HomeMy WebLinkAbout0012 SAIL-A-WAY - Health (2) � 3 `� " .o�j<� .� v o J
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THE COMMONWEALTH OF MASSACHUSETTS Entered in computer:
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.PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS
0(pplication f Or.3kgo 0.Y �p!tem C005trurtjon permit
Application for a Permit to Construct( ) Repair(X) Upgrade( ) Abandon( ) ❑Complete System ❑Individual Components
Location Address or Lot No. Owner's Name,Address,and Tel.No.
12 Sail-a-Way, Centerville Harold & Elaine Renzi
Assessor'sMap/Parcel 230 94 12 Sail-a-way, Centerville
Installer's Name,Address,and Tel.No. 7 7 5—8 7 7 6 Designer's Name,Address and Tel.No. 3 6 4—0$9 4
Wm E Robinson Sr Septic Eco-Tech
PO Box 1089 , Centerivl 4% 43 Trian le Cir Sandwich
Type of Building:
Dwelling No.of Bedrooms Lot Size sq.ft. Garbage Grinder (nc)
) Cafeteria
Other Type of Building No.of Persons Showers( ( )
Other Fixtures
Design Flow(min.required) gpd Design flow provided T/ 0 gPd �
Plan Date Number of sheets Revision Date
Title
Size of Septic Tank Type of S.A.S.
Description of Soil
Install a new Title 5 septic
Nature of Repairs or Alterations(Answer when applicable) .
system to plans of Eco-Tech, #ETE-2285
Date last inspected:
Agreement: s
The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in
accordance with the provisions of Title 5 of the Environmental Code and not to.place the system in operation until a Certificate of
Compliance has been issued by this Board of Health. v
1 Signed A( Date
Date Z e6
1 Application Approved by
Application Disapproved by: Date
for the following reasons
1 / c
Permit No. 2—OO( /, I Date Issued
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