Wastewater Forms
Water, Wastewater & Wetlands: Wastewater Forms
Groundwater Discharge
Certification Statement
Revised May 2010.
To accompany Forms BRP WP 11, 68, 79, 80, 81, 84, 85, 86, 87, 88, 89, and 90 as required.
Filing Options: MS Word Form 113 KB | PDF Form 11 KB
BRP WP 83 - Hydrogeologic Evaluation Report
Revised August 2011.
Filing Options: MS Word Form 179 KB | PDF 292 KB
Instructions: MS Word 683 KB | PDF - included with form above
BRP WP 79 - Individual Permit for Sewage Treatment Plant
BRP WP 85 - Individual Permit for Other Groundwater Discharges
Revised September 2009.
Filing Options: MS Word Form 343 KB | PDF 86 KB
Instructions: MS Word 319 KB | PDF - included with form above
BRP WP 11 - Groundwater Discharge Renewal with Plan Approval
BRP WP 12 - Groundwater Discharge Renewal without Plan Approval
Revised November 2011.
Applicants filing BRP WP 12 should refer to BRP WP 81 below to see if they qualify for administrative renewal.
Filing Options: MS Word Form 294 KB | PDF 83 KB
Instructions: MS Word 247 KB | PDF - included with form above
BRP WP 82 - Administrative Renewal of Groundwater Discharge Permit
Revised September 2009.
Filing Options: MS Word Form 125 KB | PDF 50 KB
Instructions: MS Word 265 KB | PDF - included with form above
BRP WP 80 - General Permit Coverage for Specified Discharges
BRP WP 81 - General Permit Coverage for Small Wastewater Treatment Facilities
General Permits Revised May 2011.
Filing Options: MS Word Form 253 KB | PDF 76 KB
Instructions: MS Word 311 KB | PDF - included with form above
General Permits Associated with BRP 80 & BRP 81
General Permit for Car Washes (BRP 80):
Fact Sheet: MS Word 56 KB | PDF 21 KB
General Permit: MS Word 103 KB | PDF 124 KB
General Permit for Small Privately Owned Treatment Facilities (PSTFs) (BRP 80, 81):
Fact Sheet: MS Word 25 KB | PDF 64 KB
General Permit: MS Word 113 KB | PDF 118 KB
General Permit for Small Publicly Owned Wastewater Treatment Facilities (POTFs) (BRP 80, 81):
Fact Sheet: MS Word 60 KB | PDF 23 KB
General Permit: MS Word 106 KB | PDF 125 KB
BRP WP 68 - Treatment Works Plan Approval
Revised September 2009.
Instructions: MS Word 91 KB | PDF 36 KB
Deleted Groundwater Discharge Permit Application Categories
BRP WP 05 Groundwater Discharge - Experimental
This permit category has been deleted. Refer to new permit BRP WP 85.
BRP WP 06, 08 - Groundwater Discharge - Major & Minor
This permit category has been deleted. Refer to new permits BRP WP 79 or BRP WP 81.
BRP WP 10 - Groundwater Discharge - Other
This permit category has been deleted. Refer to new permits BRP WP 80 or BRP WP 85.
BRP WP 42 Groundwater Discharge - Reclamation Projects
This permit category has been deleted.
Groundwater Discharge Reporting
Groundwater Discharge Report Forms
Filing Options: 
Instructions & FAQs: Web page
Other Related Groundwater Forms
Trust Agreement for Capital Reserve Account for Groundwater Discharge Permits and Renewals
Revised June 2010.
Filing options: MS Word Form 120 KB | PDF Form 539 KB
Escrow Agreement for Immediate Repair and/or Replacement Account for Groundwater Discharge Permits and Renewals
Revised June 2010.
Filing options: MS Word Form 116 KB | PDF Form 37 KB
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Water, Wastewater & Wetlands: Wastewater Forms
Reclaimed Water Use
BRP WP 84 - Individual Permit for Reclaimed Water Use
Revised August 2011.
Filing Options: MS Word Form 299 KB | PDF 86 KB
Instructions: MS Word 311 KB | PDF - included with form above
BRP WP 84 - Supplemental Application Form for Reclaimed Water Use
Revised August 2011.
