Status message (*) Mandatory field (*) Check Current Fee Schedule for increase in payments Requester’s Information * Company Name * Drain Layer Name * Certificate of Liability Expiration Date * First Name * Last Name * Phone Number * Phone Type Phone Type Cell Business Home * E-mail Address * Owners Name/Address * Owner's Name * Job Address * Neighborhood Select Neighborhood Allston/Brighton Back Bay/Beacon Hill Charlestown Central Citywide East Boston Hyde Park Jamaica Plain Mattapan North Dorchester Roslindale Roxbury South Boston South Dorchester South End West Roxbury State * Zipcode * GSA Type GSA Type Repair New Install Repair * Account # * Type of Repair Water Firepipe Sewer Drain Sewer Liner * Lateral Program [**MUST RELAY 8' OR MORE TO QUALIFY**] Yes No * Location of Cut - Select - Street Sidewalk Both On Site * Cut Size New Install * Site Plan * File Upload Select File Upload Rough Sign Off Photo of House * Rough Sign Off One file only.2 GB limit.Allowed types: pdf doc docx. * Photo of House One file only.2 GB limit.Allowed types: gif jpg png svg. ISD Covid Safety Confirmation One file only.2 GB limit.Allowed types: pdf doc docx. Comments CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions. “I certify that the information I have provided in this application is true and accurate. By submitting this GSA Request Form, I acknowledge that, if issued this GSA, I will only perform the work as requested on this Form, and I must perform all work authorized under this GSA in accordance with all applicable Massachusetts laws and BWSC’s Water and Sewer Use Regulations.”
