BRP WP 62 - Determination of Acceptability for the use of Septic System Additives or Soil Absorption System Conditioners/Restoratives and Approval of Septic Tank Effluent Tee Filters

Revised March 2008.
Filing Options: MS Word Form 169 KB | PDF Form 59 KB
Instructions: MS Word 220 KB | PDF - included with form above

Back to Title 5 forms index

Form 7 - Letter of Noncompliance

Revised June 2003.
Form that notifies system owners of non-complying on-site systems.
Filing Options: MS Word Form 39 KB | PDF Form 9 KB

Form 8 - Enforcement Order Form 

Revised June 2003.
For use by local Boards of Health in local enforcement actions.
Filing Options: MS Word Form 51 KB | PDF Form 12 KB

Back to Title 5 forms index

BRP WP 57, 64b, 64c - Installation of Alternative Systems
BRP WP 57 - Recirculating Sand Filter (RSF) or Approved Equivalent; BRP WP 64b - Alternative System for Piloting
BRP WP 64c - Alternative System for Remedial Use

Revised December 2003.
Filing Options: MS Word Form 153 KB | PDF Form 72 KB
Instructions: MS Word 383 KB | PDF - included with form above

BRP WP 61a, 61b, 61c 61f - Approval of Alternative Technologies
BRP WP 61a: Approval of Alternative Technology for Remedial Use
BRP WP 61b: Approval of Alternative Technology for Piloting, Provisional Use, or Certification for General Use
BRP WP 61c: Approval of Alternative Devices for Grease Removal
BRP WP 61f: Renewal of Approval or Certification of Alternative Technology

Revised September 2004.
Application to be submitted to MassDEP for approval of use of I/A technologies in Massachusetts.
Filing Options: MS Word Form 229 KB | PDF Form 96 KB
Instructions: MS Word 372 KB | PDF - included with form above

Back to Title 5 forms index

Title 5 Official Inspection Form

For large systems, shared systems, and state and federal facilities. Revised September 2008 to include clearer indicators for system conditions, more room for detailed descriptions, instructions for including a system sketch, and a report completeness checklist.
Filing Options: MS Word Form 297 KB | PDF Form 62 KB

Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems

Revised November 2005.
For Massachusetts Certified Wastewater Operators inspecting I/A systems
Filing Options: MS Word Form 124 KB | PDF Form 16 KB
For Operators inspecting I/A systems that do not require a Massachusetts Certified Wastewater Operator
Filing Options: MS Word Form 137 KB | PDF Form 26 KB

Inspection and O&M Form and Checklist for Title 5 Greywater Disposal Systems Piloting

Revised October 2005.
For Massachusetts-registered Professional Engineers or Sanitarians inspecting of greywater systems
Filing Options: MS Word Form 179 KB | PDF Form 22 KB

Bottomless Sand Filter Technology Checklist

Revised April 2006.
For Massachusetts Certified Wastewater Operators inspecting Bottomless Sand Filters
Filing Options: MS Word 122 KB | PDF 20 KB

Operation & Maintenance Inspection Checklist Form for Recirculating Sand Filter (RSF) Systems

Revised October 2006.
Filing Options: MS Word Form 126 KB | PDF Form 18 KB

Form 4 - System Pumping Record

Revised March 2006.
To record results of system pumping
Filing Options: MS Word Form 45 KB | PDF Form 13 KB

Form 5 - Application for Septage Hauler Permit

Revised June 2003.
For persons seeking a license to pump and haul septage.
Filing Options: MS Word Form 46 KB | PDF Form 13 KB

Form 6 - Septage Hauler Permit

Revised June 2003.
Permit issued by the Board of Health to persons licensed to pump and haul septage.
Filing Options: MS Word Form 30 KB | PDF Form 8 KB

Back to Title 5 forms index

Form 11 - Soil Suitability Assessment for On-Site Sewage Disposal

Revised October 2007.
Filing Options: MS Word Form 185 KB | PDF Form 35 KB

Form 12 - Percolation Test for MassDEP-approved Soil Evaluators

Revised June 2003.
Filing Options: MS Word Form 50 KB | PDF Form 13 KB

Form 1A - Application for Disposal System Construction Permit

Revised June 2003.
Submitted to the Board of Health to begin construction or repair of a site.
Filing Options: MS Word Form 70 KB | PDF Form 17 KB

