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PermitApplication_Est. Russell Myette c_o Atty Dick EvansPermit Application Today's Date: 07/07/2010 Owner Applicant Est. Russell Myette c/o Atty Dick Evans Estate of Russell Myette c/o Atty Dick Evans 56 Main Street 56 Main Street Northampton, Mass. 01060 Northampton, Mass. 01060 Northampton, Massachusetts 01060 City, Massachusetts 01060 413-586-1348 rmel222@gmail.com City of Northampton department: No Work Location Information How many lots involved in the project: 1 Map / Block Lots of all lots in project: 25-079-001 & 25-083-001 Deed Book of all lots in project: B1984 P207, B 6370 P 6 Project work address: 86 Riverbank Road City/ State/ Zip: Northampton 01060 Zoning District: SC Application for following Permit Types ❑ Planning Bd. Special Permit w/ Site Plan ❑ Planning Bd. Special Permit w/ MAJOR Site Plan NO Special Permit ❑ Planning Bd. Major Site Plan Approval (No Special Permit), including 40R projects ❑ Subdivision Preliminary ❑ Subdivision Definitive with no Preliminary Approved ❑ Zoning Board Special Permit ❑ Appeal of Building Commissioner -Zoning ❑ Variance ❑ Historic District (Elm St) Determination of Appropriateness ❑ Wetlands Notice of Intent IF state wetlands Wetlands Request for Determination OR Resource Delineation ❑ Wetlands Certificate of Compliance reauest ❑ Planning Bd. Special Permit w/ Site Plan for flag lots ❑ Planning Bd. Site Plan (NO Special Permit) ❑ Approval Not Required Plans ❑ Subdivision Definitive with Preliminary Approved ❑ Subdivision Definitive Amendment ❑ Zoning Board Finding ❑ Comprehensive Permit (40B) ❑ Demolition (Demolition Delav) ❑ Central Business Architecture ❑ Wetlands Notice of Intent IF ONLY local wetlands ❑ Wetlands Amendment or extension 210 Main St., Rm. 11, City Hall, Northampton, MA 01060 (413) 587-1262 Fee Information Wetlands Request for Determination OR Resource Delineation $125 (WPA form 1 or 4a) - $125 Total Fee Amount: Existing Use Single family residence $125.00 Planned Use Single family residence, 2 bedrooms (as present). No change proposed in use of structure. Please see attached details. Detailed Project Information Wetlands Description: n/a Files Uploaded: By typing my name in the signature box, I certify that all the information above is accurate to the best of my knowledge, I am the property owner or have permission from the property owner to apply for this permit. I also grant permission to the City of Northampton to inspect the proposed work Signature: Richard M. Evans, Atty for Estate of Russell Myette Date Signed: 07/07/2010 210 Main St., Rm. 11, City Hall, Northampton, MA 01060 (413) 587-1262 Richard M. Evans Attorney at Law 56 Main Street Northampton Massachusetts 01060 July 7, 2010 Northampton Conservation Commission c/o Office of Planning and Development City Hall 210 Main Street Northampton, Massachusetts 01060 Re: Est. Russell Myette s 86 Riverbank Road, Northampton To the Commission: Enclosed please find nine (9) copies of a Request for Determination of Applicability, together with your Permit Application form,. a check payable to the City for $125 and a check payable to the Daily Hampshire Gazette for $40.00. Kindly determine applicability of the Wetlands/Rivers Protection Act. Please call me if you have any questions, or otherwise let me know how, I can be helpful. The property is question is the former home of Russell Myette, who died in October of last year. The property has been on the market, but uncertainty about the septic system is precluding its sale. The purpose of this application is to enable the Estate to obtain a permit to repair/replace the septic system so that the house can be sold and it will not continue to sit empty. Thank you for your courtesy and assistance. Vejy truly yours, M. Evans RME:ed Encl. c: Mass. DEP, 436 Dwight Street, Springfield, Mass. 01103 Cold Spring Environmental Consultants, Inc. Telephone 413-586-1348 Fax 413-585-9234 