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06-044 (3) City of Northampton Mail - Fwd: Leeds Thermostat https://mail.google.com/mail/u/0/?ui=2&ik=39211afc3d&view=pt&se... D�-- 04f ! r Charles Miller<cmiller @northamptonma.gov> Fwd: Leeds Thermostat 1 message Peter Bishop<peterbishop @fastmail.fm> Mon,Aug 4,2014 at 10:04 AM To:cmiller @northamptonma.gov This may be relevant to the question of whether turning the office building at 241 Haydenville Road in Leeds counts as turning unconditioned space into conditioned space. A nighttime temperature of 60 degrees would not be unreasonable even with people sleeping there. Peter Bishop peterbishop@fastmail.fm -----Original message----- From:John Hultman<ihultman .gscwm.org> To:"peterbishopOfastmail.fm"<peterbishoo @fastmail.fm> Cc: Deborah Mansfield<dmansfieldCcDOscwm.org> Subject:Leeds Thermostat Date:Thu,31 Jul 2014 13:01:39+0000 Peter, Our programmable thermostats at the 241 Haydenville Rd, Leeds,MA property were set at 60 degrees during the heating season from 7 PM to 7 AM on the weekdays and from 7 PM Friday through 7 AM Monday on the weekends.During the cooling season they were set at 75 degrees for the same periods. John Hultman Facilities Manager Girl Scouts of Central and Western Massachusetts 301 Kelly Way,Holyoke,MA 01040 Phone:800-462-9100(in MA) Cell Phone:413 455-5009 Forget the box,just think outside!Current Girl Scout or not,we've got a memorable summer camp experience for your girl. Check out all the offerings here. Important Notice:This transmission,together with any attachments,is intended only for the use of the individual or entity named above.If you have received this transmission in error,please contact our office immediately and destroy or delete hard copies,electronic copies,and any accompanying information or attachments. 1 of 1 8/4/2014 11:19 AM K Carpentry & Drywall Maurice G. Kirouac Jr. 603-674-0877 lic. #97695 45 Wolcott Street Holyoke, Ma 01040 June 29, 2014 Client: Edwin and Sheila Bishop Job Location: 241 Haydenville Road, Leeds Ma 01053 Job Description: 1. Frame 5 new double window openings (64"x52"); new 9" LVL's for headers, double jacked on both sides of the openfrrr 2. Install new windows. 3. Pad exterior wall to accept R- insulation. 4. Close off doorways as shown on the prints. 5. Close off windows as shown on the prints. 6. Remove walls as shown on the prints. 7. Add walls as shown on the prints. 8. Remove and reinstall upper cabinets in new kitchen. 9. Install new base cabinets, 10.Remove walls in server room to create new bathroom. 11.Remove walls in existing bathroom to create laundry room. 12.Remove walls in master bath. 13.Paint new and existing trim. 14.Paint all walls. 15.Respray ceilings. 16.Remove old vinyl baseboard. 17.Install new baseboards. 18.Remove old rugs— possible save for office # 3. 19.Install 14 new 6— panel doors. 20.Install new 3' exterior front door. 21.Vent bathroom fans through the roof. 1 Mud Room Dining Room Living Room Guest Bath N 0 sic Laundry Room Master "s Bedroom 0 � Kitchen T 7F Master Second Bath Bedroom seopmm 1 del, S s;," '�a,�G �e�4P��+'I FIRST FLOOR r Residential Configuration �0 /0°^3 ce, I M, odd doubGe w%v dons dmtUe w VLv ow double window WOW ' ■,add dooYwa� ■ Office 5 Mud Chose off dooYwa� — Room t Dining Room S Living Room a Server 6 -.N'A_ Room 4' CYeate Office 4 �tdd clrse± Pass-thY�t � s bat Hvoowti '.9 r�evuove� Close off doorway �' batl�roovw Master Bedroom r�ecowfi�uYe q Kitchen En cLoset c et Office 1 z, Office 2 Office 4 J CS.K o) Sink Closet FIRST FLOOR v Renovations O 'F-athV-t)oM as Door %v�,to reeovLfi.c�vYed vuast:er Bath 2 bedroovu it 1 office 5 Reception South Room Server Conference Room Room Office 4 Bath 1 North � Photocopier Conference Room Bath Room Office 1 Office 2 Office 3 Sink Closet FIRST FLOOR Current Configuration cz 1% K CL LO Nod fo Scajo 03 to lea c 1"'.1 to (10 14, J,, COL P PIE L. 4K V.k"Vi 7, V mi z iD 2 r C Map It CL 3 roe- LU r'' V CL Lo 0 C, k: IN, : S. tank Q|m Baffle/Riser 241 Hay enG|+ road. Leeds (Northamotom. ? n7 02,2042 u t 4� S. tank Outlet Baffle/Riser 2411 Haydenville road. Leeds (Northampton), Ma @um% R%ay, ChamberBand z . H�den7Rc qty Leeds (Northampton), Ma §\2d2G}2 M k , "Mov ,a D. box 241 Haydenville road. Leeds (Northampton), Ma 07.02?n12 Y r .-•- � •..:,� .,s, �u { " `..,w.. ;tea " x B Septic Inspection Area 241 Haydenville road. Leeds (Northampton), Ma ��. 