HomeMy WebLinkAboutRaggs Septic Service, Inc. - 12/31/2020*03 66 H - 10000
Town of Mansfield
Town of Mansfield - Board of tla 6 Park Row
Mansfield, MA 02048
Septcage Pumpers Application
DATE:
LICENSE NUMBER:
BUSINESS NAME:
MAIL ADDRESS:)/Y'1 Plot
TOWN: ��j�fOCbNlor STATE: ylAf/\ M N ZIP CODE: &@M
NAMEOFOWNER: S'f,,(sy S, Ao /o 0 f I4 ),
BUSINESS TELEPHONE: �( 297-55 K I CELL: FAX: q -� 7c� __
E-mail: ��p r 5� yt C r C 0 vH Alt E-mail:
FED ID/SS NO: l� _> I Z (6 Z (7 NUMBER OF TRUCK(S): r
REGISTRATION NUMBER(S): q i I lLf
FEE PER TRUCK:
Please make appropriate changes.
Board of Health, Town of Mansfiek
SIGNATURE:
, date. and enclose check payable to Town of Mansfield. Mail to:
Park Row, Mansfield, MA 02048.
DATE: 2--9 —Zv
TRUCKS INSPECTIONS: DATE: 'a lL�' ^. O V TIME:
PLACE: AT THE TOWN HALL, ADJACENT TO SOUTH COMMON, PARK ROW, SO. MAIN STREET
PLEASE BE THERE, OR CALL THE FOLLOWING NUMBER (508) 261- 7366, IF YOU CAN NOT MAKE THESE DATES
FOR HEALTH AGENT'S USE ONLY
310 CMR: State Environmental Code, Title 5; Minimum Requirements for the Subsurface Disposal of Sanitary Sewage.
15.502 Transportation and Disposal of Privy, Cesspool, and Septic Tank Contents,
15,505 Equipment: No person shall use equipment to remove or transport the contents of prives, cesspool, or septic
tanks or other offensive substances unless such equipment has first been inspected and approved by the Board of
Health.
A Mobile Tank:
� ecurely mounted on truck
✓ watertight
Leak -proof cover
Tight discharge tanks
A = Acceptable
NA = Not Acceptable
B. Ve�nfing of Mobile Tanks:
_Vent permits escape of gas, but not liquid
C. yose:
Suction or pressure hose in good repair
D. P mps:
7\/ Maintained to prevent leaking of sewage
Inspected
Inspected