Form 2A - Disposal System Construction Permit

Revised June 2003.
Approval to begin construction or repair of an on-site system.
Filing Options: MS Word Form 44 KB | PDF Form 10 KB

Form 3 - Certificate of Compliance

Revised June 2003.
Issued by the Board of Health when an on-site system has been installed or repaired.
Filing Options: MS Word Form 41 KB | PDF Form 10 KB

On-site System Installation Checklist

Revised June 2003.
Filing Options: MS Word Form 171 KB | PDF Form 26 KB

BRP WP 63 - Disposal System Construction Permit for State or Federal Facilities

Revised August 2001.
Submitted when beginning construction or repair of an on-site system owned by state or federal agencies.
Filing Options: MS Word Form 141 KB | PDF Form 62 KB
Instructions: MS Word 446 KB | PDF - included with form above

BRP WP 64a - Approval of Tight Tank

Revised July 2001.
Filing Options: MS Word Form 144 KB | PDF Form 63 KB
Instructions: MS Word 343 KB | PDF - included with form above

BRP WP 67 - Title 5 - Approval for Pumping Sewage Prior to Septic Tank

Revised July 2003.
Filing Options: MS Word 134 KB | PDF 63 KB
Instructions: MS Word 457 KB | PDF - included with form above

BRP WP 58a - Approval of a Nitrogen Aggregation Loading Plan

Revised December 2003.
Filing Options: MS Word Form 157 KB | PDF Form 70 KB
Instructions: MS Word 343 KB | PDF - included with form above

Back to Title 5 forms index

BRP WP 58b - Approval for installation of Shared System

Revised December 2003.
Filing Options: MS Word Form 152 KB | PDF Form 63 KB
Instructions: MS Word 444 KB | PDF - included with form above

Form 10a - Application for Shared Disposal System Construction Permit

Revised June 2003.
Filing Options: MS Word Form 98 KB | PDF Form 21 KB

Form 10b - Shared Disposal System Construction Permit

Revised June 2003.
Filing Options: MS Word Form 48 KB | PDF Form 14 KB

Form 10c - Certificate of Compliance for Shared Disposal System  

Revised June 2003.
Issued by the Board of Health
Filing Options: MS Word Form 39 KB | PDF Form 9 KB

Back to Title 5 forms index

BRP WP 59b - MassDEP Approval of Variance granted by Board of Health, except Variance for Increased Flow to Existing System

Revised July 2001.
Filing Options: MS Word Form 160 KB | PDF Form 64 KB
Instructions: MS Word 451 KB | PDF - included with form above

BRP WP 59c - MassDEP Approval or Issuance of Variance for Increased Flow

Revised July 2001.
Filing Options: MS Word Form 148 KB | PDF Form 72 KB
Instructions: MS Word 452 KB | PDF - included with form above

BRP WP 60 - Variances for Schools

Revised December 2003.
Submitted to MassDEP for variances to Title 5 regulations governing schools.
Filing Options: MS Word Form 147 KB | PDF Form 61 KB
Instructions: MS Word 458 KB | PDF - included with form above

BRP WP 61d: Upgrade of a Failing Large System
BRP WP 61e: Determination of Manifest Injustice for Large Systems

Revised December 2003.
Approval for an upgrade of a large system and determination of manifest injustice for large systems pursuant to 310 CMR 15.304.
Filing Options: MS Word Form 150 KB | PDF Form 64 KB
Instructions: MS Word 450 KB | PDF - included with form above

BRP WP 66a: Approval of Large System Expansion or Upgrade (except State, Federal, or Failed Systems)
BRP WP 66b: Public Health, Safety, Welfare, Environment, or Consistency Approval of an upgrade of a large system

Revised March 2002.
Filing Options: MS Word Form 150 KB | PDF Form 66 KB
Instructions: MS Word 447 KB | PDF - included with form above

BRP WP 70: Alternative Design Flow for Title 5 Systems

Revised December 2003.
Filing Options: MS Word Form 135 KB | PDF Form 89 KB
Instructions: MS Word 180 KB | PDF - included with form above

Form 9A - Application for Local Upgrade Approval

Revised July 2006.
Filing Options: MS Word Form 85 KB | PDF Form 24 KB

Form 9B - Local Upgrade Approval Form

Revised July 2006.
Filing Options: MS Word Form 58 KB | PDF Form 15 KB

Back to Title 5 forms index