07.02.2012 Commonwealth of Massachusetts I{ - i Title 5 Official Inspection Form } Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 241 Haydenville Road - Property Address Girl Scouts of Central and Western Mass. _ Owner Owner's Name information is Leeds MA 01053 07.2.2012 required for every page. City/Town State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, S, C, D,or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file 15ins.11110 Title 5 official Inspection Foom:Subsurface Sewage Disposal System•Page 17 of 17 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 241 Haydenville Road__ Property Address Girl Scouts of Central and Western Mass. Owner Owner's Name — information is Leeds MA 01053 07.2.2012 required for -._ - - - - -- _._ every page. Cityfrown State Zip-Code Date of Inspection D. System Information (cont.) Site Exam: ® Check Slope ❑ Surface water ® Check cellar ❑ Shallow wells Estimated depth to high ground water: 4'+/(1982 design elevations) feet Please indicate all methods used to determine the high ground water elevation: ® Obtained from system design plans on record If checked,date of design plan reviewed: Dale_ ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ® Checked with local Board of Health-explain: see plans ® Checked with local excavators, installers- (attach documentation) ❑ Accessed USGS database-explain: You must describe how you established the high ground water elevation: Interpreted soils and topogra relative to brook. Before filing this Inspection Report, please see Report Completeness Checklist on next page. 15ins•11110 Tille,5 Official Inspection Form:Subsurface Sewage Disposal System•Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form ri# Subsurface Sewage Disposal System Form-Not for Voluntary Assessments ;•.> '~ 241 Haydenyille Road Property Address Girl Scouts of Central and Western Mass. Owner Owner's Name information is Leeds MA 01053 07.2.2012 required for _ _ _ ___-- _-- ..__ - _ every page. City(Town State Zip Code Date of Inspection O Sys en7 inforitil is usi kUU[Ii..j Sketch Of Sewage Disposal System:Provide a view of the sewage disposal system, including ties to ai least Iwo periiianent reference lands-narks or benchmarks i-ncate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: hand-sketch in the area bYfniN drm,01i0 attarhed E j i i i Commonwealth of Massachusetts !a Title 5 official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 241 Haydenville Road — Property Address Girl Scouts of Central and Western Mass. - Owner Owners Name information is Leeds MA_ 01053 07.2.2012 —_ _ _ required for State Zip Code Date of Inspection every page. city/Town D. Systems information ((;orA.) Comments(note condition of soil,signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): Title 5 offidal Inspection Form:Subsurface sewage Disposal Syslam•Page 14 of 17 l5ins•11110 Commonwealth of Massachusetts I _ trvs Title 5 Official Inspection Form Ai Subsurface Sewage Disposal System Form Not for Voluntary Assessments 241 Haydenville Road _ Property Address Girl Scouts of Central and Western Mass. Owner Owners Name information is Leeds MA 01053 07.2.2012 required for _ _ _----- —_ every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Type: ❑ leaching pits number: __- ❑ leaching chambers number: ❑ leaching galleries number. -- - -- ® leaching trenches number, length: 2 @ 3'x 50' ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovativelalternative system Type/name of technology: -- -- Comments(note condition of soil,signs of hydraulic failure,level of ponding,damp soil, condition of vegetation, etc.): No signs of failure or ponding noted in stone or D. box area. Cesspools(cesspool must be pumped as part of inspection) (locate on site plan): Number and configuration - -- - Depth-top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No l5ins-11!10 Title 5 Official Inspection Form:Subsinface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts r Title 5 Official Inspection Form Subsurface Sewage Disposals System Form-Not for Voluntary Assessments 241 Havdenville Road Property Address Girl Scouts of Central and Western Mass. Owner Owner's Name information is .2.2012 required for Leeds MA 01053 07- --- - _ - _ every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened) (locate on site plan): Depth of liquid level above outlet invert Inv. Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover,any evidence of leakage into or out of box, etc.): Good level flow, no high staining, box @ 24"BG. Pump Chamber(locate on site plan): Pumps in working order: ® Yes ❑ No Alarms in working order: ® Yes ❑ No Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): Pump operational, Alarm float repaired 2 yrs earlier. - Soil Absorption System (SAS) (locate on site plan, excavation not required): If SAS not located,explain why: t5ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 12 of 17 .