41-008 NOV -23 -2009 03:03P FROM: TO:14135290006 P.2
Massachusetts Department of Conservation and Recreation
Office of Water Resources 148239
AN LY Well Completion Report
ATION I GPS(Required) North ° \ . West - 7 ° "k . L\ . \ t� A
at Well Location: - .> 4\t \ \ \e--• (A Property Owner /Client: �� 1=-1 • c‹..` (AU A
.ulvision Name: Mailing Address: \Li C O 1 � ' S 4C\
City/Town: y O'S '\\rCU<'N.� N C\ City/Town: � ,S\\∎44 ii C 1 k % \ fi`
Assessors Map Assessors Lot #: NOTE: Assessors Map and Lot # mandatory if no street address available
Board of Health permit obtained; Yes EiCI Not Required ❑ Permit Number Date Issued
2. WORK PERFORMED 3, WELL TYPE 4. DRILLING'METHOD ' 6. CASING
Overburden -, Bedrock From (ft) To (ft) Type Thickness Diameter
I\ h s al, rg E az o , El 9 \14 \.9"
5. WELL LOG I OVERBURDEN Extra
Water Loss or Drop in Fast o r CI El
LITHOLOGY Bearing Addition Drill Slow
ft To ft
Zone of Fluid Stem 7. SCREEN
From
O O Code Color Comment Drill Rate
c/ J JC y ,� Y / N Y / N F / S From (ft) To (ft) Type Slot Size Diameter
Y /N Y/N F/S 000
❑❑❑ . __
Y/N Y/N F/S - • ❑❑ . ___ _
Y/N Y / N F / S 8. ANNULAR SEALIFILTEFI PACK /ABANDONMENT MTL.
Y/N Y / N F / 5., From (ft) To (ft) Material Description Purpose
Y/N Y/N F/S 00 0
Y/N Y/N F/S ' 0 0
Y/N Y/N F/S 0 0
Y/N Y/N F /S 0 0
WELL LOG BEDROCK Water Drop in Extra Fast Slo w s Visible Loss or # of 9. SITE
'SKETCH
LITHOLOGY Bearing Drill Large or , Rust Addition Fractures
Zone Stem Chips Slaining of Fluid per toot
From (ft) To (ft) Code Comment Doll Rate
-S7 L I SC-- %C4■(■ya \a Y /NY /NF /S'Y /NY /N
U\ C) 2 SC \„\C (4,kN.\ Y /NY /NF /SY /NY /N f
f)j j S[. (' \ -C1\∎\ Y /NY /N /S Y/N Y/N �_ ). tQ
5 C ) 9 \V s c, ( 2 ) 6 o � t 1 - \ ‘ ' , \ \ p \ A Y/ N Y/ N F/ S Y/ N Y/ N r
‘ 4 " ) WI. SC, \ � � . q- x C31)/ N Y / f ■M S , Y / N Y / N i0 e.
\ \� '_p SL C- \ c„ -\�� `\C Y / N Y / N F / S Y / N Y / N
Y /NY /NF /SY /NYIN ,. �t� J
Y /NY /N F/S Y/N Y/N
Y /NY /NF /SY /NY /N
Y /NY /NF /SY /NY /N
10. WELL TEST DATA (ALL SECTIONS MANDATORY FOR PRODUCTION WELLS) 11. STATIC WATER LEVEL (ALL. WELLS)
Yield Time Pumped Pumping Level Time to Recover Recovery Depth Below
Date Method (GPM) (hrs & min) (F1 BGS) (hrs & min) (Ft. BGS) Date Measured Ground Surface (ft)
C A),. lai WKS %
I___: 3 v )-L1ol _ 1 :_ _ \\•1 a"? 'col
12. PERMANENT PUMP (IF AVAILABLE) 13. ADDITIONAL WELL INFORMATION
Pump Description ❑ ❑ ❑ ❑ Horsepower Develope Y / N Fracture Enhancement Y
Pump Intake Depth (ft) Nominal Pump Capacity (gpm) DisinfectedZ/ N Surface Seal Type n
14. COMMENTS I ,Total Well Depth 1 \ Depth to Bedrock
15, WELL DRILLER'S STATEMENT IThis well was drilled, altered, and/or aban oned under my supe ision, according to applicable
rules and regulations, and this rep rt is m �p pl llett and r the best of my knowledge.
�.r�
Driller: f ` 1 �\r.G e.+� ..Q \, q r ,,\c"• Supervising Driller Signatur ' / ` Registration #: l 1 /) 71 61
Firm: . ( \KU I \\��S. \1'` ". . Date Complete: \1 \C Rig Permit #: 1 I -1 la A
NOTE: Well Completion Reports must be filed by the registered well driller within 30 days of well completion.
, DRILLER COPY
NOV -23 -2009 03:03P FROM: TO:14135290006 P.3
Howard Laboratories
62 Main Street - Hatfield, MA 01038 Tel. (413) 247 -5533 Fax (413) 247 -9599
WATER ANALYSIS REPORT
Henshaw Well Drilling Invoice Number: 12855D
Sample Location: 45 Loudvllle Rd. Northampton
Client: Tom Bacis Sampled By: HWD
Date Sampled: 12/29/06
Date Received: 12/29/06
Parameter Results Limits Comments
Total Coliform Bacteria 0 colonies / 100m1 0 colonies / 100mI OK
Color 21 PtCo Color Units 15 PtCo Color Units
Iron 0.10 mg /I 0.3 mg /I OK
Manganese 0.022 mg /I 0.05 mg /I OK
Nitrate 0.5 mg /I 10 mg /1 OK
Nitrite 0.009 mg /I 1 mg /I OK
pH 7.66 pH Units 6.5 - 8.5 Ph Units OK
Sodium ND mg /I 28 mg /1 OK
Conductivity 0.25 mS /cm No Standard No Standard
Turbidity 3.16 NTU No Standard No Standard
Chloride 46 mg /1 250 mg /l OK
Hardness 95 mg /1 No Standard <50 soft
>100 hard
ND = None Detected
Recommendations: This sample meets acceptable standards of potability. The parameters with
an asterisk which are over the limit should go down after a few weeks as the water and
materials floating In the well settle.
