PIMA COUNTY
REGIONAL FLOOD CONTROL DISTRICT
201 NORTH STONE AVE, 9TH FLOOR
TUCSON AZ 85701
Drainage Complaint Form
Complainant Information
Date: Name:
Daytime Phone: Mailing Address:
Were you referred by another department?
yes no
If yes, which department:
Complaint Information
1. Location of drainage problem
a. Complaint tax code/address:
If no address, the drainage problem is located near the cross streets of and
The exact location of the problem:
b. Responsible party tax code/address:
2. Is the problem related to recent development?
yes no
If no, skip to question 3.
a. Who caused the drainage problem?
Neighbor New subdivision
Other
Name of subdivision
Please specify
b. Cause of drainage problem (please check all that apply):
altered or diverted
flow of wash
constructed culvert
in wash
constructed fence
or wall across wash
erosion of wash excavation in wash filled in wash
graded property
that altered flow
graded regulated
riparian habitat
placed debris in
wash
other,
please specify
3. Is the problem within a basin or wash located in an existing subdivision?
yes no
If no, skip to question 4.
a. Is the cause of the drainage problem (please check all that apply):
debris excessive erosion excavation fence needs repair
fill material placed
in basin or wash
graffiti excessive homeless camp
ponding water sediment excessive trash excessive
vegetation
excessive
other,
please specify
4. Is the problem within a major watercourse?
yes no
a. Is the cause of the drainage problem (please check all that apply):
bank protection
requires maintenance
barrier needs repair debris excessive erosion excavation fence needs repair
fill material placed in
major watercourse
graffiti excessive homeless camp motorized vehicles ponding water sediment excessive
trash excessive vegetation excessive other,
please specify
5. Impact of drainage problem
Flood or erosion damage to a structure
yes no
Flood or erosion damage to fence or wall
Flood or erosion damage to driveway yard or pool
yes no
Ponding or erosion damage concerns
6. Summary of complaint
a. Briefly describe the drainage problem:
This portion to be completed by RFCD
Received by:
Page 1 of 1 DC Complaint Form ver 201208
Date received: Drainage complaint number:
b. Name of subdivision
If structure flooded, is it Primary Residence
Do you have Flood Insurance?
yes
no
yes no
yes no
yes
no
