Pollution Report Form

Please fill out the form as completely as possible. We will be adding a map to the form in the next update. Call WATR at 828-269-8561 if you have any questions.

If you have problems with the form, contact us. Thank you!

Your Name
First Last
Your Email*
Your Phone
Your Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
County Where Pollution Observed (note elsewhere if not listed)*
Address Where Pollution Observed
Address Address Line 2 City State ZIP Code
GPS Coordinates or Map Link
Date and Time Observed*
How long has this been happening?
Waterway Affected
Describe the pollution (note appearance, odor, any dead wildlife)
Party you believe responsible and any contact information for them (if known)
Any other important information? (Weather conditions? Relevant history? Enforcement officials who have dealt with this matter before?)
Attach Photos
Max. file size: 128 MB.
Name
This field is for validation purposes and should be left unchanged.

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