offered by
Massachusetts Department of Environmental Protection
related to
Septic Systems & Wastewater Permitting & Reporting
Septic Systems & Title 5

Title 5 septic system forms

Forms for inspection of septic systems, enforcement, innovative technologies, and more.
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Table of Contents

Additives, Conditioners, & Effluent Filters Forms

WP 62: Septic System Additives, Effluent Tee Filters, Grease Removal Devices 

Title 5 Enforcement Forms

Title 5 Letter of Non-Compliance (DOC 37.5 KB)
Title 5 Enforcement Order (PDF 11.91 KB)
Title 5 Enforcement Order (DOC 51.5 KB)

Title 5 Innovative/Alternative Technologies Forms

WP 61a, 61b, 75a, 75b: Approval of Title 5 Alternative Technologies 
WP 57, 64, 64c: Title 5 Alternative Systems Installations 
Title 5 Provisional Use Approval Certification Forms (DOC 126 KB)
Title 5 Provisional Use Approval Certification Forms (PDF 15.2 KB)

Title 5 Inspections & Pumping Forms

Title 5 Official Inspection Form (DOCX 59.09 KB)
Title 5 Official Inspection Form (PDF 348.67 KB)
Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems (DOC 144 KB)
Inspection and O&M Form for Title 5 I/A Treatment and Disposal Systems (PDF 79.57 KB)
Inspection and O&M Form and Checklist for Title 5 Greywater Disposal Systems Piloting (DOC 204.5 KB)
Inspection and O&M Form and Checklist for Title 5 Greywater Disposal Systems Piloting (PDF 28.48 KB)
Bottomless Sand Filter Technology Inspection Checklist (DOC 122 KB)
Bottomless Sand Filter Technology Inspection Checklist (PDF 19.3 KB)
Technology Inspection Checklist Form for Recirculating Sand Filter (RSF) Systems (DOC 125.5 KB)
Technology Inspection Checklist Form for Recirculating Sand Filter (RSF) Systems (PDF 17.99 KB)
System Pumping Record (Title 5) (DOC 53 KB)
System Pumping Record (Title 5) (PDF 17.16 KB)
Application for Septage Hauler Permit (DOC 46 KB)
Application for Septage Hauler Permit (PDF 12.86 KB)
Septage Hauler Permit (DOC 34 KB)
Septage Hauler Permit (PDF 14.08 KB)

Title 5 Construction & Repairs Forms

Form 11: Soil Suitability Assessment for On-Site Sewage Disposal (DOC 176 KB)
Form 11: Soil Suitability Assessment for On-Site Sewage Disposal (PDF 147.46 KB)
Form 12: Percolation Test (DOC 56 KB)
Form 12: Percolation Test (PDF 16.73 KB)
Application for Disposal System Construction Permit (DOC 70.5 KB)
Application for Disposal System Construction Permit (PDF 17.25 KB)
Disposal System Construction Permit (DOC 45 KB)
Form 2A - Disposal System Construction Permit (PDF 10.49 KB)
Certificate of Compliance (Title 5) (DOC 44.5 KB)
Certificate of Compliance (Title 5) (PDF 12.6 KB)
Septic System Installation Checklist (DOC 171.5 KB)
Septic System Installation Checklist (PDF 142.56 KB)
Bedroom Count Deed Restriction (DOC 30.5 KB)
Bedroom Count Deed Restriction (PDF 15.12 KB)
WP 63: Disposal System Construction Permit for State or Federal Facilities 
WP 64a: Approval of Tight Tank for State and Federal Facilities and Facilities Specifically Required to Apply 
WP 58a: Approval of a Nitrogen Aggregation Loading Plan 

Title 5 Shared Systems Forms

WP 58b: Approval for Installation of Shared System for State and Federal Facilities and Facilities Specifically Required by MassDEP to Apply 
Application for Shared Disposal System Construction Permit (DOC 121 KB)
Application for Shared Disposal System Construction Permit (PDF 26.61 KB)
Form 10b - Shared Disposal System Construction Permit (DOC 52 KB)
Form 10b - Shared Disposal System Construction Permit (PDF 17.17 KB)
Certificate of Compliance for Shared Disposal System (DOC 39.5 KB)
Certificate of Compliance for Shared Disposal System (PDF 8.94 KB)

Title 5 Variances & Local Upgrade Approval Forms

WP 59c: MassDEP Approval or Issuance of Variance for Increased Flow at State and Federal Facilities and Facilities Specifically Required by MassDEP to Apply 
BRP WP 60: Variances for Schools 
WP 66a, 66b: Title 5 Large System Upgrades 
WP 70, 70a: Alternative Design Flow for Title 5 Systems & Non-Sanitary Wastewater Discharges to Title 5 Systems 
Application for Local Upgrade Approval (Title 5) (DOC 87.5 KB)
Application for Local Upgrade Approval (Title 5) (PDF 28.54 KB)
Local Upgrade Approval Form (Title 5) (DOC 64.5 KB)
Local Upgrade Approval Form (Title 5) (PDF 19 KB)
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