Email rmel222@gmail.com LL O W¢ >-F-p QOct (LFO 0 LL. ■ rm r6 O O O ca ti Ln c CQ. c0 a C` - ..a .a ru L13 I rr, ca °o a� fD C) m eJ Nu `H J O 1 - D C-� i 00 i I J\� W �J Q Q Q 0 0 z� c, v J J i' i u, a Z O cc 4c IX Z0Z� Qa 64/1 s z� ■ Ir W o O O O cc ti Ln CD CC3 COcc Z �rm 00 C cD -0 a5;C :) WF' m= L� cc .a = vi ( ru W a �■ cc .Rm Zo oc a Co W Ir rm z s W cc O O z N O m LL O W¢ . LU CLOo O LL O W¢ >-F-p QOct (LFO 0 LL. ■ rm r6 O O O ca ti Ln c CQ. c0 a C` - ..a .a ru L13 I rr, ca °o fD C) m `.MJ U) c n Q J O D C-� i i I J\� W �J Q 0 0 0 z� lb co coD S Wa �a i' i u, a Z cc 4c IX Z0Z� Qa s z� LL O W¢ >-F-p QOct (LFO 0 LL. ■ rm r6 O O O ca ti Ln c CQ. c0 a C` - ..a .a ru L13 I rr, ca °o I GOLD- SPRING ENVIRONMENTAL CONSULTANTS INC. • 21E Site Investigations • Percolation Tests • Subsurface Investigations Septic ]designs • Pollution Remediation • Regulatory Compliance • LSP on Staff Recycling and Solid Waste • Forensic Septic Investigations Second Opinions June 28, 2010 Northampton Conservation Commission City Hall ' Northampton, Massachusetts 01007 RE. Singe Fancily Residence Septic Repair Wetlands/Rivers Protection Act, Local Wetland Protection Bylaw Request for Determination: (Myette Residence) Map #2, Block, 1, lots 1& 78 3, 89 Riverbank Road, Northampton, MA Dear Conservation Commissioners: Enclosed please find the Septic System Repair Plan and Request for Determination of the applicability of the Wetland/River Protection Act and local Bylaw for the above mentioned property. Work is to be completed only 40-55 feet off the River as shown. The work area will be less than 1000 SF for the septic tank and leach area. While the leaching area is located 50+ feet from the River, the plan attempts to maximize setbacks where limited by property lines and topography. Fine Sandy Terrace (Rapoly drained) soil conditions were encountered on portions of the site away frorn the Bank and River. The work associated with excavation and grading of the septic system will as shown and meets Title 5 requirements and setbacks. Restabilization of any disturbed area between the septic and resource area is required with seed and mulch for vegetative ground cover after construction. The total area to be altered within the buffer is less than 1000 square feet No change in grade is required. The no work line is noted with a silt control line delineated using properly buried (6"), staked silt fence and double staked straw bales. (see plan detail). All above noted locations are referenced on the Figure 1: Site Locus Map and Figure 1: Site Plan (Dated 06/28/10 attached). Inspection services will be contacted for proper Board of Health well and septic system approvals and permits. Wetland delineation and placement of boundary was based on observation and interpretation of typical topography, soils and hydrology observed in the field . Delineation included topographic observations, the installation of soil bores for hydric soil determination and the identification of prominent features defining the resource area. The plan intention is to utilize the "best" part of the property for a septic with the least disturbance of the resource area. Mitigative measures include a silt fence, establishment of a no work zone, inspections as well as follow-up regrading, mulching and seeding of work areas and margins. Please note that the RFD forms have been filed with your office and the MADEP in duplicate and feel free to contact me, on behalf of my client in order to advise me of your next available hearing date and time. Please let me know whether we or your office handles the legal advertising for the public hearing. Sincerely, CId Spring Environmental Consultants, Inc. tianE. Weiss, M.S.pal Hydrogeologist Registered Sanitarian Lic. #933 President PC: Mass DEP, Wetlands Div., Springfield, Ma. 350 Old Enfield Road -- Belchertown, A. 01007 ° Phone: 413.323.5957 Fax 413.323.4916 M email agweiss@charter.net www. coldspringenviroDmentaLcom - - - i l Massachusetts Department of Environmental Protection Northampton Bureau of Resource Protection - Wetlands city/Town 1nIPA Form ® Request for Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. C. 131, §40 A. General Information Important: When filling out 1. Applicant: forms on the Attorney Dick Evans richardevans@justice.com computer, use Name E -Mail Address (if applicable) only the tab key to move your 86 Riverbank Road cursor - do not Mailing Address use the return Northampton MA 01060 key. City/Town State Zip Code 586-1348 585-9234 r� Phone Number Fax Number (if applicable) 2. Representative (if any): `Pry" Cold Spring Environmental, Inc. Firm Alan E Weiss, M S aeweiss@charter.net Contact Name E -Mail Address (if applicable) 350 Old Enfield Road Mailing Address Belchertown MA 01007 City/Town State Zip Code 413-323-5957 413-323-4916 Phone Number Fax Number (if applicable) B. Determinations 1. I request the Northampton make the following determination(s). Check any that apply: Conservation Commission ❑ a. whether the area depicted on plan(s) and/or map(s) referenced below is an area subject to jurisdiction of the Wetlands Protection Act. ❑ b. whether the boundaries of resource area(s) depicted on plan(s) and/or map(s) referenced below are accurately delineated. ® c. whether the work depicted on plan(s) referenced below is subject to the Wetlands Protection Act. ® d: whether the area and/or work depicted on plan(s) referenced below is subject to the jurisdiction of any municipal wetlands ordinance or bylaw of: Northampton Name of Municipality ® e. whether the following scope of alternatives is adequate for work in the Riverfront Area as depicted on referenced plan(s). (Residential Septic System Repair) Leach area is greater than 50 feet from MAHW, In addition, this is repair in of degraded (existing system) area with no grade changes required. Page 1 of 4 WPA Forml __ _ _ Rev._ 02100 Massachusetts Department of Environmental Protection Northampton Bureau of Resource Protection -Wetlands _ cirylTown WPA Form 1- Request for Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 C. Project Description 1. a. Project Location (use maps and plans to identify the location of the area subject to this request): 86 Riverbank Road Northampton Street Address City/Town 25-1 1 & 78 Assessors Map/Plat Number Parcel/Lot Number b. Area Description (use additional paper, if necessary): The area consists of work conducted in the area noted for the repair a septic system at a single family dwelling. All of the proposed work for the septic meets Title 5 and maximizes offset from the resource area(s) to the extent Possible. c. Plan and/or Map Reference(s): Septic Repair Plan Plan, (Attachment 1) 06/28/10 Title Date 2. a. Work Description (use additional paper and/or provide plan(s) of work, if necessary): Work will include the proper placement of siltation fencing prior to the start of work, where needed. (work is downgradient of swale location). All grading as well as seeding and mulching will be completed as shown for the Project as noted. The limit of work is noted as and the leach ara is over 50 feet from the river MAHW. b. Identify provisions of the Wetlands Protection Actor regulations which may exempt the applicant from having to file a Notice of Intent for all or part of the described work (use additional paper, if necessary). See above. WPA Formi Page 2 of 4 Rev. 02/00 ` \ Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands _ WPA Form I - Request for Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Northampton City/Town C. Project Description (cont.) 3. a. If this application is a Request for Determination of Scope of Alternatives for work in the Riverfront Area, indicate the one classification below that best describes the project. ® Single family house on a lot recorded on or before 8/1/96 ❑ Single family house on a lot recorded after 8/1/96 ❑ Expansion of an existing structure