� Commonwealth of Massachusetts ._� Title 5 Official Inspection Form t, I Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 241 Haydenville Road Property Address - - Girl Scouts of Central and Western Mass. Owner Owner's Name information is Leeds MA 01053 07.2.2012 required for _ ---— .--- . . --- --- — — -_ ___ -- ._ _ every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): good conditions&levels. Tight or Holding Tank(tank must be pumped at time of inspection) (locate on site plan): Depth below grade: Material of construction: ❑concrete ❑metal ❑fiberglass ❑polyethylene ❑ other(explain): Dimensions: Capacity: --- gallons Design Flow: gallons per day Alarm present: ❑ Yes ❑ No Alarm level: - —- ----- Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): "Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins-iiltO Title 50raciA Form Subskrface Di Inspection Sewage SPOSai System-Page 15 0(f 7 Yt{ ii Commonwealth of Massachusetts Title 5 Official Inspection Form f ,� 1 Subsurface Sewage Disposal System Form V Not for Voluntary Assessments :. ' 241 Haydenville Road Property Address Girl Scouts of Central and Western Mass. Owner Owner's Name information is Leeds MA 01053 07.2.2012 required for _ _._-- -- — every page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 38"-- - <2„ Scum thickness - Distance from top of scum to top of outlet tee or baffle 6" --- — ------ --- - Distance from bottom of scum to bottom of outlet tee or baffle 12 How were dimensions determined? Meas. Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage,etc.): stucturally sound. - Grease Trap(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑metal ❑fiberglass ❑polyethylene ❑other(explain): Dimensions Scum thickness Distance from top of scum to top of outlet tee or baffle — - --- Distance from bottom of scum to bottom of outlet tee or baffle - Date of last pumping: Date- — - -- ---- t5ins-15/10 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 10 of 17 Commonwealth of Massachusetts I� r. Title 5 Official Inspection Form ! 1 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 241 Haydenville Road -- Property Address Girl Scouts of Central and Western Mass. Owner Owner's Name information is Leeds MA 01053 07.2.2012 required for _ _._. � _- ------------- _._.._-- — _ _- every page. Citylrown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components,date installed (if known)and source of information: 30+/-_yrs, S. tank, Pump and L. trenches. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sewer(locate on site plan): DeDepth below grade: 3.0 p g feet Material of construction: ® cast iron ❑40 PVC ❑ other(explain): Distance from private water supply well or suction line: X20 feet Comments(on condition of joints, venting,evidence of leakage, etc.): ok goes out through floor. - Septic Tank(locate on site plan): 4.5 Depth below grade: feet - -- Material of construction: ®concrete ❑metal ❑fiberglass ❑ polyethylene ❑ other(explain) Good condition baffles in place, If tank is metal, list age: -__ years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No 8.5 x 4.5'x 42 Dimensions: 6" Sludge depth: tans.11/19 Title 5 Official Inspection Form:Suhsudace Sewage Disposal System-Page 9 of 17 Commonwealth of Massachusetts 1�7 - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments 241 Haydenville Road — Property Address Girl Scouts of Central and Western Mass. Owner Owner's Name information is M d ees A 01053 07.2.2012 required for L --------- —A _ __-_- - every page. Cityfrown State Zip Code Date of Inspection D. System Information (cont.) current Last date of occupancy/use: —Date_ - _- -- Other(describe below): Girl Scout office has 8-12 workers 8 hrs ago. General Information Pumping Records: Source of information: Was system pumped as part of the inspection? ® Yes ❑ No If yes,volume pumped: 1000 gallons eas. How was quantity pumped determined? -m-- Reason for pumping: Inspection Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes,attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest inspection of the I/A system by system operator under contract ❑ Tight tank.Attach a copy of the DEP approval. ❑ Other(describe): 15ins•11/10 Title 5 Orfidal Inspection Fom:Subsurface Sewage Disposa!System•Page 8 0117 Commonwealth of Massachusetts l - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 241 Ha denvtlle Road Property Address Girl Scouts of Central and Western Mass. Owner Owners Name information is 2012. required for Leeds MA 01053 07.2- - --- __ --- -_ --- _—__— ------- ---- ---- - -- - -- --_ -- _— _- .----- every page. CitytTown State Zip Code Date of Inspection D. System Information Description: Number of current residents: -- Does residence have a garbage grinder? ❑ Yes ❑ No Is laundry on a separate sewage system?