EOEEA-DEP – Department of Environmental Protection

PWS Information

PWS(Required)

How many service connections does your PWS have?(Required)

Primary Contact Information

Phone Number(Required)

Service Line Inventory Questions

If your system has not done so already, submit your initial service line inventory to MassDEP in a CSV (comma separated values) file format. The MassDEP template Service Line Inventory Excel Workbooks and instructions for use and submittal can be found at the MassDEP Lead and Copper Forms and Templates webpage.

If your system has not done so already, submit the LCRR-NONLSL-CERT form to certify that your system has no LSL, GRR, or service lines of unknown material.

Explain Other(Required)

LSL Replacement Plan Questions

See the LSLRP Summary Form (https://app.smartsheet.com/b/form/8f676b18cc224884a7069e3cc727f968)

Consulting Firm Preference for COM PWS

By completing this form, I certify that

it is my PWS’ responsibility to provide to MassDEP and its technical assistance partners all service line records of which I am aware;
the records my PWS provides are accurate and up to date, to the best extent of my knowledge;
I understand that MassDEP and its technical assistance partners will use the records I provide to complete the SLI and may not confirm the accuracy of said records;
I understand that I am responsible for the accuracy of my system’s records;
it is my responsibility to submit an official SLI to MassDEP and certify that the information in the SLI is true, accurate, and complete to the best extent of my knowledge.