Georgia Environmental Protection Division

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EPD Forms
Watershed Protection Branch

Please Note:

As of February 2014, the Georgia EPD Watershed Protection Branch offices have relocated from the

4220 International Parkway location to the Capitol Hill area.

Please refer to the New WPB Program/Unit Addresses and Contact Numbers for more information.

This page contains links to frequently requested forms and instructions and other information for the Watershed Protection Branch. Download these forms by right-clicking and selecting "Save Link (Target) As" to save them to your computer.

Branch and Regulated Facility Group Contact Person Contact Phone

Drinking Water

Application and Modification Forms


Sanitary Survey for Public Water Systems


Treatment Plant Monthly Operating Report Forms


Disinfection Byproducts (TTHM & HAA5) Report Forms


Certifications for Drinking Water

Ted Jackson 404.651.5155

Erosion and Sedimentation

*link to Technical Guidance page*


Michael Berry

Frank Carubba

Peggy Chambers

Jan Sammons






Engineering and Technical Support (Wastewater)


Jane Hendricks


Non-Point Source


Section 319(h) Georgia’s Nonpoint Source Implementation Grant

Under Section 319(h) of the Clean Water Act, the U.S. Environmental Protection Agency (USEPA) awards a Nonpoint Source Implementation Grant to the Georgia Environmental Protection Division (GAEPD) to fund projects in support of Georgia’s Nonpoint Source Management Program. Funding is distributed via a competitive process to projects that will lead to direct reductions in pollutant loads and measurable water quality improvements. The maximum amount of individual Federal awards is $400,000 over a maximum timeline of 3 years.

Update July 2, 2013: FY2014 funds are now available.

Visit the Georgia EPD Nonpoint Source Grant page for FY2014 Grant Announcement, Application and Guidance materials for your proposals. 

Application Deadline is OCTOBER 31, 2013


Jeff Linzer 404.651.8532

Storm Water


Update Sept. 30, 2013:

For information regarding the NPDES Construction Storm Water General Permit Re-Issuance and public hearing, please visit Georgia EPD NPDES Construction Storm Water General Permits page.

Notice of Intent Forms *New for Version 2013*


Notice of Termination Forms *New for Version 2013*


Construction Land Disturbance Fees Form


The 2012 NPDES General Permit No. GAR050000 for Storm Water Discharges Associated with Industrial Activity (2012 IGP) was issued April 16, 2012. This is the replacement permit for the 2006 IGP (GAR000000) which expired on July 31, 2011. The new general permit became effective on June 1, 2012.

FINAL PERMIT AND FORMS: NPDES General Permit No. GAR050000 for Storm Water Discharges Associated with Industrial Activity (2012 IGP) [April 16, 2012]

Existing permitttees will have 30 days after the effective date of the 2012 IGP to submit a 2012 Notice of Intent (2012 NOI, Version 2012 only) to obtain coverage under the new permit.

New facilities and/or facilities that are seeking new coverage under the 2012 IGP must submit an NOI 7 days before commencing discharge.

The 2012 forms (Notice of Intent, No Exposure Exclusion, Notice of Termination and Annual Report Form) are now available on the NPDES Industrial Storm Water General Permits web page. Older versions of these forms will not be accepted.

For information regarding GAR050000 contact Dan Loudermilk, Lyn Mickelson or Frances Carpenter at 404.651.8548. 










Jan Sammons






















Dan Loudermilk

Lyn Mickelson

Frances Carpenter











Mildred Granderson

Connie Haynes

Lyn Mickelson

Lisa Perrett















































Wastewater (NPDES & LAS)

NPDES forms are available from USEPA NPDES Permit Program Basics: Permit Applications and Forms page.  Below are direct links to most recent forms available from USEPA. *updated*

Land Application System Permit Form

Pretreatment Permit Form

Notice of Intent Form



Gigi Steele




Jane Hendricks







Underground Injection Control


Bijan Rahbar 404.656.3229
Water Well Standards


Jim Kennedy

Ted Jackson



Water Withdrawal Permitting



Municipal and Industrial Surface Water



Municipal and Industrial Groundwater


All Groundwater Permit Applicants Must Complete:


Municipal Groundwater Permit Applicants Must Also Complete:


Industrial Groundwater Permit Applicants Must Also Complete:

Golf Course Groundwater Permit Applicants Must Also Complete:





Cliff Lewis












Surface Water

Lebone Moeti













Bill Frechette
































Updated 04/09/2014


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Georgia Environmental Protection Division
Georgia Department of Natural Resources
2 Martin Luther King Jr. Drive, Suite 1456 East Tower
Atlanta, GA 30334
Telephone: 404.657.5947 or 888.373.5947 (toll-free throughout Georgia)
Copyright © 2013 by the Georgia Environmental Protection Division. All rights reserved.