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44-014 (16) 254 OLD WILSON RD BP-2021-0138 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:44-014 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:demolition BUILDING PERMIT Permit# BP-2021-0138 Project# JS-2021-000229 Est.Cost: Fee: $60.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq.ft.): Owner. BROADBENT ERICSSON zoning: Applicant. BROADBENT ERICSSON AT. 254 OLD WILSON RD Applicant Address: Phone: Insurance: 51 HILLCREST DR (978) 906-5592 FLORENCEMA01062 ISSUED ON.81612020 0:00:00 TO PERFORM THE FOLLOWING WORK.-DEMO SHED AND CLUBHOUSE POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 8/6/2020 0:00:00 $60.00 212 Main Street, Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner RECEIVED AUG - 4 2020 The Commonwealth of MassachuseiTspT OF BUILDING INSPF IONS i1 NnRTHAMP70N,P.1A 01 60' �� Board of Building Regulations and StandarUZI MUNICIPALITY T It' Massachusetts State BuildingM Code,780 CR USE Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised May-2011 One-or Two-Family Dwelling This Section For Official Use Only Building Permit Number: — / 3 Date Ap ppli.d: UN Y 1nfVr--, Building O cial not Name St nature Date SE TION 1:SITE INFORMATION 1.1 Property ddrgss: 1. Assessors Map&P�rcel Numbers Z J g 0 i c� Lti�11.S 6 n ��. �O(�1� �")Pe a��r hQc; �?If 1"►S� �(� U�. 1.1 a Is this an accepted street?yes ✓ no Map Number Parcel Number 1.3 Zoning Information: 1.4 Properrtty�Dimensions: 2es.de.,h'��a1 22q213 Cla�erJc) 2- Zoning Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: PubGo I/ Private❑ Zone: _ Outside Flood Zone? Municipal L1On site disposal system fd/ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: �� `�� pp I�1 A —E:h C."San a.t,;s +t aC il+,ail G _nacrae r'�a f2�u OI Z 2, Name(Print) City,State,ZIP S i �,oIc rest oC: `IAIO 5592 .eb�Da�lelf C�mac.,cam . No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK--(check all that apply) New Construction Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition Accessory Bldg.❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work': R fmnue- SECTION 4:ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: (Labor and Materials) Official Use Only 1.Building $ 1. Building Permit Fee:$ Indicate how fee is determined: 2.Electrical ❑Standard City/Town Application Fee $ ❑Total.Project Cost'(Item 6)x multiplier x 3.Plumbing S 2. Other Fees: S 4.Mechanical (HVAC) S List: 5.Mechanical (Fire S Suppression) __------.- Total All Fees: eckNo. Ar noun Aount: Cash Amount: 6.Total Project Cgst $ ❑ aid in Full ❑Outstanding Balance Due: All.)o SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) 1 SF's �.ti�t.hej� ��te) License Number Expiration Date Name of CSL Holder List CSL Type(see below) No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances I Insulation Telephone Emai'.address D Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC Company Name or HIC Registrant Name iLIC Registration Number Expiration Date No.and Street Email address City/Town,State,ZIP Telephone SECTION 6:WORKERS' COMPENSATION INSURAIN'CE AFFIDAVIT(M G.L.c.152.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes .......... No...........17 SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIITT I,as Owner of the subject property,hereby authorize ` � ��aIJ :t n xc �r3f;n to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) I Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. ffic— Print Owner's or Authorized Agent's Name(Electronic Signature) nate NOTES: 1. An Owner who obtains a building permit to do his/her otvn work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(MC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Odic:important information on the HIC Program can be found at www.mass_,-ov/oca Information on the Construction Supervisor License can be found at NvwNv.mass.51ov/dos 2. When substantial work is planned,provide the information below: Total floor area(sq.fr.