51A Well Application Gm
Jill Keiter<jillmkeiter @gmail.com>
well drillers license
1 message
cr <henshawwells @aol.cam> Fri, Jan 8, 2016 at 11:46 AM
To: jillmkeiter @gmail.com
Jill,
I checked with our service manager and he said that the current year license has not come in yet, the renewal it
was sent in at the end of December and has not come in yet. I am enclosing the 2015 license, hope this helps.
Sandy
Kirke R. Henshaw Well Drilling
-j Kirke Drillers License.pdf
253K
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CERTIFICATE RS
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Pursuant to the provisions of �
Yfa,sachuseu Genet al Laws ( ;Ittpter 21C Section 20 ...94
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f Kirke Henshaw #196
1-7- is authorized to di; or drill all types of wells
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01/01/2015 to 12/31/2015 x'.*
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BOARD OF HEALTH FILE COPY
City of Northampton
APPLICATION FOR A WELL CONSTRUCTION PERMIT
Well Permit Number. M/° (TO BE ASSIGNED BY BOARD OF HEALTH) Fee $50.00
This application must be accompanied by a scaled plot plan, produced by a civil engineer or registered
sanitarian showing the minimum distances required in Title 5 of the State Environmental Code. For new
construction, requiring a septic system, the septic system plan submitted for the property in compliance
with Title 5 requirements will be acceptable if the proposed well location is included.
Application is hereby made to construct
or repair ( ) a private well.
SCOTT KEITe12 I ' -1 (o
Owner's Name Date
51 A ftftTPIEt,C> ST - 1O3S
Street Address Telephone Number
NoRT#M kPY N MA. 0(0(0c
City, State, Zip Code
573 S`/LATE-au RU. PLOrcEKIG6 (
Location of Proposed Well Tax Map #
(if different from address)
IlLE/vSH AW
oott
Parcel #
Well Driller(submit evidence of valid state registration) Co ervatio•Co sion Approval ¥
(SL,Valley!a�northamotonma.gov) SEE ar"�tte+.i
For new construction:
Septic system plan complies with Title 5:
Septic system plan shows location of well:
yes ( no ( ) n/a ( )
yes,k) no ( ) n/a ( )
For new, repair or location to leach field,septic tank or city sewer:
A scaled well construction plan has been submitted:yes ( ) no ( ) n/a ( )
/ / z
ienature of Applicant
Please Mail Application to:
Northampton Board of I lealth
212 Main Street
Northampton. MA 01060
O/ o6. i6
Date
TO BE COMPLETED BY BOARD OF IIE II
, ovZO V, Permit expires on: ///.i/i7 (One year from date of issuance)
Permit issued (date)
Important:
When filling out
forms on the
computer,use
only the tab
key to move
your cursor-
do not use the
return key
-o3 Sycv ESTEic ' A-1)
Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Wetlands
WPA Form 2 - Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
A. General Information
From.
Northampton
Conservation Commission
To: Applicant
Scott Keiter
Name
51A Hatfield Street
Mailing Address
Northampton
City/Town
MA
State
01060
Zip code
Property Owner(if different from applicant):
Stanley Boszko
Name
110 Florence Road
Maili ng Address
Easthampton MA 01027
enyrrown State zip Code
1_ Title and Data(or Revised Date if applicable)of Final Plans and Other Documents:
Runoff and Erosion Control Plan
Tile
Title
The
2. Date Request Filed:
May 21, 2013
May 11, 2013
Date
Date
Date
B. Determination
Pursuant to the authority of M.G.L. c. 131, §40,the Conservation Commission considered your
Request for Determination of Applicability, with its supporting documentation, and made the following
Determination.
apamrmx e:.oewmi
Project Descnption (if applicable).
Construction of a driveway to access new single f
ly home
Project Location:
Sylvester Road
Street Address
21
Assessors Map/Plat Number
MpreabO.y•rev. 0rero4
Northampton(Florence)
Crty/Town
004
Parcel/Lot Number
Page f ms
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
WPA Form 2 - Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
B. Determination (cont.)
The following Determination(s)is/are applicable to the proposed site and/or project relative to the Wetlands
Protection Act and regulations:
Positive Determination
Note: No work within the jurisdiction of the Wetlands Protection Act may proceed until a final Order of
Conditions(issued following submittal of a Notice of Intent or Abbreviated Notice of Intent)or Order of
Resource Area Delineation(issued following submittal of Simplified Review ANRAD)has been received
from the issuing authority(i.e., Conservation Commission or the Department of Environmental Protection).
