Exception to Drain Pool into Street

First Name

Last Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Phone Number

Date the pool will be drained

Who will be draining the pool?

Myself

Pool Company

If Pool Company, please provide name and contact information

Company Name

Contact Info

Is the water clear, free of chemicals and have a neutral pH?

Yes

Reason for draining pool

Reason why pool can't be drained into sanitary sewer cleanout

Please post this form as your authorization to drain into the City Street.

By submitting this form, you agree to the following:

No sediment or pollutants including, but not limited to algae, salt, diatomaceous earth, sludge, acid, etc. will be discharged into the street or stormwater system.
No obstructions to public rights-of-way are permissible.
No discharges are allowed in alleyways.
Take appropriate steps to avoid erosion.
If water will enter an HOA retention basin or system, authorization from that entity is required and is not provided by this exception.
Any material left in street after the draining is complete must be cleaned up and properly disposed by the resident.
Failure to adhere to the stipulations of this exception may result in a Notice to Correct or a request to immediately cease the discharge.

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