Town of Raynham
Board of Health
558 South Main Street
Raynham, Ma 02767
508-824-2766
Commonwealth of Massachusetts
Application for Septage Hauler Fee: $125.00
In accordance with MGL c. 111, Section 31B, and 310 CMR 15.502 (Title V), 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.
Applicant Information:
Name
Company Name
__________________________________________________________________________________________________
Address Telephone Number
__________________________________________________________________________________________________
City/Town State Zip Code
Mailing Address_____________________________________________________________________________________
Number and Types of Equipment and their gallon capacity:
__________________________________________________________________________________________________
Number Type Gallonage
__________________________________________________________________________________________________
Number Type Gallonage
__________________________________________________________________________________________________
Number Type Gallonage
**Areas from which septage will be accepted (append customer list):___________________________________________
Location of final disposal of septage: ____________________________________________________________________
__________________________________________________________________________________________________
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.
__________________________________________________________________________________________________
Signature of Applicant Date
**New Applications must include three references from other communities' Boards of Health.
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