow/Sleet
Pick 1
Type of Pollution Observed
*
-- Select One --
Automotive
Concrete Spoils
Construction Materials
Dirt/Soil
Garbage
Grease/Cooking Oil
Leaves/Yard Waste
Paint
Sewage
Vehicle/Surface Washing Water
Other
Please Specify
Photo of Pollution/Polluter
Please upload a photo of the pollution or polluter that you observed.
Photo of Pollution/Polluter
Please upload a photo of the pollution or polluter that you observed.
If pollution was observed in waterway, what did the water look like?
*
Pollution not observed in waterway
Clear
Foamy/Sudsy
Gray/Black/Blue
Green/Algae
Muddy
Oily
Scummy
Other
Please check all that apply
What did the water smell like?
*
No Smell Observed
Musky/Organic
Nothing
Oil/Gas
Rotten Eggs
Sewage
Chemical
Other
Please check all that apply
Please Specify
Please Specify
How much was spilled?
*
-- Select One --
Unknown/Not a liquid spill
Less than 1 Gallon
1-5 Gallons
5-10 Gallons
More Than 10 Gallons
Did you observe:
*
Select 1, you will be prompted for more information
A spill from mobile vehicle washing?
A spill from automotive work being done at a business?
Improper storage techniques leading to spills or leaks?
Excessive erosion?
A sanitary sewer overflow?
Improper landscape maintenance?
None of the above were observed
Business Name
Business Contact Information
Make/Model of Business Vehicle
Vehicle Color
License Plate Number
Description of what you observed
What you observed
-- Select One --
Brake Changing
Engine Work
Other Fluid Changing
Please Specify
What is being stored
-- Select One --
Fuel
Grease
Hazardous Materials
Oil
Soap Detergent
Other
Please Specify
Storage Issues
No lid on container
Leaking
No secondary containment
No labels
Container in bad condition (rusty, corroded, holes)
Spill reaching storm drain/creek
Yes
No
Erosion Observed
Dirt reaching storm drain/creek
Yes
No
Construction Nearby
Yes
No
Name of contractor/developer, if known
Call Water and Sewer Maintenance Immediately at 919-560-4344
Location of overflow and what you observed
Location of improper landscape maintenance, and what you observed
Work being done by private homeowner or landscaping business
-- Select One --
Private Homeowner
Landscaping Business
Not Sure
Additional Information
Please include any other information that you think would be helpful to our investigators.
Continue
Contact Information
Contact Information
Please be aware that you do not have to provide us with your name and/or contact information. If you choose
not
to remain anonymous, the information you supply may be subject to the North Carolina Public Records Law and Disclosed to 3rd parties. However, if you choose to remain anonymous, we will not be able to contact you with updates on the situation, or to request additional information if it is needed.
Note
: If this is an emergency, or there is an immediate threat to human life,
call 911
!
First Name
Last Name
Phone Number
Email
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