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

Wastewater Permits and Reporting Forms

Use these forms for approvals of wastewater discharge, management, and reuse.
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Table of Contents

Groundwater Discharge Forms

Certification Statement for Groundwater Discharge, Surface Water Discharge & Reclaimed Water Use Permits (DOC 129.5 KB)
Certification Statement for Groundwater Discharge, Surface Water Discharge & Reclaimed Water Use Permits (PDF 112.46 KB)
WP 83: Hydrogeologic Evaluation Report 
WP 79, 85: Individual Discharge Permits 
WP 11, 12: Groundwater Discharge Permit Renewals 
WP 82: Administrative Renewal of Groundwater Discharge Permit 
WP 80, 81: General Groundwater Discharge Permit Coverage 
WP 86, 87, 88, 89, 90: Industrial Wastewater Treatment Facility Permits & Plan Approvals 
Groundwater Discharge Report Forms 
WM 16 and WP 68: Treatment Works Plan Approval 
Permit Requirements for Hydrostatic Water Testing of New Pipelines (PDF 48.87 KB)
Escrow Agreement for Immediate Repair and/or Replacement Account for Groundwater Discharge Permits and Renewals (DOC 104.5 KB)
Escrow Agreement for Immediate Repair and/or Replacement Account for Groundwater Discharge Permits and Renewals (PDF 135.03 KB)

Reclaimed Water Use Forms

WP 84: Reclaimed Water Use 
Certification Statement for Groundwater Discharge, Surface Water Discharge & Reclaimed Water Use Permits (DOC 129.5 KB)
Certification Statement for Groundwater Discharge, Surface Water Discharge & Reclaimed Water Use Permits (PDF 112.46 KB)

Industrial Wastewater/Holding Tanks Forms

WP 91, 92: Permit for Industrial Sewer User 
Industrial Wastewater Toxic Pollutants Certification (DOC 227.5 KB)
Industrial Wastewater Additional Industrial Wastewater Pretreatment System Certification (DOC 155.5 KB)
WP 56: Industrial Wastewater Holding Tank Compliance Certification 
Industrial Wastewater Holding Tank Return to Compliance Plan (DOC 115 KB)
Industrial Wastewater Holding Tank Return to Compliance Plan (PDF 80.1 KB)
Industrial Wastewater Hauler Permit (DOC 33.5 KB)
Application for Industrial Wastewater Hauler Permit (PDF 77.95 KB)
Application for Industrial Wastewater Hauler Permit (DOC 52 KB)
Industrial Wastewater Hauler Permit (PDF 66.08 KB)

Residuals Management Approvals Forms

WP 28, 29, 30, 31, 32: Residuals Management 
WP 33: Approval of Wastewater Treatment Residual Landfills 
WP 34: Approval of Closure Plans for Wastewater Residual Landfills 
WP 35: Approval of Design Plans and Specifications 
WP 44: Modifications to Residuals Management Facilities 
WP 93: Renewal of Type I Approval of Suitability (AOS) 

Sanitary Sewer Overflow/Bypass/Backup Notification Form

Sanitary Sewer Overflow/Bypass/Backup Notification 

Sewer Connections/Extensions Forms

WP 91, 92: Permit for Industrial Sewer User 

Surface Water Discharge (NPDES) General Permits

WM 15: NPDES General Permit Notice of Intent 

Surface Water Discharge (NPDES Individual) Permits

WM 05, 06, 07: Surface Water Discharge (NPDES) Individual Permit Application 
WM 16 and WP 68: Treatment Works Plan Approval 
Certification Statement for Groundwater Discharge, Surface Water Discharge & Reclaimed Water Use Permits (DOC 129.5 KB)
Certification Statement for Groundwater Discharge, Surface Water Discharge & Reclaimed Water Use Permits (PDF 112.46 KB)
Permit Requirements for Hydrostatic Water Testing of New Pipelines (PDF 48.87 KB)

Wastewater Operator Certification Forms

Wastewater Treatment Plant Operator Status Change Form (DOC 54.5 KB)
Wastewater Treatment Plant Operator Status Change Form (PDF 23.54 KB)
Application for Wastewater Treatment Plant Operator Upgrade to Emergency Certification (DOC 53.5 KB)
Application for Wastewater Treatment Plant Operator Upgrade to Emergency Certification (PDF 19.64 KB)
Application for Wastewater Treatment Plant Operator Upgrade to Provisional Certification (DOC 53.5 KB)
Application for Wastewater Treatment Plant Operator Upgrade to Provisional Certification (PDF 19.72 KB)
Application for Wastewater Treatment Plant Operator Upgrade to Combined Grade 7 (DOC 54 KB)
Application for Wastewater Treatment Plant Operator Upgrade to Combined Grade 7 (PDF 19.76 KB)
Application for Wastewater Treatment Plant Operator Certification by Reciprocity (DOC 54 KB)
Application for Wastewater Treatment Plant Operator Certification by Reciprocity (PDF 20.05 KB)
Certified Wastewater Operator Statement of Qualifications (DOC 29.5 KB)
Certified Wastewater Operator Statement of Qualifications (PDF 11.88 KB)
Education Requirements for Recertification (DOC 48.5 KB)
Education Requirements for Recertification (PDF 21.68 KB)
Request for Training Contact Hours (TCH) Evaluation (DOC 44.5 KB)
Request for Training Contact Hours (TCH) Evaluation (PDF 15.34 KB)
Wastewater Treatment Plant Certification Program - CEU given by and course name 
Wastewater Treatment Plant Certification Program - CEU by reference number 
Wastewater Treatment Plant Certification Program - CEU by course name 
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