38 Certificate of Compliance 2016 mportant:When
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Commonwealth of Msachusptts
City/Town of /�pie D A7
Certificate o Complia ce
Form 3
FILE COPY
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 Sy tem Construction Permit(DSCP):
DSCP Number DSC ate
GILBERT LEBLANC
Facility Owner
38 NORTH FARMS ROAD,FLORENCE, NORTHAMPTON,MA 01062
Street Address or Lot#
City/rown State Zip Cede
Designer Information:
Alan E Weiss,RS Cold Spring Environmental Consultants, Inc.
Name of Company
11.22.2016
Signature Data
Installer lnforma
Na
RIVER DRIVE EXCAVATING
Name Name of Company
TOM WANCZYK 11.22.2016
Signature Date
Use of this system is conditioned on compliance with the provisions set forth below:
It was recommended that you pump tank every two years.
The issuance of this certificate shall not be construe as a guarantee that the system will function as
dQSlpnecJ � // ,/// /J
Approving Author
S' ure / Data ,J� /r&J b
i
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Certificate of Compliance•Page 1 of 1
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M:12C,L 07-01
GRAVITY SLOPE SEPTIC SYSTEM OPERATION AND SCALE: 1"=30'
OO MAINTENANCE NOTES FOR HOMEOWNER. i E ID OA6' AC +b
co 1.)HAVE TANK PUMPED EVERY 2 YEARS.PUMP&CHAMBER CHECKED ANNUALLY. 0.461
PERC HOLE LOCATION, NUMBER
2 J MAINTAIN AREA OVER SEPTIC SYSTEM AS GRASSY TP-1 TEST HOLE LOCATON. NUMBER
OR SIMILAR GROUND COVER —� ESTIMATED WATER LINE
3.)DO NOT PLANT ANY TREES OR DEEP ROOTING —E— ELECTRIC TITRES
SHRUBS WITHIN 10 FEET OF SYSTEM. �6� Exlsnrvc conroure Q
4.)USE ONLY LIQUID DETERGENTS 8 LOW FLOW WASHERS. ---88— PROPOSED CONTOUR Ciew
5.)WIPE ALL OIL AND GREASE FROM COOKWARE AND DISPOSE IN TRASH c.
NOT SEPTIC. S WELL LOCATION v
6)All Toilets and Faucets must be confirmed to not be leaking,because one leaking t.
fixture can fail a septic system in ONE DAY `v
0' 30' 60' 90' oik
m• r • mm ■ I ` I TYPICAL D.BOX IWATERTIGH.
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11.22.2016
M:12C,L:07-01
GRAVITY SLOPE SEPTIC SYSTEM OPERATION AND SCALE: 1"=30'
MAINTENANCE NOTES FOR HOMEOWNER. LQ
1.)HAVE TANK PUMPED EVERY 2 YEARS.PUMP&CHAMBER CHECKED ANNUALLY. —� PERC HOLE wcnnon. NUMBER
0.461 AC +/-
2.)MAINTAIN AREA OVER SEPTIC SYSTEM AS GRASSY TP-I TEST HOLE LOCATION, NUMBER
OR SIMILAR GROUND COVER. ESnMALED WATER LINE
3.)DO NOT PLANT ANY TREES OR DEEP ROOTING —E— ELECTRIC WIRES
SHRUBS WITHIN 10 FEET OF SYSTEM. ,---6--- EXISPNG CONTOUR
4.)USE ONLY LIQUID DETERGENTS 8 LOW FLOW WASHERS. -—sr-- PROPOSED CONTOUR
5.)WIPE ALL OIL AND GREASE FROM COOKWARE AND DISPOSE IN TRASH
NOT SEPTIC. S WELL LOCATION
6)All Toilets and Faucets must be confirmed to not be leaking,because one leaking
fixture can fail a septic system in ONE DAY
0' 30' 60' 90'
— — — TYPICAL D.BOX(WATERTIGH
EW 14'X 43'
LEACH FIELD
• •UMP AND REPLACE
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11.22.2016
—___ ___________________\
M:12C,L:07-01
GRAVITY SLOPE SEPTIC SYSTEM OPERATION AND AS BUILT
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MAINTENANCE NOTES FOR HOMEOWNER. LESEI'ID S0CAL.461 : 17-UI
1 +1-
1.)HAVE TANK PUMPED EVERY 2 YEARS.PUMP&CHAMBER CHECKED ANNUALLY. -� PERC HOLE LOCATION. NUMBER
2)MAINTAIN AREA OVER SEPTIC SYSTEM AS GRASSY I Tp_I TEST HOLE LOCATION, NUMBER r
OR SIMILAR GROUND COVER. TEST HOLE LOCATION,N,WATER
3.)DO NOT PLANT ANY TREES OR DEEP ROOTING -E- ELECTRIC MRES r��
SHRUBS WITHIN 10 FEET OF SYSTEM. �6� cxisnrvc carvTwR
4.)USE ONLY LIQUID DETERGENTS&LOW FLOW WASHERS. -—80— PROPOSED CONTOUR MI
5.)WIPE ALL OIL AND GREASE FROM COOKWARE AND DISPOSE IN TRASH
NOT SEPTIC. S WELL LOCATION C7
6)All Toilets and Faucets must be confirmed to not be leaking,because one leaking C,
fixture can fall a septic system in ONE DAY j -V
0' 30' 60' 90' NEC
FIMTINTIIM= IIIIIMOIl TYPICAL D.BOX (WATERTIGH.
re /eI uCE HEEDS I
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