Title 5 Septic System Forms

 

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

Revised June 2009.
Filing Options: MS Word Form 228 KB | PDF Form 61 KB
Instructions: MS Word 264 KB | PDF - included with form above

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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

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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 June 2007.
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, 75a, 75b - 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 75a: Modification of Approval or Certification for Alternative Technology
BRP WP 75b: Renewal of Approval or Certification for Alternative Technology

Revised June 2009.
Filing Options: MS Word Form 268 KB | PDF Form 93 KB
Instructions: MS Word 207 KB | PDF - included with form above

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Title 5 Official Inspection Form

For all Title 5 systems. Revised November 2010 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 313 KB | PDF Form 143 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 - revised June 2011.
Filing Options: MS Word Form 145 KB | PDF Form 42 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 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

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

Revised January 2010.
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 June 2007.
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 June 2007.
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 June 2007.
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 June 2007.
Filing Options: MS Word Form 157 KB | PDF Form 70 KB
Instructions: MS Word 343 KB | PDF - included with form above

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BRP WP 58b - Approval for installation of Shared System

Revised June 2007.
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 May 2009.
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

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

Revised June 2007.
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 June 2007.
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 66a: Approval of Large System Expansion or Upgrade
BRP WP 66b: Public Health, Safety, Welfare, Environment, or Consistency Approval of an upgrade of a large system

Revised May 2009.
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 June 2007.
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

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