49-047 BP-2023-1190
773 PARK HILL RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
49-047-001 CITY OF NORTHAMPTON
Permit: New Build
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2023-1190 PERMISSION IS HEREBY GRANTED TO:
Project# MODULAR HOME 2023 Contractor: License:
Est. Cost: 815000 RARE FORMS INC 115088
Const.Class: Exp.Date: 10/02/2024
Use Group: Owner: SILLETTO, JOHN& RABSON, BARBRA
Lot Size (sq.ft.)
Zoning: WP/WSP Applicant: RARE FORMS INC
Applicant Address Phone: Insurance:
285 NORTH KING ST (413)296-1570 WCC-500-5026846
NORTHAMPTON, MA 01062
ISSUED ON: 10/05/2023
TO PERFORM THE FOLLOWING WORK:
NEW MODULAR HOME
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:
Final: Final: Final: Rough Frame:
Gas: Fire Department Driveway Final: Fireplace/Chimney:
Rough: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
fogy7,
.
Fees Paid: $895.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
File #BP-2023-1190
APPLICANT/CONTACT PERSON:RARE FORMS INC
285 NORTH KING ST NORTHAMPTON, MA 01062(413)296-1570
PROPERTY LOCATION 773 PARK HILL RD
MAP:LOT 49-047-001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Building Permit Filled out
Fee Paid $895.00
Type of Construction: NEW MODULAR HOME
New Construction
Non Structural Renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License
3 sets of Plans/Plot Plan
V % Driveway Grade% l.OwF,tz ('uD OF 1)R,1V !i
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON Ys (
INFORMATION PRESENTED: IN\' 1;.6 t\itvR ,
Approved N Additional permits required(see below) I 0
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
X Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
Demolition Delay
V V ` , •,
Sign ure of Building Official i Date
Note:Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission,Department
of public works and other applicable permit granting authorities.
*Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact Office of
Planning&Development for more information.
RECEI V lu��
a pry Coup
<. Th Commonwealth of Massachusetts ru
�„ bG 3 ':oar of Building Regulations and Standards
{" 20 ass chusetts State Building Code, 780 CMR MUNICIPALITY
O. USE
At
Hq TOn - P-roNs t Ap li One-or Two Family Dwelling To Construct,Repair, anovate Or Demolish a Revised Mar 2011
N.it4A U1op�
This Section For Official Use Only
Building Permit Number: ' -�,3-•1( qt/ Date Applied:
I 0 ' })
SI
Building Official(Print Name) I Signature / DD tc
SECTION 1:SITE INFORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
773 Park Hill Road 49 49-047-001
1.1 a Is this an accepted street?yes X no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
WSP single family residence 94,861 +/-sq ft 128.23'
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
20' 96'7' 15' 15' 20' 200'+
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 0 Private Ca Municipal_ Outside Flood Zone? Municipal 0 On site disposal system
Check if yes®
SECTION 2: PROPERTY OWNERSHIP'
2.1 Owner'of Record:
John Silletto and Barbra Rabson Belmont,MA 02478
Name(Print) City,State,ZIP
100 Stults Rd. 857-373-9464 lsilletto@gmail.com
No.and Street Telephone Email Address
SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction 21 Existing Building❑ Owner-Occupied ❑ Repairs(s) 0 Alteration(s) ❑ Addition 0
Demolition ❑ Accessory Bldg. 0 Number of Units Other ❑ Specify:
Brief Description of Proposed Work2: Two section modular home set with site built garage and porch.
Oversee installation of well,septic,driveway,and utlitly hookups.
