If you believe liquids or materials are being released into the drainage system that are not clean water, and should not flow untreated into our streams and rivers, please fill out the form below.

If you have a surface water drainage issue you wish the Town to investigate, please notify us using Drainage Problem as the category.

Problem Location

Street Number and Name:*

Address Line 2:

Zip Code:*

Are you a resident of the Town of Bethlehem?

Yes

No

Is this the first time you have contacted the town regarding this issue?*

Yes

No

Nature of this issue:*

Erosion/Sediment from a construction site Illegal/Illicit storm connection Stormwater pond Dumping Flooding/poor drainage Other - please specify below

Brief Description*

Photograph:

Your Information

Name:*

Street Number and Name:

Address Line 2:

Zip Code:

Daytime Phone Number:*

Email Address:*