Analyst: SH
Date: 01/05/07
MA Certification: M -00851
/ --
C3 MAIN ROAD
MAIN ROAD ROUTE 66 °b o AN UNMONUMENTEp 1794 F
A 1980 HAMPSHIRE COUNTY O ff '
L- 107.06' BO
Q'�
ALTERA7 N1 RELOCATION _� ,e N:
PLAN OK 114 P AND AGES 47 & 48 Q• 44304.01- 165. N1 T55'29'W /
R.1 967.00' 246.16' N54'22 '20'E L =284.86' R.1033.00' L_1 11.77' - 16.50' -
162.16' - -
- L.! pp' t
i a U L .,12'1 II
� : 75.90' - 1.173.09' '_ • 1_ / $ m
t; / :' DANIEL E. HEW1NS
/ 1 BOOK 4985 PAGE 156
M w 2 PLAN BOOK 180 PAGE 114
PARCEL A 1 * / - 2 ,1.� C t
►R EA = 3.842 S.F.f / AREA IN NORTHAMPTON = PARCEL 3 ,
IAMP TON ASSESSOR'S MAP 28, LOT 9
4 IS TO BE COMBINED WITH ADJACENT ./ 2.205 ACRES (96,058 S.F.±) .1 1' - 5 ' y9
TON LAND OF THE HEIRS OF EDMUND D. TIMOTHY P. & AMY B. BARNES
& DYMPNA M. CONNOLLY TO FORM ONE I BOOK 6107 PAGE 190 AREA IN WESTHAMPTON =
ICEL OF CONTIGUOUS OWNERSHIP # : PLAN BOOK 85 PAGE 19 a Q +
ARCEL A IS NOT A BUILDING LOT o c 5,313 S.F.t 3. -
�7'
�a TOTAL AREA 2.327 A& ES Re, -
-" -- - - -- _
- G > { G OB . NORTHAMPTON ASSESSOR'S MAP 41 LOT 008 - ma y ki' - /
-IEIRS OF EDMUND D. CONNOLLY & N 7.' W ESTHAMPTO N ASS M A P 28 LOT 9 - r� PARCEL 5 .
DYMPNA M. CONNOLLY m r 43 /4* 4 '‘''C'
� , p ¢ AREA = % � l ' q IRE COUNTY B00K PROBATE 4P0259E1 0 1 ��+ i s°, ' + ' • µ, IS OR11 COMBINED F P PARCEL 3 IN PORTION OF � � ^ �lJ \� N i 1
1 ON t ( � � 1.92 ACRESt
P � � Q Q PARCEL 3 IN NORTHAMPTON TO FORM .'' y (83 ,415 S.F.f) $, ' x
4
p } ,%�. 'd ONE PARCEL OF CONTIGUOUS OWMERSHIP ; K' NORTH " MPTON ASSESSOR'S �' O e3' ?5• , \ )�P,,Fy 41 LOT 008
'AP / • N "3r d
N, y 5
*a r � .' ., , _ -- 54727 2x7.39' - N !7 g.7 `' ' i.,§' 1 • , 236.06' N 47 ' 54 ' 311- 8 {.70' - �.� . O 4.111' '771 NNNN. 0, .
,. I /�
-L $ 37.35' .+l '-42.81.-- 142.69' !
T
5.3T 155.90' -, (....C.. (....C.. • �
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NOTES:
y� es m
\ PARCEL 1 / / 1. FOR REF
N , .' / ' 1 % / / � / AND AN REF
N49'58'4519 1 / AREA = b* N i /
u .,� ,% 1 / DYMPNA M.
• fi0 29 / � / 1.837 ACRES rj / j / FEBRUARY 1
f (80,011 S.F.f) 1 / EDMUND D.
N35'27 1 W NORTHAMPTON ASSESSOR
1 PT'S r /. % /
5 I /
MARIE MECKEL & GYEPI SAM 39.19' I / I
/ MAP 41 LOT 008
BOOK 6850 PAGE 149 �`` 4 1
PLAN BOOK 79 PAGE 75 / / NOT A BUILDING LOT L. PLANNING 8(
WESTHAMPTO
.3. / L 1 I • / / - 106.98' -43.02'^ I V f, I •j� '+1'
OVAL U
/ J
4177.(-:!). � i / i —549'40'45'W 150.00' - C AI ` � k` �� 1
CON
TROL LAI
• AREA = c.,3-
' 41 ---0
T DATE —S`,[
/
� �� �m W / � . 1.950 ACRES ^' ' �' • O o g / X ' WESLEY M. & \ � (84,945 S.F.f) 1 �/ ,.,.
��
� j �Q 4 C ( ) ( m GRACE M. RAUCH N it e NORTHAMPTON ASSESSOR'S 1 •
j ) y O O / N N BOOK 1555 PAGE 446 `ir. '$ MAP 41 LOT 008 ‹C /j
Q ,. .. Q / / • fi PLAN BOOK 68 PAGE 97 'u• X 0 1 ' /
�� J= - _ / // 19.16' ,>/°%N
o r i
$ + .:.i.1 :t1 (xh of �NIIrr1 aI?Tpti?II Z . . --- -, 0 $mil r�`_+- t" _ JR assay aseffs -
— c
" ''= DEPARTMENT Or BUILDING INSPECTIONS �' ='
212 Main Street 0 Municipal Building \-,,,,,.,,,,,-
/
INSPECTOR 5.•
Northampton, MA 01060
•
(-1 C Lov6 vi lie (2 ,
LOCATION
SQUARE FOOTAGE AMOUNT
BASEMENT @ . 20 060 g 1 ;
1 FLOOR @ .50 1 0 6 0 ` 3 0
2 FLR @30 . `7 );) 70 jo
% /�� FLOORS, FINISH ATTIC, GARAGE @ .20 lfr A 1 12 F
DECK/PORCHES @ :20 l I` 71, ,
TOTAL I 1 27?, `
w •
Es Mfr
Ceiling / Roof 38.00
Wall 19.00
Floor / Foundation 19.00
Ductwork (unconditioned spaces):
X2 1 � �`� 2 � r 4r's .tea
Window 0 .30 0.29
Door 0.25 0.29
Conditioner 13 SEER
Furnace 91 AFUE
Water Heater:
..x. H, ..,,,.�'2 r' . r"i u��'+:�, r : , ry ���3,,,�..n+�,`�, sirs �- �_ _.> �. h.,�� , �w �,✓Iii%/���1
Name: Date:
Comments:
Exceptions:
Class III (10 perm or less) vapor retarder is permitted for vented cladding over OSB, plywood, fiberboard, gypsum, or for sheathing
over 2x4 framing having insulation of R -5 or better, or for sheathing over 2x6 framing having insulation of R -7.5 or better.
Materials Identification and Installation:
❑ Materials and equipment are installed in accordance with the manufacturer's installation instructions.
❑ Insulation is installed in substantial contact with the surface being insulated and in a manner that achieves the rated R- value.
Li Materials and equipment are identified so that compliance can be determined.
Li Manufacturer manuals for all installed heating and cooling equipment and service water heating equipment have been provided.
❑ Insulation R- values, glazing U- factors, and heating equipment efficiency are clearly marked on the building plans or specifications.
Duct Insulation:
U Supply ducts in attics are insulated to a minimum of R -8. All other ducts in unconditioned spaces or outside the building envelope are
insulated to at least R -6.
Duct Construction:
Li Air handlers, filter boxes, and duct connections to flanges of air distribution system equipment or sheet metal fittings are sealed and
mechanically fastened.
• All joints, seams, and connections are made substantially airtight with tapes, gasketing, mastics (adhesives) or other approved closure
systems. Tapes and mastics are rated UL 181A or UL 181B.
u Building framing cavities are not used as supply ducts.
u Automatic or gravity dampers are installed on all outdoor air intakes and exhausts.
❑ Additional requirements for tape sealing and metal duct crimping are included by an inspection for compliance with the International
Mechanical Code.
Temperature Controls:
Li Thermostats exist for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and /or
cooling input to each zone or floor is provided.
Heating and Cooling Equipment Sizing:
Li Additional requirements for equipment sizing are included by an inspection for compliance with the International Residential Code.
u For systems serving multiple dwelling units documentation has been submitted demonstrating compliance with 2006 IECC Commercial
Building Mechanical and /or Service Water Heating (Sections 503 and 504).
Circulating Service Hot Water Systems:
❑ Circulating service hot water pipes are insulated to R -2.
Li Circulating service hot water systems include an automatic or accessible manual switch to turn off the circulating pump when the
system is not in use.
Heating and Cooling Piping Insulation:
• HVAC piping conveying fluids above 105 degrees F or chilled fluids below 55 degrees F are insulated to R -2.
Certificate:
Li A permanent certificate is provided on or in the electrical distribution panel listing the predominant insulation R- values; window
U- factors; type and efficiency of space- conditioning and water heating equipment. The certificate does not cover or obstruct the visibility
of the circuit directory label, service disconnect label or other required labels.
NOTES TO FIELD: (Building Department Use Only)
Project Title: Report date: 11/23/09
Data filename: Page 3 of 3
Generated by Scheck-Web Software
Inspection Checklist
Ceilings:
❑ Ceiling: Flat or Scissor Truss, R -38.0 continuous insulation
Comments:
Above -Grade Walls:
❑ Wall: Wood Frame, 16in. o.c., R -19.0 cavity insulation
Comments:
Windows:
❑ Window: Vinyl Frame, 2 Pane w/ Low -E, U- factor: 0.300
For windows without labeled U- factors, describe features:
#Panes Frame Type Thermal Break? Yes No
Comments:
Note: Up to 15 sq.ft. of glazed fenestration per dwelling is exempt from U- factor and SHGC requirements.
Doors:
❑ Door: Solid, U- factor: 0.250
Comments:
❑ Door: Glass, U- factor: 0.320
Comments:
Floors:
❑ Floor: All -Wood Joist/Truss Over Uncond. Space, R -19.0 cavity insulation
Comments:
Floor insulation is installed in permanent contact with the underside of the subfloor decking.
Heating and Cooling Equipment:
❑ Air Conditioner 1:: 13 SEER or higher
Make and Model Number:
❑ Furnace 1:: 91 AFUE or higher
Make and Model Number:
Air Leakage:
❑ Joints, attic access openings, and all other such openings in the building envelope that are sources of air leakage are sealed.
❑ Recessed lights in the building thermal envelope are 1) type IC rated and ASTM E283 labeled and 2) sealed with a gasket or caulk
between the housing and the interior wall or ceiling covering.
❑ Access doors separating conditioned from unconditioned space are weather- stripped and insulated (without insulation compression or
damage) to at least the level of insulation on the surrounding surfaces. Where loose fill insulation exists, a baffle or retainer is installed
to maintain insulation application.
❑ Wood- burning fireplaces have gasketed doors and outdoor combustion air.
Sunrooms:
❑ Sunrooms that are thermally isolated from the building envelope have a maximum fenestration U- factor of 0.50 and the maximum
skylight U- factor of 0.75. New windows and doors separating the sunroom from conditioned space meet the building thermal envelope
requirements.
Vapor Retarder:
• A minimum of Class II (1.0 perm) vapor retarder is installed on the interior side of above -grade framed walls or it has been determined
that moisture or its freezing will not damage the materials.
Project Title: Report date: 11/23/09
Data filename: Page 2 of 3
Generated by ESchec - eb Software
Compliance Certificate
Energy Code: 2007 IECC
Location: Hampshire County, Massachusetts
Construction Type: Single Family
Conditioned Floor Area: 1987 ft2
Glazing Area Percentage: 14%
Heating Degree Days: 6999
Climate Zone: 5
Construction Site: Owner /Agent: Designer /Contractor:
45 loudville Road Tom Bacis Alabama
Northampton, Massachusetts 01060 Bacis Properties Inc.
Massachusetts
z '
... . ,,, ,. ""- _; `a„s�t : •': s`. °Keks. nY „u•,1 .a ...... „�'y1 „✓ „ , ,.ry '', ,,,,.
Compliance: Maximum UA: 299 Your UA: 285
Gross Cavity Cont. Glazing UA
Assembly Area dr R -Value R -Value or Door
Perimeter U- Factor
Ceiling: Flat or Scissor Truss 927 0.0 38.0 23
Wall: Wood Frame, 16in. o.c. 2144 19.0 0.0 108
Window: Vinyl Frame, 2 Pane w/ Low -E 257 0.300 77
SHGC: 0.29
Door: Solid 59 0.250 15
Door: Glass 36 0.320 12
SHGC: 0.29
Floor: All -Wood Joist/Truss Over Uncond. Space 1060 19.0 0.0 50
Air Conditioner 1: 13 SEER
Furnace 1: 91 AFUE
Compliance Statement: The proposed building design described here is consistent with the building plans, specifications, and other
calculations submitted with the permit application. The proposed building has been designed to meet the 2007 IECC requirements in
REScheck -Web a to comply with the mandatory requirements listed in the REScheck Inspection Checklist.