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ $750,000 1. Building Permit Fee: $ Indicate how fee is determined:
2.Electrical $ $25,000 ❑Standard City/Town Application Fee
❑Total Project Cost3(Item 6)x multiplier x
3.Plumbing $ $20,000 2. Other Fees: $
4.Mechanical (HVAC) $ $20,000 List:
5.Mechanical (Fire $ $0 �j
Suppression) Total All F : $ f%' ,/
Check No. )2'Check Amount: ` cash Amount:
6.Total Project Cost: $ $815,000 0 Paid in F 0 Outstanding Balance Due:
...._.....,,....In.c»rcr7A .-mono AC,.,.mA., 1ti')I AA,.mACIA
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL) CS-115088 10/02/2024
License Number Expiration Date
Name of CSL Holder
Gregory A.Bossie List CSL Type(see below)
No.and Street Type Description
285 N.King St. U Unrestricted(Buildings up to 35,000 cu.ft.)
R Restricted I&2 Family Dwelling
City/Town,State.ZIP M Masonry
Northampton,MA 01060 RC Roofing Covering
WS Window and Siding
SF Solid Fuel Burning Appliances
413-296-1570 office@rareforms.design I Insulation
Telephone Email address D Demolition
5.2 Registered Home Improvement Contractor (HIC) 206723 10/16/2024
Rare Forms,Inc. -
HIC Registration Number Expiration Date
HIC Company Name or HIC Registrant Name
285 N.King St. office@rareforms.design
No.and Street Email address
Northampton,MA 01060 413-296-1570
City/Town,State,ZIP Telephone
SECTION 6:WORKERS' COMPENSATION INSURANCE 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 I No .
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I,as Owner of the subject property,hereby authorize Rare Forms,Inc.
to act on my behalf,in all matters relative to work authorized by this building permitapplication.
BaJcGIu1.Rairsen, flj'siI/ 2023/08/15
Print Owner's Name(Electronic Signature) 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.
2023/08/15
Print Owner's or Authorized Agent's Name(Electronic Signature) Date
NOTES:
1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
(not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration
program or guaranty fund under M.G.L.c. 142A. Other important information on the HIC Program can be found at
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps
2. When substantial work is planned,provide the information below:
Total floor area(sq.ft.) 2310 sq.ft. (including garage,finished basement/attics,decks or porch)
Gross living area(sq. ft.) 1442 Habitable room count 6
Number of fireplaces 0 Number of bedrooms 3
Number of bathrooms 2 Number of half/baths 0
Type of heating system electric Number of decks/porches 2
Type of cooling system electric Enclosed 1 Open 1
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
•
Sri imont In-F"7SFS7r1-r7dR.ASoo-Q7da_7h714d13MdQd
City of Northampton
Massachusetts was. 1. c,?
�_ :r
DEPARTMENT OF BUILDING INSPECTIONS ra_.
212 Main Street • Municipal Building IA .1e
._ Northampton, MA 01060 sf .., �10�
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, 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: \ 1Dk( O -L1 MA - CAS dI \ ,v'�-eAo- S --- lk
The debris will be transported by:
Name of Hauler: )-)- .ve vv 1CY• les �,rAcic-I
7.
1011
Signature of Applicant: _ , \N Date: $ ''22 23
The Commonwealth of Massachusetts
Pr:p ,--i• Department of Industrial Accidents
"W m 1 Congress Street,Smite 100
—=t:)=4-1
Boston,MA 02114-2017
'�.... a wwwmass.gorldia
11"otters'Compensation Insurance Affidavit:Solider,iCantractors/Eiectrkians/Plumben.
TO 1!E FILED WITH THE PERMITTING A(THORITI'.
Applicant IfGeasatioa Please Print Legibly
Name(Rr'kinncvOrganimtionrindividuall: Q. Sj Inc .
Address: 2435 . IC-4
CityiStateiZip: 1\10✓ a ) MA" 0640 Phone#: 4I3 21 le• IS-10
An you as employer!Check the appropriate bat:
Type of project(required):
it]lam a employee wadi_ ___employees 4tuii sailer past-rise).• 7.jaNew construction
201 am a sok proprietor or peraaeaiip and have no employees wonting forme in 8_ a Remodeling
any capacity.(No workers'comp.aaauemcr remind.)