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" City of Northampton Massachusetts DEPARTMENT OF BI=DING INSPECTIONS �. a 212 Main street • Municipal Building Northampton, MA 01060 sjyj1�4� HOMEOWNERS`EXEMPTION ELIGIBILITY AFFIDAVIT I, .(insert full legal name), born _ (insert month, day,year),hereby depose and state the following: 1. I am seeking a building permit pursuant to the homeowners'exemption to the permit requirements of the Massachusetts State Building Code, codified at 780 CMR 110.R5.1.3.1, in connection with a project or work on a parcel of land to which I hold legal title. 2. I am not engaged in, and the project or work for which I am seeking the aforementioned homeowners`. exemption, does not involve the field erection of manufactured.buildings constructed in accordance with 780 CMR 110.83. 3. I qualifij under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.85.1.2: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to.be, a one-or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a home owner. 4. I do not hold a valid Massachusetts construction supervision license and, except to the extent that I qualifij for and will abide by the Massachusetts State Building Code's requirements for the supervision of the project or work on my parcel, I am not engaged in construction supervision in connection with any project or work involving construction, reconstruction, alteration, repair, removal or demolition involving any activity regulated by any provision of the Massachusetts State Building Code. 5. I I engage an other person or personsfor hire in connection with the aforementioned project or work on Ify p p f f ln"1 my parcel,I acknowledge that I am required to and will act as the supervisor for said project or work. Signed under the pains and penalties of perjury on this day of 20 2? (Signature) i The Commonwealth of Massachusetts Department oflndustrialAccidents 3 I Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia `Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMMING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organizado dividuai ' 6 _,S--sby) I-L �} Address: S 1 c ("-sJ. ` IVP City/State/Zip: 1 ('8Y C�e_ MA G 0&Z Phone#: cJ-78 9 7. Are you an employer'.'Check the appropriate box: Type of project(required): 1.❑1 am a employer with employees(full and/or part-time).' 7. n New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in $, E]Remodeling any capacity.[No workers'comp.insurance required.] 3J71 am a homeowner doing all work myself.[No workers'comp.insurance required]+ 9. -Demolition 4.J7I am a homeowner and will 6e hiring contractors to conduct all work an my property. I will 10 0 Building addition ensure that all contractors either Gave workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.[]Plumbing repairs or additions 5.❑1 am a general contractor and I have hired the sub-contractors listed on the attached sheet 13.❑Roof repairs These sub-coutrsctors have employees and have workers'comp.i„�ranee. 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.0 Other 152,§1(4),and we have no employees.[No workers'comp_insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site informatiom Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains andpenalties of perjury that the information provided above t bove is true and correct. Simature: —�� ice_ _ }'�e���� Date: 04 I2-0 Phone#: 9-7p p P6 Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: i The City of Northampton } ; Building Department 212 Main Street Northampton,Massachusetts 01060 Phone(413) -52t-t t2 Fax (413) 529-1433 CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance with the.provisions of MGL c40, s54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c 111, S 150A. The debris will be disposed of in: Location of Facility_ The debris will be transported by: Name of Hauler_ _ �� y. 1 � _ _ _ _ _ _ _ _ _ _ _ _ _ _ Signature of Applicant: _ �'JJ —— ——— —Date:_ C CITY OF NORTHAMPTON SETBACK PLAN MAP:, _ LOT:_ _ LOT SIZE: REAR LOT DIMENSION REAR PARD afi�a��e d zpP� ,d by �1 SIDE YARD SIDE PARD i FRONT:SETBACK_ _ FRONTAGE________ I On Jul 17, 2020, at 8:29 