Name - Title Signature Date
ac (.5 Vi.le
Project Title: Report date: 11/23/09
Data filename: Page 1 of 3
No. Qfe 33 THE COMMONWEALTH OF MASSACHUSETTS FEEE ''_v e
0 OF HEALTH
APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT
Application for a Permit to Construct ( ) Repair (i(Upgrade ( ) Abandon ( ) - Complete System ❑ Individual Components
.15 /d ''pValk fit?,'.) 1 .4 75 15 - /1/r74' . E 'o ) /1 'd
Location Owner's Name
4/ ; Ler 008 6 A i/ /S /c./ - ,fir: 4 - 1 le-Z.7
e3 T arZ 4 1� Map/Parcel # ,4-2 7-a Address
�j - C � j
Lot # Telephone #
'TgtIO /G A'ATA) y' ce2M4 -
Installer's Name Designer's Name
4e6_5 01/DJ(/<Lt. gr 6 2 e & >I —Pidfe J /,' 0-173 it/4 Oier;
Address Address
Telephone # Telephone #
Type of Building: .S/ //,.L— 1/ /24 /P 1 r - t-
"��G� Lot Siz �, ��
Dwelling - No. of Bedrooms 1/06 Garbage Grinder (47
Other - Type of Building No. of persons Showers ( ), Cafeteria ( )
Other fixtures
D esign-Ff -(rrtia required) 3 'c gpd Calculated design flow gpd Design flow provided ' gpd
Plan: Date //i✓liU 3 24) Number of sheets 14 Revision Date
Tit1e_4 'e' J ?' .e"1cc �4' ---- Lc%G't7 P'1 f E'er
Description of Soil(s) L /144! /� Z
Soil Evaluator Form No l*Lilf 7/ Name of Soil Evaluator ,r y ?h': Date of Evaluation ice=. 2, Vc
DESCRIPTION OF REPAIRS OR ALTERATIONS i r /- 1 /ADO E 04/ i' `r ' G.
4 el' . e/ " r l E, i x 2- ' .dr.:„ /EZ Col S/5 X D,-- 6
rifiegrlefrizisq "0 J /rfi - F O B ' " c ., J1 7cs
The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of
TITLE 5 and I er rees not to place the system in operation until a Certificate of Compliance has been issued by the Board of Health.
Signed "� ,jral Date
Inspecti s
FORM 1 - APPLICATION FOR DSCP DEP APPROVED FORM 5/96
No �' - " " ' _ % THE COMMONWEALTH OF MASSACHUSETTS FEE -
';' " " A BOARD OF HEALTH
r r %`:!, b t r
I
CERTIFICATE OF COMPLIANCE
Description of Work: ❑ Individual-Component(s) Q"tomplete System
The undersigned hereby certify that the Sewage Dsspnsal System; Constructed ( ), Repaired (Upgraded ( ), Abandoned ( )
by r- -- - _
at _ • _
has been installed - in accordance with the�rovisions of 310 CMR 15.00 (Title 5) and the approved design plans /as -built
plans relating to application No..-- ,. . - - -. dated ' -4- ` -- - - Approved Design Flow (gpd)
• -_,° -( '' `'
Installer - _, , r.,
- : _... Inspector , r f ..._.D
Designer: ate , = - .-
The issuanceVof this certificate shall not be construed as a guarantee that the system will function as designed.
A
FORM 3 - CERTIFICATE OF CO MPLIANCE DEP APPROVED FORM 5/96
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Attv: • ,-
Septic System Permit Payment Receipt . .
Permit la Coiist Repair
Amount: 5 Ob Cash Cheelcit 3C3C
oifyi,„4,"„eka„
Address: if,5 ,4-ei2.
Owner:
,':::',---.:-.FT-'7',--°:.1:,--,,•.-7-=':,-,,";°:-..-,-,4,7,, ,,: „ ' `s- ,".",'1/4 „,
Eli ENG LAND iitrib'ROnbtituNd 8435
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GENERAL tOt•itRAcTOR04INC.,, i
67 STREET PH: 41 - 8 ,' L ( ' ,'; ' A '/,■• 0,a,,,, 5168/ ',:i
EA§ 1-1 1 4A1 7 °k, : MA'010 P 7 ' ' '' ':. '.,':,:,,,,..', ' \ ,', '-‘: ' ':,:nae , , 4-7- •'''' er/ , 4 M ' ',‘',` 11 '''
iir ' ' ' '.- ' '', ' ' ' ' ' ',' ' , ,' ,' . /,'"' ' ' , ' ,^ ::''' ', ', ' • ' i ' ' •''' 1 ': , ''' ' , ' • ' ' , ''':' , : ■ , ' /, '' ' - •,, ' ''',, , ' ' • '`•': . , `• , , ' , • 1 111 ' ^ ,
0 of a i pr ., '. - , , 1 , $ ' co
'1 FLORENCESAV1NGSBANK
t, g e5 MAIN S1EET. FLORENCE. UA OO2
III 'r ‘' trie, - '. 40 .‘,:' ., ' , ,--t.,/,, , , ,, ,,,
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e Quit a/ /1/910111 Prd
Title V Certification of Compliance
TO BE FILLED OUT BY THE DESIGNING ENGINEER AND THE
SYSTEM INSTALLER
DESIGNER SIGN -OFF
Pursuant to 310.CMR 15.00 of the State Environmental Code: Title V, Minimum Requirements for the
Subsurface Disposal of Sanitary Sewage, Section 15.012 (3), the Designer and the Installer of a system are
required to sign this form as a condition for issuance of a Board of Health Certificate of Compliance for the
onsite septic system.
This is to certify that the onsite sewage disposal system that I designed as: new construction
/iepair (existing system)
at ¢S`411/ V "LLL 7 on 4i1r ; ;4/ Zcr l , DWCP number
(Address) (Date)
has been constructed in compliance with 310 CMR 15.00, and all local requirements. Any changes to the
original approved plans have been reflected on an as-built plan that has been submitted to the Board of Health.
(Print Designer's name) (Address)
rgner s signature) (Date)
INSTALLER SIGN -OFF
This is to certify that the onsite sewage disposal system that I installed on (P.Qi i g 04.
(Date)
at the above - referenced address has been cnstructed in compliance with 310 CMR 15.00, and with the approved
plan and all local requirements.
72)11 I ; / l9- i-'7 ire /--.; f1 7Q '..J Caec a / /��a
(Print Installer's name) (Address)
(Installerl signature (Date)
NOTE: This certification represents no warranty, expressed or implied as to the functioning or longevity of the on -site
subsurface disposal system. Rather, the plan and installation are in compliance with all applicable rules and regulations
as are in effect at the time of plan submittal.