9. Demolition
30 l am a ltomevnav sit er doing ad ww myself.[Ta wo orkers'comp.mstiwace r neguired.1• ❑
401 am a homeowner and will be blares contractors to viaduct all rods ma in,property. 1 will 10❑Building addition
mare that ail atalraaoes either leave trotters'commutation imaranoe or as oak 1 1 a Electrical repairs or additions
proprietors with no 12.0 Plumbing repairs or additions
50 lama gem contractor and I have Aired die listed as the attached sheet_ 13 Q Roof repairs
These sub-comacitits have employees and have winters'camp.asaanoce.:
sC3 we arc a corporation and its officers have exercised there remit of ezaepu Ar uu per G1-c. 14_ Other
13t f bet.and we lane no imployees.(No workers'comp.insurance impaired.,
•Any applicant that checks bar el aunt abo fill out thr maim below showing their waakaa'computation atioa policy
h liorneowinees who mbar this affidavit indicting they are daft all work sod then hire outside contractors mean webat a new affidavit indicating such.
'Coe t:acdors that check ibis but sera attached an mittiaral sheet sbowma the name tithe aa►caemctras tad state whether or not thane eoliths haw
employees tf the nab castracsnrs lave employer.they mat provide their woiteeoe roam.policy number.
II fin a providing skit kr/ workers'compensation Mrn r ay rance for employees. Below Is the policy and fob she
aurhate
Insurance Company Name: K�YI�i, Gn�51,-,r►�, - P I M MM*1 i v.. Co .—
policy f(or self-ins.Lie.#: V\I CL—S00 SO2t)84 6 -2_023/S4- Expiration Date: o4) I 1 J'2O2i4
Job Site Address` - _ .- City/State/Zip:
Attach a copy of the workers'einspenssakis hey declaration page(shy the policy number sad expiration date).
Failure to secure coverage as respired under MGL c. 152,*25A is a cr>n final violation punishable by a fine up to S1.500.00
andior one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a
day against the violator.A copy of this statement may be forwarded to die Office of Investigations of the DIA for insurance
coverage verification.
I do hereby cVihi,u pouts aend penalties of perjury that the information provided above Is true and enact
Signature: -e — �1 Date: 22.2
4
Phone#: 4 13.2 lQ • 1570
Official use only. Do not wee in this area.to be completed by thy or town official
City or Tows: Permit/Lk-awe I
ism Authority(circle one):
I.Board of Health 2.flaiiiling Department 3.C y/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
b.Other
Contact Person: Phone It:
ouaiu or tsunamg Regulations and Standards
Co nstrtzctron'Svpprvisor
:S-115088 ( spires: 10/02/2024
GREGORY ABOSSIE ,
118 FLORENCE. SSTREET'
LEEDS MA 01053 ,__. ;
Commissioner da.P.
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs and Business Regulation
1000 WashingtokAtret - Suite 710
Boston,:Massachusetts 02118
Home Improvement contractor Registration
� A
f / ,..,, F i Type: Corporation
RARE FORMS, INC y.yi Registration: 206723
285 N. KING ST S ; , «• , Expiration: 10/16/2024
NORTHAMPTON, MA 01060 t, �� « ; �" 5
rr
Update Address and Return Card.
THE COMMONWEALTH OF MASSACHUSETTS
Office of Consumer Affairs& Business Regulation Registration valid for Individual use only before the
HOME IMPROVEMENT CONTRACTOR expiration date. If found return to:
TYPE:Corporation Office of Consumer Affairs and Business Regulation
Registration Expiration 1000 Washington Street -Suite 710
206723 - 10/16/2024 Boston,MA 02118
\RE FORMS, INC
lEGORY BOSSIE
5 N.KING ST S C Y. • 6
)RTHAMPTON, MA 01060
Undersecretary Not id without signature
A Tradition of Ensuring Your Future
ING
USHMAN
April 18, 2023
Rare Forms, Inc.
285 North King St
Northampton, MA 01060
Insurance Company: AIM Mutual Ins Co
Policy Number: WCC-500-5026846-2023A
Effective/Expiration Dates: :
Dear Greg:
King and Cushman would like to take this opportunity to thank you for RENEWING your insurance needs
with our office. We appreciate your business and we take pride in the complete range of insurance services
that we provide.
