230 Septic Compliance 2005 Important:
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Commonwealth' of Massachusetts
City/Town of morzt-RN/151210
Certificate of Compliance
Form 3
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here, Before using this form, check with
the local Board of Health to determine the form they use
This is to Certify that the following work on an On-Site Sewage Disposal System
❑ Construction of a new system
❑ Repair or replacement of an existing system
Z Repair or replacement of an existing system component
Has been done in accordance with Title 5 and the Disposal System Construction Permit(DSCP):
DSCP Number
Pete Ciszewski
Facility Owner
230 Damon Road
Street Address or Lot#
Northampton
City/Town
DSCP Date
Designer Information:
Installer Information:
James Dimos
Name
MA
State
01060
Zip Code
Timothy E. Maginnis &Associates
Name of Company
April 15, 2005
Date
J.0 &Company Inc.
Name of Company
Signature Date
Use of this system is conditioned on compliance with the provisions set forth below:
This Certificate is for a new 1500 gallon septic only. It does not certify that the existing SAS is
functioning properly. No garbage disposal allowed.
The issuance of this certificate shall not be construed as a guarantee that the system will function as
designed.
Approving Authority
Signature Date
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