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11-002 (7) the final NOI and Stormwater Pollution Prevention Plan (SWPPP) shall be submitted to the Northampton DPW for approval prior to the start of construction and prior to issuance of a building permit. 3. The proposed stormwater drainage system in the area of the proposed cell tower compound shall be completed in accordance with sheet Z -1 which specifies a 3'6" Wide by 2' Deep Infiltration Trench outside of the southwestern and a portion of the southeastern fence line. 4. Prior to the start of construction test pits shall be conducted by a Certified Soil Evaluator or Certified Professional Soil Scientist in the area of the proposed infiltration trenches A and B to confirm at least a two foot separation between the seasonal high ground water and the bottom of the proposed trenches. Test Pit logs shall be submitted to the DPW for approval. 5. The proposed stormwater management system is designed to mitigate peak stormwater flows. If, after construction of the proposed system, the system is found to increase stormwater flows to Haydenville Road or to adjacent properties, or cause increased erosion, the owner shall redesign and reconstruct the drainage system to prevent any increased and /or erosive stormwater flows. 6. Prior to construction, the applicant must secure all necessary permits and approvals from the Massachusetts Highway Department for construction work in the State Highway System layout and proposed stormwater discharges to the stormwater system owned and operated by the Commonwealth of Massachusetts. 7. All stormwater systems shall be installed as proposed and stabilized prior to receiving drainage flows. AIL 1l tur of City Engineer ate cc. Planning Board c/o Office of Planning and Development Building Department Conservation Commission c/o Office of Planning and Development M: \Stormwater Program\Stormwater Permits Internal\Permits_new applications\Haydenville Rd Cell Tower.doc Page 3 of 3 b. Limited Stormwater Hydrology Report for Upgrade of a Gravel Access Road & Installation of a Telecommunications Facility MA -5025 Northampton, Dated July 21, 2011, Stamped by Jesse M. Moreno, P.E., ProTerra Design Group, LLC. c. Northampton MA -5025, Leeds, MA, Details Sketches SK -1 and SK -2, dated August 3, 2011, and submitted by Jesse M. Moreno, P.E., ProTerra Design Group, LLC. 2. The Northampton Department of Public Works (DPW) or its authorized representative shall be provided access to the property to conduct inspections before, during, and after construction activities as necessary. The applicant shall arrange with the DPW to schedule the following inspections: Initial Inspection, Erosion Control Inspection, Bury Inspection, and Final Inspection. The DPW may also conduct random inspections to ensure effective control of erosion and sedimentation during all phases of construction. 3. At the completion of the work, including construction of stormwater management facilities and landscaping, the applicant shall submit a statement to the DPW from a professional engineer of record in the Commonwealth of Massachusetts certifying that the materials and construction of the stormwater management system was constructed in accordance with the approved plans and will function as designed. All changes to the approved stormwater facilities shall be documented by a professional engineer of record in the Commonwealth of Massachusetts and approved by the DPW prior to submission of the certification statement described above. 4. Annual Reports that are stamped by a Registered Professional Engineer documenting the actions completed as required by the Operation, Maintenance and Inspection Agreement shall be submitted to the Northampton Department of Public Works by October 1 of each year (see Specific Condition 1 below). 5. If construction of the proposed stormwater system has not started within five years of the issue date of this permit, then the permit will expire and a new permit will be required. Construction is defined as clearing, grading, excavation, filling, and installation of drainage structures on the lots specified in this permit. Specific Permit Conditions: 1. Prior to issuance of a Building Permit or start of construction, the applicant or property owner(s) shall record an executed Stormwater Operation, Maintenance, and Inspection Agreement that is binding on all subsequent owners of land served by the private stormwater management facility by recording it in the land records of the Registry of Deeds. The maintenance schedule and responsibility for maintenance of the proposed stormwater management system must be adequately specified in Attachment A to this Agreement. This agreement shall be approved by the Northampton DPW and signed by the owner and the Mayor of Northampton. Section 22 -85 of the Northampton Stormwater Management Ordinance provides additional guidance for the requirements of this agreement. 2. This project may be required to submit one or more Notice of Intent (NOI) to the U.S. EPA for coverage under the NPDES Stormwater Construction General Permit. A copy of M: \Stormwater Program\Stormwater Permits Internal\Permits_new applications \Haydenville Rd Cell Tower.doc Page 2 of 3 ' L 1 STORMWATER MANAGEMENT PERMIT .,� APPLICATION DECISION City of Northampton Department of Public Works Project / Site Name: Northampton MA -5025 — Raw Land Cell Tower Project Street or Location / Assessor ID: 0 Haydenville Road, Leeds, MA / 11- 002 -001 _ Applicant Name: Global Tower Assets, LLC (H. Castagnaro) Applicant Address/Phone: 238 Littleton Road, Suite 205B, Westford, MA 01886 / 561- 982 -1955 Owner Name: Smith Vocational & Agricultural High School c/o City of Northampton Owner Address/Phone: 80 Locust Street, Northampton, MA 01060 Application Submission Date: 7/26/2011 THE FOLLOWING ACTION BY THE NORTHAMPTON DEPARTMENT OF PUBLIC WORKS HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: Disapproval of the Stormwater Management Permit Application based on a determination within seven days of the receipt of the application that the application is administratively incomplete (see attached documentation). Approval of the Stormwater Management Permit Application. X Approval of the Stormwater Management Permit Application subject to any conditions, modifications or restrictions required by the Department of Public Works (see below) Disapproval of the Stormwater Management Permit Application based upon a determination that the proposed plan, as submitted, does not meet the purposes set forth in the Northampton Stormwater Management. Standard Permit Conditions: 1. All clearing, grading, drainage, construction, and development shall be conducted in strict accordance with the following plans and information submitted with the application and as amended by any conditions attached to this permit: a. GTP (Global Tower Partners) Northampton MA -5025, 0 Haydenville Rd., Leeds, MA, Site Plans, Sheets T -1, C -1(1), C -1(2), C -01, C -02A, C -02B, C -02C, C -03A, C -03B, Z-1, Z -2, Z -3, Z -4, Z -5, Dated 7/7/2011, Stamped by Jesse M. Moreno, P.E., ProTerra Design Group, LLC. M \Stormwater Program \Stormwater Permits Internal\Permits_new applications \Haydenville Rd Cell Tower.doe Page 1 of 3 , - , , ., % 'a ,,,,. ..- . . .._... . '''''. , at. a se itt., nd41 '''''/''''...- ;i ; 1. �� st : .* k` # a w r $ a Y � . r 5 :'..,,:ii SIX.. &"2a ,et. `" �` E xptt rt .201 4 i =i , 104639 S.J 2.. y „- , a ..... us � ? Client#: 703814 SITEACQUI ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 7/21/2011 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 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). PRODUCER CONTACT NAME: USI Insurance Svcs of NE, Inc. PHONE Ext): 603 625 -1100 (PJC, No): PO Box 6360 E-MAIL ADDRESS: Manchester, NH 03108 -6360 PRODUCER 603 625 -1100 CUSTOMER ID #: INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A : Starr Indemnity & Liability Com 38318 Site Acquisitions, Inc. INSURER B : Everest National Insurance Comp 10120 dba SAI Communications an I Company of State of P 19429 22 Keewaydin Drive INSURERC: P Y Salem, NH 03079 INSURER D : Hanover Insurance Company 22292 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE 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. INSR TYPE OF INSURANCE ADDL BUBR POLICY EFF POLICY EXP LIM<TS