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Illicit Discharge Detection Reporting Form

If you suspect violations of the Town’s Illicit Discharge Ordinance, you may either call Town Hall at (321) 724-5860 or complete the form provided below.

Choose all that apply from the following: *

Item was liquid

The item was solid

The item has a foul odor

The item was clear

The item was gray

The item was green

The item was brown

The item was yellow

The item was orange

Address of Discharge: *

Discharger Name:

Discharger Phone:

Discharger Street Address: *

Your Contact Information

Your Name:

Your Email Address:

Your Street Address:

Discharge Details

Do you know what was discharged?

Yes

No

How much did you see discharge? If known, what was discharged?

Where did the discharge end up?

Swale

Ditch

Stormdrain

If the item emitted odor, was it:

Sewage

Rancid/Sour

Petroleum/Gas

Sulfide

Other

Did you take photographs of the discharge?

Yes

No

Upload Photo:

There is a maximum file size of 5MB.
Files must be less than 5 MB.
Allowed file types: gif jpg jpeg png pdf avi mov mp3 wav.

Additional Comments:

Leave this field blank

FDEP Coastal Access Guide
Service Request

Contact Info

Phone:

(321) 724-5860

Fax:

(321) 984-8994

Address:

Town Hall

507 Ocean Avenue

Melbourne Beach, FL 32951

United States

See map: Google Maps

Town of Melbourne Beach • 507 Ocean Ave • Melbourne Beach, FL 32951
Phone: 321-724-5860 • Fax: 321-984-8994 • Hours: Mon - Fri 8:30 - 4:30 Add'l hours by app't
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