NCS000518_Public Reporting of SW IDs_20191209

Town of Navassa
Stormwater Management
Public Reporting of Stormwater Illicit Discharges
This form is used to report potential illicit discharge contamination of stormwater in the Town of Navassa only.
An illicit discharge is defined as "discharges not entirely composed of stormwater". If you suspect that an entity is
illegally discharging to anything other than a stormwater system, please speak with your local law enforcement.
If you wish to report illegal discharge to stormwater systems not in the Town of Navassa, please contact the local
Stormwater Management Officer of the locality where the potential illicit discharge is occurring. If they do not have
a local Stormwater Management Officer and are unable to provide a suitable contact, you may contact the North
Carolina Department of Environment and Natural Resources.
Please print and provide as much detail as possible. Use the back of this sheet if necessary.
Please Return This Form To: Navassa Town Planner
334 Main St
Navassa, NC 28451
Date:
Name of Person/Company Completing this Report:
Contact
Location of Potential Illicit Discharge:
Type of Structure Receiving the
Description of discharge:
❑ Continued on Back
Comments:
❑ Continued on Back
For Office Use Only
Have the adjacent outfalls been recently inspected? oYeso No Date_/ /
Is it industrial? ❑ Yes oNo Is Project in an MS4 Designated Area? oYes oNo