AM, DUFFY-WILLARD PAVING EXCV <duffywillard @comcast.net> wrote: Good Morning Eric, The proof of insurance and facility hauling debris to are no problem. We will haul the debris ourselves using our own trucks. We do not hold a Construction Supervisors License as it is not required for our line of work, I believe that is why as the homeowner you can apply for the demo permit yourself. I can have our insurance company send you a Certificate of Insurance which you can add to the permit. We will be hauling to Valley Recycling on Easthampton Road, Northampton. I do not know if you have to list both buildings separately. You might list it as "Remove clubhouse and locker room facilities" I'll have our insurance Co. email you our policies today. Tom Duffy Willard Paving & Excavating (P) (413) 586-1477 (F) (413) 586-9210 duffywillard@comcast.net On 07/17/2020 2:22 AM Ericsson Broadbent <ebroadbent@mac.com> wrote: Hi Tom, from what I can tell, the regular building permit is the right form to use for a demolition: http://northamptonma.gov/DocumentCenterNiew/220/Building-Permit--- One-and-Two-Family-Homes-PDF The form requires a bit of info that you or someone at D&W would provide - such as license, confirmation of Worker's Comp Insurance, facility where debris will be taken and how hauled, etc. Once we get rolling you can let me know how best to coordinate this - e.g. I can fill in as much as I know and hand it over to you, or vice versa - whatever works best. Also, do you know if we need a permit for each building, or is this something I should ask Carolyn Misch? Thanks for all your help, -Eric DATE(MMIDDIYYYY) ACO CERTIFICATE OF LIABILITY INSURANCE F07/22/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT Christina Barrett PRODUCER NAME: Aquadro&Associates PHONE (413)586-7373 FAX No: (413)584-0859 (AC. C No Ext E-MAIL christina@aquadroinsurance com 355 Bridge St.,P O Box 357 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC N Northampton MA 01061 INSURERA: Travelers Indemnity Cc 25658 INSURED A.LM Mutual Insurance Companies AIM001 INSURER B: Duffy Willard Paving&Excavating Inc INSURER C: Duffy Willard Trucking LLC INSURER D: _ Po Box 60137 INSURER E Florence MA 01062 INSURER F COVERAGES CERTIFICATE NUMBER: CL18122709674 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS IN R OLICY EFF LI Y EXP LIMITS LTR v TYPE OF INSURANCE IN POLICY NUMBER MMIDD/YYYY MM/DD/YYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE b 1,000,000 DAMAGF TO REN 1 300,000 CLAIMS-MADE OCCUR PREMISES Ea occurrence b _ MED EXP(Any one person) b 5,000 A 680OJ976472 03/17/2020 03/17/2021 PERSONAL&ADV INJURY $ 1,000,000 $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PE GENERAL AGGREGATE R: PRO- PRODUCTS-COMP/OPAGG g 2,000,000 X POLICY ❑ JECT ❑ LOC b OTHER COMBINED SINGLE LIMIT $ 1,000,000 AUTOMOBILE LIABILITY Ea accident BODILY INJURY(per person) $ ANY AUTO A OWNED tOTH- WORKERS BA2D347138 08/01/2019 08/01/2020 BODILY INJURY(Per acadenti $AUTOS ONLY PROPERTY DAMAGEHIRED Per accident $X AUTOS ONLY bUMBRELLA LIAB EACH OCCURRENCE bEXCESS LIAB AGGREGATE $ DED RETpER OTH- WORKERS COMPENSATION STAT TE ER AND EMPLOYERS'LIABILITY Y/N1,000,000 B ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N/A VMdZ-800-8006793-2020 03/17/2020EE E L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED E L.DISEASE-EA EMPLOYEE $ 1,000,000 (Mandatory In NH) If yes,describe under E L DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ERICSSON BROADBENT AUTHORIZED REPRESENTAILVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Green Environmental Consulting, Inc 180 Pleasant Street, Suite 213 tel/fax 413-341-3418 Easthampton, MA 01027 www.GecEnviro.com July 23, 2020 Matt Murphy Western Mass Environmental, LLC 93 Wayside Avenue West Springfield, MA 01089 RE: Pre-Demolition Asbestos Survey 254 Old Wilson Road (Club House and Locker Room Building) Florence, Massachusetts 01062 Dear Mr. Murphy: Pursuant to your request, Green Environmental Consulting, Inc (GEC) performed a pre-demolition asbestos survey of the club house and locker room building at the above-referenced former golf course. Fieldwork associated with the project was performed on July 8, 2020 by Massachusetts-licensed Asbestos Inspector, David Abad (Lic.