[if yes separate inspection required) ❑ Yes ❑ No Laundry system inspected? ❑ Yes ❑ No Seasonaluse? ❑ Yes ❑ No n/a Water meter readings, if available(last 2 years usage(gpd)): — -- Detail: Sump pump? ❑ Yes ® No Current Last date of occupancy: rrent -- Date Commercial/industrial Flow Conditions: Type of Establishment: Office-, Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/personslsq.ft., etc.): 4200 sf Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings,if available: l5ins-11110 Tide 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts 17l, - Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments � Ir 241 Haydenville Road - Property Address Girl Scouts of Central and Western Mass. Owner Owners Name information is Leeds MA 01053 07.2.2012 required for — every page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done.You must indicate"yes'or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner,occupant,or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components,excluding the SAS,located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions,depth of liquid,depth of sludge and depth of scum? ® ❑ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® 11 approximation in the field (if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): — — Number of bedrooms(actual): - - - DESIGN flow based on 310 CM 15.203(for example: 110 gpd x#of bedrooms): - - ---- (Sins-11110 Title 5 Orfidal Inspection Form:Subsurface Sewage Disposal System•Page&of 17 t Commonwealth of Massachusetts i Title 5 Official Inspection Form Subsurface Sewage Disposal System Form Not for Voluntary Assessments t ;% 241 Haydenville Road Property Address Girl Scouts of Central and Western Mass. Owner Owner's Name information is Leeds MA 01053 07.2.2012 required for _.--—___ -- -_ __—.---- .—..._ —__-- every page. Cityrrown state Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS,cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. (This system passes if the well water analysis,performed at a DEA certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.) ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ❑ ® The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails.The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ ❑ the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes"in Section D above the large system has failed.The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304.The system owner should contact the appropriate regional office of the Department. 15ins•11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 5 of 17 Commonwealth of Massachusetts 1,, Title 5 Official Inspection Form '1 Subsurface Sewage Disposal System Form-Not for Voluntary Assessments n ^i 241 Haydenville Road Property Address Girl Scouts of Central and Western Mass. Owner Owner s Name - information is Leeds MA 01053 07.2.2012 requiredfor _ _---.--..--_----__ - _-- _ _ �__----- every page. City/Town State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health(and Public Water Supplier,if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: **This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ❑ ® Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ❑ ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool El ® Liquid depth in cesspool is less than 6"below invert or available volume is less than "/z day flow 15ins-11110 Me 5 official inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts ,+ Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 241 Ha denville Road Property Address Girl Scouts of Central and Western Mass. Owner Owner's Name information is Leeds MA 01053 07.2.2012 required for —. __---- —_— _— _ _------- —_�.__. —ip — - -- ._�__..-- -- every page. al-wrown State Zip Cade Date of Inspection B. Certification (cost) B) System Conditionally Passes(cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken,settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s).The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND (Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-11110 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 3 of 17 ti Commonwealth of Massachusetts Title 5 official Inspection Form r j} Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 241 Ha denville Road Property Address Girl Scouts of Central and Western Mass. _ Owner Owner's Name information is Leeds MA 01053 07.2.2012 required for -- __-_--- -----. -_—_-- every page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E(always complete all of Section D A) System Passes: ® 1 have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Property