SO
CONSTRUCTION NOTES 45 Loudville Roam Northampton
Existing septic tank: not located. Install new 1500 - gallon single - compartment Underground Supply septic tank
on 6 -inch crushed stone base. Install Schedule 40 PVC tees centered within manholes and install manhole
risers-to - within-six inches - of_fiiai grade to provide air gap for tees. Install gas baffle on outlet. Install new
building sewer pipe of cast iron, schedule 40 PVC d o e uivalent. Pipe- €r-onr- septic -tame to_distribution
box shall be four inch SDR 35 solid PVC with watertight joints. At owner's discretion an effluent tee filter may
be substituted for gas baffle: recommend Orenco 4 -inch FT SO444 - 36 [Contact Bob Johnson, Atlantic
Solutions, Ltd. [401- 293-01761).
Existing seepage pit to be pumped of its contents, crushed and filled.
Existing well inside bulkhead must be decommissioned in accordance with Board of Health requirements.
Install new well in excess of 50 feet from new septic tank and 100 feet from proposed soil absorption system.
Existing basement plumbing must be reconfigured and building sewer pipe must be raised to exit foundation
wall at elevation = 98.5 as shown.
New distribution box: USI DB -6 or approved equal; minimum inside dimension of box to be twelve (12)
inches. Set box level on compacted base; install speed levelers on six outlet lines. Adjust using water test.
Distribution lines must be set level for minimum of 24 inches from d -box. Pipe from d-box to bed shall be SDR
35 PVC 4" solid with watertight joints.
Leach bed: Dimensions= 17' x 24' total area =408 square feet. Remove all topsoil, subsoil, and any filled
materials if encountered (approximate total depth= 19 inches) in leach bed area to bottom of bed elevation=
97.3. Total - excavated area =l7' x 24'. Fill between all rows and on outside edges with dean, granular sand
that is free from organic matter and deleterious substances, must not contain any stonesiarger than 2 inches.
Up to 45% by weight of a representative fill sample may be retained an_a #4 sieve. Compact in six -inch lifts.
SAS consists of 36 Infiltrator "Quick -4' chambers set in 6 x 6 bed configuration. Distal ends of all rows of
chambers to capped with "Posilod ' end plates. Finish grading of final leach bed cover to be awned to 2%
slope for runoff`. Site to be seeded immediately upon completion of work by owner or contractor.
Precise location of all distribution laterals must be documented either by placement of magnetic tape
along top surfaces or by accurate as -built distances in sketch provided to owner, Board of Health and
Designer.
Observation ports must be placed in SAS as per new requirement in code. Four -inch solid PVC may be utilized
at distal ends of all rows, brought to within 3 inches beneath finish grade with removable caps.
Temporary bench mark: =100.0 = concrete footing around base of bulkhead as shown.
GENERAL NOTES:
A pre- construction conference is required. Installer must contact Designer at least 72 hours prior to
commencing onsite construction.
This drawing is not a survey; the owner or agent is responsible to ensure that the septic system is installed on
the subject parcel.
Percolation test and deep hole locations are as indicated on plan.
All construction shall be in strict compliance with Title V of the Massachusetts Environmental Code.
The proposed system as designed is not for the disposal of wastes from a garbage grinder.
Installation of a lint filter on washing machine discharge line is recommended.
To help ensure the optimal functioning and longevity of the system, the septic tank should be pumped every
two (2) years.
To preserve the integrity of the system, all vehicular traffic must be preduded from encroaching on system
components,induding septic tank, line to D -box, and the SAS.
System is for the disposal of sanitary sewage only All storm water, cooling water, chemicals or other
objectionable wastes must be exduded.
No other subsurface examinations were made other than as indicated. The exact locations of any subsurface
utilities or drainage easements are unknown. Any problems encountered during construction of the system are
the responsibility of the owner.
If field conditions (ledge, mottling, groundwater, etc.) are encountered other than as indicated on the plan,
Designer and Board of Health shall be notified immediately and construction halted until resolution is reached.
No changes to the plan will be allowed without the prior authorization of the Designer, Board of Health, or
both.
No warranty shall be made by the Designer as to the installation, functioning or duration of the system.
Rather, the plan is in compliance with all applicable rules and regulations as are in effect at the time of plan
submittal. • • 4.
,•�P�
OF 41, _
L SEARrE G �
fr No. #11115 r n
C y
R r
S gkRARNPs
lIlie a: U/ujr rnnrea Jepte,,,uc, cv, lrrJ•
FORM 12 - PERCOLATION TI
4 . Date / t- 2 f .
s. Commonwealth_ f M2SS2ChUSettS �; Address '�'"� Location Addre or Lot No. ' J it Pkrt'zt i pm.)
�l✓l�d �7 --e , Massachusetts
Site Suitability Assessment for On -site Sewage Disposal COMMONWEALTH OF MASSACHUSETTS
f /� ,O7V ("Massachusetts
/ ��
Performed By:.. e ( i « Certification Number: f V
Witnessed By:. �<��r+*`' //141
Percolation Test`
Location Address or Lbt No. Owner's Name, Address and Tel. I Date: .: .
..1----- / pV (G« Ae4-) e 2 ' e'dfr"4'aee( G�i � r r c� T . . ,�. ,,...,
ren tS, oe cte Observation Hole #
(/f1 F'E`Z �z��t�7Y � �G /�.' h # /
��*'� �� D epth of Pere r,, 2AI)
, 2- New Construction ❑ Repair re
g ja( ,fian''.((%' !l'f e7Q Start Pre - soak
Office Review /{lei �fiye . p ($f End Pre -soak Zo
•
Published Soil Survey Available: No ❑ Yes L, J Time at 12" f 'r t 7i- <. -
77 / 1� - G ' o •
'fear Published ../q Publication Scale /^ . f Soil Map Unifire://' • / Time at 9" , 7(
Drainage Class .... Soil Limitations 'e'Pl /Vhf......... t.. a.(.......... / / _ .
Surficial Geologic Report Available: No ❑ Yes a Time at 6"
Year Published Publication Scale Time (9 " -6 ")
Geologic Material (Map Unit) e( //1/(1/f / 47 (4"?✓ C
Rate Min. /Inch
Landform �f v 7/"T e i*' -. <.!ij % ' , C ,, L G_�._ ---
Flood Insurance Rate Map: -
Above 500 year flood boundary No ❑ Yes ` Minimum of 1 percolation test must be performed in both the primary area F
reserve area.
. Within 500 year flood boundary No Yes ❑ ,-,/
Within 100 year flood boundary No lfl Yes ❑ Site Passed Site Failed 0
Wetland Area: ` "'
National Wetland Inventory Map (map unit) Performed By: /i�iF'/� �' • � 'C�
Witnessed By: , �if44 /&Ga D /y
Wetlands Conservancy Program Map ,map unit) • Wi
. - �' � ��r r
Current Water Resource Conditions (US ): Month /fast- e( 6' ( Comments::...,. ./7 5.� !`Wt . 0.- 1- '
Range : Above Normal EV Normal ❑ Below Normal ❑ 7/Ti .
Other References Reviewed:
mown
D F P
r ‘,.e 7 /-6/6/4,1)) - .
DEP APPROVED FORM -12/07195 '
•
--
`� --- ,/aae Massachusetts - Department of Public Saf'et}
y Re
I • Board of Building, z`ulations and Standards
Board of 'Building Regulations and Standards
t , f/ HOME IMPROVEMENT CONTRACTOR Construction Supervisor License
e a R .
License: CS 70061
Ei.' 3/2010 Tr# 263077 Restricted to: 00
Corporation �� � A � � �� THOMAS M BAGS ■ ` a
GENERAL CONTRACTS -';
NEW ENGLANDR_ 67 DIVISION ST �_
THOMAS BACIS EASTHAMPTON, MA 01027 --
67 DIVISION STREET Administrator
EASTHAMPTON, MA 01 G-% –�=-- --- ---jam Expiration: 3/6/2011
- - - - - ( iimmi..iioner Tr#: 11914
UBC POWERED INDUSTRIAL TRUCK OPERATOR
Thomas M Bacis JAN N.E. REGIONAL COUNCIL F
U- 3860 - AR
has successfu► i MAR. !--:= ; CARPENTERS MAR,
requirements of IY completed the training ! the UBC Powered Industrial G APR. APR
Truck Operator Course, in accordance with 29 MAY` MAY
CFR 191 0.178(1), qualifying on: JUNE I ' JUNE
{ S imon R lames, District Manager
JULY (413) 736- 2878.3050 Fax (413) 781 -1640 JULY
I + IMetntal t O - Meets - 287&3050 F . (413) 7 AUG
I Pneumatic CO Tires n Solid X R oug h Terrain AUG 29 oakia a St.. Springfield
I I FOr k LiRS SEP Berkshire Meeting Wed. following SEP.
3rd Thu* of the month 5:30 p.m.
Instructor : Timothy R Tudor r OCT. 150 North St., suite 27 OCT
I (413)447 -7414 Nov.
Date : 06/22/2006 4 ' 1 Nov. ,le Bacis U-3860-3040 NEC.
Expires : (1 6/22/ 2009 _ --------------- ------ -----
2 09 29 Oakland St., Springfield, MA 0110&1731 ® 0 109 2010 ■
✓` M F 0 CERTIFIED TM
P�U AE
Hoisting Engineer License .. VINYL SIDING
Number HE 123775
_ INSTALLER
Eat{; 4 010 Tr. no: 16083 asamm"i ASTM
D4756
Resit***, 1.,2 # 800002929 slimmed by the Vial suns
THOMAS M BACK`. - Bacis, Thomas Expires: 07/01!09
67 DIVISION ST 67 Division street
Easthampton, Massachusetts 01027 ♦ AdminIStered By:
EASTHAMPTON MA 95427 ./ -J �7Z Architectural Testing, g. Inc
(> J1
'�— ZAN Narle
WOWS .
ut es0 euhlIctl.
H Pue AsisS leuolledno00 InoltOC It
0 098t - n SIOIS /401
uMuls"imPothilsof4 # eS 1
�
Asa
LLTLOT009
>. 3,3 THE COMMONWEALTH OF MASSACHUSETTS G Q
FEE \d
A Lf :4..i.[,e,' ` 3 OARD OF HEALTH - A4
DISPOSAL SYSTE • CONST ' UCTION PERMIT
Permission is hereby Granted to Construct uct (• ) Re.air (../ Upgrade ( ) Abandon ( ) an individual sewage
sposai system at _4... .., _ I�j ∎—. )t/ L , , _+ n . /i - as described
1 the application for Disposal System Construction Permit No. _ _(V�33 , dated , 3/ ep
'rovided: Construction sh 1 be completed within three years of the date of this permit. All local cond ions must be met.
)ate //2 G l)� Board of Health A e`' ° -
FORM 2 - DSCP DEP APPROVED FORM 5196
FORM 1255 (REV 5/96) Ha�W HOBBS8 WARREN T PUBLISHERS - BOSTON
NEW ENGLAND REMODELING 3636
GENERAL CONTRACTORS; 114C. 67 DIVISION STREET PH: 413- 529 - S3— 16812118
EASTHAMF1ON, MA 01027 Date J u � G
f ' Paytothe C '7 ./ drl ,4 am7 ( $ U
S.04
li, Order of y }�
--I, Y Dollars 8 , :
i4
'' FLORENCE SAVINGS BANK
M - 85 l*AIN STREET. GWPENCE, -MA 01082. I } '
i
LI 1-5 et / e For ' ` t' 7 ,. / ..., 4.. } ! '�� 1 " - -,4 , 04 - m.
1:2la 1873�688 ? 25 002O?Ru' 3636
_. GunaovnosaFerr GLUE way
S - re- 5 Y r 1 'I
4 s7/Y9 -er ,
®G"aeke American - _ - -_
t t l
� ti P. of Northampton f in
,�.•V =_= v)„.. M-HIPe
Wig" DEPARTMENT OF BUILDING INSPECTIONS " mi==
r
INSPECTOR 212 Main Street • Municipal Building ' %
Northampton, MA 01060 �M
e'
HOME OWNER EXEMPTION ACKNOWLEDGEMENT
The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to
act as his /her construction sup : :. sor. The state defines "Homeowner" as, " Person(s)
who owns a parcel on which he /she resides or intends 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."
The building department for the City of Northampton wants any person(s) who seek to
use the home owner exemption, to act as their own construction supervisor, to be aware
that by doing so you become responsible for compliance with state building codes
and regulations. The inspection process requires that the building department be called
to inspect work at various stages, which include foundation /footings (before backfill)
sonotube holes (before pour). a rough building inspection (before work is
concealed). insulation inspection (if required) and a final building inspection. The
building department requires these inspections before the work is concealed, failure to
secure these inspections can result in failure to obtain a certificate of occupancy
until the work can be inspected.
If the homeowner hires other trades to perform work (electrical, plumbing & gas) the
homeowner will be responsible to make sure that the trades hired secure their proper
permits in conjunction to the building permit issued, and that they get their required
inspections. Failure of the individual trades to secure the permits and inspections as
required can DELAY the project until such time as the proper permits and inspections are
made
I, understand the above.