Filing Options: MS Word Form 135 KB | PDF 20 KB
BRP WP 79 - Individual Permit for Sewage Treatment Plant
Revised September 2009.
Filing Options: MS Word Form 343 KB | PDF 86 KB
Instructions: MS Word 319 KB | PDF - included with form above
Certification Statement
Revised May 2010.
To accompany Forms BRP WP 11, 68, 79, 80, 81, 84, 85, 86, 87, 88, 89, and 90 as required.
Filing Options: MS Word Form 113 KB | PDF Form 11 KB
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Water, Wastewater & Wetlands: Wastewater Forms
Industrial Wastewater/Holding Tanks
BRP WP 86 - Permit and Plan Approval for Type II Wastewater Treatment Facility
BRP WP 87 - Permit and Plan Approval for Type I Wastewater Treatment Facility
BRP WP 88 - Permit Renewal or Modification, with Plan Modification of Wastewater Treatment Facility for BRP WP 86 or BRP WP 87
BRP WP 89 - Permit Renewal or Modification, without Plan Modification of Wastewater Treatment Facility for BRP WP 86 or BRP WP 87
BRP WP 90 - Plan Approval Modification for BRP WP 86 or BRP WP 87
Revised August 2011.
Filing Options: MS Word Form 330 KB | PDF 114 KB
Instructions: MS Word 305 KB | PDF - included with form above
BWP IW 02, 03, 05, 30, 31, 32 - Groundwater Discharge
This permit category has been deleted. Refer to BRP WP 86, BRP WP 87, BRP WP 88, BRP WP 89, and BRP WP 90 above.
BWP IW 16, 18, 26, 27, 35, 36, 37 - Surface Water Discharge (NPDES)
Revised October 2005 (Instructions Revised January 2011).
Filing Options: MS Word 327 KB | PDF 411 KB
Instructions: MS Word 466 KB | PDF - included with form above
BWP IW 38, 39 - Permit for Industrial Sewer User
Revised March 2008.
Application Form
MS Word Form 312 KB
Instructions
MS Word 608 KB
Toxic Pollutants Form
MS Word Form 210 KB
Additional IWPS Form
MS Word Form 180 KB
Documentation of Public Notice Form
MS Word 134 KB
Fact Sheet for Facilities in the MWRA Service Area
MS Word 45 KB
NOTE: If you need these forms in an alternate format, please contact John Reinhardt at 617-292-5667 or john.reinhardt@state.ma.us.
Related: Draft & Final Permits for Facilities withIndustrial Wastewater Sewer Connections
Web page
Industrial Wastewater Sewer Connection Certification
Web page
Industrial Wastewater Holding Tank Forms
Compliance Certification (DEP 01) & Return to Compliance Plan
Web page
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Water, Wastewater & Wetlands: Wastewater Forms
Residuals Management Approvals
BRP WP 28 Sampling and Analysis Plan Approval
BRP WP 29 Approval of Suitability (AOS)
BRP WP 30 Certification of Land Application Projects Greater than or Equal to 0.5 Acres in Size
BRP WP 31 Certification of Land Application Projects Less than or Equal to 0.5 Acres in Size
BRP WP 32 Renewals or Modifications to Land Application Certifications
Revised November 2010.
Filing Options: MS Word Form 579 KB | PDF 251 KB
Instructions: MS Word 542 KB | PDF - included with form above
BRP WP 33 - Approval of Wastewater Treatment Residual Landfills
Revised June 2007.
Instructions: MS Word 572 KB | PDF 154 KB
BRP WP 34 - Approval of Closure Plans for Wastewater Residual Landfills
Revised June 2007.
Instructions: MS Word 521 KB | PDF 158 KB
BRP WP 35 - Approval of Design Plans and Specifications for Residuals Treatment Facilities
Revised June 2007.
Instructions: MS Word 521 KB | PDF 51 KB
BRP WP 44 Modifications to Residuals Management Landfills
Revised June 2007.
Instructions: MS Word 523 KB | PDF 157 KB
BRP WP 45 - Modifications to Residuals Management Facilities
Revised June 2007.
Instructions: MS Word 486 KB | PDF 57 KB
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Water, Wastewater & Wetlands: Wastewater Forms
Sanitary Sewer Overflow/Bypass/Backup Notification
Owners and operators of wastewater collection or treatment systems must notify MassDEP by phone and in writing whenever there is an emergency overflow, bypass of wastewater or a backup of sewage into a building, within 5 days of the time you become aware of the overflow, bypass or backup.
Revised July 2010.
Filing Options: MS Word Form 182 KB | PDF Form 106 KB
Instructions: MS Word 176 KB | PDF - included with form above
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Water, Wastewater & Wetlands: Wastewater Forms
Sewer Connections/Extensions
Important Note: The Bureau of Resource Protection (BRP) issues sewer connection and extension permits for domestic sewage from residential, educational, and commercial facilities. The Industrial Wastewater Program of the Bureau of Waste Prevention (BWP) issues permits for wastewater generated by certain industrial facilities.
List by SIC Code of industrial facilities regulated by BWP
Web page
BWP IW 38, 39 - Permit for Industrial Sewer User
Revised January 2007.
Web page
Industrial Wastewater Sewer Connection Certification
Web page
BRP WP 55, 71, 74 - Sewer System Extension, Connection, or Industrial Wastewater
Revised January 2007.
Filing Options: MS Word Form 198 KB | PDF 70 KB
Instructions: MS Word 252 KB | PDF - included with form above
BRP WP 72, 73 - Compliance Certification for Sewer Extensions less than 1000 ft or Sanitary & Industrial Connections 15,000-50,000gpd
Revised January 2007.
Filing Options: MS Word Form 174 KB | PDF 66 KB
Instructions: MS Word 135 KB | PDF - included with form above
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Water, Wastewater & Wetlands: Wastewater Forms
Stormwater
How Stormwater Permitting Works
Web page
BRP WM 08 - NPDES Stormwater General Permit Notice of Intent for Discharges from Small Municipal Separate Storm Sewer Systems (MS4s)
Revised March 2007.
Filing Options: MS Word 161 KB | PDF 206 KB
Instructions: MS Word 306 KB | PDF - included with form above
Excel Time Frames Form: MS Excel 161 KB | PDF 60 KB
BRP WM 09 - Approval of NPDES Stormwater Pollution Prevention Plans for Construction or Industrial General Permits Discharging to Outstanding Resource Waters (ORWs)
Revised March 2007. (Instructions revised November 2008.)
Filing Options: MS Word 121 KB | PDF 113 KB
Instructions: MS Word 329 KB | PDF - included with form above
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Water, Wastewater & Wetlands: Wastewater Forms
Surface Water Discharge Permits (NPDES General Permits)
NPDES Permitting Q&A
Web page
BRP WM 10 - Request for General Permit Coverage: Dewatering General Permit
Revised April 2009.
MassDEP is accepting US EPA's Notice of Intent Form for this Permit.
Instructions: MS Word 60 KB | PDF 34 KB
More information from US EPA:
Dewatering General Permit (DGP)
US EPA Website
US EPA NOI form and instructions
US EPA Website
BRP WM 11 - Request for General Permit Coverage: Surface Water Discharge Of Non-Contact Cooling Water
Revised January 2009
MassDEP is accepting US EPA's Notice of Intent Form for this Permit.
MassDEP instructions: MS Word 63 KB | PDF 38 KB
More information from US EPA:
Noncontact Cooling Water General Permit (NCCWGP)
US EPA Website
US EPA NOI form and instructions:
NOI Form | NOI Instructions
BRP WM 12 - Request for General Permit Coverage: Remediation & Miscellaneous Contaminated Sites
Revised June 2007.
MassDEP is accepting EPA's Notice of Intent Form for this permit.
More information from US EPA:
US EPA Website
EPA Form ("Notice of Intent Instructions and Suggested Form")
US EPA Website
Instructions: MS Word 270 KB | PDF 35 KB
BRP WM 13 - Request for General Permit Coverage: Surface Water Discharge from Potable Water Treatment Facilities
Revised September 2009.
MassDEP is accepting EPA's Notice of Intent Form for this permit.
More information from US EPA
US EPA Website
US EPA NOI form and instructions ("Appendix IV: Notice of Intent (NOI) Instructions and Suggested Form")
US EPA Website
Instructions: MS Word 259 KB | PDF 39 KB
BRP WM 14 - Request for General Permit Coverage: Pesticide General Permit
Revised January 2012.
MassDEP is accepting EPA's Notice of Intent Form for this permit.
MassDEP Instructions: MS Word 40 KB | PDF 22 KB
More information from US EPA
Pesticide General Permit (PGP)
US EPA Website
US EPA NOI Form and Instructions
US EPA Website
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Water, Wastewater & Wetlands: Wastewater Forms
Surface Water Discharge (NPDES-Non-Industrial)
BRP WM 02A - Application for Permit to Discharge Municipal Wastewater
Revised August 2007.
Filing Options MS Word Form 186 KB | PDF Form 63 KB
Instructions: MS Word 392 KB | PDF - included with form above
BRP WM 05 - Permit and Plan Approval for Type II Discharge (Non-Industrial)
Revised May 2003.
Filing Options MS Word 191 KB | PDF 87 KB
Instructions: MS Word 503 KB | PDF - included with form above
BRP WM 06 - Permit and Plan Approval for Type I Discharge (Non-Industrial)
Revised May 2003.
Filing Options MS Word 160 KB | PDF 87 KB
Instructions: MS Word 503 KB | PDF - included with form above
BRP WM 07 - Permit Renewal/Plan Modification (Non-Industrial)
Revised June 2007.
Filing Options MS Word 191 KB | PDF 87 KB
Instructions: MS Word 503 KB | PDF - included with form above
BRP WP 68 - Treatment Works Plan Approval (June 2007)
Revised June 2007.
Instructions: MS Word Form 411 KB | PDF Form 29 KB
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Water, Wastewater & Wetlands: Wastewater Forms
Wastewater Operator Certification
Graded wastewater treatment plants by town
Revised March 2009.
These grading lists determine the necessary certification level for treatment plant operators. Contact the Board of Wastewater Treatment Plants Certification Program in writing if there are any changes to your facility name, address or grading.
Combined municipal and industrial list: MS Word 404 KB | PDF 220 KB
List of municipal WT plants: MS Word 97 KB | PDF 56 KB
List of industrial WT plants: MS Word 272 KB | PDF 144 KB
Status Change Form
Revised March 2009.
For changes in operator contact information or to make other changes in status that do not require passing an exam.
Filing Options: MS Word 51 KB | PDF 33 KB
Upgrade to Emergency Certification
Revised March 2009.
To enable an operator to work at a facility for up to six months in a position for which the operator is not otherwise certified.
Filing Options: MS Word 44 KB | PDF 24 KB
Upgrade to Provisional Certification
Revised March 2009.
To allow an operator with emergency certifications to continue as operator at a specified facility for an additional six months under certain circumstances.
Filing Options: MS Word 45 KB | PDF 25 KB
Upgrade to Combined Grade 7
Revised March 2009.
To certify an operator as Grade 7.
Filing Options: MS Word 44 KB | PDF 25 KB
Reciprocity
Revised March 2009.
To allow an operator certified in other states to apply for certification in Massachusetts.
Filing Options: MS Word 45 KB | PDF 25 KB
Statement of Qualifications
Revised October 2005.
To document an operator's status as a certified operator.
Filing Options: MS Word 31 KB | PDF 12 KB
Education Requirements for Recertification
Revised October 2005.
Documentation requirements for training or coursework in order for operators to receive Training Contact Hours.
Filing Options: MS Word 39 KB | PDF 25 KB
Request for Training Contact Hours Evaluation
Revised October 2005.
To be used by providers of training and/or operators to provide information about opportunities to earn Training Contact Hours.
Filing Options: MS Word 33 KB | PDF 20 KB
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