Enclosed is your a I policy as noted above Please take a few moments to
review the policy and coverage limits to make sure they are adequate and inform us of any alterations
that need to be made. As your business grows, your insurance needs change.
Thank you for your continued business!!!
Sincerely,
A44--1
Scott A. King, CIC
President
sking@kingcushman.com
(413)584-5610 x12
176 King Street•P.O.Box 447 •Northampton,MA 01061 (413) 584-5610• Fax(413) 584-9322 • (877) 534-9053
www.kingcushman.com
TT A Tradition of Ensuring Your Future
USHMAN
July 5, 2023
Rare Forms, Inc.
285 North King St
Northampton, MA 01060
Insurance Company:Northfield Insurance Co
Policy Number: WS556542
Effective/Expiration Dates.
Dear Greg:
King and Cushman would like to take this opportunity to thank you for RENEWING your insurance needs
with our office. We appreciate your business and we take pride in the complete range of insurance services
that we provide.
Enclosed is your Cowinterelid_ al Liability renewal policy as noted above. Please take a few
moments to review the policy and coverage limits to make sure they are adequate and inform us of
any alterations that need to be made.
Thank you for your continued business!!!
Sincerely,
Scott King
President
string@kingcushman.com
(413)584-5610 x12
176 King Street• P.O.Box 447•Northampton,MA 01061 (413)584-5610 •Fax(413) 584-9322 • (877)534-9053
www.kingcushman.com
"
Home Energy Rating Certificate Rating Date: 2023-08-17 .0,
Projected Report Registry ID:
Based on Plans Ekotrope ID: vpOQP04d
HERS® Index Score: Annual Savings Home:
Your home's HERS score is a relative 733 Park Hill Ave
36 performance score.The lower the number, Northampton, MA 01062
the more energyefficient the home.To
5,2 Builder:
learn more, visit www.hersindex.com *Relative to an average U.S.home Rare Forms Design Build
Your Home's Estimated Energy Use: This home meets or exceeds the
Use[MBtuj Annual Cost criteria of the following:
Heating 10.8 $745 2021 International Energy Conservation Code
Cooling 0.8 $57
Hot Water 2.0 $138
Lights/Appliances 17.6 $1,217
Service Charges $84
Generation (e.g. Solar) 0.0 $0
Total: 31.2 $2,241
HERS Index Home Feature Summary: Rating Completed by:
More Energy Home Type: Single family detached Energy Rater: Rachel Balon
150 Model: N/A
Existing 140 Community: N/A RESNET ID: 1726523
Homes 130 Conditioned Floor Area: 2,251 ft2 Rating Company: Power House Energy Consulting
20 Number of Bedrooms: 3 PO Box 9571,North Amherst,MA 01059
Reference 1� Primary Heating System: Air Source Heat Pump•Electric•12 HSPF 413 835 5162
Home am
vo Primary Cooling System: Air Source Heat Pump•Electric•21.5 SEER Rating Provider: Energy Raters of Massachusetts
IIII 80ill Primary Water Heating: Residential Water Heater•Electric•3.75 UEF 2 Woodlawn Street Amesbury,MA 01913
70 House Tightness: 1 ACHSO 978-270-3911
Ventilation: 65 CFM•32 Watts•ERV
.o� Duct Leakage to Outside: Forced Air Ductless . .06
}o Above Grade Walls: R-37
•20 This Home � •
Ceiling: Attic,R-59 / 4%.1/
Zero Energy 10 Window Type: U-Value:0.24,SHGC:0.39
Home 0
Foundation Walls: R-15 Rachel Balon,Certified Energy Rater
LM]S*ISM•
W. um E0�rsy Framed Floor: N/A Digitally signed:8/18/23 at 11:42 AM
1 ekotrope Ekotrope RATER-Version:4.1.0.3222
The Energy Rating Disclosure for this home is available from the Approved Rating Provider.
This report does not constitute any warranty or guarantee.