has 1000 gal. S.tank and"barrel"P. Chamber. (installed, 1982)two 3'x 50'+I-leach trenches. System was functional with no failure evidence,with 8-12(workers) persons using. System serves 4,200 SF office. Pump&alarm was be checked. It should be checked every year with pumping septic tank every 2 years.All conditions were functional. No signs of failure observed. Process water from dehumifier,AC and hot water heater should not discharge to septic. Some roots in D. box, but sound. Elbow 145)added to inlet pipe._ B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass"section need to be replaced or repaired.The system, upon completion of the replacement or repair,as approved by the Board of Health,will pass. Check the box for"yes","no"or"not determined"(Y, N,ND)for the following statements. If"not determined,"please explain. The septic tank is metal and over 20 years old*or the septic tank (whether metal or not)is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑ Y ❑ N ❑ ND(Explain below): 15ins•11110 Title 5 Official inspection Form:Subsurface Sewage Disposal System•age 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form 1� Subsurface Sewage Disposal System Form-Not for Voluntary Assessments i 241 Haydenville Road - Property Address Girl Scouts of Central and Western Mass. Owner Owner's Name information is Leeds MA 01053 07.2.2012 required for _ --_ _—_ _-__-- -- _ -__ _ every page. Cityrrown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important: A. General Information When filling out forms on the computer,use 1. Inspector: only the tab key to move your Alan E Weiss, M.S, H dro Bolo 9 ist, RS#933 _ cursor-do not ----— -- —Y 9_ -- _---—._ use the return Name of Inspector key. Cold S_ri i Environmental Consultants Inc. Company Name a ^. 350 Old Enfield Road Company Address p Belchertown MA 01007 Cityrrown State Zip Code 413.323.5957 #738 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection.The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000).The system: ® Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority [A-A-� 07.02.2012 Inspector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or, has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP.The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. 15ins 11110 Title 5 official Inspection Form:Subsurface Sewage Disposal System-Page 1 or 17 ow - J.W. Cotton LLC P.O. Box 713 Hatfield,MA 01038 Phone:413-247-9608 Fax:413-247-0276 06/05/2014 Girl Scouts of Central and Western Massachusetts 301 Kelly Way Holyoke,MA 01040 Atta:John Hultman Facilities Manager Dear Mr.Hultman, On Monday June 02,2014;at approximately 9:00 AM—in the presence of both yourself and Mr.Denny Nolan,I tested the septic system pump located at 241 Haydeaville Road, Leeds,Ma. Testing consisted of opening the pump chamber,performing a visual inspection of pump and pump control floats inside the pump chamber. Water was supplied from the office building by running water into sinks and flushing toilets. I/We then observed the septic system puanp function normally activating when the pump chamber filled to the correct level,shutting off when the pump chamber emptied. A weep hole installed in the discharge pipe from the pump also functioned as designed. The purpose of this weep hole is to prevent the pump from becoming"air bound"on start up,and to allow any water in the discharge pipe to empty after a pump cycle,thus i preventing freezing during cold conditions. t Proper operation was observed through four pump cycles. Sincerely, Q / ,4"ill. ��,► er acceptance ate John W.Cotton JWC/cc IMPORTANT FEE NOTICE: CHANGE IN LAW ABOLISHES CSL's HIC REGISTRATION FEE EXF1%fPT1ON. As a result of a recent change in the law(Section 80 of Chapter 27 of the Acts of 2009),the holders of Construction Supervisors Licenses are no longer exempt from the HIC Registration fee. CONSEOUENTLY.ALL CONTRACTORS,INCLUDING CSL's WHO ARE APPLYING FOR A HIC REGISTRATION MUST PAY A REGISTRATION FEE OF$150.00.AND A GUARANTY FUND FEE. (See instructions for Guaranty Fund fee schedule.) c 16. REGISTRATION FEE ENCLOSED:$ GUARANTY FUND FEE ENCLOSED:0,9,0,00 PLEASE INCLUDE TWO(2)SEPARATE CERTMED CHECKS OR MONEY ORDERS,ONE MARKED "REGISTRATION FEE"AND ONE MARKED"GUARANTY FUND."ONLY CERTIFIED CHECKS OR MONEY ORDERS CAN BE ACCEPTED.ANY OTHER FORM OF PAYMENT,INCLUDING BUT NOT LIMITED TO PERSONAL OR BUSINESS CHECKS,WILL BE RETURNED AS INELIGIBLE.MAKE BOTH CHECKS PAYABLE TO"COMMONWEALTH OF MASSACHUSETTS." I hereby swear,under the pains and penalties of perjury,that all information set forth on this application and submitted in support hereof is true and accurate to the best of ney knowledge- Further,I