Private Well Form Templates for Use by Local Boards of Health

Local boards of health or health departments may use these templates to create forms specific to your municipality or district.

Use of any of the following private-well-related forms is not required by any state statutes or regulations. MassDEP offers these templates as a courtesy to local boards of health and health departments knowing that many of you are using, or are interested in using, these types of templates. The templates are compatible with the contents of the current version of the "Model Board of Health Regulations for Private Wells." You may modify any of these forms to suit the needs of your municipality or health district.

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