on a lot recorded after 8/1/96 ❑ Project, other than a single family house or public project, where the applicant owned the lot before 8/7/96 ❑ New agriculture or aquaculture project ❑ Public project where funds were appropriated prior to 8/7/96 ❑ Project on a lot shown on an approved, definitive subdivision plan where there is a recorded deed restriction limiting total alteration of the Riverfront Area for the entire subdivision ❑ Residential subdivision; institutional, industrial, or commercial project ❑ Municipal project ❑ District, county, state, or federal government project ❑ Project required to evaluate off-site alternatives in more than one municipality in an Environmental Impact Report under MEPA or in an alternatives analysis pursuant to an application for a 404 permit from the U.S. Army Corps of Engineers or 401 Water Quality Certification from the Department of Environmental Protection. b. Provide evidence (e.g., record of date subdivision lot was recorded) supporting the classification above (use additional paper and/or attach appropriate documents, if necessary.) Septic System Repair in existing degraded septic area. built 1900+/- WPA Forml Page 3 of 4 Rev. 02/00 Massachusetts Department of Environmental Protection Northampton Bureau of Resource. Protection - Wetlands city/Town WPA Form 1- Request for Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 D. Signatures and Submittal Requirements I hereby certify under the penalties of perjury that the foregoing Request for Determination of Applicability and accompanying plans, documents, and supporting data are true and complete to the best of my knowledge. I further certify that the property owner, if different from the applicant, and the appropriate DEP Regional Office (see Appendix A) were sent a complete copy of this Request (including all appropriate documentation) simultaneously with the submittal of this Request to the Conservation Commission. Failure by the applicant to send copies in a timely manner may result in dismissal of the Request for Determination of Applicability. Name and address of the property owner: Attornev Dick Evans Name 56 Main Street Mailing Address Northampton City/Town MA 01060 State Signatures: Zip Code I also understand that notification of this Request will be placed in a local newspaper at my expense in accordance with Section 10.05(3)(b)(1) of the Wetlands Protection Act regulations. /2010 Signature of Applicant Date la 06.28.2010 SigiEture of Representative (if any) WPA Fortn1 Page 4 of 4 i Rev. 02100 COLD SPRING ENVIRONMENTAL CONSULTANTS, INC. ALAN E. WEISS, M.S., R.S., L.S.P. Licensed Site Professional -Registered Sanitarian Hydrogeologist -Weiland Consults President -Soil and Water Testing •21 E Site Investigations 350 Old Enfield Rd. -Percolation Tests and Belchertown, MA 01007 -Septic Designs (413) 323-5957 & 323-4916 (FAX) -Title 5Inspections aeweis.s@charter.net FORM 11 - SOIL EVALUATOR --FORM Page I of 3 Date: Co monwealth of Massachusetts Massachusetts Soil Suitability Assessment for On-site Sewage Disposal Performed By: .... Date: 6 (�� f Z0(� Witnessed By: � t�.. �.�.�. V �� .� '� �� � cav �� . L.rxiuon Address or (Tvrrr's Name, Cep /� :� V[C,�C•t G�c.,.JS l.ot f dty Pt." .�.✓� Tckphax r [,jo New Construction ❑ Repair r6 Office Review _ f-IC�ICdcQ tG�;c,•�r� /�-j�� r Cc•i"t Published Soil Survey Available: No ❑ Yes [ J Year Published . ,. Publication Scale Soil \sap unil Drainage Class Soil Limitations Su ficial Geoiogic Repot Available: No n Yes ❑ "ear Published Publication Scale Geologic Material (Map Unit) Land 5 orni Flood Insurance Rate Map: Above 500 year flood boundary No Yes ❑ Within 500 year flood boundary No ❑Yes cl Within 100 year flood boundary No ®Yes 0 tie -co k6z.&J�, C12's Wetland Area: National Wetland Inventory Map (map unit) Wetlands Conservancy Program Map (map unit) Current Water Resource Conditions (USGS): Montle Range :Above Normal ©Normal EBelcw Normal ❑ Other References Reviewed: DEF APPROVED FOR.