certify under G.L c 62C§49A,that I am in compliance with all laws of the CoMmonweakh relating to taxes,reporting of employees and contractors,and withholding and remitting of child support tore of Applicant if If a corporation or partnership,position held 11.LIST ALL PARTNERS,TRUSTEES,OFFICERS,DIRECTORS,AND MAJOR OWNERS(10%OR GREATER OF O'WNER9M OF AN APPLICANT PARINERSW OR CORPORATION,BELOW.USE ADDMONAL PAPER IF NECESSARY AND INCLUDE NEEDED PAPERWORK(SEE INSTRUCTIONS).PLEASE INDICATE BY AN"X"IN THE LAST COLUMN THOSE INDIVIDUALS WHO REQUIRE AN APPLICATION FOR ADDITIONAL REGISTRATION LD. CARDS.USE ADDITIONAL SHEETS IF NECESSARY. FULLNAME TITLE %OWNER ADDRESS SUPP.CARD 12. (a)HAVE YOU BEEN REGISTERED PREVIOUSLY AS A HOME IMPROVEMENT CONTRACTOR? YES-Le-NO (b) IF YES,PLEASE PROVIDE THE NAME AND REGIST ATION NUMBER UNDER WHICH YOU WERE PREVIOUSLY REGISTERED: NAME: MC REGISTRATION#: 13.(a) ARE YOU CURRENTLY ORHAVE You EVER BEENAN of wEB,PARTNER,OR CO-VENTURER OF AN APPLICANT WHO PREVIOUS Y APPLIED FOR OR HELD A HOME IMPROVEMENT CONTRACTOR REGISTRATION? YES ,No (b) IF YES,PLEASE PROVIDE THE NAME OF THE APPLICAN DREGISTRANT AND THE REGISTRATION NUMBER: NAME: MC REGISTRATION#: 14.(a) ARE YOU CURRENTLY OR HAVE YOU PREVIOUSLY BEEN EMPLOYED BYA REGISTRANT OR APPLICANT FOR REG TIONAGAINST WHICHDISOPIINARYACTIONWAS TAKEN? YEs NO (b) IF YES,PRASE PROVIDE THE NAME OF THE APPLICANT/REGISTRANT AND THE REGISTRATION NUMBER: NAME: HIC REGISTRATION#: 15.(a)HAVE THERE EVER BEEN ANY FORMAL COMPLAINTS AGAINST YOU WHERE DISCIPLINARY ACTION WAS TAKEN BY THE DEPT.OF PUBLIC SAFETY OR CONSUMER AFFAIRS,OR ANY COURT JUDGMENTS OR ARBITRATION AWARDS ISSUED AGAINST YOU? YES A/ (b)DO YOU O MONEY TO THE GUARANTY FUND? _YES NO IF YES TO EITHER,PLEASE IDENTIFY BY DATE,CASE NUMBER,OR DOCKET NUMBER: THE COPARIONWEALTH OF MASSACHUSETTS For OCABR Use Only. — OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATION Regisuration No: 10 Park Plaza, Suite 5170 Boston , MA 0 2 1 1 6 Effective Date: Application for Registration as a Home Improvement Contractor or Sub-Contractor E*tratim Dom: (MGL c-142A-,201 CAM 18.00) 1. NAME OF APPLICANT: 1 d d t tie 4,Ki�?ame OMAWBEEI MRANPMnMXJM.COWORATIOKUP-U.P,TR OROIUMLFGALENnM 2. NUMBER OF EMPLOYEES:_ 3. APPLICANT TYPE: DC DIVIDUAL _CORPORATION _PARTNERSHIP TRUST ME (CHECK ONE—MUST BE SA LEGAL ENTITY AS THE ENTITY IDENTIFIED IN#1) 4. SOCIAL SECURn'Y#k D3 7E�" 3aD[3 FEDERAL TAX ID#: 5 APPLICANT PHONEG'D `� –� APPLICANT EMAIL ADDRESSi,IfL 1 ,o [ 1t�' 6. MAILING ADDRESS: , D $? r inwy-"o. STREET Crr1V 9 STATE ZIP 7. PERMANENT ADDREss: 5,�W,5-7- A5 4&V& STREET CITY STATE ZIP PLEASE NOTE THAT A P.O BOX IS NO ACCEPTABLE FOR PERMANENT ADDRESS. YOU MUST LIST A STREET ADDRESS 8. IF THE APPPLICANT IS A CORPORATION OR A PARTNERSHIP,PLEASE PROVIDE THE NAME,ADDRESS,SOCIAL SECURITY#AND TITLE OF THE INDIVIDUAL WHO WILL BE RESPONSIBLE FOR THE CORPORATION'S THE TRUST'S OR THE PARTNERSHIP'S WORK(Please review the Iltstrllctions before answering this question)- LAST FIRST SOCIAL SECURITY# TITLE 9 IF APPLICANT IS DOINGBUS]ESS UNDER A D/BIA,PLEASE STATE THAT D/B/A,AND ATTACH ACOPY OF THE FICTICIOUS NAME CERTIFICATE FILED WITH THE CITY OR TOWN CLERK: DBA NAME: 10.(a)DOES THE APPLICANT OR RESPONSIBLE INDIVIDUAL HOLD ANY OTHER CONSTRUCTION-RELATED STATE, CITY OR TOWN LICENSES OR REGISTRATIONS?_KYES NO (b)IF YES,PLEASE FILL IN INFORMATION BELOW.ATTACH ADDITIONAL SHEETS IF NECESSARY. LICENSE TYPE ISSUED BY LICEN # EXP.DAICE LICENSEE NAME S HA Ml;�,W Cashier's Check PeOp/e `---�'BaAk ` ReferenceCratuity Fund Dat,07 11/2014 8030054 v 47802;A1364D2 J; Pay Y ONE,HUNDRED) DOLLARS AND ZERO CENTS / To the*COMMONWEALTH OF MASSACHUSETTS*, v _ Order of L V CHECK I Y CASHIER'S thorized Si ature Notice to Custome�s:The purchase of an indemnity bond may bgg required before this check will be replaced or refunded.in the event it is lost,misplaced or stolel� ( Member FDIC CK-002 i r 11'80-300 5 411' is 2 2 4 L 7 2 18 61: ii' L'7000 2 9 Sii' � Peopled InU ted J l Cashier's Check V Bank Reference'SO_ Reg,, DateO7/11/2014 8030053 2=A1364D2 4780 E Pay /ONE HUNDRED FIFTY DOLLARS AND ZERO )CENTS lY i ,"r To the OF I1ASSACHUSETTS�� v Order of E —CASHIER'S CHECK I l ut orized Sig ure J 3 / Notice to Customers:The purchase of�an indemnity bond may be required before this check will be replaced or refunded in the event it is lost,misplaced or stolen. Member FDIC CK-002 11280 300 S 3�i' 1: 2 2 L L 7 2 1861: ii' i�?000 29 Silo City of Northampton Massachusetts ' DEPARTMENT OF BUILDING INSPECTIONS ? a. 212 Main Street • Municipal Building W Northampton, MA 01060 ssj�n .y7tii� INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his/her construction supervisor. 