Additives, Conditioners, and Effluent Filters Forms
- BRP WP 62 - Septic System Additives, Effluent Tee Filters, Grease Removal Devices
This determination is necessary to ensure that the disposal of sanitary sewage through the use of an on-site subsurface sewage disposal system is performed in an environmentally acceptable manner. Revised May 2012.
Title 5 Enforcement Forms
Title 5 Innovative/Alternative Technologies Forms
- BRP WP 57, 64, 64c - Title 5 Alternative Systems Installations
These approvals ensure that alternative Title 5 systems can provide the same or a higher degree of environmental and public health protection as a conventional system. Revised June 2007.
- BRP WP 61a, 61b, 75a, 75b - Approval of Title 5 Alternative Technologies
The purpose of these approvals is to ensure that alternative Title 5 technologies, which have substitute or alternative components for one or more elements of a conventional on-site system, can provide the same or a higher degree of environmental and public health protection as a conventional system. Revised June 2009.
- Title 5 Provisional Use Approval Certification Forms
Certification that an innovative or alternative technology approved for provisional use in Massachusetts meets the required standards for wastewater disposal.
- Alternative Sewage Disposal System Deed Notice
A deed notice that must be included in the chain of title for a property served by an alternative sewage-disposal system.
Title 5 Inspections and Pumping Forms
- Title 5 Official Inspection Form
System inspectors must use this form to report results of a septic-system inspection to the local Board of Health or MassDEP, within 30 days of completing the inspection.
- Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems
This form is to be used to report inspection and sampling results for innovative/alternative septic system designs approved under Title 5.
- Inspection and O&M Form and Checklist for Title 5 Greywater Disposal Systems Piloting
This form is to be used to report inspection of a greywater disposal system, within 30 days of the inspection date.
- Bottomless Sand Filter Technology Inspection Checklist
Inspection and testing form for bottomless sand filter septic system technologies.
- Technology Inspection Checklist Form for Recirculating Sand Filter (RSF) Systems
This form is to be used to report inspection and maintenance tasks on a recirculating sand filter septic system.
- System Pumping Record (Title 5)
A record of system pumping must be submitted to the local Board of Health within 14 days from the pumping date.
- Application for Septage Hauler Permit
Boards of Health may use this form as an application for a permit to remove and transport septage.
- Septage Hauler Permit
Local Boards of Health are the issuing authority for septage-hauling permits. This form may be used as a permit, and must be kept in the vehicle(s) used.
Title 5 New Construction and Repairs Forms
- Form 11: Soil Suitability Assessment for On-Site Sewage Disposal
A soil-suitability assessment must be performed before a septic system can be installed. Revised March 2015.
- Form 12: Percolation Test
A percolation test must be done when a Soil Suitability Assessment is performed. The percolation test result may be reported on this form.
- Application for Disposal System Construction Permit
Local Boards of Health issue permits for the construction or repair of a septic system. This form may be used to apply for a permit.
- Disposal System Construction Permit
Local Boards of Health may use this form to issue permits for septic-system construction or repair.
- Certificate of Compliance (Title 5)
Local Boards of Health may use this form to certify that the construction or repair of a septic system meets the conditions of Title 5 and the local construction permit issued by the Board of Health authorizing the work.
- Septic System Installation Checklist
Local Boards of Health may use this form to verify the completion of required steps in the installation of a septic system.
- BRP WP 63 - Disposal System Construction Permit for State or Federal Facilities
State and federal facilities must obtain approval from MassDEP for new systems, upgrade of small systems (less than 10,000 gallons per day), upgrade of large systems (10,000 to 15,000 gallons per day), which are not failing, expansion of an existing system, and pumping prior to septic tank, with or without variances pursuant to 310 CMR 15.000. Revised June 2007.
- BRP WP 64a - Approval of Tight Tank for State and Federal Facilities and Facilities Specifically Required by MassDEP to Apply
BRP WP 64a establishes a process for MassDEP review of proposed installation of tight tanks for site-specific use. Tight tanks are used only to eliminate a failed on-site system when there is no other feasible alternative to upgrade the system in accordance with Title 5 and a sewer connection is not feasible. Revised February 2014.
- BRP WP 58a - Approval of a Nitrogen Aggregation Loading Plan
Ensuring that the aggregation of nitrogen loading for on-site subsurface sewage disposal systems meets the provisions of Title 5 (310 CMR 15.00). Revised December 2003.
Title 5 Shared Systems Forms
- BRP WP 58b - Approval for Installation of Shared System for State and Federal Facilities and Facilities Specifically Required by MassDEP to Apply
This approval ensures that the disposal of sanitary sewage using a shared septic system protects the environment and public health. Revised February 2014.
- Application for Shared Disposal System Construction Permit
This form may be used to apply for a permit to construct a shared sewage-disposal system.
- Form 10b - Shared Disposal System Construction Permit
Local Boards of Health may use this form to issue a permit for construction of a shared sewage-disposal system. Revised February 2014.
- Certificate of Compliance for Shared Disposal System
Local Boards of Health may use this form to certify that a newly constructed or repaired shared sewage-disposal system is in compliance with the provisions of Title 5.
Title 5 Variances and Local Upgrade Approvals Forms
- BRP WP 59c - MassDEP Approval or Issuance of Variance for Increased Flow at State and Federal Facilities and Facilities Specifically Required by MassDEP to Apply
MassDEP approval or issuance of variances is necessary to ensure that the applicant has demonstrated that the proposed sewage-disposal system can maintain a level of environmental protection that is at least equivalent to the requirements of Title 5. This application does not apply to any local bylaws. Revised February 2014.
- BRP WP 60 - Variances for Schools
Ensuring that the disposal of sanitary sewage under a variance from the design flow for schools, and/or increased flow to a large system for a school, maintains a level of environmental protection at least equivalent to 310 CMR 15.000. Revised June 2007.
- BRP WP 66a, 66b - Title 5 Large System Upgrades
Approval for upgrades of large septic systems; review for protection of public health, safety, welfare, environment, or consistency with Title 5 regulations. Revised May 2009.
- BRP WP 70 - Alternative Design Flow for Title 5 Systems, BRP WP 70a - Non-Sanitary Wastewater Discharges to Title 5 Systems
Approval to allow for a determination of an alternative Title 5 design flow (BRP WP 70) or for the discharge of small quantities of non-sanitary wastewater to Title 5 systems (BRP WP 70a). Revised June 2014.
- Application for Local Upgrade Approval (Title 5)
This form may be used to apply for the upgrade of a failed or non-conforming septic system with a design flow of less than 10,000 gallons per day, subject to the requirements of Title 5.
- Local Upgrade Approval Form (Title 5)
Boards of Health may use this form to issue approvals for local upgrades of non-conforming septic systems. Revised February 2014.
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