L POLICY NUMBER /Y TR INSR WVD (MMJDD/YYYY) (MM/DDYYY) A GENERAL LIABILITY WCSICON30018611 01/01/2011 01/01/2012 EACH OCCURRENCE $1,000,000 DAMAGE TO X COMMERCIAL GENERAL LIABILITY PREMISES (Ea E occurrence) $1,000,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $50,000 X PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $2,000,000 POLICY PRO- LOC .1FCT D AUTOMOBILE LIABILITY AWV697898701 01/01/2011 01/01/2012 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE X HIRED AUTOS (Per accident) X NON -OWNED AUTOS $ _ B UMBRELLA LIAB X OCCUR 71C800432111 01/01/2011 01/01/2012 EACH OCCURRENCE $5,000,000 EXCESS LIAB CLAIMS -MADE AGGREGATE $5,000,000 DEDUCTIBLE _ $ RETENTION $ $ C WORKERS COMPENSATION WC017089158 08/01/2011 08/01/2012 TO STATU E - O TH- AND EMPLOYERS' LIABILITY TORY LIMI Y / N ANY PROPRIETOR/PARTNER/EXECUTIVEl N I NIA E.L. EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $1,000,000 If yes, describe under ono 000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) This Certificate covers all operations usual and customary to the insured's business. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN "For information purposes only" ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ® 1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) 1 of 1 The ACORD name and logo are registered marks of ACORD #S6250033/M6242180 LCACA _. t GTP LE' 'TER OF AUTHORIZATION Mr. David Vivian New Cingular Wireless PCS, LLC 500 Enterprise Drive, Suite ?A Rocky Hill. CT (10067 RE: Application Building Permit 1, Alexander lam: - t4finatt as Preside+ -ttttt -F(4K) GTP ACQUISITION PARTNERS II, LLC owner of the below described telecommunications tower, do hereby grant permission to SAl on behalf of New Cingular Wireless. LLC to ,seek any application to the City of Northampton and its administrative agencies anti hoards necessary to ensure their ability to use and /or construct improvements to the telecommunications tower described below. We understand that the application(s) may he denied. muddied or approved with conditions .ind that such conditions or modifications must he complied with by New Cingular Wireless, LLC prior to issuance of the necessary building and other permits. SITE N A VIE: GTP -- N1A -5025, Northampton New CinInlar Wireless PCS. LLC - MA55=19 /EA #1(1552 10 Northampton (Leeds) SITE ADDRESS: 125 Haydenville Road. Northampton, NIA GTP ACQUISITION PARTNERS 11. LLC —� Signature: / Print Name: a - t'!'71c(r °�'T /9 6c't j7JJe Print Title: I-;rr' 4ei+t- attc4- E()()- .S V 6 por -; fish), Date: /f (Ttor93.7 • Version1.7 Commercial Building Permit May 15, 2000 SECTION 10- STRUCTURAL PEER REVIEW (780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes ® No ® SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPUES FOR BUILDING PERMIT 1, , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date I, , as Owner /Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print Name Signature of Owner /Agent Date SECTION 12 - CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : License Number Address Expiration Date Signature Telephone SECTION 13 - 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 0 No Version13 Commercial Building Permit May 15, 2000 SECTION 9- PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES - FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116 (CONTAINING MORE THAN 35,000 C.F. OF ENCLOSED SPACE) 9.1 Registered Architect: Clough Harbor Associates 2139 Silas Deane Hwy, Ste 212, Rocky Hill, CT 06067 Not Applicable Name (Registrant): Clough Harbor Associates 2139 Silas Deane Hwy, Ste 212, Rocky Hill, CT 06067 Registration Number Address (860) 257 -4557 Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor Site Acquisitions, Inc. Not Applicable o Company Name: Responsible In Charge of Construction 22 Keewavdin Dr. Salem. NH 03079 Address (413) 218-5042 Signature Telephone Version1.7 Commercial Building Permit May 15, 2000 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size 182 ac N/A Frontage N/A Setbacks Front 1166 Side L: R: L: 3 R 1643 Rear 1421 Building Height 10.5 Bldg. Square Footage % 230 Open Space Footage (Lot area minus bldg & paved 99.1 