(Home owner /resident's signature requesting exemption)
I will call to schedule all required building inspections necessary for the building permit
issued to me.
Date
Address of work
location
•
•
l' ( if z � cif Ycrrilla11t toll
DEPARTh-(ENT OP BUILDTNC INSPECTIONS
212 plain Strcct • Municipal Buiidmn2
Northampton, 'Mass. 01000 r `_
WO ,IZ'S COMPENSA`l.lON Lei ISURA±(_."r A F U)/ VIT •
Z C vY'i iJG% Gi f
with a plincipai place of at: dIC ) - 7
D 5,'IJ✓1 57 [ar74impt- 1.(phone') 5'2 c/
(sD idol tylstatcfa p)
do hereby certify, under the pains and penalties of perjury, that
(1 I am an employer providing die following worker's compensation cove age for Illy
employees vorD"ng on this job.
A c566,G tel) Co'' t ' v � J Co- 56e_ 6 e , i f o f :Zee et 5 ep
(lasiranc Coca,—) (Policy Ntunbcr) ( : it Son Dots)
( ? c l 1 am a sole proprietor, general ocou dctor or homeowner(circie one) aD have hired
the conizac ors listed below w o h2ve the fotlowin2, worker's co E2 trs2don policies:
( smc of Co cractu l (Insurailcc Coinoanl'iPo•c,• Num'cc:) (1-_) :pirouon Date) tt
(Name of Concacior) (Iiisarancc ComoaavvPo!ie; Date)
•
(N. me of Conu•ac1o7) (i surancc ComP.anr•IPoGcy Nruat, ) (EXpiUOQn Datc)
' t
• J
(Name of Coauaclor) \ �tcuC Co li ? - y/Po0c Nit lrli ]atC) .
( aaac i :d'!:�oc,J s3ca.if occcsr: t a:�cucz iafec�.,a oc p� ias w .1! co¢'r --c ora
( ) I E a sole proprietor and bave no one wor'rd.og for me.
( ) I am,a home owner performing all the work myself.
NOTE: pic_s.- cwarc Lc: u't tc bcmcw•om uts0 cam? tay pczon>, w c5� t-. r - tom • rr —. , c r i t urork ca of
apt moce t1=c tb oc >.=i'a in v.Jaril the bo mo vv r road, or ea the grour. a Doi J2v oce3:G -ui to be
ei>yloy 7.-s u'v' -- the svc" u•: tim Aci (G1...1.52.....=1(5)), .Ppi r;oo try a bomm far _ _ oc pc-an cry cvid_arn �e
icp ctz2ac of en exploy..r undar cho wore.ce Cooapocc.�tion ,'
[ oadcaaad th.ot x copy of Cal, caaonscar may bo 19,-xnrd.ad to the Dcpenmma a Offioe of tz� for z�
mvcrc vt- i6c:akc cad th_.i (_ih to ,.coot tovcc - ems tro't'- uo 2SA of MOL 151 can 1o4 to cbc i_2 ;iosslioa of c-imiasl prnslSia
cocciri g of . floc or up to S 1.S00.0o cr>t'Jor irapri.3.0ann. of up W ooc y-,.:r rind vi.1 paraltia m t,e form of Stop Wort Orcict and
fire o(.11. 00.00 i dry t.{pina me
Foe dq,ruz»l LLK only
„ Pcrcait Numbcr
ntap:t Lot °
Sim - stun of Li scrlPcrm etc ate
SECTION 8 - CONSTRUCTION SERVICES
8.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : � Gf o U�
License Number
6 ! /'
Address �j Expiration Date
Signature Telephone .
9. Registered .Home Improvement Contractor , _ y , _ _, _ Not Applicable ❑
�,/(e,- [vl la kld rl. 1 '/i v; ‘.-, , .L✓r c i q q`I Z
Com any Name Registration Number
6--? D,\/; sfo✓► ST ra s - 71)4i. n - * P /, a, -(273 - /0
Address Expiration Date
Telephone 5` -0E6/
SECTION 10- 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 No ❑
11 =:Home Owner Exemption
The current exemption for "homeowners" was extended to include Owner occupied Dwellings of one (1) or two(2) families
and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts
as supervisor. CMR 780, Sixth Edition Section 108.3.5.1.
Definition of Homeowner: Person -(s) -who- own -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 homeowner.
Such "homeowner" shall submit to the Building Official, on a form acceptable to the Building Official, that he /she shall be
responsible for all such work performed under the building permit.
As acting Construction Supervisor your presence on the job site will be required from time to time, during and upon
completion of the work for which this permit is issued.
Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to
Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, von may be liable for person(s)
you hire to perform work for you under this permit.
The undersigned "homeowner" certifies and assumes responsibility for compliance with the State Building Code, City of
Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated.
Homeowner Signature
•
1 5- DESCRIPTION OF PROPOSED WORK (check all applicable)
use Addition n Replacement Windows Alteration(s) Roofing I I
Or Doors CD
ory Bldg. Demolition 1 . New Signs [G} Decks [E,I Siding [EJ] Other [IJ]
ascription of Proposed c � r
Cv01S ri,„c G} ae lis 6 G S C w 174 g a c qi- 9 4ri fe
.ion of existing bedroom Yes No Adding new bedroom Yes No
led Narrative Renovating unfinished basement Yes No
Attached Roll - Sheet
Newlhousearid b -:addition td eii4inq housifici c omplete the`follovuinq:
Use of building : One Family Two Family Other
Number of rooms in each family unit 6 Number of Bathrooms 2 ild,
Is there a garage attached? Ve S
Proposed Square footage of new construction. 1 t 7 Dimensions 3 5 3
Number of stories?
Method of heating? Vr 0941n e Fireplaces or Woodstoves e-5 Number of each
. Energy Conservation Compliance. Y € S Masscheck Energy Compliance form attached? Yej
I. Type of construction 14 /00J
. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes e No
j. Depth of basement or cellar floor below finished grade
k. Will building conform to the Building and Zoning regulations? V Yes No .
1. Septic Tank ! ( : City Sewer Private well X City water Supply
SECTION 7a- AUTHORIZATION —TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
/ /
I ` o in a (4 S , 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
1, v.. a,, 1 - S , as wn uthorized
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
___.- 4 e‘,.;,..„..._, 0_ 2-3-- 0 q
Signature of Owner /Agent Date
Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
9, , 8d q A
Lot Size ____...1..2 _,t..2 .._.. _n__ ___ _ .. .....�. .�_._. L. Off. G? ".
Frontage -
Setbacks Front ___: - _�Q
Side L _._— _.; R::— L: Ko° R OIN?'.. 2p T ;;0 —
Rear -. Pq 0 ~ '
Building Height ^a — -µ 'AM M - J S _
Bldg. Square Footage __ % 7
Open Space Footage % ' �%, �C
(Lot area minus bldg & paved V J
parking)
# of Parking Spaces `_ __- -----
(volume & Location) - - ---- -- --- ---- --- - - — ---- -- -
A, Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DON'T KNOW 0 YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: . enter Book Page and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW 0 YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained Date Issued:
C. Do any signs exist on the property? YES 0 NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO 4
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 Q NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
Department use only , .
City of N ort hampton status of Permit` '
Building Department Curb C fDr ' , :Permit
212 Main Street Se
Room 100 Water/We
Northampton, MA 01060 T o Stru ctural Plans
p ub 413 - 587 -1240 Fax 413- 587 -1272 P1otS Plans
t , Oth ,ec% `
p fy
PPLICATION TO CON¢TR�1CT; ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY D
11 -SITE INFORMATION .
erty Address: �U� v + . f / Q This section to be com by o rr office
Map . 1 tot° ' , 0: 0 ' . Unit
Zone Over District:
EtrtiSt. District CB.[listrict
ON 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
caner of Record:
a�
(Pri Current L7il�Addrses q _ ��
,/ ' CJ1 r - �
� i� /)1 4 - Telephone
ature
A - zed An
Tp R GAS (0 7 1ir � �Cl�`t '. �.
me (print) Cu rren t M ailing Addre
! nature Tel
:CTION -3 - ESTIMATED CONSTRUCTION COSTS
m Estimated Cost (Dollars} to be Offic Use Only
completed by permitappGeant
Building (a) Building Permit
Electrical (b) Estimated Tota! Fee Cost of
Construction from ( 6)
Plumbing Building, Permit Fee
Mechanical (HVAC)
Fire Protection
9� //7r°5-r°
Total = (1 +2 + 3 + 4 + 5) / C�0 U e Check N umber _
- 14,6et.0 This Section For Official Use Drily ildin P er mt umber.' Date,
g Issued:
Inature:
Building Commissioner /inspector of Buildings Date
LE RD BP- 2010 -0561
COMMONWEALTH OF MASSACHUSETTS
41- 008 CITY OF NORTHAMPTON
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
BP -2010 -0561
JS -2010- 000787
$198000.00
78.50 PERMISSION IS HEREBY GRANTED TO:
lass: Contractor: License:
)up: THOMAS BACIS 070061
etsq. ft.): 123231.24 Owner: BACIS PROPERTIES INC
RR(100)/ /WP Applicant: THOMAS BACIS
AT: 45 LOUDVILLE RD
icant Address: Phone: Insurance:
►IVISION ST (413) 529 -0801 WC
5THAMPTONMA01027 ISSUED ON:1/12/2010 0:00:00
0 PERFORM THE FOLLOWING WORK:CONSTRUCT 2 STORY SFH W /ATT
,RAGE /PORCH
)ST THIS CARD SO IT IS VISIBLE FROM THE STREET
spector of Plumbing Inspector of Wiring D.P.W. Building Inspector
i
nderground: Service: it ;'l Meter:
Footings: Ip� 1 i1 � 10 L) IS
oughg I7 16 Rough:, /? /6 House # Foundation:
r��s
r�/ Driveway Final:
inal:8 A. "fO f Final: 7—[ -d'-J (.� 1ti 1 Ott Ut
Rough Frame:
.as: Fire Department �' ^ ^ ^' = =i = = =�.y: 911-i I t 1 is
ou h: 1 " a' °'' 17 1,714ii: * — 7/11‘1\u , Insulation
inal:8 -ate ' D (ii Smoke: '"}t Final: OL< 9-- l -/ c , ,tt;
'HIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
►NY OF ITS RULES AND REGULA IONS. •
� ' ° ,
,ertificate of Occupancy .,E� f i g nature:
'eeT_ype: Date Paid: Amount:
wilding 1/12/2010 0:00:00 $1178.50
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo
._ _
�, T he Commonwealth of Massachusetts I �x
)1
City of Northampton
Certificate
r�
of Occupancy
f f p y
In accordance with 780 CMR, Section 5120.0 (The Seventh Edition of the Massachusetts State Building Code)
this Certificate of Occupancy is issued to the premise or structure or part thereof as herein identified.
Identify Name of Building of Space Within Certificate No.
Issued to
Bacis Property Inc. BP 2010 - 0561
Identify property address including street number, name, city or town and county
Located at
45 Loudville Road
Florence, Hampshire, Massachusetts
Use Group
Classification(s) Single Family Residential
This Certificate of Occupancy is hereby issued by the undersigned to certify that the premise, structure or portion thereof as herein specified has been inspected for
general fire and life safety features. This certificate shall allow for the use as herein described and in conformance with any and all conditions as identified below. It
shall be posted in a conspicuous place within the space as directed by the undersigned. Failure to post the certificate, failure to comply with conditions or, tampering
with the contents of the certificate is strictly prohibited.
Conditions of Use Single Family Residential
Name of Municipal Date of Final Map /Plot:
Building Official Charles Miller Inspection 09/01/10
Signature of Municipal Date of 41 -008
Building Official Issuance 09/01/10
File # BP- 2010 -0561
APPLICANT /CONTACT PERSON THOMAS BACIS
ADDRESS/PHONE 67 DIVISION ST EASTHAMPTON (413) 529 -0801
PROPERTY LOCATION 45 LOUDVILLE RD
MAP 41 PARCEL 008 001 ZONE RR(100) / /WP
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out If_ fJ �f p�f
Fee Paid / 7d'`� t
O f' (_ TJ�
Typeof Construction: CONSTRUCT 2 STORY SFH W /ATT GARAGE/PORCH S; f }�(,mf1 N
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner,' Statement or License 070061
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFOMATION PRESENTED:
/ /Approved Additional permits required (see below)
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:
r,1( IStlCurb Cut from DPW fi A. Water Availability NP Sewer Availability
Lr/ Septic Approval Board of Health L.r Well Water Potability Board of Health
P l p Permit from Conservation Commission r1 I (. Permit from CB Architecture Committee
ifA Permit from Elm Street Commission _ ti % A Permit DPW Storm Water Management
1\i/ Demolition Delay
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Signature of Building Official 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.