1. Instructions: BRP WS 10 doc format of Cross Connection Cert. Instructions pdf format of BRP WS 10 - Cross Connection Certification

  2. Form: BRP WS 10 doc format of BRP WS 10 - Cross Connection Certification pdf format of BRP WS 10 - Cross Connection Certification

  3. Transmittal Form & Number for Permit Application & Payment


Permit Fact Sheet

  1. What is the purpose of this certification?

    This certification protects the health and welfare of the public by insuring that facilities are surveyed for cross connection and backflow prevention devices are inspected by properly trained and knowledgeable professionals.

    These permits consist of an approval to allow the applicants to perform test on backflow prevention devices or conduct cross connection survey on drinking water lines. Legislative authority for this permit is stated in M.G.L. Chapter 111 '160A. Regulatory authority for this permit is stated in 310 CMR 22.22 (13), Drinking Water Regulations.
  2. Who can apply for this certification?

    Any individual who passes a MassDEP approved written and practical examination for inspecting and testing backflow prevention devices or a MassDEP approved written examination for conducting cross connection surveys is eligible to apply for a certification.
  3. What are the requirements for certification or renewal?

    3.1. CERTIFICATION
    • Cross Connection Surveyor: Applicants must show proof that they have passed the cross connection surveyor examination approved by the Department.
    • Backflow Prevention Device Testers: Applicants must show proof that they have passed the written and practical examination approved by the Department.
    3.2. CERTIFICATION RENEWAL
    • Backflow Prevention Device Testers: Applicants must have completed at least 24 inspections/tests of backflow prevention devices and received at least three (3) training contact hours (TCH) in the past three years. Proof of inspections and TCH must accompany the application.
      • If the applicant has completed twelve (12), but less than twenty four (24) inspections in the past three (3) years, the applicant need only take the practical examination.
      • If the applicant has completed less than twelve (12) inspections in the past three (3) years, the applicant must pass both the written and practical examination or attend a re-certification class.
    • Cross Connection Surveyor: Applicants must show that, in the last three (3) years, they have received at least three (3) TCHs and conducted at least three (3) cross connection surveys in any of the following facilities: industrial, commercial or institutional.
      • If applying for a Combination Certification (Backflow Tester and Cross Connection Surveyor) applicants must satisfied all the requirements for renewal as a Backflow Tester and Cross Connection Surveyor, except for the TCHs requirements. Only proof of three (3) TCHs is required.
      • These additional requirements are intended to serve as a guide to the applicant. It does not necessarily include all additional requirements.
  4. What is the application fee for certification or certification renewal?

    See Permit Application Timelines and Fees Schedule pdf format of Permit Application Timelines and Fees Schedule . THERE IS NO FEE EXEMPTION FOR THIS CERTIFICATION / CERTIFICATION RENEWAL (BRP WS10).
  5. Where should this application be submitted?

    Submit: a) the completed application (BRP WS10) form, b) the completed original copy of the MassDEP Transmittal Form for Permit Application and Payment, c) any required supporting documentation for the type of certification that you are applying for to:

    Department of Environmental Protection
    Drinking Water Program
    One Winter Street
    Boston, MA 02108
    Attn.: Cross Connection Certification
  6. Where should I send the fee payment for this application?

    Submit the fee payment by using a check or money order, payable to the Commonwealth of Massachusetts, and attach a copy of the completed MassDEP Transmittal Form for Permit Application and Payment. Please write on your check or money order the transmittal number that appears on your transmittal form and the permit category that you are applying for - BRP WS10 - and send to:

    Department of Environmental Protection
    P.O. Box 4062
    Boston, MA 02211
  7. Where can I get a copy of the timelines?

    The timelines are available on the MassDEP Website:   Permit Application Timelines and Fees Schedule pdf format of Permit Application Timelines and Fees Schedule
  8. What is the annual compliance assurance fee?

    There is no annual compliance assurance fee for BRP WS 10.
  9. How long is the certification valid?

    This permit is valid for three (3) years from the date of issuance.
  10. How can I avoid the most common mistakes made in applying for this permit?
    1. Answer all questions on the application forms and indicate "not applicable" (n/a) where appropriate.
    2. Make sure that the application is submitted to right location. DO NOT submit your application form (BRP WS10) with your payment.
    3. For certification renewal, ensure copies of supporting documentation are attached.
  11. What are the regulations that apply to this permit?

    These regulations include, but are not limited to:
    1. Drinking Water Regulations, 310 CMR 22.00, Section 22(13).
    2. Timely Action and Fee Provisions, 310 CMR 4.00.
    3. Administrative Penalty Regulations, 310 CMR 5.00.
  12. Where can I purchase copies of these regulations?

    These may be purchased online, in person, or by mail at the Massachusetts State Bookstore .