850 Certificate of Compliance 2016 Commonwealth of Massachusetts
City/Town of Northampton
Certificate of Compliance
Form 3
iortanL When
g out forms
he computer,
only the tab
to move your
for-do not
the return
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):
#o/'-/ 7
DSCP Number DSCP Date
Marty's Real Estate 200 Center Street, Suite 17C , Ludlow, Ma. 01056 , C/O Brian 413-543-6766
Facility Owner
850 Westhampton Rd.
Street Address or Lot#
Northampton Ma 01060
City/Town State Zip Code
Designer Information: Cppy
Name of Company
Name
Signature Date
Installer Information:
Christopher J. Lemek C. Lemek&Sons Construction, Inc.
Name of Company
10-24-2016
Date
Use of this system is conditioned on compliance with the provisions set forth below:
Replace leaking Septic Tank with new 2 compartment,1500 gal tank, with filter in outlet pipe
The issuance of this certificate shall not be c.nstrued as a guarantee that the system will function as
ptle4 PP % > /f('4/Y"h
Approving Authority
Sign
arm3.dac•06/03 Certificate of Compliance•Page 1 of 1