#A1071927). The purpose of GEC's survey was to identify asbestos-containing materials (ACMs) prior to the planned demolition of the buildings. In accordance with state and federal asbestos regulations, identified ACMs are required to be removed prior to any demolition/renovation activities. Asbestos Sampling/Results Thirty-one (31) samples of suspect asbestos-containing materials (ACMs) were collected and submitted to an accredited laboratory for analysis using Polarized Light Microscopy with Dispersion Staining (PLM/ DS). Materials determined to contain one percent or greater asbestos are considered to be ACMs. Materials determined to contain trace or less than one-percent (<1%) asbestos are considered to be asbestos-containing waste materials (ACWMs). The following materials were determined to be asbestos-containing materials (ACMs): -. Reference Sample •- Joint Compound Club House - Bar Area I 2,586 Sq. Ft. 1 02874 - 02A & 02B Pre-demolition Asbestos Survey 254 Old Wilson Road, Northampton, MA (Club House and Locker Room Building) The following materials were sampled and determined to be asbestos-containingwaste materials (ACW M's): Table • 2, Asbestos-containing Location Estimated Reference Sample Quandity .- Exterior Window Glazing Club House - Front of Building in Bar (Old Double Hung Area, Storage Room, Kitchen and 8 Each 02874 - 15A&15B Windows) Bathroom The following materials were sampled and determined not to be asbestos-containing materials(less than one-percent asbestos): Table No. Reference Sample Number(s) Club House- Bar Area, Kitchen, Ladies 02874 - OlA & 01B Room and Men's Room Black Rubberized Floor and Club House- Bar Area, Ladies Room, 02874- 03A, 03B, 04A& associated Mastic Men's Room and Basement 04B Bar Carpet Mastic Club House - Bar Area 02874- 05A White w/ Brown Ceiling Formica (Yellow Mastic) Club House- Kitchen 02874- 06A White w/ Brown Ceiling Formica Club House- Kitchen 02874- 07A (Brown Mastic) Sub-Floor Paper Club House- Kitchen 02874- 08A (Black) Sub-Floor Paper Club House- Kitchen 02874 - 09A (Tan) Sub-Siding Paper(Black) Club House- Exterior 02874 - 10A&10B Roof Paper Club House- Exterior 02874 -11A&11B (Porch Side) Roof Shingle Club House- Exterior 02874 - 12A&12B (Porch Side-Architectual) Roof Paper(Front Side) Club House- Exterior 02874-13A&13B Roof Shingle Club House- Exterior 02874 -14A&14B (Front Side - 3 Tab) Picture Window Glazing (Windows w/ Roll out Sides) Club House - Exterior 02874 - 16A&16B Exterior Window Glazing Club House- Exterior 02874 -17A (Roll out Windows) Page 2 of 4 Pre-demolition Asbestos Survey 254 Old Wilson Road, Northampton, MA (Club House and Locker Room Building) Exterior Window Glazing Club House- Exterior 02874 - 18A (Verical Sliders) Roofing Shingles Locker Room Building 02874 -19A&19B Peter to Attachment No. 1 for laboratory results, including detailed descriptions of sampling locations, as well as chain-of custody records for samples collected. Samples were collected in a statistically random manner, per EPA guidelines. Limitations This report is intended for the sole use of the Western Mass Environmental, LLC. This report is not intended to serve as a bidding document nor as a project specification and actual site conditions and quantities should be field-verified. The scope of services performed in execution of this evaluation may not be appropriate to satisfy the needs of other users, and use or re-use of this document, the findings, conclusions, or recommendations herein is at the risk of said user. Although a reasonable attempt has been made to locate suspect ACMs in the areas identified, the inspection techniques used are inherently limited in the sense that only full demolition procedures will reveal all building materials of a structure and, therefore, all areas of potential ACM. Caution should be used during