Bureau of Water Standards and Facility Regulation

Forms, Permits, and Applications

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Document ID Document Title Type
3800-FM-WSFR013410 Acre Permit Exemption Documentation Form
3800-FM-WSFR0092Act 537 Municipal/Local Agency Program Evaluation Form* Form
3800-FM-WSFR0003Act 537 Plan Content & Env Assessment Checklist Form
3800-FM-WSFR0039Activity Record for Enforcement of the PA Sewage Facilities Act (Act 537)* Form
3800-FM-WSFR0416Alternative Pebble Count Field Form Form
3800-FM-WSFR0056Application and Notice of State Certification for Corporation Tax Benefits for Air and Water Pollution Control Devices Application
3800-FM-WSFR0009Application for Act 537 Sewage Facilities Planning Assistance* Application
3800-FM-WSFR0029Application for Approval of Certificate or Associates Degree Program Application
3800-FM-WSFR0027Application for Approval of Training Course or Course Content Application
3800-FM-WSFR0412 a & bApplication for Certification to Operate Water or Wastewater Systems Application
1400-FM-OS0048Application for Certification of Sewage Enforcement Officers* Form
3800-FM-WSFR0035Application for Course Offering Schedule Report and Instructions Application
3800-FM-WSFR0271Application for Growing Greener Grant Assistance New or Innovative Water/Wastewater Technology FY 2007-08 Application
3800-PM-WSFR0030Application for Individual Generator Permit for the Beneficial Use of Biosolids by Land Application Application
3800-PM-WSFR0031Individual Site Permit for Beneficial Use of Biosolids by Land Application  Permit
3800-FM-WSFR0346Application for Land Application of Sewage Sludge and Instructions Application
3800-PM-WSFR0008Application for Permit to Discharge Industrial Wastewater Application
3800-PM-WSFR0009(a-l)Application for NPDES Permit to Discharge Sewage* Application
3800-PM-WSFR0018Application for NPDES Permit to Discharge Sewage (small flow form) Application
3800-FM-WSFR0037Application for PA DEP Client Registration and Instructions Application
3800-PM-WSFR0041Application for NPDES or WQM Permit Transfer Application
3800-FM-WSFR0030Application for Post-Presentation Credit Application
3800-FM-WSFR0095Application for Reimbursement - Test or Exam Fees Only Application
3800-FM-WSFR0051Application for Reimbursement - Training and Continuing Education Only Application
3800-FM-WSFR0281Application for Reimbursement Growing Greener New or Innovative Water/Wastewater Technology Program Application
3800-FM-WSFR0284Application for Reimbursement of Expenses for Sewage Management Program Administration Under the PA Sewage Facilities Act, Act 537 Application
3800-PM-WSFR0016Application for Single Residence Sewage Treatment Plant NPDES & WQM Permit Transfer Application
3800-FM-WSFR0032Application for Training Course Approval Administrative Completeness and Technical Review Checklists and Instructions Application
3800-PM-WSFR0040 Transfer of a Public Water Supply Permit  Application
3800-PM-WSFR0479Transfer of Coverage Under a Biosolids PAG-7, 8,9 General or Individual Permit Permit
3800-FM-WSFR0411Approved Examination Provider Application Application
3800-FM-WSFR0088Aquifer Test Recovery Data Form Form
3800-FM-WSFR0090Available Operator Annual Report Form Form
3800-FM-WSFR0067Biosolids Daily Operation Record and Instructions* Form
3800-FM-WSFR0103Biosolids Lime Stabilization Log Form
3800-FM-WSFR0068Biosolids Storage Log and Instructions* Form
3800-FM-WSFR0148Bonded Disposal System Confirmation* Form
3800-FM-WSFR0418Borrower's Disadvantaged Business Enterprise (DBE) Solicitation Documentation Checklist Form
3800-FM-WSFR0062Certificate of Construction/Modification Completion Form
3800-FM-WSFR0004Checklist for Producing Filter Profiles Form
3800-FM-WSFR0053Checklist for Producing Filter Profiles - LT1ESWTR Form
3800-FM-WSFR0191Tier 2 Notice for Violation of a Chemical or Radiological MCL  Form
3800-FM-WSFR0010Class Participant Reporting Authorization Form
3800-FM-WSFR0075Disadvantaged Business Enterprise Review Checklist Form
3800-FM-WSFR0141Clean Water and Drinking Water State Revolving Fund M-WBE Firm Utilization Report Form Form
3800-FM-WSFR0280Combined Application for Reimbursement for Enforcing the Pennsylvania Sewage Facilities Act and Onlot Sewage Disposal Program Annual Report Form
3800-FM-WSFR035002 Sewage Facilities Planning Module - Component 1 (Exception to the Requirement to Revise the Official Plan  Form
3800-FM-WSFR035203 Sewage Facilities Planning Module - Component 2 (Individual and Community Onlot Disposal of Sewage) Form
3800-FM-WSFR035304 Sewage Facilities Planning Module - Component 3 (Sewage Collection and Treatment Facilities) Form
3800-FM-WSFR0353m05 Sewage Facilities Planning Module - Component 3m (Municipal or Authority Sponsored Minor Sewage Collection Report) Form
3800-FM-WSFR0353s06 Sewage Facilities Planning Module - Component 3s (Small Flow Treatment Facilities) Form
3800-FM-WSFR0362AComponent 4A - Municipal Planning Agency Review Form
3800-FM-WSFR0362BComponent 4B - County Planning Agency Review Form
3800-FM-WSFR0362CComponent 4C - County or Joint Health Department Review Form
3800-FM-WSFR0008Conference Notification and Instructions* Form
3800-FM-WSFR0049Conference Operator Roster Report Form
3800-FM-WSFR0087Constant Rate Aquifer Test Data Form Form
3800-FM-WSFR0084Consumer Confidence Report (CCR) Certification Form Form
3800-FM-WSFR0085Consumer Confidence Report (CCR) Completeness Checklist for Water Suppliers Form
3800-FM-WSFR0113Consumer Confidence Report (CCR) Template and Instructions for Systems Using Only Groundwater Sources Form
3800-FM-WSFR0114Consumer Confidence Report (CCR) Template and Instructions for Systems Using Only Surface water Sources Form
3800-FM-WSFR0059Continuing Education Discrepancy Report Form
3800-FM-WSFR0116Contract Procurement Breakdown Form
3800-FM-WSFR0115Contractor's DBE Solicitation Documentation Checklist Form
3800-FM-WSFR0342Contractual Consent of Landowner Form
3800-FM-WSFR0024Course/Instructor Evaluation Form
3800-FM-WSFR0012aDEP Sample Information System Sample Submission Sheet Form
3800-FM-WSFR0012bDEP Sample Information System Sample Submission Sheet Form
3800-FM-WSFR0097Disinfection Profiling Form
3800-FM-WSFR0091Distance Education Monthly Training Course Certified Operator Roster Report Form
3800-FM-WSFR0021Drinking Water Electronic Lab Reporting (DWELR) System Form
3800-FM-WSFR0424eDMR Permittee Registration Form Form
3800-FM-WSFR0425eDMR Trading Partner Agreement Form
3800-FM-WSFR0300Emergency Response Plan* Form
3800-FM-WSFR0405Engineering Internal Review and Recommendations Form
3800-FM-WSFR0058aExaminee Profile (Internal Use Only) Form
3800-FM-WSFR0159Experimental Drip Irrigation System Monitoring Record Form
3800-FM-WSFR0160Experimental Sewage System Monitoring Record Form
3800-FM-WSFR0060Field Data Sheet Tissue Sampling Form
3800-FM-WSFR0282Field Narrative Form* Form
3800-FM-WSFR0007Field Order (Internal Use Only) Form
3800-FM-WSFR0007AField Order (continuation) Page 2 (Internal Use Only) Form
3800-FM-WSFR0007BField Order (continuation) Page 3 (Internal Use Only) Form
3800-FM-WSFR0041Filter Backwash Recycling Rule Recordkeeping Form Form
3800-FM-WSFR0040Filter Backwash Recycling Rule Recycle Notification Form Form
3800-FM-WSFR0343 First Land Application Notice and Instructions* Form
3800-FM-WSFR0086Flowing Waterbody Field Data Form Form
3800-FM-WSFR0110cFor DEP Official Use Only (Internal Use Only) Form
3800-FM-WSFR0194Fluoride MCL Violation Form
3800-FM-WSFR0169General Inspection Report Form
3800-PM-WSFR0339General Permit (PAG-07) for Beneficial Use of Exceptional Quality Biosolids* Permit
3800-PM-WSFR0340General Permit (PAG-08) for Beneficial Use of Biosolids by Land Application* Permit
3800-PM-WSFR0341General Permit (PAG-09) for Beneficial Use of Residential Septage by Land Application* Permit
3800-FM-WSFR01111General Water Distribution System Survey (2007)* Form
3800-FM-WSFR0079Habitat Assessment Field Data Sheet (Glide/Pool Prevalence) Form
3800-FM-WSFR0117Habitat Assessment Field Data Sheet -Low Gradient Streams Form
3800-FM-WSFR0406Hydrogeology Internal Review and Recommendations Form
3800-FM-WSFR0430IDSE Report for Standard Monitoring - Form & Instructions Form
3800-FM-WSFR0080Impaired Reaches Form
3800-FM-WSFR0345Individual Generator Permit - Recordkeeping and Reporting Form Form
3800-FM-WSFR0002Individual Filter Follow-up Activities DEP Notification Form
3800-FM-WSFR0180Instructions for BWA Due to Line Breaks/Loss of Pressure Form
3800-FM-WSFR0191Instructions for completing a Tier 2 notice for violation of a chemical or radiological MCL Form
3800-FM-WSFR0192Instructions for completing a Tier 2 notice for IESWTR/SWTR monthly exceedance of turbidity limit Form
3800-FM-WSFR0193Instructions for completing a Tier 2 notice for violation of the total coliform MCL Form
3800-FM-WSFR0194Instructions for completing a Tier 2 notice for violation of the Fluoride MCL Form
3800-FM-WSFR0195Instructions for completing a Tier 2 notice for violation of the LCR TT Form
3800-FM-WSFR0011Instructor Qualification Verification Form
3800-FM-WSFR0050Lake/Reservoir Field Data Sheet Form
3800-FM-WSFR0195Lead and Copper Rule Treatment Technique Violation Form
3800-FM-WSFR0180Line Break/Loss of Pressure Form
3800-FM-WSFR0426Mandatory Water Conservation Notice Form
3800-FM-WSFR0107Mark-Recapture Field Data Sheet Form
3800-FM-WSFR0038MBE/WBE Commitment Statement Form
3800-FM-WSFR0046MBE/WBE Contact Telephone Log Form
3800-CD-WSFR0061MCL Notification Postcard Post Card
3800-FM-WSFR0077AModule 16-A Bottled Water (in-state) Form
3800-FM-WSFR0077BModule 16-B Bottled Water (out-of-state) Form
3800-FM-WSFR0077EModule 17 Bulk Water Haulers Form
3800-FM-WSFR0077CModule 18 Vended Water Systems Form
3800-FM-WSFR0077DModule 19 Retail Water Facilities Form
3800-CD-WSFR0047Municipal Financial Assistance Postcard Post Card
3800-FM-WSFR0001Municipal Request for PA Natural Diversity Inventory (PNDI) Data* Form
3800-FM-WSFR0132Narrative Description Form for Water Supply Systems (was 0004) Form
3800-PM-WSFR0337NOI for Coverage Under General Permit for Beneficial Use of Biosolids by Land Application* Permit
3800-FM-WSFR0168NPDES Compliance Inspection Report (Internal Use Only) Form
3800-PM-WSFR008301 PAG-03 Discharges of Stormwater Associated with Industrial Activities  Permit
3800-PM-WSFR0173DRAFT PAG-10 Discharges Resulting From Hydrostatic Testing of Tanks and Pipelines  Permit
3800-PM-WSFR009302 PAG-04 Discharges from Small Flow Treatment Facilities (PAG-04)* Permit
3800-PM-WSFR007604 PAG-06 Wet Weather Overflow Discharge From Combined Sewer Systems  Permit
3800-FM-WSFR0042On-Site Certificate Information Form Form
3800-FM-WSFR0055On-Site Water/Wastewater Class Registration Form Form
3800-FM-WSFR0301Operation and Maintenance Plan* Form
3800-FM-WSFR0108Operator Certification Examination Registration (For DEP Staff) Form
3800-FM-WSFR0109Operator Certification Examination Registration (For Approved Examination Providers (AEPs) Form
3800-FM-WSFR0417PA DEP Periphyton Survey Data Sheet Form
3800-PM-WSFR017103 PAG-05 Discharges from Petroleum Product Contaminated Groundwater Remediation Systems Permit
3800-FM-WSFR0415Pebble Count Form Form
3800-FM-WSFR0063Permit by Rule Registration for Vended Water Systems Form
3800-FM-WSFR0291Permit for Installation of Sewage Disposal System (Internal Use Only) Form
3800-FM-WSFR0081Prequalification for Increased Municipal Reimbursement and New Land Development* Form
3800-FM-WSFR0076Public Notification (PN) Certification Form*  Form
3800-FM-WSFR0033Public Water Supply Inventory and Brief Description Form and Instructions* Form
3800-PM-WSWM0254Public Water Supply Modules* Permit
3800-PM-WSFR0002Public Water Supply Permit Application and Instructions Permit
3800-PM-WSFR0058bQuestion Evaluation Sheet (Internal Use Only) Form
3800-FM-WSFR0339Recordkeeping and Reporting Form and Instructions for PAG-07* Form
3800-FM-WSFR0340Recordkeeping and Reporting Form and Instructions for PAG-08* Form
3800-FM-WSFR0341Recordkeeping and Reporting Form and Instructions for PAG-09* Form
3800-FM-WSFR0423Reporting of Expenses to DEP by AWWA Form
3800-FM-WSFR0410Request for Examination Services Form
3800-FM-WSFR0349Request for Planning Waiver and Non-Building Declaration Request* Form
3800-FM-WSFR0104Residential Septage Lime Stabilization Log Form
3800-FM-WSFR0356Resolution for Plan Revision for New Land Development* Form
3800-FM-WSFR0065Safe Drinking Water Act - Lead and Copper Distribution System Summary Analysis Form
3800-FM-WSFR0031Safe Water Grants Project Construction Inspections Form
3800-FM-WSFR0129SDWA-1 Bacteriological Residual Disinfectant/Turbidity/TTHM Analysis Form
3800-FM-WSFR0128SDWA-4 Inorganic/Organic Chemical Analysis Form
3800-FM-WSFR0130SDWA-5 Monthly Filter Plant Performance Form
3800-FM-WSFR0127SDWA-S Summary Analysis Form
3800-FM-WSFR0093SEO Major Evaluation Form* Form
3800-FM-WSFR0094SEO Minor Evaluation Form* Form
3800-CD-WSFR0359Sewage Facility Planning Module Application Mailer* Form
3800-FM-WSFR0204Sewage Treatment Plant Operations Grant Application (long form)* Form
3800-FM-WSFR0204aSewage Treatment Plant Operations Grant Application (short form)* Form
3800-FM-WSFR0290aSite Investigation and Percolation Test Report for Onlot Disposal of Sewage* Form
3800-FM-WSFR0265Small Drinking Water Systems Engineering Services Program Information Request Form
3800-FM-WSFR0020SOC Monitoring Waiver Application Form and Instructions Form
3800-FM-WSFR0133Source Water Quality Report Form
3800-FM-WSFR0014Special Permit by Rule for Water Vending Machines Form
3800-FM-WSFR0034Specification Certification Form
3800-FM-WSFR0026Sponsor Application Form
3800-FM-WSFR0190Standard Health Effects Language for PN (Appendix B)  Form
3800-FM-WSFR0044Statistically Valid Noncompliance Rates Project* Form
3800-FM-WSFR0044aStatistically Valid Noncompliance Rates Project, Form A* Form
3800-FM-WSFR0044bStatistically Valid Noncompliance Rates Project, Form B* Form
3800-FM-WSFR0073Supplemental Worksheet Part 2.a.2. Residual Organic Nitrogen from Biosolids Application in Current Year Form
3800-FM-WSFR0074Supplemental Worksheet Part 2.a.3. Available Residual Nitrogen from Historical Manure Applications Form
3800-FM-WSFR0414Supplemental Worksheet (Part 2.a.2. and Part 4) Volatilization and Mineralization Rate Tables Form
3800-FM-WSFR0078Surface Waters Assessment Field Form: Wadeable Streams Form
3800-FM-WSFR0006Surface Water Supply Monthly Turbidity Report Form
3800-FM-WSFR0005Task/Activity Report and Instructions Form
3800-FM-WSFR0182-188Tier 1 Notices* Form
3800-FM-WSFR0193 Instructions for completing a Tier 2 notice for violation of the total coliform MCL Form
3800-FM-WSFR0036Training Course Certified Operator Roster Report Application
3800-FM-WSFR0355Transmittal Letter for Sewage Facilities Planning Module* Form
3800-FM-WSFR0192Turbidity (Monthly Violation) Form
3800-FM-WSFR0290bVerification of Prior Testing* Form
3800-FM-WSFR0082VOC Analysis for a Modified Minor Permit Amendment for Water Storage Tank Repainting (EPA Method 502.2) Form
3800-FM-WSFR0083VOC Analysis for a Modified Minor Permit Amendment for Water Storage Tank Repainting (EPA Method 524.2) Form
3800-FM-WSFR0427Voluntary Water Conservation Notice Form
3800-FM-WSFR0401Water Quality Instream Flow Measurements Form
3800-PM-WSFR0400Water Quality Management Permit Application Permit
3800-FM-WSFR0402Water Quality Network Habitat Assessment (Riffle/Run Prevalence) Form
3800-FM-WSFR0400Water Quality Network Regional Monthly Gauge Report Form
3800-FM-WSFR0106Water Supply Inspection Report Form
3800-FM-WSFR0054Water/Wastewater Class Scheduling Form Form
3800-FM-WSFR0013Water/Wastewater Operator Training Student Tracking List Form
3800-FM-WSFR0138Water/Wastewater Outreach Classroom Bi-Weekly Time Sheet Supplemental Form
3800-FM-WSFR0070Worksheet B1 Biosolids Annual Agronomic Loading Rate Form
3800-FM-WSFR0071Worksheet B2 Biosolids Cumulative Pollutant Loading Rates (CPLRs) on Land Application Sites Form
3800-FM-WSFR0072Worksheet RSI Residential Septage Annual Agronomic Loading Rate Form
3800-PM-WSFR0020WQG-01 Water Quality Management General Permit for Small Flow Treatment Facilities* Permit
3800-PM-WSFR0045WQG-02 Water Quality Management General Permit for Sewer Extensions and Pump Stations* Permit
3800-PM-WSFR0179aWQM Post Construction Certification Permit
3800-PM-WSFR0179b WQM Post Construction Certification Manure Storage Facility Checklist Permit

* These forms have links that go to a folder in eLibrary containing all additions of that particular form.
(Internal Use Documents) - Only found in Environmental Print Shop (Not for public use)

Key to Acronyms
DW = drinking water
TFA = technical & financial assistance
WW = wastewater
WQS = water quality standards
PDF = Portable Document Format from Adobe PDF Logo
Word = Microsoft Word Document Word Logo
N/A = not available in this file format
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