North Shore Mosquito Abatement District
Standing Water Report Form

The NSMAD is interested in finding and locating potential breeding sites. This
form will help us with our Larvaciding program and our control efforts in treating
standing water throughout the district. If you could please fill out the following
information and when finished please click on the "Send Form" button below.
Your information is greatly appreciated.

If you would like to leave a message instead with the NSMAD district
office,  @ (847) 446 - 9434:  Please Press/Enter in THREE(3) anytime
during the welcome message and Report your Potential Breeding Site.

Standing Water Report Form:(That Stands for seven days or more):

Name:

Telephone#:

Email Address:

Location of Standing Water:

Address:

Type of Mosquito Breeding Site(s):

Catch Basin

Artificial Pond

Construction Site

Bird Bath

Drainage Ditch

Forest Area

Old Tires

Roadside Ditch

Swimming Pool

Tire Ruts

Yard Depression

Other

If "Catch Basin": is Checked Above, Please Select # Found:

Please Give A Brief Description of the Breeding Site(s) Location(s):