renovation/demolition activities. GEC's inspection did not include the following areas: • Electrical systems and/or components (due to safety issues inherent with sampling such systems). The Massachusetts Department of Environmental Protection (DEP), as well as the U.S. Environmental Protection Agency (EPA) currently recognize Polarized Light Microscopy (PLM) analysis as an acceptable analytical method for determining the Asbestos content in non-friable, organically bound (NOB) materials. However, comparative studies between PLM analysis and Transmission Electron Microscopy (TEM) analysis have shown that PLM analysis may yield false negative analytical results for NOB's such as floor tiles. GEC recommends that, prior to renovation activities, one sample from each homogeneous area of mastic and other non-friable organically bound (NOB) materials that originally tested negative by PLM undergo confirmatory analysis by TEM, utilizing ELAP-198.4 TEM Method for Identifying and Quantifying Asbestos in NOB bulk samples. Page 3 of 4 Pre-demolition Asbestos Survey 254 Old Wilson Road, Northampton, MA (Club House and Locker Room Building) Conclusions/Recommendations Asbestos-containing materials (ACMs) were identified during GEC's survey. Identified ACMs should be removed, handled, and disposed of properly, in accordance with applicable state and federal regulations prior to disturbance. Window glazing the Club House building was determined to contain trace or less-than one-percent asbestos. Although materials that contain <1% asbestos are not by definition asbestos-containing materials, certain regulatory requirements still apply. These requirements include the Occupational Safety and Health Administration's (OSHA) employee exposure requirements and MassDEP regulations for "Asbestos-Containing Waste Material" (ACWM). ACWM is not subject to MassDEP notification requirements but is required to be managed as prescribed by 310 CMR 7.15(15) through 310 CMR 7.15(18). Planned activities involving asbestos-containing waste materials (ACWM's - Table No. 2) should be performed in accordance with the requirements of the OSHA construction standard (29 CFR 1910.1101) and current MassDEP regulations (310 CMR 7.15) including, but not limited to the following: • use of wet methods, to reduce exposure and prevent asbestos fiber migration and contamination of surfaces in the work area • Avoid dry sweeping, shoveling, or other dry clean-up methods • Use of disposable protective clothing and respiratory protection • Waste containing any amount of asbestos should be kept segregated from demolition or renovation debris or material that does not contain asbestos and must be handled, packaged, labeled and disposed of as ACWM. Solid waste that has been contaminated or mixed with material containing any amount of asbestos cannot be sent to a solid waste facility that accepts construction and demolition debris. Any suspect asbestos-containing material that is discovered during building renovation/demolition that is not included in this report should be assumed to contain asbestos until further bulk sampling and analysis is performed. If you have any questions regarding this report, please contact us at (413) 341-3418. Sincerely, Green Environmental Consulting, Inc AL - David Abad Adam Lesko Senior Project Manager President Page 4 of 4 EMSL Analytical, Inc. EMSL Order: 042016344 Customer ID: GECL78 200 Route 130 North Cinnaminson,NJ 08077 Customer PO: Tel/Fax:(800)220-3675/(856)786-5974 http://www.EMSL.com/cinnasblab@EMSL.com Project ID: Attention: EMSLReports@gecenviro.com Phone: (413)341-3418 Green Environmental Consulting, Inc. Fax: (413) 341-3419 180 Pleasant St Received Date: 07/09/2020 9:50 AM 2nd Floor, Suite 213 Analysis Date: 07/10/2020-07/13/2020 Easthampton, MA 01027 Collected Date: Project: Pine Grove Golf Course-02874-Old Wilson Road, Florence, MA Test Report:Asbestos Analysis of Bulk Materials via EPA 600/R-93/116 Method using Polarized Light Microscopy Non-Asbestos Asbestos Sample Description Appearance %Fibrous %Non-Fibrous %Type 02874-01A Bar Area-Sheetrock Brown/White 20%Cellulose 80%Non-fibrous(Other) None Detected Fibrous 042016344-0001 Homogeneous 02874-01 B Bar Area-Sheetrock Brown/White 15%Cellulose 85%Non-fibrous(Other) None Detected Fibrous 042016344-0002 Homogeneous 02874-02A Bar Area-Joint White 100%Non-fibrous(Other) None Detected Compound Non-Fibrous 042016344-0003 Homogeneous 02874-02B-Joint Bar Area-Joint White 100%Non-fibrous(Other) None Detected Compound Compound Non-Fibrous Homogeneous 042016344-0004 02874-0213-Joint Bar Area-Joint Tan 98%Non-fibrous(Other) 2%Chrysotile Compound 2 Compound Non-Fibrous Homogeneous 042016344-0004A 02874-03A Bar Area-Black Various/Black 100%Non-fibrous(Other) None Detected Rubberized Flooring Non-Fibrous 042016344-0005 Homogeneous 02874-03B Bar Area-Black Various/Black 100%Non-fibrous(Other) None Detected Rubberized Flooring Non-Fibrous 042016344-0006 Homogeneous 02874-04A Bar Area-Black Yellow 100%Non-fibrous(Other) None Detected Rubberized Flooring Non-Fibrous 042016344-0007 Mastic Homogeneous 02874-04B Bar Area-Black Yellow 100%Non-fibrous(Other) None Detected Rubberized Flooring Non-Fibrous 042016344-0006 Mastic Homogeneous 02874-05A Bar Area-Bar Carpet Yellow 100%Non-fibrous(Other) None Detected Mastic Non-Fibrous 042016344-0009 Homogeneous 02874-06A Kitchen-White Tan 100%Non-fibrous(Other) None Detected w/Brown Ceiling Non-Fibrous 042016344-0010 Formica Mastic- Homogeneous Yellow 02874-07A Kitchen-White Yellow 100%Non-fibrous(Other) None Detected w/Brown Ceiling Non-Fibrous 042016344-0011 Formica Mastic- Homogeneous Brown 02874-08A Basement-New Black 65%Cellulose 35%Non-fibrous(Other) None Detected Front Section- Fibrous 042016344-0012 Sub-floor Paper- Homogeneous Black 02874-09A Basement-Original Black 80%Cellulose 20%Non-fibrous(Other) None Detected Section-Sub-floor Fibrous 042016344-0013 Paper-Tan Homogeneous Initial report from:07/14/2020 07:55:52 ASB-PLM-0008-0001-1.78 Printed:7/14/2020 7:55 AM Page 1 of 3 EMSL Analytical, Inc. EMSLOrder: 042016344 Customer ID: GECL78 200 Route 130 North Cinnaminson,NJ 08077 Customer PO: Tel/Fax:(800)220-3675/(856)786-5974 hftp://www.EMSL.com/cinnasblab@EMSL.com Project ID: Test Report:Asbestos Analysis of Bulk Materials via EPA 600/R-931116 Method using Polarized Light Microscopy Non-Asbestos Asbestos Sample Description Appearance %Fibrous %Non-Fibrous %Type 02874-10A Exterior-Sub-siding Black 40%Cellulose 60%Non-fibrous(Other) None Detected Paper-Black Non-Fibrous 042016344-0014 Homogeneous 02874-10B Exterior-Sub-siding Black 40%Cellulose 50%Non-fibrous(Other) None Detected Paper-Black Fibrous 10%Glass 042016344-0015 Homogeneous 02874-11A Exterior-Roof Paper Black 5%Glass 95%Non-fibrous(Other) None Detected -Porch Side Non-Fibrous 042016344-0016 Homogeneous 02874-11 B Exterior-Roof Paper Gray/Black 100%Non-fibrous(Other) None Detected -Porch Side Non-Fibrous 042016344-0017 Homogeneous 02874-12A Exterior-Architectual Black 20%Cellulose 75%Non-fibrous(Other) None Detected Roofin Shingles- Non-Fibrous 5%Glass 042016344-0018 Porch Side Homogeneous 02874-12B Exterior-Architectual Gray/Black 10%Cellulose 75%Non-fibrous(Other) None Detected Roofin Shingles- Fibrous 15%Glass 042016344-0019 Porch Side Homogeneous 02874-13A Exterior-Roof Paper Black 100%Non-fibrous(Other) None Detected -Front Side Non-Fibrous 042016344-0020 Homogeneous 02874-13B Exterior-Roof Paper Black 100%Non-fibrous(Other) None Detected -Front Side Non-Fibrous 042016344-0021 Homogeneous 02874-14A Exterior-Front Side- Black 20%Glass 80%Non-fibrous(Other) None Detected Roof Shingle-3 Tab Non-Fibrous 042016344-0022 Homogeneous 02874-14B Exterior-Front Side- Black 15%Glass 85%Non-fibrous(Other) None Detected Roof Shingle-3 Tab Fibrous 042016344-0023 Homogeneous 02874-15A Exterior-Old Double White/Red 2%Fibrous(Other) 98%Non-fibrous(Other) <1% Chrysotile Hung-Front of Non-Fibrous 042016344-0024 Building-Kitchen- Homogeneous Bathrooms-Exterior Window Glazing 02874-15B Exterior-Old Double Gray 100%Non-fibrous(Other) <1%Chrysotile Hung-Front