Get Adem Form 415

This guide will provide you with step-by-step instructions for completing the Adem Form 415 online, used for reporting sanitary sewer overflow events. Whether you're familiar with digital forms or new to the process, this comprehensive guide will assist you in ensuring all necessary details are submitted correctly.

Follow the steps to fill out the Adem Form 415 online.

1. Press the ‘Get Form’ button to obtain the form and open it in the digital editor.
2. Begin by entering the permittee's name in the designated field.
3. Next, enter the permit number and facility name. Ensure all details are accurate and match official records.
4. Input the county where the overflow incident occurred, followed by the date and time the sanitary sewer overflow (SSO) began.
5. Record the date and time the SSO stopped. This is important for timing and volume calculations.
6. Estimate the volume discharged in gallons. You must select one of the options provided: <1,000gal, >1,000gal, >10,000gal, >100,000gal, or >1,000,000gal.
7. Indicate if the Department was verbally notified within 24 hours by selecting ‘Yes’ or ‘No’.
8. Fill in the date and time of this notification and include the name of the person who notified the Department, along with their contact phone number.
9. Specify whether you contacted the SSO hotline by selecting ‘Yes’ or ‘No’.
10. Indicate the source of the discharge event by selecting the relevant option(s) such as manhole, cleanout, lift station, treatment plant, broken line, or other, and provide descriptions if necessary.
11. Detail the location of the discharge including a street address or other specific identifiers.
12. Describe the known or suspected cause of the discharge.
13. Record where the discharge ultimately ended up by selecting your options for destination such as storm drain or other locations.
14. Indicate the monitoring method of the receiving water: ground absorption, creek or river (Provide name), drainage ditch, or other.
15. In the provided space, describe any corrective actions taken, plans to prevent future discharges, and efforts to mitigate environmental or public health impacts.
16. Indicate how you notified the public, checking all relevant methods such as press release, signage placement, or state that notice was not required, explaining why if applicable.
17. Select other officials that were notified, checking all relevant options, or state reasons why notifications were not required.
18. If applicable, indicate if any public water supply intake locations were affected.
19. Provide the name and title of the facility representative responsible for the information submitted.
20. Affix the signature of the responsible official and add the date.
21. If the discharge was greater than 10,000 gallons, ensure you attach a copy of a USGS quad sheet or another geographically referenced map showing all discharge locations.
22. Once you have completed the form, save the changes, and choose whether to download, print, or share it as needed.

Start filling out your Adem Form 415 online today to ensure accurate and timely reporting of sanitary sewer overflow events.