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 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations x 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/O �rganizationandividual): C L a t 6_i ATin Address: 43 - tt)QL6`-7 �T, Ae'7 , 1 t— — -� City/State/Zip: D 1 0 Q Phone #: Are you an employer. Check the appropriate box: Type of project(required): 1.El am a employer with 4. E] I am a general contractor and I employees (full and/or part-time). * have hired the sub-contractors 6. ❑ New construction 2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance. 9. E] Building addition required.] 5. E] We are:a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 121-1 Roof repairs insurance required.]t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. tHo meowners 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 information. 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 Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that 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 a' s and penalties of perjury that the information provided above is tr a and correct. Signature ' Date: Phone#: 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#: 241 Haydenville Road -#of bedrooms Ed Smith Dear Peter Sorry for the delay in getting back to you about this property, and your question about whether it should be listed as ... Jul 23 (5 days ago)Pin to petersbusiness, cc Daniel Wasiuk, Merridith O'LearyShow details BusinessMark as UnreadReply to All More From: Ed Smith <esmith(@ north ampton ma.gov> To: petersbusiness(,fastmail.fm Cc: Daniel Wasiuk <dwasiuk(a-)-northamptonma.gov>, Merridith O'Leary <molearyCc northamptonma.gov> Subject: 241 Haydenville Road -#of bedrooms Date: Wednesday, July 23, 2014 3:58 PM Size: 6 KB Dear Peter Sorry for the delay in getting back to you about this property, and your question about whether it should be listed as 2 Bedrooms, or 3 Bedrooms. You appear to have a septic field with 2-50' leaching trenches T wide; you have 300'of leaching area; at the best loading rate(.74 gpm/sgft. you have barely enough capacity for 2 bedrooms(each bedroom is figured at 110 gpd, so 2=220 gpd; .74 x 300=222). We don't have perc test results or modern soil evaluation data for this property, so you should treat this as 2 Bedrooms for the purpose of your permit applications or for resale, although you may want to hire a septic designer to determine and make a case for 2 or 3 bedrooms. I think he/she would advise you that we are already making a generous estimate at 2 and make changes(increasing capacity)when a new system or repairs are eventually required. sincerely Ed Smith Edmund Smith Health Inspector Northampton Health Department 212 Main Street, Northampton MA 01060 (413)587-1339 Regular Schedule: Monday&Wednesday, 8-4:30; Thursday 8-12 noon. (City of Northampton E-mail is a public record except when it falls under one of the specific statutory exemptions. ) Section 4. ZONING All Information Must Be Completed.Permit Can Be Denied Due To inmmptete Information Bxisting Proposed Required by Zoning This colmn to be fifted in by Bu$ding Depataneat Lot Size ETnU e Setbacks Front Side L= K—= L:= R Rear Building Height Bldg.Square Footage Open Space Footage % (Lot area minus bldg 8c paved aAdn #of Parking Spaces Fill: volume&Location) A. Has a Permit/Variance/Finding ever been issued for/on the site? NO Q DON-r KNOW 0 YES IF YES, date issued:�� . --1 IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW ® YES IF YES: enter Book r I Pag and/or Document# B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW ® YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained 0 , Date Issued: _—� C. Do any signs exist on the property? YES 0 NO 0 IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES O NO 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 0 NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. FROM SEND IT PACKIN' PLUS CTHU) 8 20 2014 14:32/ST. 14:30/No. 8001884848 P 4 SECTION 8-CO,NSTRUCTION SERVICES 8.1 Licensed Construction Sueervlsor, ✓ Not Applicable £ J 9 Name of License H�der /fO License Number ,CJt" _�� Expi Bon e Address r V S' nature Telephon --„+---=>r^--r•-.-_.�_ � ,?. y� ��. ?`1 i°` i2+ ' e Not Applicable £ i9 RealsteredFC6me.lmproyemortt`ConfraGf r' � aa ;t s � tea: -. APP Company Name Registration Number Address Expiration Date Telephone SECTION 10-WORKERS!COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c-162,§26C(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...... £ 1 �=80-i��Q�ne��akelriAtian The current exemption for"homeowners”was extended to include Owner-occupied DwellinQS 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 108.15.1. 