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Application for Septic System Installer

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

  2. I hereby apply for a Septic System Installer's Permit as required by Regulation 15.02(2) of Title 5 of the State Environmental Code and the Rules and Regulations of the Board of Health

  3. If Applicable

  4. The undersigned agrees that he/she has read and understands Title 5, for the state Environmental Code and Board of Health Rules and Regulations and also agrees to abide by them. Also, the undersigned understands that any violation of Title 5 of the Board of Health Rules and Regulations will be sufficient cause for revocation of Septic System Installer's Permit.

  5. Under the Laws of the Commonwealth of Massachusetts, Chapter 233, Section 35, Acts of 1983, You are required to Complete the following: "Pursuant to M.G.L., Ch 62C, Sect. 49A, I certify under the penalties of perjury, that I, to my best knowledge and belief, have filed all state tax returns and paid all taxes required under law.

  6. By signing in this field, I agree to all of the terms listed above and certify that all of the information provided above is correct.

  7. No permit will be issued until payment has been received in full and processed by the City of Gardner Health Department. Payment for this permit is $150.00. Send payment made out to "City of Gardner" to Gardner Board of Health, Gardner City Hall Rm 29, 95 Pleasant St. Gardner, MA 01440.

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