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State Organizations

This page, UV Drinking Water Treatment Forms, is offered by
Massachusetts Department of Environmental Protection

UV Drinking Water Treatment Forms

Forms for public water systems that use UV treatment.

MassDEP Drinking Water Program

Online

MassDEP Drinking Water Program Email MassDEP Drinking Water Program at program.director-dwp@mass.gov

The Details

What you need

All public water systems must receive approval from MassDEP to use UV treatment.

All UV applicants must complete the following forms:

UV-CAL
UV-OFF SPEC
UV-A

Applicants using the "Calculated Dose Approach" must also complete form UV-CDA.

Applicants using the "Intensity Setpoint Approach" must also complete form UV-ISA.

How to report

See details below.

Next steps

Review the Instructions

Open PDF file, 248.37 KB, Form UV-CAL Instructions (English, PDF 248.37 KB)

Open PDF file, 260.18 KB, Form UV-OFF SPEC Instructions (English, PDF 260.18 KB)

Open PDF file, 365 KB, Form UV-A Instructions (English, PDF 365 KB)

Open PDF file, 395.29 KB, Form UV-CDA Instructions (English, PDF 395.29 KB)

Open PDF file, 379.12 KB, Form UV-ISA Instructions (English, PDF 379.12 KB)
Complete the Report Forms

Open DOCX file, 42.17 KB, UV Equipment Calibration Report (UV-CAL) (English, DOCX 42.17 KB)

Open DOCX file, 40.73 KB, UV Reactor Monthly Off Specification Report, UV-OFF SPEC (English, DOCX 40.73 KB)

Open DOCX file, 40.12 KB, Ultraviolet Disinfection Treatment Report (UV-A) (English, DOCX 40.12 KB)

Open DOCX file, 64.95 KB, UV Reactor Report - Calculated Dose Approach, UV-CDA (English, DOCX 64.95 KB)

Open DOCX file, 49.06 KB, UV Reactor Report - Intensity Setpoint Approach, UV-ISA (English, DOCX 49.06 KB)
Submit the Report
Submit the completed report forms by:
- Mail - Print and mail the completed report forms to the appropriate MassDEP Regional Office (see listing below)
MassDEP regional offices by community

Contact

Online

MassDEP Drinking Water Program Email MassDEP Drinking Water Program at program.director-dwp@mass.gov

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