of Non-Fibrous 042016344-0025 Building-Kitchen- Homogeneous Bathrooms-Exterior Window Glazing 02874-16A Exterior-Picture Gray 100%Non-fibrous(Other) None Detected Window Glazing-Roll Non-Fibrous 042016344-0026 Out on Side Homogeneous 02874-16B Exterior-Picture Gray 100%Non-fibrous(Other) None Detected Window Glazing-Roll Non-Fibrous 042016344-0027 Out on Side Homogeneous 02874-17A Exterior-Exterior Black 15%Cellulose 75%Non-fibrous(Other) None Detected Window Glazing-Roll Fibrous 10%Glass 042016344-0028 Outs Homogeneous 02874-18A Exterior-Exterior Gray 40%Cellulose 60%Non-fibrous(Other) None Detected Window Glazing- Fibrous 042016344-0029 Vertical Sliders Homogeneous 02874-19A Exterior-Locker Black 15%Cellulose 75%Non-fibrous(Other) None Detected Room Building-Roof Fibrous 10%Glass 042016344-0030 Shingle Homogeneous 02874-19B Exterior-Locker Black 15%Cellulose 75%Non-fibrous(Other) None Detected Room Building-Roof Fibrous 10%Glass 042016344-0031 Shingle Homogeneous Initial report from:07/14/2020 07:55:52 ASB—PLM-0008-0001-1.78 Printed:7/14/2020 7:55 AM Page 2 of 3 EMSL Analytical, Inc. EMSL Order: 042016344 Customer ID: GECL78 200 Route 130 North Cinnaminson,NJ 08077 Customer PO: Tel/Fax:(800)220-3675/(856)786-5974 http:/twww.EMSL.com/cinnasblab@EMSL.com Project ID: Analyst(s) Andrew Coward(11) Samantha Rundstrom,Laboratory Manager Mark Shuts(9) or Other Approved Signatory Nancy Stalter(2) Olutunke Akintunde(10) EMSL maintains liability limited to cost of analysis. The above analyses were performed in general compliance with Appendix E to Subpart E of 40 CFR(previously EPA 600/M4-82-020"Interim Method"),but augmented with procedures outlined in the 1993('final")version of the method.This report relates only to the samples reported above,and may not be reproduced,except in full,without written approval by EMSL. EMSL bears no responsibility for sample collection activities or analytical method limitations. Interpretation and use of test results are the responsibility of the client. All samples received in acceptable condition unless otherwise noted.This report must not be used by the client to claim product certification,approval,or endorsement by NVLAP, NIST or any agency of the federal government. EMSL recommends gravimetric reduction for all non-friable organically bound materials prior to analysis. Estimation of uncertainty is available on request. Samples analyzed by EMSLAnalytical,Inc.Cinnaminson,NJ NVLAP Lab Code 101048-0,AIHA-LAP,LLC-IHLAP Lab 100194,NYS ELAP 10872,NJ DEP 03036,PA ID#68-00367,LA#04127 Initial report from:07/14/2020 07:55:52 ASB—PLM-0008-0001-1.78 Printed:7/14/2020 7:55 AM Page 3 of 3 OrderID: 042016344 �� L U l� U L! Page 1 of 3 Analysis Type: Asbestos Chain of CustodyPLM Record urnaround Time: 96-Hour Green Environmental Consulting, Inc 180 Pleasant Street-Suite 213 Easthampton, MA 01027 Project Into: Phone/Fax (413)341-3418 Send Results To: Project Name: Results to: Pine Grove Golf Course emslreports@gecenviro.com rroject Number: Invoice to: 02874 mary@gecenviro.com Project Address: Comments Special Instructions: Old Wilson Rd. Florence, MA Sample Number Sample Location Sample Description 02874-01A Bar Area Sheetrock 02874-OIB Bar Area Sheetrock 02874-02A Bar Area Joint Compound 02874-02B Bar Area Joint Compound 02874-03A 77ar Area Black Rubberized Flooring 02874-038 Bar Area Black Rubberized Flooring 02874-04A Bar Area Black Rubberized Flooring Mastic 02874-04B Bar Area Black Rubberized Flooring Mastic 02874-05A Bar Area Bar Carpet Mastic 02874-06A Kitchen White w/ Brown Ceiling Formica Mastic (Brown) 02874-07A Kitchen White w/Brown Ceiling Formica Mastic (Yellow) 02874-08A Baseement - New Front Section Sub-Floor Paper (Black) OrderID: 042016344 U�-'J C4J 1 b -) L'1 Ll Page 2 of 3 �.r nalysis Type: Asbestos Chain of Custody f4 PLM Record k9' Turnaround Time: 96-Hour Green Environmental Consulting, Inc 180 Pleasant Street-Suite 213 Easthampton, MA 01027 Project Info: Phone/Fax (413)341-3418 Send Results To: Project Name: Results to: Pine Grove Golf Course