This page, Drinking Water Permits, Forms, and Templates, is
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This page, Drinking Water Permits, Forms, and Templates, is
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Drinking Water Permits, Forms, and Templates
Find drinking water permit applications, reporting forms, and templates.
Table of Contents
Autodialer & Contact Information
Certified Operators Forms
Consumer Confidence Reporting Forms & Templates
Cross Connections Forms
Distribution System Modifications Forms
Emergency Response Forms
Open DOCX file, 91.72 KB, for
Emergency Response Checklist
(DOCX 91.72 KB)
Open DOCX file, 57.46 KB, for
Bulk Water Questionnaire
(DOCX 57.46 KB)
Open DOCX file, 39.98 KB, for
Emergency Certification of Public Water System Temporary Closure (Non-Operational Status)
(DOCX 39.98 KB)
Form to be used when a Non-Community Public Water System (TNC, NTNC) has to temporarily close due to a declared State of Emergency.
Open PDF file, 149.44 KB, for
Emergency Certification of Public Water System Temporary Closure (Non-Operational Status)
(PDF 149.44 KB)
Form to be used when a Non-Community Public Water System (TNC, NTNC) has to temporarily close due to a declared State of Emergency.
Ground Water Rule Forms
Ground Water Under the Direct Influence of Surface Water (GWUDI) Forms
Laboratory Analytical Forms
Open DOCX file, 41.61 KB, for
Asbestos Report
(DOCX 41.61 KB)
Open DOC file, 231 KB, for
Bacteriological Report
(DOC 231 KB)
Open DOCX file, 36.95 KB, for
Bromate Report
(DOCX 36.95 KB)
Open DOCX file, 36.21 KB, for
Bromide Report
(DOCX 36.21 KB)
Open DOC file, 121 KB, for
DBPR TT Compliance Report
(DOC 121 KB)
Open DOCX file, 35.57 KB, for
Haloacetic Acids Report
(DOCX 35.57 KB)
Open DOCX file, 37.1 KB, for
Inorganic Contaminant Report
(DOCX 37.1 KB)
Open DOCX file, 38.72 KB, for
Nitrate Report
(DOCX 38.72 KB)
Open DOCX file, 35.15 KB, for
Nitrite Report
(DOCX 35.15 KB)
Open DOCX file, 35.23 KB, for
Tetrachloroethylene (PCE) Report
(DOCX 35.23 KB)
Open DOCX file, 34.54 KB, for
Perchlorate Report
(DOCX 34.54 KB)
Open DOCX file, 34.42 KB, for
Radionuclide Report
(DOCX 34.42 KB)
Open DOCX file, 42.15 KB, for
Secondary Contaminant Report
(DOCX 42.15 KB)
Open DOCX file, 35.2 KB, for
Sodium Report
(DOCX 35.2 KB)
Open DOCX file, 34.91 KB, for
Total Organic Carbon (TOC) Report
(DOCX 34.91 KB)
Open DOCX file, 35.72 KB, for
Total Trihalomethanes Report
(DOCX 35.72 KB)
Lead and Copper Forms & Templates
Monitoring Waiver Forms
Monthly and Daily Reporting Forms
New Source Approval Forms
New Technology Approvals Forms
Public Notification Forms & Templates
Public Water System Modifications Forms
Source Water Protection Forms & Templates
Statistical Reporting Forms
Surveys and Questionnaires
Open DOC file, 177.5 KB, for
2019-2020 Mercury Questionnaire
(DOC 177.5 KB)
Questionnaire conducted approximately every five years to determine the extent of the use of mercury-containing products at public water systems.
Underground Injection Control Forms
Vending Machines Forms
Water Management Act (WMA)
Water Treatment Plant Forms
Well Drillers Forms
WIIN Act
Open DOCX file, 324.22 KB, for
WIIN Template A
(DOCX 324.22 KB)
For households where the public water system's 90th percentile level in their most recent sampling round is below the action level and the household's lead sample result is greater than 15 ppb.
Open DOCX file, 325.11 KB, for
WIIN Template B
(DOCX 325.11 KB)
For households where the public water system's 90th percentile level in their most recent sampling round and the household's lead sample results are greater then 15 ppb.
The Confirmation Form is for public water system (PWS) to confirm distribution of the required information to EPA, MassDEP, and the Local Board of Health.
Zone II Determinations Forms
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