parking) # of Parking Spaces 1 N/A Fill: (volume & Location) A. Has a Special Permit/Variance/Finc> ever been issue /on the site? NO ® DON'T KNOW YES IF YES, date issued: 09/13/2011 IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES Q IF YES: enter Book 10676 Page 338 and /or Document # B. Does the site contain a brook, body of water or wetlands? NO ® DON'T KNOW ® YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained ® Obtained 0 , Date Issued: 09/20/2011 C. Do any signs exist on the property? YES © NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES ® NO Q IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES ® NO 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. • 1 Version1.7 Commercial Building Permit May 15, 2000 SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs ❑ Demolition ❑ Repairs ❑ Additions ❑ Accessory Building ❑ Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing❑ Change of Use ❑ Other 12 Brief Description Attach antennas to proposed cell tower with 12' x 20' equipment shelter w /in fenced tower Of Proposed Work: compound. SECTION 5 - USE GROUP AND CONSTRUCTION TYPE USE Cg3UP (Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A -1 A -2 ❑ A -3 ❑ 1A 1 ❑ ❑ A-4 ❑ A -5 ❑ 1B ❑ B Business 8 2A ❑ E Educational 5 2B 1 ❑ F Factory a ` F -1 ❑ F -2 ❑ 2C I ❑ H High Hazard 5 3A ❑ 1 Institutional 8 1 -1 ❑ 1 -2 ❑ 1 -3 ❑ 3B ❑ M Mercantile 8 4 ❑ R Residential g R-1 ❑ R -2 ❑ R -3 ❑ 5A ❑ S Storage S -1 ❑ S -2 ❑ 5B ❑ U Utility 0 Specify: M Mixed Use 13 Specify: S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND /OR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor (sf) 1st 1st 230 2nd 2nd 32 3 b 3rd 4 4' 4th Total Area (sf) Total Proposed New Construction (sf) 262 Total Height (ft) Total Height ft 11 • 7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone 12 Municipal ❑ On site disposal system❑ ��' �� ...w.W� , <.�.,.,, ._ ,.�. i Z ,p.�- Version1.7 Commercial Building Permit May 15, 2000 Department use only City of Northampton Status of Permit: 2 l 2011 E uilding Department Curb Cut/Driveway Permit 212 Main Street Sewer /Septic Availability Room 100 Water/Well Availability DEar: of BUILDING MINT Northampton, MA 01060 Two Sets of Structural Plans phone 413 -587 -1240 Fax 413 -587 -1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION 1.1 Property Address: This section to be completed by office 0 Haydenville Road Map 11 Lot 002 unit 001 Leeds, MA 01053 Zone RR/SR Overlay District Elm St. District CB District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: Smith Vocation & Agricultural High School 80 Locust Street. Northampton. MA 01060 Name (Print) Current Mailing Address: (413) 587 -1414 Signature Telephone 2.2 Authorized Agent: SAI Communications (for AT &T Mobility) 500 Enterprise Dr. Ste 3A. Rocky Hill_ CT 06067 Name (Print) 1 Current Mailing Address: / (413) 218 -5042 Signature Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building $22,000.00 (a) Building Permit Fee 2. Electrical $18,000.00 (b) Estimatl o Construction ted To from a Cost (6) f 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) s© 1 1 K- '300,00 5. Fire Protection $10,000.00 6. Total= (1 +2 +3 +4 +5) a c 1 ood Check Number This Section For Official Use Only Building Permit Number Date Issued Signature: 6L4,—,___4) i ( / ! / Building Commissioner /Inspector of Buildings Date HAYDENVILLE RD BP- 2012 -0517 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 11 - 002 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: ANTENNA TOWER BUILDING PERMIT Permit # BP- 2012 -0517 Project # JS- 2012- 000057 Est. Cost: $50000.00 Fee: $300.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: SITE ACQUISITIONS INC 104639 Lot Size(sq. ft.): 7932711.60 Owner: NORTHAMPTON CITY OF SMITH SCHOOL Zoning: RR/ SR (100)/URA//RI/WP/WSPApplicant: SITE ACQUISITIONS INC AT: HAYDENVILLE RD Applicant Address: Phone: Insurance: 22 KEEWAVDIN DR (413) 218 -5042 0 WC SALEMNH03079 ISSUED ON:11/29/2011 0:00:00 TO PERFORM THE FOLLOWING WORK:ATTACH AT & T ANTENNAS W/12 X 20 EQUIP SHELTER 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 11/29/2011 0:00:00 $300.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner