offered by

Massachusetts Department of Environmental Protection

Public Notification Forms and Templates

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Certification Forms

Public Notification Certification Form for Tier 1-3 violations (DOC 173.5 KB)

Public Notification Certification Form for Tier 1-3 violations (PDF 189.58 KB)

Manganese Certification Form for Public Notice of a Manganese Health Advisory (DOC 62 KB)

Manganese Certification Form for Public Notice of a Manganese Health Advisory (PDF 17.26 KB)

Tier 1 Templates

Public Notice Tier 1 Template: Nitrate (DOC 247 KB)

Public Notice Tier 1 Template: Nitrate - Spanish translation (DOC 266 KB)

Public Notice Tier 1 Template: Nitrate Failure to Take Confirmation Sample (DOC 249 KB)

Public Notice Tier 1 Template: Coliform Rule (DOC 255.5 KB)

Public Notice Tier 1 Template: Coliform Rule - Spanish Translation (DOC 252 KB)

Public Notice Tier 1 Template: Waterborne Disease Outbreak (DOC 302.5 KB)

Public Notice Tier 1 Template: Turbidity (DOC 229 KB)

Public Notice Tier 1 Template: Chlorine Dioxide (DOC 209.5 KB)

Public Notice Tier 1 Template: GWR Boil Order (DOC 296.5 KB)

Public Notice Tier 1 Template: GWR 4-log (DOC 225.5 KB)

Public Notice Tier 1 Template: GWR Source Removed (DOC 228 KB)

Public Notice Tier 1 Template: GWR Boil Order-NC (DOC 409.5 KB)

Public Notice Tier 1 Template: Problem Corrected (DOC 112 KB)

Tier 2 Templates

Public Notification Template for Tier 2 Violations of Drinking Water Regulations (DOC 174 KB)

Tier 3 Templates

Public Notification Template for Tier 3 Violations of Drinking Water Regulations (DOC 48 KB)

Public Notice Tier 3 Template: Special Notice for Availability of UCMR Data (DOC 118 KB)

Templates for Non-Community Public Water Systems

Public Notification Templates for Non-Community Public Water Systems (DOC 107.5 KB)

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