6 CEDARCREST ROAD - SEPTIC CERTIFICATE OF COMPLIANCE Commonwealth of Massachusetts RECEIVED
City/Town of Salem JUL 312023
° Certificate of Compliance CITY OFSALEM
a Form 3 BOARD OF HEALTH
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 existing system
use only the tab ® Repair or replacement of an existing system component
key to move your
cursor-do not
use the return Has been done in accordance with Title 5 and the Disposal System Construction Permit(DSCP):
key.
DSCP Number DSCP Date
Dion Realty Trust
Facility Owner
_ 6 Cedarcrest Road
Street Address or Lot#
Salem MA 01970
City/Town State Zip Code
Designer Information:
N/A N/A
Name Name of Company
N/A
Signature Date
Installer Information:
Jonathan Granz Preventative Septic
Name Name of Company
7/22/23
gna 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
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