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!5farm3.dac· 06/03

Alan Wsiss

Commonwealth of Massachusetts City/Town of Amherst Certificate of Compliance Form 3

413-323-4916 p.3

DEP has provided this form for use by local Boards of Health . Oll1er forms may be used, but the iniormation 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

D Construction of a new system C8J Repair or replacement of an existing system D Repair or replacement of an existing system component

Has been done in accordance with Title 5 and the Disposal System Construction Permit (DSCP):

OSCP NLmber

Ed Ladd Facility Owner

715 Station Road Street Add.ress or Lot #

Amherst c ityrrown

Designer Information :

A lan Weiss, RS, # 933

Installer Information:

Paul Lussier Name

Signature

DSCP Date

MA 01002 State Zip Code

Cold Spring Environmental. Inc. Na~of Company

>S123/Z010 Date

Name of Company

Dale

Use of this system is conditioned on compliance with the provisions set forth below:

The issuance of this certificate shall not be construed as a guarantee that the system will function as designed.

Approving Authority

Signature Date

Certificate of Complia nee' Page 1 af 1

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t5form3.doc· 06103

Commonwealth of Massachusetts CityfT own of Amherst 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, check with the local Board of Hea~h to determine the form they use.

This is to Certify that the following work on an On-Site Sewage Disposal System

o Construction of a new system I3l Repair or replacement of an existing system o Repair or replacement of an existing system component

Has been done in accordance with Title 5 and the Disposal System Construction Permit (DSCP):

DSCP Number

Ed Ladd FaCility Owner

715 Station Road Street Address or Lot #

Amherst CitylTown

DeSigner Information:

Alan Weiss, RS, # 933

Installer Information:

Paul Lussier Name

Signature

DSCP Date

MA 01002 State Zip Code

Cold Spring Environmental, Inc. Na~¥-f Company

'<S? 23 r zo,o Date

Name of Company

Date

Use of this system is conditioned on compliance with the provisions set forth below:

The issuance of this certificate shall not be construed as a guarantee that the system will function as designed.

Approving Authority

Signature Date

Certificate of Compliance· Page 1 of 1

NOT AN ACTUAL SURVEYII LINES DRAWN FOR SEPTIC LOCATION PURPOSES ONL YI

K l' N. III T j - -

08.23.2010 MAP 24b LOT 35

SCALE: 1 "=30' 52A98± Sq. Ft.

1.2± Ac,

NEW L.BED '4' )(43'

94 9B

389.95' -- --

T· 5 SAND 5 FT OUT

EXISTING CONTOUR·

_ NET _._ ~o~~ .______----------101 4' --" <

298~ 15M

NEW'500G SEPTIC TANK (pump, crush, fill old s. tank"

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NOT AN ACTUAL SURVEYII LINES DRAWN FOR SEPTIC LOCATION PURPOSES ONLYI

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EXISTING

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298.54' 15.64'

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Alan Weiss

~ .. 413·323-4916

COLDSP~NGE~RONMENTAL CONSULTANTS INC.

--------------------------------------

p.1

• 2l.E Site Investigations • PCTColatio[l Tests .. Subsurface foYeStigarions • ~epcK: i>r:signs • PollutIon Rcmeeiation • Regulatory Compl.i;u)Ce • Lt)PonS'.Af[ • Recycling 2Jld Solie.! W2Ste • Forenslc Se!Jtlc Investigations • ~cond Op:mons

August 23 2010

Amherst, Board of Health

RE : Septic Syst:em (5. tank and ~. Fie~d)

LnstaL~ation Inspection # 715 Station Road

c~ th~s date, the writer inspected the installation of a (septic tank and L . Fie~d) . The writer found the installation to be complete (except for completion of cove r mate r ial) and in compl i ance with our plans and 310 CMR 15 . 000. The ins taller repr esentative (Pa~ Lussier Excavating) a nd our inspection noted that the sys~em was built & i nstal l ed properly, in accordance with the state/ l ocal regulations and our pla~s. rhe co~tractor was requested to have sufficient soi l on s~te and p r operly cover the system according to our p~ans and may backfi ll the system after review by l ocal Health Department r epresentatives.

Sincerely,

Cold Spring Environmental Consultants , rnc .

Alan/E. We i ss , M. S. , . P . Pres i dent Pri ncipal Hydr ogeologist Li censed Site Professional #6442 Registered Sanit arian #933

Cold Spring Envlro nmt:ntal 350 Old Enfield Road Belcbcrto\W, Ma 0 I 007

413-323-5957, poone 413-323-4916, fax

350 Old Enfield Road · &Ichertown, MA 01007 · Phone: 413.323.5957 Fax 413.323.4916 email: ;U:w~i 5S@c:h.u .. cr .n ct \Vwy • .;.coldspringenviI'onmentalcom

, . . COLD SPRING ENVIRONMENTAL CONSULTANTS INC.

• 2lE Site Investigations • Pat:ol:llion Tests • Subsuda£:e In~stigations • Septic ~igns • Pollution Remediation • Regulatory Compliance • LSP on Staff • Recycling and Solid Waste • Forensic Septic Investigations • Second Opinions

August 23 2010

Amherst , Board of Health

RE: Septic System (5. tank and ~ . Fie~d)

Insta~~ation Inspection # 715 Station Road

On this date , the writer inspected the installation of a (septic tank and L. Fie~d). The writer found the installation to be complete (except for completion of cover material) and in compl iance with our plans and 310 CMR IS . 000. The installer representative (Pa~ Lussier Excavating) and our inspection noted that the system was built & installed properly, in accordance with the state/local regulations and our plans . The contractor was re~uested to have sufficient soil on site and properly cover the system according to our plans and may backfill the system after review by local Health Department represen tatives.

Sincerely,

Cold Spring Environmental Consultants, Inc .

Ala E. Weiss , M.S., . P . President Principal Hydrogeologist Licensed Site Professional #6442 Registered Sani tarian #933

Cold Spring Environmental 350 Old Enfield Road Belchenown, Ma. 0 I 007

413 ·323-5957, phone 413·323-4916, fax

350 Old Enfield Road ' Belchertown. MA. 01007 • Phone: 413.323.5957 Fax 413.323.4916 email: a.::weis..<;@charter.nCl WVIW.coldspringenvironmentalcom