Building Specification Summary
Property Organization Inspection Status
733 Park Hill Ave Power House Energy Con. Results are projected POWER HOUSE
eve11crconsuLnrw
Northampton, MA 01062 Rachel Balon
413-992-8375
PHEC-2975 733 Park Hill Ave
projected -AM revised Builder
Rare Forms Design Build
Building Information Rating
Conditioned Area [ft2] 2,250.60 HERS ERI 36
Conditioned Volume[ft3j 20,933.70 HERS ERI w/o PV 36
Thermal Boundary Area [ftl 5,416.17
Number Of Bedrooms 3
Housing Type Single family detached
Building Shell
Ceiling w/Attic R59,CE16",4-24; U-0.017 Windows (largest)I U-Value: 0.24, SHGC:0.39
Vaulted Ceiling None Window/Wall Ratio 10.20
Above Grade Walls R35,CE1,4&4-16,D; U-0.029 Infiltration I 1 ACH50
Found. Walls R15, ISO; R-15 Duct Lkg to Outside I Forced Air Ductless
Framed Floors None Total Duct Leakage I Untested
Slabs
Glavel_Foam Glass 12"_R20 under, R10 edge_13'W; R-10
Mechanical Systems
Heating Air Source Heat Pump • Electric• 12 HSPF
Cooling Air Source Heat Pump • Electric•21.5 SEER
Water Heating Residential Water Heater• Electric•3.75 UEF
Programmable Thermostat Yes
Ventilation System 65 CFM • 32 Watts • ERV
Whole House Fan N/A
Lights and Appliances
Percent Interior LED 100% Clothes Dryer Fuel Electric
Percent Exterior LED 100% Clothes Dryer CEF 3.9
Refrigerator(kWh/yr) 650.0 Clothes Washer LER(kWh/yr) 190.0
Dishwasher Efficiency 270 kWh Clothes Washer Capacity 4.5
Ceiling Fan None Range/Oven Fuel Electric
Ekotrope RATER-Version 4.1.0.3222
All results are based on data entered by Ekotrope users.Ekotrope disclaims at liability for the information shown on this report.
Component Loads
Property Organization Inspection Status 1111
733 Park Hill Ave Power House Energy Con Results are projected
Northampton, MA 01062 Rachel Balon
413-992-8375
PHEC-2975 733 Park Hill Ave
projected -AM revised Builder
Rare Forms Design Build
Heating & Cooling Loads
8
7
6
5
4
3
'' 2
7
m
2 1
0 mom
-1
-2
-3 •
-4
-5
Above-Grade Infiltration & Slabs & Roofs Ducts Windows & Foundation Internal
Walls Ventilation Floors Doors Walls Gains
Heating
Cooling • Ekotrope RATER-Version 4.1.0.3222
All results are based on data entered by Ekotrope users.Ekotrope disclaims all liability for the information shown on this report.
• Commonwealth of Massachusetts
IManufactured Buildings Program-Plan Identification Number Assignment
Name of Manufacturer KBS Building Systems MC Identification Number
243
Third Party Identification Number
03
Project Title
KBS-3822
Use Group Single Family R-3 BBRS\OPSI
Identification Number 0 2 49-2 3
Review Required All plans are reviewed by MA and a BBRS Number
assigned when approved Date: 0 8/3 0/2 3
Manufactured Buildings Program
From: Syno Tell, CBO
Manufactured Buildings Program Director
Re: Confirmation of Receipt of Building Plans & Assignment of BBRS\OPSI
Identification Number (BBRS\OPSI I.D.Number)
The Board of Building Regulations and Standards and Office of Public Safety (BBRS\OPSI) has
received your building plans for the referenced project and has assigned the identification number
noted above (in the block marked BBRS\OPSI I.D. Number). This number has been assigned for
purposes of internal tracking methods. This number shall be used in reference to this project and on
all future correspondences, inquiries and plan revisions.
Thank you for your cooperation with this matter.
Send all correspondences,inquiries and plan revisions to:
Office of Public Safety&Inspections-Syno Tell
1000 Washington Street,Suite 710
Boston,MA 02118
.HEurftr
Syno.Tell@mass.gov .vo- *f
Bbrs\forms2\manufacturedbldgplanid-06/2018 " 4.r*a '4c r kt
4- 4(
R 1`e4
Apr AA r o
G y:
`i •p .Zll o l
p, ti
\ \ �•' .
