EC DOH: Standing Water Monitoring Report Form

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Standing Water Monitoring Report Form

County of Erie (located in Western New York) addresses only.

We are taking standing water complaints for tracking purposes in order for the Department of Health to identify potential problem areas. We will not be able to visit and treat all reported nuisances, therefore, we are depending on county residents and business owners to eliminate standing water on their property.

Directions

Enter all information requested below by typing on the computer keyboard in the available spaces. Use the Tab button to move from box to box or use your mouse to point and click. Use your Space Bar to make checks within the boxes. After all of the information is entered, use the Submit button at the bottom of the page to submit the Standing Water Monitoring Report form.

Registration Form
Standing Water Reported by
Full Name:
Day Phone:
Evening Phone:
E-mail Address:
Street Address:
City:
State:
Zip Code:
Standing Water Information
Today's Date:
Date Found:
Type of Standing Water (please check one)
catch-basin/sewer	pond
depression in street (pot holes, etc.)	roof gutters
discarded tires	rooftop
ditch in ground	small containers (bucket, etc.)
large containers (childrens' wading pool, refrigerator, etc.)	swimming pool cover
marsh / swamp	unchlorinated swimming pool
	other
Please classify the Standing Water as
Small (bucket, childrens' wading pool, etc.)
Medium (swimming pool)
Large (large outside area is flooded)
Location of Standing Water
Private House
Apartment Building
Business / Commercial Property
Vacant Lot (abandoned house, non-active construction site, etc.)
Public Property (please specify site name)
Other
Owner / Resident/ Property Name (if known):
Address or Street:
Cross Streets:	&
City/Town:
Zip:
Comments

If the above information is correct, use the Submit button to submit the Standing Water Monitoring Report Form. If you need to make a change, you can hit the Reset button below to erase all of the information entered. Again, this form is for Erie County, NY addresses only.

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