310 Certificate of Compliance 2014 1406:34a Robert Adair
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Commonwealth of Massachusetts
City/Town of Northampton
Certificate of Compliance
Form 3
DEP has provided this form for use by local Boards of Health. Other forms may be use
information must be substantially the same as that provided here. Before using this for
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
El 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 Perm
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DSCP Number DSCP Date
Ian and Brooke Breen
Facility Owner
310 Old Wilson Road
Street Address or Lot x
Northampton (Florence) MA 01 D62
City/Town State 24 Code
Designer Information:
Alan E Weiss, RS Cold Spring Environmental Canal
Na a Name of Company
08.142014
Signature Date
Installer Information:
Rob Adair A Adair Septic
Name 'a ' .— Name of COmpary
/ 08.142014
Signature Date
Use of this system is conditioned on compliance with the provisions set forth below:
Pumping of tank every 2-3 years recommended,
The issuance of this certificate shall not be construed as a guarantee that the system v
designed.
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