' - ,
. •
RARE
`• FORMS
1 . •
``1 tel 9.16.9.44
NMNwebn,NaeeasCa 01060
NW*:413.296.1570
I -\ •, Nw.nrtfeaN.aeap
\ V..1 Nalco:
/ ^') \1,
/ ••)1
19
/
/`J^ G 1
•
I'`-;' /f----
SILLETTO/RASSON
/ `N+-1' y HOUSE
/1 773 PARK HILL RD
♦ _---" �■ -I I NORTHAMPTON,MA
e I _ - I e' ' ,' Phase:
111
i� .A -.i �'' Deelpn Development
i •
-/ Consultants:
i
Revisions:
--.*: :::-..:::1::::-.7:::::-..:-.7.7..-::::::::..ssi 1.,•;::::11'. ; i
• ''
-,= � :
'lt't1� �`;r,;`��;, YI
A 01
Drawn By:GB
SITE PLAN
Date:May 17,2023
1 Suk:]'.30'-0' Scale:AS Noted
L. Commonwealth of Massachusetts
`- --_= City/Town of Northampton 202�17
Number
•
:_; D isposal System Construction Permit
_ ,• Form 2A
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
Permission is hereby
/�granted
to:
�1 / ,.Important:When S.gwlt?yt44ovoler - R k4iiimcii -+:tagaEactbwrig11{' W Q N i LJ .
filling out forms Name Name of Company
on the computer, �1 /y� r�.
use only the tab -64-F • a 3 flG nh[l._..St' .....
key to move your Address
cursor-do not s „A. sn t 1b il MA .44098 ()1 306)
use the return City/Town State Zip Code
key
m
'' to perform the following work on an on-site sewage disposal system:
's
0 Construction
!Wail ❑ Repair or replacement
❑ Repair or replacement of system components
773 Park Hill Road Map/Lot 49-007-041
Facility Address
Florence MA 01062
City/Town State Zip Code
John Silletto&Barbara Rabson do Rare Forms _ 575-741-1295(Kelley Wagner)
Owner Telephone Number
The work to be performed is further described in the Application for Disposal System Construction
Permit The applicant recognizes his/her duty to comply with Title 5 and the following local provisions
or special conditions
New 2c-1500 gallon septic tank distnbub_,ri box and two leach trenches 3wx481s1 h.It is recommended that the desgner evaluate the groundwater
elevation at the tank site once excavation for the building foundation is done It shallow groundwater is found at the house site,buoyancy calculations sha4d
be done to determine d ballast is needed on the septic tank Groundwater conditions at the house site should be documented by the designer prior to backfithng
around the balding loundabon and submitted to the Northampton DHHS veal applicabte calculations to support the need for ballast or that ballast will not be required
Final installation inspection by the City of Northampton Health Agent prior to back-fill.
II construction must be completed within three years of e d to below.
RT 1a3
Appro y Date
Commissioner
Title
t5form2a doc•06/03 Disposal System Construction Permit•Page 1 of I
10/4/23,10:25 AM 773 Park Hill Rd.Well Permit.png
1101
( W )\% F k1 i II 01 \t 4NS.t( Ht-'f:Tric
: .� , t Ti Of \ORTII \\II' 1 t ►N .:•
.•., , I 1 _`.,, it Ht '1 ) I♦ (IIIP.(1
OFF![ F Of fnt t)41"''
I.t, i •• BO%RI) 01' Nt ‘l IU
i+3 k.l'11 i,
•
Nell Constriction
rrI Riii t;r Bill' 202 t-ij.ile: i
U9 11 2.112 t
.°;(1 c' ; ..it , r > hi. %.. I.' 40.001.0.-
In West CfiecterfieW, 94.4
• 1't t it ( ufstrurti9n
„; Park I-Jill Rd.
https://mail.google.com/mail/u/1/#search/773+PARK+H ILL+RD/FMfcgzGtwgpbdxZxgVkNczfXgz.lbTRQb?projector=1&messagePartld=0.1 1/1