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Water Forms

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Permits-Drinking Water
PDF Size Description
 275KB Algicide Permit Application
 134KB Construction Permit Application
 6KB Groundwater under the Direct Influence of Surface Water (200ft Setback version)
 6KB Groundwater under the Direct Influence of Surface Water (400ft Setback version)
 381KB Schedule A: Engineer's Cost Estimate
 210KB Schedule B: Water Main Construction
 210KB Schedule C-I: Well Construction
 216KB Schedule C-II: Well Completion
770KB Operating Permit Application



Permits-Wastewater
PDF Size Description
52KB Address Correction
 62KB Certification of Pollution Control Facility (Property Tax Treatment) Application
327KB Certification of Sewer Use Ordinance Review
511KB CSO Operational Plan Checklist and Certification
352KB CSO Pollution Prevention Plan Certification
125KB General NPDES Permit for Construction Site Activities (Revised as of April 30, 2014 to clarify BMP for post-construction)
125KB General NPDES Permit for Industrial Storm Water
164KB General NPDES Permit for MS4
235KB General NPDES Permit for Pesticide Application Point Source Discharges
Joint Application Form for Corp of Engineers Permit
125KB Livestock Waste Release Required Report Information Form
269KB Notice of Intent for General Permit to Discharge Wastewater
257KB NPDES Form 1 General Information (Consolidated Permits Program)
131KB NPDES Form 2A Application Overview
579KB NPDES Form 2B USEPA Application for Permit to Discharge Wastewater on Concentrated Animal Feeding Operations and Aquatic Animal Production Facilities
 3,014KB NPDES Form 2C Wastewater Discharge Information (Consolidated Permits Program)
 1,218KB NPDES Form 2D New Sources and New Dischargers - Application for Permit to Discharge Process Wastewater
 1021KB NPDES Form 2E Facilities which do not Discharge Process Wastewater
 1081KB NPDES Form 2F USEPA Application for Permit to Discharge Stormwater Discharges Associated with Industrial Activity
 93KB NPDES Form 2S Application Overview
49KB Pesticide Notice of Intent
34KB Pesticide Notice of Termination
632KB Pesticide Annual Report
40KB Pesticide Adverse Incident Report
40KB Pesticide Discharge Evaluation Worksheet
284KB WPC-PS-1 Application for Permit or Construction Approval
 374KB Schedule A/BPrivate Sewer Connection or Sewer Extension
 245KB Schedule C Sewer Extensions (Construction only)
 251KB Schedule D Treatment Works
 12KB Schedule E Excess Flow Treatment
 334KB Schedule F Sewer System Lift Station/Force Main
409KB Schedule FTP Fast Track Service Connection Permit
 390KB Schedule G Sludge Disposal and Utilization
 231KB Schedule H Spray Irrigation
 268KB Schedule I Septic Tank/Seepage Field System
 240KB Schedule J Application for Construction/Operation Permit for Industrial
 74KB Schedule MA and Instructions: Construction, Opening, or Reopening a Mine
 75KB Schedule MB and Instructions: Operating a Mine
 73KB Schedule MC and Instructions: Mine Refuse Disposal
 74KB Schedule MD and Instructions: Abandonment of a Mine
 76KB Schedule ME and Instructions: Discharge Location and Characteristics
 1.6MB Schedule N Waste Characteristics
 321KB Schedule P Erosion Control
 228KB Schedule T Trust Disclosure
 355KB Tax Certification Program for Livestock Waste Management Facilities
 77KB WPC-PS-MW and Instructions: Mine Related Pollution Control Permit Application


Storm Water Permits
134KB  Annual Facility Inspection Report for General Storm Water Discharges
30KB Annual Facility Inspection Report for Individual NPDES Permit for Storm Water Discharges
150KB  Storm Water Annual Facility Inspection for MS4
159KB  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

185KB Storm Water Notice of Intent for Construction
204KB  Storm Water Notice of Intent for Industrial
329KB  Storm Water Notice of Intent for MS4
159KB Storm Water Notice of Termination for Construction
 


Surface Water Forms
PDF Size Description
121KB Priority Lake and Watershed Implementation Program Project Proposal
785KB Illinois Clean Lake Program Pre-Application
14KB Lake Education Assistance Program Application Form
11KB Lake Notes Order Form
47KB VLMP Registration Form



Watershed Management Forms
PDF Size Description
 29KB Federal Funding Accountability and Transparency Act Required Reporting (FFATA)
 50KB IGIG BMP (Proposed/Installed) Form
 29KB MBE/WBE Utilization Under Federal Assistance Agreements and Interagency Agreements (US EPA Form 5700-52A)
 39KB SCALE Event Reporting Form
 141KB Section 319 BMP (Proposed/Installed) Form
92KB Section 319 Proposed/Installed BMP Form Instructions
 134KB Section 319 Project Cost Summary Revision Form
 30KB Single Audit Act Form
 46KB Water Quality Management Plan Amendment Application



Financial Assistance
PDF Size Description
12KB Disbursement Request
744KB

Section 319 Application

  Streambank Cleanup And Lakeshore Enhancement Application Form (SCALE)< br> Applications will be accepted again during the summer of 2013
  Green Project Reserve Guidance
   
  FY 2011 Small Systems Compliance Grant Program
192KB Application for Small Systems Compliance Grant
85KB Factsheet for Small Systems Compliance Grant
   
  Drinking Water
 889KB Loan Applicant Environmental Checklist(PWSLP/WPCLP)
 26KB Pre-application for Loan Assistance for Drinking Water Facilities
 12KB Project Plan Submittal Checklist
12KB Certificate Regarding O & M (PWSLP)
 86KB Public Water Supply Sample Ordinance (Non-Home Rule) Authorizing Loan Agreement
 64KB Public Water Supply Sample Ordinance (Home Rule) Authorizing Loan Agreement
37KB Public Water Supply- Sample Water Ordinance/Service Charges
943KB PWSLP Plans-Specs Checklist / Front-end Documents
85KB Davis-Bacon Wage Act Requirements
49KB PWSLP Financial Information Checklist and Program Financial Requirements
63KB Bidding Review Certification and Checklist for Construction Contracts
44KB PWSLP Loan Application Form
20KB Central Contractor Registration Tip Sheet
19KB Getting a DUNS Number
65KB Tax Exemption Certificate and Agreement
28KB PWSLP Green Project Reserve Quick Reference Guide
138KB USEPA Form 4700-4 - Compliance Review
38KB USEPA Form 5700-49 - Debarment, Suspension
203KB Five Officer Certification Form
  Engineering Eligibility Guide and Checklist
   
  Wastewater
 889KB Loan Applicant Environmental Checklist(PWSLP/WPCLP)
50KB Pre-application for Loan Assistance for Wastewater Facilities
11KB Facility Plan Submittal Checklist
12KB Certificate Regarding O & M (WPCLP)
85KB Water Pollution Control Sample Ordinance (Non-Home Rule) Authorizing Loan Agreement
64KB Water Pollution Control Sample Ordinance (Home Rule) Authorizing Loan Agreement
157KB Water Pollution Control - Sample Sewer Use Ordinance/Service Charges
88KB Loan Applicant Environmental Checklist
697KB WPCLP Plans-Specs Checklist and Front-end Documents
85KB Davis-Bacon Wage Act Requirements
50KB WPCLP Financial Information Checklist and Project Financial Requirements
63KB Bidding Review Certification and Checklist for Construction Contracts
44KB WPCLP Loan Application Form
20KB Central Contractor Registration Tip Sheet
19KB Getting a DUNS Number
65KB Tax Exemption Certificate and Agreement
WPCLP Green Project Reserve Quick Reference Guide
138KB USEPA Form 4700-4 - Compliance Review
38KB USEPA Form 5700-49 - Debarment, Suspension
203KB Five Officer Certification Form
  Engineering Eligibility Guide and Checklist



Water Quality Standards
PDF Size Description
 27KB Effluent Disinfection Exemption Request Form for 35 Illinois Adm. Code 378



Operator Certification-Wastewater
PDF Size Description
 56KB Collection System Operator Certification Application
 553KB Class 1-4 Domestic/Municipal Wastewater Operator Certification Application
 6KB Facility Data Maintenance Form
 276KB Industrial Class K/K-WR Wastewater Operator Certification Application
 437KB Reciprocity Request
  Examination Schedule for Wastewater Operator Certification
18KB Rescheduling Form for Wastewater Operator Certification Examinations
30KB Wastewater Operator Contract Form
30KB Replacement Certificate Request Form
31KB Change in Personnel Notification Form



Operator Certification-Drinking Water
PDF Size Description
 463KB Application for Certification as a Public Water Supply Operator
 201KB Operator Certification Program Training Provider Application for Course/Training Event Approval Form
 269KB Operator Training Submission Form
506KB Notification of Ownership and Responsible Operational Personnel
33KB Drinking Water Certification Examination Request



Compliance and Enforcement-Drinking Water
PDF Size Description
15KB CCR Certification Form
88KB Chlorine Dioxide Distribution Monitoring Report Form (Daily)
88KB Chlorite Distribution Monitoring Report Form (Daily)
 125KB Coliform Analysis Report Form
 71KB Consumer Notice of Lead Tap Water Results
95KB DBP Analysis Report Form
 11KB DBP's Site Plan and Information Sheet
114KB Distribution WQP Report Form
127KB Entry Point WQP Report Form (Bi-Weekly)
 78KB Entry Point WQP Report Form (Daily)
118KB IOC Analysis Report Form
62KB Lead Consumer Informational Notice Certification Form
14KB Lead and Copper Sampling Information
 66KB Lead and Copper Chemical Analysis Report
 44KB Lead and Copper Reduced Monitoring Site Plan for 5 Sites
201KB Lead and Copper Reduced Monitoring Site Plan for 10 Sites
 45KB Lead and Copper Reduced Monitoring Site Plan for 20 Sites
 74KB Lead and Copper Reduced Monitoring Site Plan for 30 Sites
 63KB Lead and Copper Reduced Monitoring Site Plan for 50 Sites
 60KB Lead and Copper Samples Sites Data Input Form
 259KB Lead and Copper Sampling Site Summary
 35KB Natural Optimal Corrosion Control Designation
104KB Nitrate Analysis Report Form
185KB Nitrite Analysis Report Form
47KB Operator Training Form
 66KB OCCT Verification Form
 232KB PB/CU Sample Site Review Checklist
 444KB Phase 2 and 5 Monitoring Waiver Application
 11KB Public Education Summary Report Form
 11KB

Public Notice Certification Form

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

197KB Radiological Analysis Report Form
120KB Radiological with Uranium Analysis Report Form
 102KB RDC Distribution Monitoring
 25KB RDC at Entry Point Monitoring Report
111KB Repeat Sample Collectors Form
163KB SOC Analysis Report Form
163KB SOCG Analysis Report Form
 37KB Source Water Treatment Recommendation: Option 1
 35KB Source Water Treatment Recommendation: Option 2
118KB TOC Analysis Report Form
93KB TTHM Analysis Report Form
125KB Turbidity Monitoring Report Form A for large surface waters
137KB Turbidity Monitoring Report Form B for large surface waters
126KB UV Monthly Certification Form
94KB UV Monthly Operating Log (Daily)
94KB UV Monthly Summary
117KB VOC Analysis Report Form
77KB WQP Excursion Report Form
 75KB WQS Analysis Report Form



Compliance and Enforcement-Wastewater
Type PDF Size Description
 571KB
Fiscal Report Form for NPDES Permits
20KB
Guidelines for the Completion of Preprinted Discharge Monitoring Report Forms
rtf
 15KB
Modified Form A
rtf
 9KB
Monitoring Report Form: Metals, Cyanide, and Total Phenols - Effluent
rtf
 9KB
Monitoring Report Form: Metals, Cyanide, and Total Phenols - Final Sludge
rtf
 9KB
Monitoring Report Form: Metals, Cyanide, and Total Phenols - Influent
rtf
 18KB
Monitoring Report Form: Organic Priority Pollutants - Effluent
rtf
 18KB
Monitoring Report Form: Organic Priority Pollutants - Final Sludge
rtf
 18KB
Monitoring Report Form: Organic Priority Pollutants - Influent
rtf
 15KB
POTW Pretreatment Annual report Certification Statement
rtf
 16KB
Program Summary
738KB
Sludge Management Report Form
413KB
Sanitary Sewer Overflow or Bypass Notification Summary Report



Public Water Supply - Field Operations
Type File Size Description
23KB
Distribution System Operating
31KB Membrane Filtration Daily Operation Report
31KB
Monthly Coagulation and Lime Softening
33KB
Monthly Iron Removal and Ion Exchange Softening
25KB
Monthly Operation and Chemical Feeding



Mine Pollution Control Program
Type 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

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