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Septage Hauler Application

  1. Application for Septic Hauler Permit

  2. Fee: $150

  3. No permits will be issued until payment has been received in full and processed by the staff of the City of Gardner Health Department.

  4. In accordance with MGL c.111, Section 31B, and 310 CMR 15.502 (Title 5), the undersigned makes application to the Board of Health or approving authority for permission to remove and transport septage and the content of privies and cesspools as set forth below:

  5. Number and Types of Equipment and Their Gallon Capacity:

  6. Your other licenses

  7. Certification:

    I certify that the information I have provided above is true and accurate. I recognize that it is a violation of this permit to dispose of septage anywhere other than the identified disposal locations or others approved by the Board in writing as an amendment to this permit.

  8. Under the Laws of the Commonwealth of Massachusetts, Chapter 223, Section 35, Acts of 1983, you are required to provide the following: Pursuant to M.G.L. Ch62C, Sec. 49A, I certify under the penalties of perjury, that I, to the best knowledge and belief, have filed all state tax returns and paid all state taxes required by law

  9. Important Note*

    A social security number or federal identification number is required for the completion of this application. Someone from the Health Department will contact you via phone to get this information. Please do not send this information via email.

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  11. This field is not part of the form submission.