emslreports@gecenviro.com roject Number: Invoice to: 02874 many@gecenviro.com Project Address: Comments Special Instructions: Old Wilson Rd. Florence, MA Sample Number Sample Location Sample Description 02874-09A Baseement - Original Section Sub-Floor Paper(Tan) 02874-10A Exterior Sub-Siding Paper(Black) 02674-10B Exterior Sub-Siding Paper (Black) 02874-11A Exterior Roof Paper(Porch Side) 02874-11B Exterior Roof Paper(Porch Side) 02874-12A Exterior Architectual Roof Shingles (Porch Side) 02874-12B Exterior Architectual Roof Shingles (Porch Side) 02874-13A Exterior Roof Paper(Front Side) 02874-13B Exterior _T Roof Paper(Front Side) 02874-14A Exterior - Front Side Roof Shingle (3 Tab) 02874-14B Exterior - Front Side Roof Shingle (3 Tab) 02874-15A Exterior - Old Double Hung - Front of Exterior Window Glazing Bldg, Kitchen, Bathrooms 7nr,�IDl OrderID: 042016344 U`-1 'Vl L5U"I Page 3 of 3 Analysis Type: Asbestos Chain of Custody ( ` PLM Record Turnaround Time: 96-Hour Green Environmental Consulting, Inc' 180 Pleasant Street-Suite 213 Easthampton, MA 01027 Project Into: Phone/Fax(413)341-3418 Send Results To: Project Name: Results to: Pine Grove Golf Course emslreports@gecenviro.com rroject Number: Invoice to: 02874 mary@gecenviro.com Project Address: Comments Special Instructions: Old Wilson Rd. Florence, MA Sample Number Sample Location Sample Description 02874-15B Exterior- Old Double Hung - Front of Exterior Window Glazing Bldg, Kitchen, Bathrooms 02874-16A Exterior Picture Window Glazing (Roll Out on Side) 02874-16B Exterior _T Picture Window Glazing (Roll Out on Side) 02874-17A Exterior Exterior Window Glazing (Roll Outs) 02874-18A Exterior Exterior Window Glazing (Vertical Sliders) 02874-19A Exterior- Locker Room Bldg Roof Shingle 02874-19A Exterior- Locker Room Bldg Roof Shingle Sampled By: Date: Received By: e/Ti b Cf�), J R quisheA Sy: Date/Time: Received in Lab By: Uate/TiQ?J: / The \ Open Space �re'���n 0 Berkshire p 36k R. 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I.M. E-- EA*o EE MAOVED Crvn Er�q t` \ \ Nnnirq [J::sstra9NGLE+�ii'_.-__ y � \.\ Miweyiy '+ouBE ro R' OQ. - — �-- ��\ PROPOSED FLAG LOT(1) SEE SHEET C 3 HiAiEtnoE M:A su.ws�� LOT 1 FLA LOT 77 i mw \ EXISTING ACCESS \ ^� i \ DRIVE70 REMAIN \ b.�,-„-..,.--.•,<o„-,,,,Me.,,.,.,. r_ i _LOT 2 EXISTING PARKING LOT, I! PINE GROVE CLUBHOUSEs OTHER ; GOLF COURSE ASSOCIATEDSTRUCTURES _q TO BE REMOVED.SEE i 254 Old Wilson Rd SHEET Ca ; Northampton,MA TOW£R FALL ZONE-- - - ' TOWER LEASE AREA CITY CONSERVATION LAND--- I 1 1 I ! EXISTING CELL TOWER- TO REMAIN LOT 3 J � PROPOSED SPECIAL PERMIT CLUSTER LOTS(3) APPLICATION FOR SEE SHEET c a FLAG LOT&CLUSTER S -'-- LOTS 4 3 LOT 4 Lot Plan ZONING TABLE NEW ASPHALT —..Berkshire / DRIVEWAY,12'WIDE _— \ NEW DRAIN 8 OUTLET Design EX.DRIVE TO BE O TO GRASS SWALE Group � G REMOVED EXISTyNHOUSE /c Kris �q REMAIN LOTI C ' O O� F LOT NIAw.000��.�Mw� / O �t, t NEW DRAINAGE SYSTEM WITH LEVEL SPREADER + EXISTING DRIVEWAY TO REMAIN AS SHARED DRIVE LOAM&SEED ALL PREVIOUSLY DISTURBED REMOVE 8 REPLACE AREAS BEING REMOVED,TYP. R / CATCH BASIN EXISTING DRAIN LINES AND EXISTING STONE CATCH BASINS TO BE SWALE TO REMAIN LOCATED AND REMOVED t —PROPOSED HOUSE I LOCATION.TYP. i PINE GROVE \ EXISTING DRIVEWAY LO I NEW ASPHALT DRIVEWAY GOLF COURSE TO REMAIN / 15'WIDE,TYP --ALL EXISTING DRA/N LINES 8 ti 254 Old Wilson Rd BEGIN NEW ASPHALT��� --LIMIT OF CLEARING UNDERGROUND STRUCTURES ; Northampton,MA ON CITY CONSERVATION LAND I DRIVEWAY TO BE REMOVED.ANY _ EXISTING GRAVEL AREA INFRASTRUCTURE DISCOVERED I REMOVE CATCH BASIN O TO BE LOAMED&SEEDED AFTER TRANSFER OF LAND I AND INSTALL CULVERT SEE SHEET C 4 SHALL BE DISCONNECTED BY I AND LEVEL SPREADER THE OWNER. NEW TREE PLANTINGS SEE PLANTING PLAN SHEET C.4 EXISTING CELL TOWER NEW DRYWELL TYP OF B GRAVEL ACCESS I \t DIBVE TO REMAIN 1 I I NEW CULVERT AND tx ------ LEVEL SPREADER x LOT3 ! ;� ,x• SPECIAL PERMIT _ + ` APPLICATION FOR LIMIT of CLEARING / y, FLAG LOT&CLUSTER (AFprox. acres LOTS Ii i I ). I I -O`4_ Site Plan ZONING TABLE .�M ,Ax,Cft ootz ti; taw 104