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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 I et A -2 = a3 ' \\ \ , ' , ti A - 3 , a7 ' oo \ ` ti I 6- 1 = a& 4z 3 04. I e- 11 13 - a = •d6 T 13 " 3 _ Q4 av*LET Q Covn r.lmeh14 ISOO 9a11O1, TAN. I I Iti I r,ir Lril �`uL 1 V •(A)45"'