❑ 1. The area described on the referenced plan(s)is an area subject to protection under the Act
Removing,filling,dredging,or altering of the area requires the filing of a Notice of Intent.
❑ 2a. The boundary delineations of the following resource areas described on the referenced plan(s)are
confirmed as accurate.Therefore,the resource area boundaries confirmed in this Determination are
binding as to all decisions rendered pursuant to the Wetlands Protection Act and its regulations regarding
such boundaries for as long as this Determination is valid.
Z 2b. The boundaries of resource areas listed below are not confirmed by this Determination,
regardless of whether such boundaries are contained on the plans attached to this Determination or
to the Request for Determination.
Resource area boundaries shown on plans are not confirmed with this determination.
❑ 3. The work described on referenced plan(s)and document(s)is within an area subject to
protection under the Act and will remove, fill, dredge, or alter that area. Therefore, said work
requires the filing of a Notice of Intent,
❑ 4. The work described on referenced plan(s) and document(s) is within the Buffer Zone and will
alter an Area subject to protection under the Act Therefore, said work requires the filing of a
Notice of Intent or ANRAD Simplified Review Of work is limited to the Buffer Zone).
❑ 5. The area and/or work described on referenced plan(s)and document(s) is subject to review
and approval by:
Name of Municipality
Pursuant to the following municipal wetland ordinance or bylaw.
Name
wramrm2doc•OeIerminatbn of Np9pkataty•rev 10.604
Ordinance or Bylaw Citation
Page 2 cr5
waiare2 doe•Del
Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Wetlands
WPA Form 2 - Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
B. Determination (cont.)
❑ 6.The following area and/or work, if any is subject to a municipal ordinance or bylaw but not
subject to the Massachusetts Wetlands Protection Act:
❑ 7. If a Notice of Intent is filed for the work in the Riverfront Area described on referenced plan(s)
and document(s),which includes all or part of the work described in the Request,the applicant
must consider the following alternatives. (Refer to the wetland regulations at 10.58(4)c. for more
information about the scope of alternatives requirements)'.
❑ Alternatives limited to the lot on which the project is located.
❑ Alternatives limited to the lot on which the project is located, the subdivided lots, and any
adjacent lots formerly or presently owned by the same owner.
❑ Alternatives limited to the original parcel on which the project is located,the subdivided
parcels. any adjacent parcels, and any other land which can reasonably be obtained within
the municipality.
❑ Alternatives extend to any sites which can reasonably be obtained within the appropriate
region of the state.
Negative Determination
Note: No further action under the Wetlands Protection Act is required by the applicant. However, if the
Department is requested to issue a Superseding Determination of Applicability,work may not proceed
on this project unless the Department fails to act on such request within 35 days of the date the
request is post-marked for certified mail or hand delivered to the Department.Work may then proceed
at the owners risk only upon notice to the Department and to the Conservation Commission.
Requirements for requests for Superseding Determinations are listed at the end of this document.
❑ 1. The area described in the Request is not an area subject to protection under the Actor the
Buffer Zone.
❑ 2. The work described in the Request is within an area subject to protection under the Act, but will
not remove, fill, dredge, or alter that area. Therefore, said work does not require the filing of a
Notice of Intent.
Z 3. The work described in the Request is within the Buffer Zone, as defined in the regulations, but
will not alter an Area subject to protection under the Act. Therefore, said work does not require
the filing of a Notice of Intent, subject to the following conditions(if any).
Please see Attachment A
❑ 4. The work described in the Request is not within an Area subject to protection under the Act
(including the Buffer Zone). Therefore,said work does not require the filing of a Notice of Intent,
unless and until said work alters an Area subject to protection under the Act.
of P csbifl•rev 10/51
Page 3 of
Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Wetlands
WPA Form 2 - Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
B. Determination (cont.)
❑ 5.The area described in the Request is subject to protection under the Act. Since the work
described therein meets the requirements for the following exemption, as specified in the Act and
the regulations, no Notice of Intent is required:
Exempt Activity(site applicable statuatory/regulatory provisions)
❑ 6. The area and/or work described in the Request is not subject to review and approval by'.
Name of Municipality
Pursuant to a municipal wetlands ordinance or bylaw.
Name Ordinance or Bylaw Citation
C. Authorization
This Determination is issued to the applicant and delivered as follows:
❑ by hand delivery on
Date
(leg9 by certified mail, return receipt requested on
hR ,37 e2o13
This Determination is valid for three years from the date of issuance (except Determinations for
Vegetation Management Plans which are valid for the duration of the Plan). This Determination does not
relieve the applicant from complying with all other applicable federal, state, or local statutes, ordinances,
bylaws, or regulations.