�j . 12/07195 44 i FORM 11 ZSOTL EVALUATOR FORM Page 2 of 3 Location Address or Lot No. Ve eue"Ltc( ro Qn-site Review Deep Hole Number Date:id4Zcrqc'2G I,1 �%DG `..,_ Time: Dr.� Weather Location (identify on site plan) .........,....... Land Use ,,:... .. Slope (%) Surface Stones f��f Vegetation 1'--<55 Landform �``k.r 7'C -K? `-Q Position on landscape (sketch on the back) .... Distances from: Open Water Body3-5 ^_feei Drainage way �..' feet 5'_ Ft'j� Possible Wet Area 35 � feet Property Line 5 ' feet Drinking WaterVeli, 1( feet Other DEEP OBSERVATION HOLE LOG 1 Depth frcrn S r zee (Inc :est jj Soil Horizon Soil Tem ire {USDA? ' Soil Coior1 (Munsell) Soii , oniirig y 3' G,:)er (S�ucura, Stones. Boulders, consistency, r ! 1 ! Gravel) S /S ZE �� IZG�I C, L5 to II � �(lG s — U �.-c 5�,� F i 1 « O '- `� �(7 � r V-5 L (0'.j 3(g -- i�1 4 !r Z� Cr L5 1O �1� 'Fl1 L C` L edS- �vT Z ! � ''� ( 1 � to �. � " � w, � S/G''('^ .�-• � MIN1 i_., ti 1 Z,l Parent Material {geologic) Fj'j �'� �✓7(� Dept-rtoBedrock: l� Decth to Groundwater: Standing Water in the Hole: /Y/_(T_ Weeping from Pit Face. wr ^ Estimaird Seasonal High Ground Water: At it 1 gi ej- LPc,,.Q 1 2 d —2 5 tx,Q r -ft^w S r d� 1 DEP APPROYED FORA - 11/07/95 FOW 12 - PERCOLATION TEST I-ocation Address or Lot No. OF MASSACHUSETTS &/crkLt1�­V4L',41 Massachusetts -Percolation Test* Date: wzaeD-Time:, Observatipn Hole Depth of Perc Start Pre-soak -Ind Pre-soak I imite at, 12' i ime at. Time at 6' I Ime Rate Min./inch I T_ ------- S t --* 7p L � , 4 Minimum of I percolation test must be performed in both the primary area AND reserve area. Site Passed Site Failed El I .................................................................................................................................... . ... Perf ormed By: ec S S...... ........ Witnessed By: 4P.-( - C Comments: DEP APPROVED FORM - 12107/95 P29e 3 of 3 Loe2lion Address or Loi No. V('ic Determination hor Sea.,sfflzar High Water Fable Method Used: ❑ Depth observed standing in observation mole .......... inches ❑ Depth weeping from side of observation hole... inches Depth to soil mottles . /�—�'�� inches ❑ Ground water adjustment ................... feet Index Weil Number ................ Reading Date ................ index well level Adjustment factor ............. Adjusted ground water level ........................... Deoth of Naturally Occurring Pervious iVlaterial Does at least four feet of naturally Occurring pervirUS material exist !n all areas observed throughout the area proposed for the soi, ab sorption systern? If not, what is the depth of naturally occurring pervious material? l'_erLi !cation certify that on (date) l have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed ned by me consistent with the required training, expertise and experience described in 310 CMR 15.017. Signature OF ��vS ALAN C. vf[ISS G, C) m RLc. 7'S'n z m DEP APPRONBD FO%NJ - 12/07195 NC6THAMPT0 PRV� SSACHUSE' i� ! CYNTHIA A_ MCDONAM E 1_-40, JURE 21. 2041 40 4 40 80 1 150 FEET MARK D. ANNlS Yl—S- RfC151ERED pROFESSIOhAL LAND SURVEYOR RA. BOX 324 SOi7TH&W 1UN. Ad ASS tri THIS PLAT IS COMPILED FROM DEEDS, PLANS, AND OTHER SOURCES FOR MORTGAGE PURPOSES ONLY, AND DOES NOT CONSTITUTE AN ACCURATE SURVEY, AND IS SUBJECT TO CHANGES A MORE ACCURATE SURVEY MAY DISCLOSE d01A6 MARX D. AHUM ow. TO r ( _ MORTGAGE LOAN :INSPECTION PLAT U.