36-343 JAMES A. GRACIA, PE
SS Glendale Street, Easthampton, MA 01027
I NEW
LEACHING SYSTEM
I
I � 50' �
I 45.5' --- --- 27'
---- 43'
I 23'
24.5' 37.5'
C'� I
I GARAGE
1500 GALLON
Z I NEW SEPTIC TANK
4 BEDROOM
I DWELLING
� I
a
� I
I � �
WESTHAMPTON ROAD - RTE 66
THEODORE TOWNE SEPTIC SYSTEM "AS BUILT"
9 CARDINAL WAY
NORTHAMPTON, MA SCALE: 1" = 30 2/27/08
36 ,31-1
�. Commonwealth of Massachusetts
1 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 used, but the
information must be substantially the same as that provided here. Before_using this form.oheo 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 ® Construction of a new system
forms on the ❑ Repair or replacement of an existing system
computer,use ❑ Repair or replacement of an existing system component
only the tab key
to move your
cursor-do not Has been done in accordance with Title 5 and the Disposal System Construction Permit (DSCP):
use the return
key.
DSCP Number DSCP Date
r� Theodore Towne
Facility Owner
Cardinal Way
S
Street Address or Lot#
Northampton MA 01060
CityrTown State Zip Code
Designer Information:
James A. Gracia James A. Gracia, PE
am Name of Company
Z -Z7-1��
ignature Date
Installer Information:
Mark Lavailey Lavalley&Sons Trucking
Name Name of Company
gna ure Date
Use of this syste is conditioned on compliance with the provisions set forth below:
The issuance of this cZ icate shall not be construed as a guarantee that the system will function as
I' e
1/ d
Date
t5form3.doc•06/03 Certificate of Compliance•Page 1 of 1