219 Certificate of Compliance 2018 Commonwealth of Massachusetts
1,r241,4€ City/Town of Northampton
'"i $ Certificate of Compliance
;„, Form 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
Important:When
filling out forms ❑ Construction of a new system
on the computer. ❑�{Repair or replacement of an existingsystem
use only the tab lt`1 Repair or replacement of an existinsystem coponent
key to move your P P
cursor-do not
use the return Has been done in accordance with Title 5 and the Disposal Sy temConstruction Permit(DSCP):
key.
La_I dors- 9 518 II
DSCP Number 1 DSCP Da e
SVSC...a M.1 r01��/
Facility14 Owner 1 1 /W
Street Address or fflt# l e 1 Wel AAA"IA
Le-Cc..5 / Osoi R
City/rown State Zip Code
Designer Information: •
Name Name of Company
Signature Date
Installer Information: naol (tl,NCzyR 'c
ttemiue. ExcA.u01.11� JName Name Pan
OM P.t ie. •
Signature Date
Use of this system is conditioned on compliance with the provisions sect forth below:
NORTHAMPTON BOARD OF HFAITH QA0InS � r1;11'
212 MAIN STREET I!ll �°I
11 , I , E. , ,IP I , Ni 1 ' . r /� f
it
(.bee '• StpAb C 4?..-11)k ref IG r • ( o+)A;4- .] J R 5 5'1
of T;-1-le s il.3spec 6reft's G3e.•ska&SerFS took)
cyt re �l1/I $
The issuance ofihls certificat sFall not be cnstr ed as a guara tee that the system will function as
design d.
Sor+X � .I+4, E-
AApproving Authority 1�u
s/a4 1 rs
Signature -' I- Date
ID `;es SwF
t5Por3.doc•06/03 Certificate of Compliance•Page 1 of 1
Proposal Page No. 1 of 1 Pages
• RIVER DRIVE EXCAVATING, INC.
i,5G * 146 River Drive
�r P.O.Box 126
HADLEY, MA 01035-0126
' (413)584-1814 _
j
PROPOSAL SUBMITTED To PHONE DATE
Susan Murphy 781-820-1385 5/21 /18
STREET JOE NAME
219 Audubon Road
aflY, STATE AND ZIP CODE Joe LOCATION
Leeds, MA
ARCHITECT DATE OF PIANS
Joe PRONE
n/a n/a
We hereby submit specifications and estimates for.
Work to consigtsp : cut_and_rsistove opo apple tree, Sawcut
sidewith and attempt to save, without guarantee it will not
• break. Remove existing electric line over existing septic
tank Pump, crush and fill existing septic tank. Install one _
new 1 J.fl,D_..gallon tWo compartment: tank. Tank to be equipped
.__ with_.Schedule 40 baffles in and out. Replliq new tank to
h use, and reconnect to existiag..aray water line. Water line
to be sleeved tp protect from sewage infiltration. Upon _ —
• inspection by Board of Health, all disturbed areas- to be
loamed and seeded. __ `—
____Note: Dan from the Board of Health said a trench permit was
, not required. ___
Total cosi' of above work: $ 5,100.
v fzapup s hereby to furnish material and labor -complete in accordance with above specifications, for the sum of:
Five Thousand One Hundred dollars(; 5,100.
Payment to be Made es follows:
One third at start, balance due in full upon completion.
AM mea Is swanned to be a.TCW.e.AO week to d adoa•11 a M a workmanlike ,{f
cimanner wggma a Monty!plectron Any alteration or to orris nem above brio erne. Authorized ..'-1 T'
ons I/waMee exam Dam will be executed only c con written onion,and M bonnie an signature ! �
dabs chargerwr and strew thessemets.Aaaenaments eoutMBMt UponWen*Silents
Owner delays beond ocontrol.ownto wry fin,tornado and Mier soma(Insurance. Note:This proposal may be
Our wean are nay mend by Wwmmnda ComngmsUm Mconnt withdrawn by us if not accepted within da/a.
At ptaance: aniw? 3�
DD —The above prices,specifications o
and iwork an saticlaclory and are behereby
accepted. You are authorized SlgnaWre /✓' J �� (iat.)471AY. b 731
to do the work as specified..- moot rill ba made es*waned above. 11
Date of Acceptance: -J�z`�// 0 Signature
ft Tanks,
Tanks, Dry Wells, Leaching Fields - Installed, Pumped, Cleaned, Sold, Delivered
ICL
1.$1)
RIVER DRIVE EXCAVATING, INC:` >
Complete Septic Tank Service
CUSTOM EXCAVATING P.O. Box 126 FILL•LOAM•GRAVEL
AND BULLDOZING 146 River Drive • Hadley, Mass. 01035
Telephone (413) 584-1814
SIZE yvtuiz PNY
TERMS: NET 30 DAYS
` LEE a ( /�1 BQDOB OW it) LGE °S UNLESS OTHERWISE INDICATED
LDATE I) 5 Bu , 9- 5-/2y/08
SERVICE CHARGE 11/2%PER MONTH ON PAST DUE ACCOUNTS BALANCE
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