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE OMB No. 1660-0008 Federal Emergency Management Agency I Expires March 31, 2012 National Flood Insurance Program Important: Read the instructions on pages 1-9. SECTION A PROPERTY INFORMATION For Insurance Company Use: Al. Building Owner's Name Russell J. Myette Policy Number A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Company NAIC Number 86 Riverbank Road City Northampton State MA ZIP Code 01060 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Hampshire County Registry of Deeds Book 1984, Page 207 A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) Residential A5. Latitude/Longitude: Lat. 42°20'03" Long. 72°37'02" Horizontal Datum: ❑ NAD 1927 ® NAD 1983 A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. AT Building Diagram Number 8 A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage: a) Square footage of crawlspace or enclosure(s) sq ft a) Square footage of attached garage sq ft b) No. of permanent flood openings in the crawlspace or b) No. of permanent flood openings in the attached garage enclosure(s) within 1.0 foot above adjacent grade within 1.0 foot above adjacent grade 0 c) Total net area of flood openings in A8.b sq in c) Total net area of flood openings in A9.b 0 sq in d) Engineered flood openings? ❑ Yes ® No d) Engineered flood openings? ❑ Yes ® No SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION Bl. NFIP Community Name & Community Number B2. County Name B3. State 1 I 250167 Hampshire MA B4. Map/Panel Number B5. Suffix B6. FIRM Index B7. FIRM Panel B8. Flood B9. Base Flood Elevation(s) (Zone 0002 A Date Effective/Revised Date Zone(s) AO, use base flood depth) April 3, 1978 April 3, 1978 A13 125.0-14. B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9. ❑ FIS Profile ® FIRM ❑ Community Determined ❑ Other (Describe) Bl 1. Indicate elevation datum used for BFE in Item B9: ® NGVD 1929 ❑ NAVD 1988 ❑ Other (Describe) B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes N No Designation Date ❑ CBRS ❑ OPA SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building elevations are based on: ❑ Construction Drawings' ❑ Building Under Construction' ® Finished Construction 'A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations -Zones Al -A30, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, AR/A, ARAE, AR/A1-A30, AR/AH, AR/AO. Complete Items C2.a-h below according to the building diagram specified in Item A7. Use the same datum as the BFE. Benchmark Utilized Vertical Datum 1929 Conversion/Comments Check the measurement used. a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 122.9 ® feet ❑ meters (Puerto Rico only) b) Top of the next higher floor 1`24.4 ® feet ❑ meters (Puerto Rico only) c) Bottom of the lowest horizontal structural member (V Zones only) ❑ feet ❑ meters (Puerto Rico only) d) Attached garage (top of slab) 124.6 ® feet ❑ meters (Puerto Rico only) e) Lowest elevation of machinery or equipment servicing the building 126.1 ❑ feet ❑ meters (Puerto Rico only) (Describe type of equipment and location in Comments) f) Lowest adjacent (finished) grade next to building (LAG) 115.0 ® feet ❑ meters (Puerto Rico only) g) Highest adjacent (finished) grade next to building (HAG) 124.6 ® feet ❑ meters (Puerto Rico only) h) Lowest adjacent grade at lowest elevation of deck or stairs, including ❑ feet ❑ meters (Puerto Rico only) structural support SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information. I certify that the information on this Certificate represents my best efforts to interpret the data available.) understand that any false statement may be punishable by fine orimprisonment under 18 U.S. Code, Section 1001.❑ Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a licensed land surveyor? ® Yes ❑ No Randall E. Izer License Number 35032 Company Name Harold L. Eaton & Associates, Inc. Address 235 Russell Street City Hadley State MA ZIP Code 01035 re Date January 25, 2010Telephone 413-584-7599 FEMA Form 81-31, Mar 09 See reverse side for continuation. Replaces all previous editions IMPORTANT: In these spaces, copy the corresponding information from Section A. For Insurance Company Use: Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number 86 Riverbank Road City Northampton State MA ZIP Code 01060 Company NAIC Number SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. Comments Lowest elevation of machinery is an electric meter outside the house. We did not have access to the interior of the house to determine machinery elevations inside. Front of house appears to be slab on grade with rear of house supported by piers. I don't consider the area under the piers to be a crawl space. Signature Date 01/25/10 ❑ Check here if attachments SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO and A (without BFE), complete Items E1 -E5. If the Certificate is intended to support a LOMA or LOMR-F request, complete Sections A, B, and C. For Items E1 -E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter meters. E1. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent grade (HAG) and the lowest adjacent grade (LAG). a) Top of bottom floor (including basement, crawlspace, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the HAG. b) Top of bottom floor (including basement, crawlspace, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the LAG. E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9 (see pages 8-9 of Instructions), the next higher floor (elevation C2.b in the diagrams) of the building is ❑ feet ❑ meters ❑ above or ❑ below the HAG. E3. Attached garage (top of slab) is ❑ feet ❑ meters ❑ above or ❑ below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is ❑ feet ❑ meters ❑ above or ❑ below the HAG. E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown. The local official must certify this information in Section G. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A, B, and E for Zone A (without a FEMA -issued or community -issued BFE) or Zone AO must sign here. The statements in Sections A, B, and E are correct to the best of my knowledge. Property Owner's or Owner's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments ❑ Check here if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in Items G8 and G9. G1. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2. ❑ A community official completed Section E for a building located in Zone A (without a FEMA -issued or community -issued BFE) or Zone AO. G3. ❑ The following information (Items G4 -G9) is provided for community floodplain management purposes. G4. Permit Number G5. Date Permit Issued G6. Date Certificate Of Compliance/Occupancy Issued G7. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement G8. Elevation of as -built lowest floor (including basement) of the building: ❑ feet ❑ meters (PR) Datum G9. BFE or (in Zone AO) depth of flooding at the building site: ❑ feet ❑ meters (PR) Datum G10. Community's design flood elevation ❑ feet ❑ meters (PR) Datum Local Official's Name Title Community Name Telephone Signature Date Comments Check here if attachments FEMA Form 81-31, Mar 09 Replaces all previous editions w 2� 24 ON073Y d0 SNOdd dO AM 'd3H 9.4 1 .g 1 � lip � fig$ ��� •��: � � ��€� gi 51✓, p NvWi 1� 596 S g" �h CROSS PATH LANE 8$ Cil 6.b 0 u g_ < Zvi [z Z � 6 9.4 1 .g 1 � lip � fig$ ��� •��: � � ��€� gi 51✓, p NvWi 1� 596 Building Photographs See Instructions for Item A6. For Insurance Company Use: Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number 86 Riverbank Road City Northampton State MA ZIP Code m6o Company NAIC Number If using the Elevation Certificate to obtain NFIP flood insurance, affix at least two building photographs below according to the instructions for Item A6. Identify all photographs with: date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side View." If submitting more photographs than will fit on this page, use the Continuation Page, following. Left front z Building Photographs Continuation Paoe For Insurance Company Use: Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number 86 Riverbank Road City Northampton State MA ZIP Code o1o6o Company NAIC Number If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all photographs with: date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side View." Right Rear L- - - -.< _ Wit._.. � �_ - - __. .-. _-__. -- '...� .. ... _ _ __:. . 3 - :. - . .. -:.�- ..-- •- _- - _� - - - a�.�:....-- -- .a,..._��_-- - -