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Water Forms

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Permits-Drinking Water
  Description
  Algicide Permit Application
  Construction Permit Application
  Groundwater under the Direct Influence of Surface Water (200ft Setback version)
  Groundwater under the Direct Influence of Surface Water (400ft Setback version)
  Schedule A: Engineer's Cost Estimate
  Schedule B: Water Main Construction
  Schedule C-I: Well Construction
  Schedule C-II: Well Completion
  Operating Permit Application



Permits-Wastewater
  Description
  Address Correction
  Certification of Pollution Control Facility (Property Tax Treatment) Application
  Certification of Sewer Use Ordinance Review
  CSO Operational Plan Checklist and Certification
  CSO Pollution Prevention Plan Certification
  General NPDES Permit for Construction Site Activities (Revised as of April 30, 2014 to clarify BMP for post-construction)
  General NPDES Permit for Industrial Storm Water
  General NPDES Permit for MS4
  General NPDES Permit for Pesticide Application Point Source Discharges
  Joint Application Form for Corp of Engineers Permit
  Livestock Waste Release Required Report Information Form
  Notice of Intent for General Permit to Discharge Wastewater
  NPDES Form 1 General Information (Consolidated Permits Program)
  NPDES Form 2A Application Overview
  NPDES Form 2B USEPA Application for Permit to Discharge Wastewater on Concentrated Animal Feeding Operations and Aquatic Animal Production Facilities
  NPDES Form 2C Wastewater Discharge Information (Consolidated Permits Program)
  NPDES Form 2D New Sources and New Dischargers - Application for Permit to Discharge Process Wastewater
  NPDES Form 2E Facilities which do not Discharge Process Wastewater
  NPDES Form 2F USEPA Application for Permit to Discharge Stormwater Discharges Associated with Industrial Activity
  NPDES Form 2S Application Overview
  Pesticide Notice of Intent
  Pesticide Notice of Termination
  Pesticide Annual Report
  Pesticide Adverse Incident Report
  Pesticide Discharge Evaluation Worksheet
  WPC-PS-1 Application for Permit or Construction Approval
  Schedule A/BPrivate Sewer Connection or Sewer Extension
  Schedule C Sewer Extensions (Construction only)
  Schedule D Treatment Works
  Schedule E Excess Flow Treatment
  Schedule F Sewer System Lift Station/Force Main
  Schedule FTP Fast Track Service Connection Permit
  Schedule G Sludge Disposal and Utilization
  Schedule H Spray Irrigation
  Schedule I Septic Tank/Seepage Field System
  Schedule J Application for Construction/Operation Permit for Industrial
  Schedule MA and Instructions: Construction, Opening, or Reopening a Mine
  Schedule MB and Instructions: Operating a Mine
  Schedule MC and Instructions: Mine Refuse Disposal
  Schedule MD and Instructions: Abandonment of a Mine
  Schedule ME and Instructions: Discharge Location and Characteristics
  Schedule N Waste Characteristics
  Schedule P Erosion Control
  Schedule T Trust Disclosure
  Tax Certification Program for Livestock Waste Management Facilities
  WPC-PS-MW and Instructions: Mine Related Pollution Control Permit Application


Storm Water Permits
  Annual Facility Inspection Report for General Storm Water Discharges
  Annual Facility Inspection Report for Individual NPDES Permit for Storm Water Discharges
  Storm Water Annual Facility Inspection for MS4
  Notice of Intent for Waiver of MS4 Permit
  Storm Water Incidence Non-Compliance for Construction
 

Storm Water No Exposure Form

Please send form to Illinois EPA:

Division of Water Pollution Control
Attn: Permit Section
Post Office Box 19276
Springfield, Illinois 62794-9276

  Storm Water Notice of Intent for Construction
  Storm Water Notice of Intent for Industrial
  Storm Water Notice of Intent for MS4
  Storm Water Notice of Termination for Construction
 


Surface Water Forms
  Description
  Priority Lake and Watershed Implementation Program Project Proposal
  Illinois Clean Lake Program Pre-Application
  Lake Education Assistance Program Application Form
  Lake Notes Order Form
  VLMP Registration Form



Watershed Management Forms
  Description
  Federal Funding Accountability and Transparency Act Required Reporting (FFATA)
  IGIG BMP (Proposed/Installed) Form
  MBE/WBE Utilization Under Federal Assistance Agreements and Interagency Agreements (US EPA Form 5700-52A)
  SCALE Event Reporting Form
  Section 319 BMP (Proposed/Installed) Form
  Section 319 Proposed/Installed BMP Form Instructions
  Section 319 Project Cost Summary Revision Form
  Single Audit Act Form
  Water Quality Management Plan Amendment Application



Financial Assistance
  Description
  Disbursement Request
 

Section 319 Application

  Green Project Reserve Guidance
   
  FY 2011 Small Systems Compliance Grant Program
  Application for Small Systems Compliance Grant
  Factsheet for Small Systems Compliance Grant
   
  Drinking Water
  Loan Applicant Environmental Checklist (PWSLP/WPCLP)
  Pre-application for Loan Assistance for Drinking Water Facilities
  Certificate Regarding O & M (PWSLP)
  Public Water Supply Sample Ordinance (Non-Home Rule) Authorizing Loan Agreement
  Public Water Supply Sample Ordinance (Home Rule) Authorizing Loan Agreement
  Public Water Supply- Sample Water Ordinance/Service Charges
  PWSLP Plans-Specs Checklist / Front-end Documents
  Davis-Bacon Wage Act Requirements
  PWSLP Financial Information Checklist and Program Financial Requirements
  Bidding Review Certification and Checklist for Construction Contracts
  PWSLP Loan Application Form
  Central Contractor Registration Tip Sheet
  Getting a DUNS Number
  Tax Exemption Certificate and Agreement
  PWSLP Green Project Reserve Quick Reference Guide
  USEPA Form 4700-4 - Compliance Review
  USEPA Form 5700-49 - Debarment, Suspension
  Five Officer Certification Form
  Engineering Eligibility Guide and Checklist
  Project Plan Submittal Checklist
   
  Wastewater
  Loan Applicant Environmental Checklist(PWSLP/WPCLP)
  Pre-application for Loan Assistance for Wastewater Facilities
  Certificate Regarding O & M (WPCLP)
  Water Pollution Control Sample Ordinance (Non-Home Rule) Authorizing Loan Agreement
  Water Pollution Control Sample Ordinance (Home Rule) Authorizing Loan Agreement
  Water Pollution Control - Sample Sewer Use Ordinance/Service Charges
  Loan Applicant Environmental Checklist
  WPCLP Plans-Specs Checklist and Front-end Documents
  Davis-Bacon Wage Act Requirements
  WPCLP Financial Information Checklist and Project Financial Requirements
  Bidding Review Certification and Checklist for Construction Contracts
  WPCLP Loan Application Form
  Central Contractor Registration Tip Sheet
  Getting a DUNS Number
  Tax Exemption Certificate and Agreement
  WPCLP Green Project Reserve Quick Reference Guide
  USEPA Form 4700-4 - Compliance Review
  USEPA Form 5700-49 - Debarment, Suspension
  Five Officer Certification Form
  Engineering Eligibility Guide and Checklist
  Facilities Plan Submittal Checklist



Water Quality Standards
  Description
  Effluent Disinfection Exemption Request Form for 35 Illinois Adm. Code 378



Operator Certification-Wastewater
  Description
  Collection System Operator Certification Application
  Class 1-4 Domestic/Municipal Wastewater Operator Certification Application
  Facility Data Maintenance Form
  Industrial Class K/K-WR Wastewater Operator Certification Application
  Reciprocity Request
  Examination Schedule for Wastewater Operator Certification
  Rescheduling Form for Wastewater Operator Certification Examinations
  Wastewater Operator Contract Form
  Replacement Certificate Request Form
  Change in Personnel Notification Form



Operator Certification-Drinking Water
  Description
  Application for Certification as a Public Water Supply Operator
  Operator Certification Program Training Provider Application for Course/Training Event Approval Form
  Operator Training Submission Form
  Notification of Ownership and Responsible Operational Personnel
  Drinking Water Certification Examination Request



Compliance and Enforcement-Drinking Water
  Description
  CCR Certification Form
  Chlorine Dioxide Distribution Monitoring Report Form (Daily)
  Chlorite Distribution Monitoring Report Form (Daily)
  Coliform Analysis Report Form
  Consumer Notice of Lead Tap Water Results
  DBP Analysis Report Form
  DBP's Site Plan and Information Sheet
  Distribution WQP Report Form
  Entry Point WQP Report Form (Bi-Weekly)
  Entry Point WQP Report Form (Daily)
  IOC Analysis Report Form
  Lead Consumer Informational Notice Certification Form
  Lead and Copper Sampling Information
  Lead and Copper Chemical Analysis Report
  Lead and Copper Reduced Monitoring Site Plan for 5 Sites
  Lead and Copper Reduced Monitoring Site Plan for 10 Sites
  Lead and Copper Reduced Monitoring Site Plan for 20 Sites
  Lead and Copper Reduced Monitoring Site Plan for 30 Sites
  Lead and Copper Reduced Monitoring Site Plan for 50 Sites
  Lead and Copper Samples Sites Data Input Form
  Lead and Copper Sampling Site Summary
  Natural Optimal Corrosion Control Designation
  Nitrate Analysis Report Form
  Nitrite Analysis Report Form
  Operator Training Form
  OCCT Verification Form
  PB/CU Sample Site Review Checklist
  Phase 2 and 5 Monitoring Waiver Application
  Public Education Summary Report Form
 

Public Notice Certification Form

Tier 1, Tier 2, Tier 3 Public Notice Violation Templates & Instructions

  Radiological Analysis Report Form
  Radiological with Uranium Analysis Report Form
  RDC Distribution Monitoring
  RDC at Entry Point Monitoring Report
  Repeat Sample Collectors Form
  SOC Analysis Report Form
  SOCG Analysis Report Form
  Source Water Treatment Recommendation: Option 1
  Source Water Treatment Recommendation: Option 2
  TOC Analysis Report Form
  TTHM Analysis Report Form
  Turbidity Monitoring Report Form A for large surface waters
  Turbidity Monitoring Report Form B for large surface waters
  UV Monthly Certification Form
  UV Monthly Operating Log (Daily)
  UV Monthly Summary
  VOC Analysis Report Form
  WQP Excursion Report Form
  WQS Analysis Report Form



Compliance and Enforcement-Wastewater
Description
  Fiscal Report Form for NPDES Permits
  Guidelines for the Completion of Preprinted Discharge Monitoring Report Forms
  Modified Form A
  Monitoring Report Form: Metals, Cyanide, and Total Phenols - Effluent
  Monitoring Report Form: Metals, Cyanide, and Total Phenols - Final Sludge
  Monitoring Report Form: Metals, Cyanide, and Total Phenols - Influent
  Monitoring Report Form: Organic Priority Pollutants - Effluent
  Monitoring Report Form: Organic Priority Pollutants - Final Sludge
  Monitoring Report Form: Organic Priority Pollutants - Influent
  POTW Pretreatment Annual report Certification Statement
  Program Summary
  Sludge Management Report Form
  Sanitary Sewer Overflow or Bypass Notification Summary Report



Public Water Supply - Field Operations
  Description
  Distribution System Operating
  Membrane Filtration Daily Operation Report
  Monthly Coagulation and Lime Softening
  Monthly Iron Removal and Ion Exchange Softening
  Monthly Operation and Chemical Feeding



Mine Pollution Control Program
  Description
  Application for Coal Mine Related Pollution Control Permit MP-1
  Application for Coal Mine Related Pollution Control Permit Instructions
  Application for Coal Mine Related Pollution Control Permit MP-2
  Application for Coal Mine Related Pollution Control Permit MP-3
  Application for Coal Mine Related Pollution Control Permit MP-4
  Application for Coal Mine Related Pollution Control Permit MP-5
  Application for Coal Mine Related Pollution Control Permit MP-6

Water Menu

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Partners for Conservation
Water Resource Assessments
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Storm Water Requirements
Green Infrastructure Plan
Nutrient Issues
Harmful Algal Bloom and Algal Toxins
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