573 Certificates of Compliance Commonwealth of Massachusetts
i pp_ City/Town of MoR nrt�rMPTbJ
�`l . Certificate of Compliance
Form 3
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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
❑ 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
Paul Bloomfield
DSCP Date
Facility Owner
573 Westhampton Road- Rt. 66
Street Address or Lot#
Northampton
City/Town
Designer Information:
Timothy E. Maginnis R.S.
Name
� i.t�
Signatur
Installer Information: F-t 3 ' ' R.4"-os
James James Dimos .
Name
Ma.
State
01060
Zip Code
Timothy E. Maginnis &Associates
Name of Company
June 30, 2005
Date
J.C. &Company
Name of Company
June 30, 2005
Signature
Use of this system is conditioned on compliance
No garbage disposal is allowed
Date
h the provisions set forth below:
The issuance of this certificate shall not be construed as a guarantee that the system will function as
designed.
Approving Authority
Signature
Date
m3.doc•06/03 Certificate of Compliance•Page 1 of 1
C
Title-5 sand
(401 x 23.5W x 31"0)
Infiltrator leaching bed
4" pvc solid pipe
Existing septic tank
23.5ft.
/////////
/
Existi 9
3 bedroom
/ houe /
Existing distribution box ("Er)
Z.S
nclosed
porch
////iii
oExisting/
goge arog /
//iii;
K
Westhampton Road — Northampton, Massachusetts
AS—BUILT DIMENSIONS
As—built plan
SUBSURFACE SEWAGE DISPOSAL SYSTEM DESIGN
573 Westhampton Road
Westhampton, Massachusetts
July 2, 2005
ant:
filling out
m the
:or,use
r tab key
=your
do not
return
a
Ku
Commonwealth of Massachusetts
City/Town of
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.
n3.doc•D6/03
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
❑ 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
James Faulkner
DSCP Date
Facility Owner
573 Westhampton Road- Rt. 66
Street Address or Lot#
Northampton Ma.
City/Town State
Designer Information:
Timothy E. Maginnis R.S.
Ngrrie Name of Company
rlw. e. ✓�,a-�tH'�� �IluL (3i 1' 6tZ
Signature Date rt
Installer Information:
James Dimos J.C. 8 Company
Nam- Name of Company
01060
Zip Code
L �2
lure Date
Use of this system is conditioned on compliance with the provisions set forth below:
No garbage disposal is allowed
The issuance of this certificate shah not be construed as a guarantee that the essystem will function as
aS.✓K / aft✓ `ice < v y,O/_
roc//�
des. d.
Ap.r.ving Authority
Signet
Date
Certificate of Compliance•Page 1 of 1
Title-5 sand
(401 x 23.5W x 31 110)
Infiltrator leaching bed
(INSTALLED JUNE 2012)
4" PVC solid pipe
Existing septic tank
(INSTALLED JUNE 2012)
i
Inspection port
(E-F-C-H)
O
•
Existing distribution box ("D")
nosed
porch\
//// // /l///////////9
/ 3 be• dsti g //////Existing/
/ room / garage/
/ hats a / / /
//• //////////// ///
Westhampton Road — Northampton, Massachusetts
AS—BUILT DIMENSIONS
June 6, 2012
As—built plan
SUBSURFACE SEWAGE DISPOSAL SYSTEM DESIGN
573 Westhampton Road
Westhampton, Massachusetts
June 6, 2012