
				Rod R. Blagojevich, Governor

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Bureau of Water

Water Forms

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Permits-Drinking Water
Permits-Wastewater
Surface Water Forms
Watershed Management Forms
Water Quality Standards Forms
Compliance and Enforcement-Drinking Water
Compliance and Enforcement-Wastewater
Operator Certification-Drinking Water
Operator Certification-Wastewater
Financial Assistance
Public Water Supply Field Operations

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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

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
125KB	General NPDES Permit for Industrial Storm Water
164KB	General NPDES Permit for MS4
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
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
384KB	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
1.6MB	Schedule N Waste Characteristics
321KB	Schedule P Erosion Control
228KB	Schedule T Trust Disclosure
134KB	Storm Water Annual Facility Inspection for Industrial
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
284KB	WPC-PS-1 Application for Permit or Construction Approval

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
46KB	Amendment for Water Quality Management Plan Application
	Joint Application Form for Corp of Engineers Permit
125KB	Livestock Waste Release Required Report Information Form
2573KB	NPDES Form 1 General Information (Consolidated Permits Program)
174KB	NPDES Form 2B USEPA Application for Permit to Discharge Wastewater on Concentrated Animal Feeding Operations and Aquatic Animal Production Facilities
3014KB	NPDES Form 2C Wastewater Discharge Information (Consolidated Permits Program)
1218KB	NPDES Form 2D New Sources and New Dischargers - Application for Permit to Discharge Process Wastewater
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
355KB	Tax Certification Program for Livestock Waste Management Facilities
77KB	WPC-PS-MW and Instructions: Mine Related Pollution Control Permit Application

Financial Assistance
PDF Size	Description
889KB	Applicant Environmental Checklist(PWSLP/WPCLP)
12KB	Disbursement Request
744KB	Section 319 Application Form
854KB	Streambank Cleanup And Lakeshore Enhancement Application Form (SCALE)

	Drinking Water
26KB	Pre-application for Loan Assistance for Drinking Water Facilities
12KB	Project Plan Submittal Checklist
82KB	Public Water Supply Loan Application Package
194KB	Plans/Specifications Review Checklist for the Public Water Supply Revolving Loan Program and Required Front End Documents
156KB	Public Water Supply Minority Business Enterprises and Women's Business Enterprises Guidance Package
12KB	Certificate Regarding O & M (PWSLP)
40KB	Public Water Supply Sample Ordinance (Non-Home Rule) Authorizing Loan Agreement
31KB	Public Water Supply Sample Ordinance (Home Rule) Authorizing Loan Agreement
37KB	Public Water Supply- Sample Water Ordinance/Service Charges

	Wastewater
50KB	Pre-application for Loan Assistance for Wastewater Facilities
11KB	Facility Plan Submittal Checklist
90KB	Water Pollution Control Loan Application Package
195KB	Plans/Specifications Review Checklist for the Water Pollution Control Revolving Loan Program and Required Front End Documents
498KB	Water Pollution Control Minority Business Enterprises and Women's Business Enterprises Guidance Package
12KB	Certificate Regarding O & M (WPCLP)
38KB	Water Pollution Control Sample Ordinance (Non-Home Rule) Authorizing Loan Agreement
31KB	Water Pollution Control Sample Ordinance (Home Rule) Authorizing Loan Agreement
157KB	Water Pollution Control - Sample Sewer Use Ordinance/Service Charges

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	Domestic Wastewater Operator Certification Application
6KB	Facility Data Maintenance Form
276KB	Industrial Wastewater Operator Certification Application
437KB	Reciprocity Request
	Wastewater Operator Certificate of Technical Competency Examination Schedule 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
116KB	Notification of Ownership and Responsible Operational Personnel

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
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
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	Turbidity Monitoring Report Form A for small surface waters
94KB	Turbidity Monitoring Report Form B for small surface waters
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
	161KB	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