Please use this form to submit a report of suspected non-hazardous/non-emergency illicit discharge activity only. If you suspect a chemical or fuel spill or incident that may cause fuel or hazardous chemicals to enter the storm sewer system, please call 9-1-1 immediately. This form should only be used to report activity such as leaves or grass clippings being blown or swept into storm sewers, commercial vehicle washing outdoors, grease spills outside of restaurants, etc.

The mailbox that receives these reports is monitored from 8:30-5:00, Monday through Friday. Please use this from to report suspected illicit discharge activity into the storm sewer system. Once received, the report will be investigated by Town staff and remedial action will be taken as needed. If you would like to receive updates on the remedial actions, please be sure to provide an email address or phone number. 

1

What type of suspected illicit discharge activity have you witnessed or do you suspect?

What type of suspected illicit discharge activity have you witnessed or do you suspect?

Leaves, Grass or Yard Waste Directed into Storm Sewer Inlet

Pet Waste Being Dumped in Storm Sewer Inlet

Excess lawn or garden products being swept or hosed into storm sewer inlet.

Oil or grease from a restaurant spilling in the parking lot

Wash water from construction vehicles running into storm sewer system

Commercial car washes or automotive dealers washing vehicles outside

Paint, solvents or other liquids being directed into an inlet

2

What date did the observed activity occur?

 *

What date did the observed activity occur?

3

Approximately what time of day/night did the activity occur?

Approximately what time of day/night did the activity occur?

4

What is the closest address or cross street to where the incident occurred or is occurring?

 *

What is the closest address or cross street to where the incident occurred or is occurring?

5

Is the suspected discharge activity on-going? (Has the activity been observed on more than one occasion or over a period of time?)

 *

Is the suspected discharge activity on-going? (Has the activity been observed on more than one occasion or over a period of time?)

Yes

No

6

Did you witness a vehicle associated with the suspected illicit discharge activity?
(i.e., a commercial vehicle with a name, vehicle with identifiable license plate?)

 *

Did you witness a vehicle associated with the suspected illicit discharge activity? (i.e., a commercial vehicle with a name, vehicle with identifiable license plate?)

Yes

No

7

Please provide any information you have on the potential associated vehicle:

Please provide any information you have on the potential associated vehicle:

8

If you were able to take a photo of the alleged suspected dumper or the dumped material you may upload it here:

If you were able to take a photo of the alleged suspected dumper or the dumped material you may upload it here: Click button for uploading file Clear Maximum size allowed: 5 MB Allowed types: .gif, .jpg, .jpeg, .png, .doc, .docx, .xls, .xlsx, .rtf, .pdf, .txt

9

Do you wish to be contacted regarding the outcome of the Town investigation into the suspected illicit discharge?

 *

Do you wish to be contacted regarding the outcome of the Town investigation into the suspected illicit discharge?

Yes

No

10

If you would like to be contacted please provide a phone number or email address:

If you would like to be contacted please provide a phone number or email address:

Thank you again for taking a moment to complete this form and provide information on the suspected illicit discharge activity. If you provided an email address or phone number, Town staff will be in touch within 2-3 business days to provide updated information on the status of the investigation. If you have any questions or need additional information in the interim, you may call 703-771-2790 or email publicworks@leesburgva.gov for assistance. Thank you.

1. To receive a copy of your submission, please fill out your email address below and submit.
2. Email Address

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