This Determination must be signed by a majority of the Conservation Commission. A copy must be sent to
the appropriate DEP Regional Office(see http://www.mass.gov/deptabout/region.findvour.htm)and the
property owner Of different from the applicant).
wpafmmzdoc•Determination or Appucaeiay•rev I
a01.3
Page 4 W 5
Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Wetlands
WPA Form 2 - Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
D. Appeals
The applicant, owner, any person aggrieved by this Determination, any owner of land abutting the land
upon which the proposed work is to be done, or any ten residents of the city or town in which such land is
located, are hereby notified of their right to request the appropriate Department of Environmental
Protection Regional Office(see httpllwww.mass.qov/dep/aboutfreoion.findvour.htm)to issue a
Superseding Determination of Applicability.The request must be made by certified mail or hand delivery
to the Department,with the appropriate filing fee and Fee Transmittal Form(see Request for
Departmental Action Fee Transmittal Form)as provided in 310 CMR 10.03(7)within ten business days
from the date of issuance of this Determination. A copy of the request shall at the same time be sent by
certified mail or hand delivery to the Conservation Commission and to the applicant if he/she is not the
appellant.The request shall state clearly and concisely the objections to the Determination which is being
appealed. To the extent that the Determination is based on a municipal ordinance or bylaw and not on the
Massachusetts Wetlands Protection Act or regulations, the Department of Environmental Protection has
no appellate jurisdiction.
o„o,mid Dear, !,ahmn atro0,0?
Paae5W5
"ATTACHMENT A"
I. Prior to the initiation of any work,the applicant/owner shall submit a letter of
understanding to the Commission stating that he/she has received read, understands and
shall comply with these conditions. The applicant, and, his or her contractor, foreman
and/or construction manager shall sign the letter of understanding.
2. Prior to the initiation of any work, the applicant shall submit to the Commission a
sequencing plan for construction,and erosion and sedimentation control installation.
3. Prior to the start of any site work,excavation or construction,a pre-construction conference
shall be held on the site, between the contractor conducting the work,the site/project
engineer,the applicant,and a member or agent of the Conservation Commission, in order
to ensure that the requirements of this Determination are understood by all parties. Prior to
the pre-construction meeting, all erosion control devices must be installed.
4. All required permits must be obtained from applicable federal, state and local agencies and
departments prior to the start of any project.
5. A copy of these conditions and associated plans shall remain on site during all construction
and/or building activities. The project manager and all equipment operators shall be
familiar with the approved plans, and shall be informed of their location on the site. This
location shall be accessible to all contractors whenever work is occurring on site.
6. All revised plans shall be approved by the Conservation Commission and incorporated into
the permit by reference and shall be followed during the course of construction.
7. The areas of construction shall remain in a stable condition at the close of each construction
day. Erosion control measures shall be inspected at this time,and maintained or reinforced
as necessary. All such devices shall be inspected, cleaned or replaced during construction
and shall remain in place until such time as stabilization of all areas that may impact
resource areas is permanent. These devices shall also be inspected to assure that the
maximum control has been provided. Any entrapped silt shall be removed to an area
outside the buffer zone and resource areas,and maintained or reinforced as necessary.
Erosion controls shall be inspected after every rainfall to assure that maximum control has
been provided.
8. An adequate stockpile of erosion control materials shall be on site at all times for
emergency or routine replacement and shall include materials to repair or replace silt
fences,straw bales,erosion control blankets,riprap, filter berms or other devices planned
for use during construction.
9. Soils exposed for periods greater than two months shall be stabilized with erosion control
blankets and netting, a covering of straw mulch,or a temporary cover of rye or other grass
to prevent erosion and sedimentation. Drainage ditches shall be stabilized and seeded with
a native perennial grass mixture. Any stabilization materials such as jute netting shall be
firmly anchored to prevent them from being washed from slopes by rain or flooding.
Preference should be given to biodegradable materials.
10. All disturbed areas shall be graded, loamed and seeded, or stabilized with erosion control
blankets or netting, and a covering of straw mulch prior to November 30,of each year. No
disturbed areas or stockpiled materials will be left unprotected or without erosion control
after this date
1I. No disposal of soils or other materials shall be allowed within: a 100-year floodplain; 40
feet of the 100-year floodplain elevation; any wetland;or any area within 100-feet of a
wetland,or 200 feet of a vernal pool unless such areas are specifically approved by the
Commission,in accordance with 310 CMR 10.00. and City of Northampton Ordinances -
Chapter 337.