Environmental Complaint Form

Environmental Complaint Form

Environmental Complaint Form

Please complete all fields below and click on the SUBMIT button to send your complaint. Staff will address your concerns as soon as possible and you will be contacted with the results of our investigation. Please be aware that an adult (over 18 years) has to be available for contact. All complaints are confidential. Although anonymous reports are accepted, we request your contact information so that we may contact you if we need additional information to properly address your complaint. Also, if you do not leave your contact information, we will not be able to inform you of our actions.
Type of of Incident/Problem

Other
Date of complaint

MonthDayYear
Time of incident

:HourMinutesAM/PM Option
Restaurant Name:
Property Owner
Restaurant Manager or Owner
Address of complaint

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Description of incident/Problem
Sewage Conditions:
Other Sewage Conditions
Upload any photos relating to the complaint

Browse Files

Cancelof
Are you a septic professional?
Is the problem intermittent or constantly occurring?
The next questions are about you, the person making the complaint. You MAY make an anonymous complaint, except for SEWAGE. Septic/sewage complaints are only able to be investigated if the person making the complaint is an aggrieved party or an adjacent land owner. If you are not an adjacent landowner please discribe how this impacts you directly.

All other complaint types may be made anonymously. Please include as much information as possible.
Complainant Full Name (Required for Septic/Sewage Complaints)

First NameLast Name
Phone Number

Area CodePhone Number
Fax Phone

Area CodePhone Number
E-mail
Please contact me by:
What is the best time to contact you?
Should be Empty: