Forms and Instructions

Publications Main Menu

Click to jump to these topics
Backflow Prevention
Disinfectants & Disinfection Byproducts
Detail Plan Review
Drinking Water Emergency Loan Fund
Emergency Plan
Filter Backwash Requirements
Sample Submission Report (SSR) Forms and Instructions
Surface Water Treatment

Backflow Prevention

• Backflow Prevention and Cross Connection Control, Protecting Our Public Water System

Disinfectant/Disinfection Byproducts Rules

• Ohio EPA Form 5022 (Rev. 1/02), Disinfection By-Product Sample Submission Report (SSR)
• Ohio EPA Form 5114, Total Chlorine Residual Quarterly Operating Report
• Ohio EPA Form 5115, Total Organic Carbon (TOC) Monitoring Quarterly Operating Report And Instructions
• Ohio EPA Form 5116, Chlorite, Bromate and Chlorine Dioxide Monthly Operating Report
• D/DBPR Sample Monitoring Plan Instructions and Template
  • Ground Water Systems
  • Surface Water Systems
• Ohio EPA Form 5115-A, Application for Approval of Alternative Minimum Total Organic Carbon (TOC) Removal Percentage (Step 2)
   

Detail Plan Review

• Plan Approval Application EPA Form 5300 (Water Supply Data Sheet)
• Plan Review Procedures for Drinking Water Facilities
• Project Summary Sheets
  • Proposed waterline extensions;   WPD  |  PDF | WORD
  • Proposed storage tanks;  WPD  |  PDF | WORD
  • Proposed pump stations; and/or   WPD  |  PDF | WORD
  • Proposed pressure reducing stations and air relief valves.  WPD  |  PDF | WORD

Drinking Water Emergency Loan Fund (DWELF)

• Drinking Water Emergency Loan Fund Fact Sheet
• Application Form - Drinking Water Protection Fund, Emergency Loan Application
• Attachment A- Repayment Schedule
• W-9 - Request for Taxpayer Identification Number and Certification

Emergency Plans

• Contingency Plan (Drinking Water)

Filter Backwash Forms

• Filter Backwash Recycling Rule - Recycle Notification Form
• Filter Backwash Recycling Rule – Recordkeeping Form
   

Sample Submission Report (SSR) Forms and Instructions

• Complete Listing of Submission Forms and Instructions

• DRINKware SSR Reporting Instructions

• Paper SSR Reporting Instructions

• Fax Notification Sheet For Chemical Analytical Results Exceeding MCL Standards
• Fax Notification Sheet For Positive Microbiological Results

Surface Water Treatment

• Ohio EPA Form 5109-A (Rev. 12/03), Addendum for Individual Filter Turbidity Results Monthly Operation Report (MOR)
• Instructions For Completing 5109-A (Rev. 12/03)
• Ohio EPA Form 5109-B (Rev. 12/03), Addendum for Individual Filter Turbidity Results Monthly Operation Report (MOR)
• Instructions For Completing 5109-B (Rev. 12/03)
• Checklist for Review and Optimization of Treatment for Protection Against
  Waterborne Disease (Surface Water Plants)