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'perlod 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,You may be flable 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 /(ofq�Massachusetts General Laws Annotated. Homeowner Signature, d�c i V FROM SEND IT PACKIN' PLUS <THU> 8 28 2014 14:32/ST. 14:30/No. 8001894848 P 3 SECTION b-DESCRIPTION O�.PROPOSED WORK(check all applicable New House ❑ Addition ❑ Replacement Windows Alteration(&) Roofing [� Or Doors U� Accessory Bldg. ❑ Demolition New Signs [O) Decks [❑ Siding[o) Other[C31 Brief Dec ptionofProp sed U.5I��Dt� —T ��nr2S ' "WEE Work: t�AWg �CRTmk/ er -f-H,---- Kd=1 J 1- 4 lj9-67" !q'Tq Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative Renovating unfinished basement Yes No Plans Attached Roll -Sheet sa�f�fuPfew'tioise a'roddtlatf 16x,5>�ing fiatsinuie�`fof[ownsi: a. Use of building:One Family Two Family Other b, Number of rooms in each family unit Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft.of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No. I. Septic Tank City Sewer Private well City water Supply SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED;WHEN, OWNERS AGENT OR CONTRACTOR APPLIES FOR.IBUIL.DING PERMIT 5 i 7 t G as Owner of the subject property hereby authorize M 4vr7 r-e, IK 1 y0✓A C qtr to act on my behalf,in all matters relative to work authorized by this building permit application. Signature of owner �-!�j Date as OwneouthpLttee1 en by declare that the state ens 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 perju . Print Str s'igrAQ nedXqent Date FROM SEND IT PACKIN• PLUS <THU> 6 2B 2014 14:31/ST. 14:30/No. 8001694949 P 2 City of Northampton Building Department 1 0 2014 212 Main$treett Room 100 Eiectnc.ri�r n c �� , �a�o', Northampton, MA 01060 '' --- 60 phone 413-587-1240 Fax 413-587-1272 - APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1-SITE.INFORMATION. 1.1 Prooe±4Address: E T do �► ed3,_b$t e .' `ir 241 H,ydeov,-Ye 1-a4 S 4� �.stx y +�Yy�7Y tri +r s"c EI�'tr„S SECTION 2;-PROPERTY OWNERSHlfi/AUTZ I MZED AGENT: 21 Owner of Record: r. E-dw-. , 8;.4,P e:)Q $:sl.9p 4271 Lake )Z-oq4) Yav►•�gs��•+,�Qh yy�// Name(Print) Current Malang Address: 79Z. y it 7 7 Telephone Signature 2.2 Authorized Aclent: Fe�6lr 271 Geedl&g4 Name(Print) ( ) Current Mailing Address: 413 - S8, - H'fvl 5ignatu Telephone SECTION 3-ESTIMATEb CONSTRUCTION COSTS. , Item Estimated Cost(Dollars)to be Official Use Only om leted by ermit applicant 1. Building a l36llding•Permit Fee' 1 2, Electrical (b)Estimated Total'Cost of ':: Construction from fi 3. Plumbing r/ Building Permit Fee r 4. Mechanical(HVAC) 6. Fire Protection 6. Total=(1 +2+3+4+5) Check tVumbQr Q Q This-.Seetibn For O'fflclaf Use On Date Building Permit Number. Issued: Signature: Building Commissionerfinspedoc`of Bindings;: Date Y'W File#BP-2015-0042 APPLICANT/CONTACT PERSON MGK CARPENTRY&DRYWALL-MAURICE G KIROUAC ADDRESS/PHONE 45 WILCOTT ST HOLYOKE (603)674-0877 PROPERTY LOCATION 241 HAYDENVILLE RD-Route 9 MAP 06 PARCEL 044 001 ZONE SR(75)/WSP(53)/RR(25)/WP(13)/RI(0) THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildiniz Permit Filled out Fee Paid tat go 3 0-0 so 3 7$ _ affOXF T-6 �}} Typeof Construction: NEW WINDOWS&DOORS,ADD CLOSETS,CHANGE LOCATION OF KITCHEN AND GUEST BATH New Construction Non Structural interior renovations Addition to Existing- Accessory Structure Buildina Plans Included: Owner/Statement or License 097695 3 sets of Plans/Plot Plan TH�FF ING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INN PRESENTED: 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: 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 D Delay Signature of uilding 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. 241 HAYDENVILLE RD BP-2015-0042 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 06-044 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Building BUILDING PERMIT Permit# BP-2015-0042 Project# JS-2015-000083 Est. Cost: $63000.00 Fee: $378.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: MGK CARPENTRY & DRYWALL - MAURICE G KIROUAC 097695 Lot Size(sq. ft.): 827640.00 Owner: BISHOP EDWIN&SHEILA Zoning-: SR(75)//WSP(53)/RR(25)/WP(13)/RI(o)/ Applicant: MGK CARPENTRY& DRYWALL- MAURICE G KIROUAC AT. 241 HAYDENVILLE RD Applicant Address: Phone: Insurance: 45 WILCOTT ST (603) 674-0877 WC HOLYOKEMA01040 ISSUED ON.712912014 0:00:00 TO PERFORM THE FOLLOWING WORK.CONVERT TO 2 BEDRM/2 BATH , NEW WINDOWS & DOORS, ADD CLOSETS, CHANGE LOCATION OF KITCHEN AND GUEST BATH 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: Feel e: Date Paid: Amount: 7 .f9lp� 0.37 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner