Cobble Hill Odour Complaint Form

2. Release of Personal Information
   In order to facilitate the review of odour incidents, this form will become part of the public record and will be shared with the facilities subject to this odour complaint. It may also be shared with other parties, including persons, agencies and governments. Personal information collected in this form will be used for program delivery and / or bylaw enforcement and is consistent with the authority to do so under Section 26 (b), (c), and (e) of the Freedom of Information and Protection of Privacy Act, (the Act). By filling out this form you are consenting to the release of your personal information in accordance with Section 26(d)(i) of the Act. If you have questions or concerns regarding the collection or disclosure of your personal information please contact the FOI Coordinator, at 250-746-2503.

   In order to facilitate the review of odour incidents, this form will become part of the public record and will be shared with the facilities subject to this odour complaint. It may also be shared with other parties, including persons, agencies and governments. Personal information collected in this form will be used for program delivery and / or bylaw enforcement and is consistent with the authority to do so under Section 26 (b), (c), and (e) of the Freedom of Information and Protection of Privacy Act, (the Act). By filling out this form you are consenting to the release of your personal information in accordance with Section 26(d)(i) of the Act. If you have questions or concerns regarding the collection or disclosure of your personal information please contact the FOI Coordinator, at 250-746-2503.

4. Date of odour incident*
   Date of odour incident

   Date of odour incident

   Please provide the time and date when you first noticed the odour

6. Odour Location
   Please provide a street address closest to where the odour was noticed, below:

   Please provide a street address closest to where the odour was noticed, below:

8. Street Number*

9. Street Name*

10. Town or City *
    -- Select One --Cobble Hill

12. Is the odour still present?*

    1. yes
    2. no

13. Has the odour been...

    (choose one)

    1. persistent since you first noticed it or
    2. on and off since you first noticed it
15. When did the odour incident end? (if applicable)
    When did the odour incident end? (if applicable)

    When did the odour incident end? (if applicable)

    Please provide date and time.

19. Tone and Intensity*

    Check the box that BEST describes the odour.

    1. bakery (roasty, malty, buttery)
    2. dead animal (putrid)
    3. earthy/musty/mouldy
    4. fecal/sewage/manure
    5. soap/fruit/citrus/green
    6. fuel/gas station (rubbery, glue, gasoline, moth balls, shoe polish, chemical)

    1. nitrogen/ammonia (fishy, urine)
    2. pine/mint/hay/lemon/eucalyptus
    3. rancid/putrid (yeast, sour milk/cheese, decay)
    4. sweet/garbage can/nail polish/solvent
    5. sulfur/cabbage/garlic (rotten egg, skunk)
    6. other
20. If odour other than listed, please describe.

21. Odour Intensity*
    -- Select One --PLEASANT (present but agreeable)BARELY NOTICEABLE/neutral (odour present but does not cause discomfort)NOTICEABLE/unpleasant (i.e., insufficient to make person take action to avoid it; "does not close a window")VERY UNPLEASANT/offensive (i.e., sufficient to cause person to take action; "closes a window" or file a complaint)UNBEARABLE (i.e., sufficient to make person take immediate action to avoid odour; "leaves", files a complaint)

    (choose one)

23. Odour Source

    I think the odour is coming from the following one or more sources:

    1. Central Landscape Supplies
    2. Fisher Road Recycling
    3. Cobble Hill Village Waste Water Treatment Plant (at Twin Cedar)
    4. Gallier Road Waste Water Treatment Plant
    5. Other
25. Wind Strength

    (choose one)

    1. no wind
    2. calm/light air (0-6km/hour: tree leaves don't move, smoke rised vertically, flag hangs still)
    3. slight/gentle breeze (7-19 km/hour: tree leaves rustle/leaves in constant motion, flag flapping)
    4. moderate/fresh breeze (20-39 km/hour: branches/small trees move, flags ripple)
    5. strong breeze (>=40 km/hour: large branches sway, flags beat loudly)
26. FROM which direction is the wind blowing?
    -- Select One --northnorthwestnortheastsouthsouthwestsoutheasteastwest

27. Weather Conditions

    (choose one)

    1. sunny
    2. overcast
    3. fog or drizzle
    4. rain
29. Temperature
    -- Select One --30+25-3020-2515-2010-155-100-5-5-0-10-0

    (choose one)

33. First Name*

34. Last Name*

36. Your Home Address (optional)

38. (optional)

40. (optional)

42. Phone Number

44. Email Address

Leave This Blank:


46. 1. Receive an email copy of this form.
47. Email address

    This field is not part of the form submission.

48. Submit Submit and Print

* indicates a required field