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34-005 (11) 296 TURKEY HILL RD BP-2019-0477 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:34-005 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A) Category:Zoning Permit BUILDING PERMIT Permit# BP-2019-0477 Project# JS-2019-000325 Esj.Cost: $139192.00 Fee: $502,00 PERMISSION IS HEREBY GRANTED TO: Const lass: Contractor: License: jj Grp WRIGHT BUILDERS 16370 Lot Size(sq. ft.): 80019.72 Owner: NAKASHIAN NICOLE Zoning Applicant: WRIGHT BUILDERS AT: 296 TURKEY HILL RD Applicant Address: Phone: Insurance: 48 Bates St - (413) 586-8287 (116) Liability NORTHAMPTON MAO 1060 ISSUED ON.•1 011 812 01 8 0:00:00 TO PERFORM THE FOLLOWING WORK.-ADDITION OF 2 BEDROOMS AND KITCHEN REMODEL 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 penariment Fireplace/Chimney: Rough: Oil: Insulation: Final: ma e: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupangy Siggature: FeeTvpe: Date Paid: Amount: Building 10/18/2018 0:00:00 $502.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck--Building Commissioner File#BP-2019-0477 1/ APPLICANT/CONTACT PERSON WRIGHT BUILDERS ADDRESS/PHONE 48 Bates St NORTHAMPTON (413)586-8287(116) PROPERTY LOCATION 296 TURKEY HILL RD MAP 34 PARCEL 005 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST E OSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildina Permit Filled out Fee Paid !ypeof Construction: ADDITION OF 2 BEDROOMS A ITCHEN REMODEL New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 16370 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF9161ATION 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: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management Demolition Delay 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. IL Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit f 212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans Other Specify APPLICATION TO CONSTRUCT, E OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: OCT 17 2018 This section to be completed by office ��� �r/►jai► �'(�(� �,p Map Lot Unit DEPT.OF pUILDING INSPEzMM Overlay District NORTHAMPTON.MA01060 Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 4! fi*ke-71 -�t`(�• N, /'6- pt"*9�40-6 1 M 1< Name(Print) - Current Mailing Arress: Telephone q! Ip Signature 2.2 Authorized Agent: Name(Print Current Mailing Address: c-�/a� 13 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed b ermit applicant 1. Building / L 'a / _� (a)Building Permit Fee 2. Electrical ` 7/ O'Q (b)Estimated Total Cost of Construction from 6 3. Plumbing • ,.. Building Permit Fee 4. Mechanical(HVAC) e 5. Fire Protection S 6. Total=(1 +2+3+4+5) FCheck Number This Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date EMAIL ADDRESS (REQUIRED; EITHER HOMEOWNER OR CONTRACTOR) f 1w, si�6- ?(--fr"44.6 UPPP--ovel> ?.o rf1'r�rr, tl 711-101(g Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information Existing Proposed Required by Zonin This column to be fi in by Building Depa nt Lot Size Frontage Setbacks Front Side L: R: L: Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved parking) #of Parkin S ces Fill ume&Location A. Has a Special Permit/Variance/Findin ever been issued for/on the site? NO © DONT KNOW YES O IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO Q DON'T KNOW YES O IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO 9 DONT KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained © Obtained O , Date Issued: C. Do any signs exist on the property? YES © NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YESQ NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,ex9kation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES © NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. SECTION 5-DESCRIPTION OF PROPOSED WORK(check all applicable) New House ❑ Addition Replacement Windows Alteration(s) Roofing EJ Or Doors ❑ Accessory Bldg. ❑ Demolition ❑ New Signs [❑] Decks [Q Siding[[3] Other[d] Brief Description of Proposed >�Dl�h 0 1�' kkAbo NJ �i1f �i WL- Alteration Alteration of existing bedroom >c Yes No Adding new bedroom Yes No Attached Narrative ��� Renovating unfinished basement Yes No Plans Attached Roll -Sheet i-r �.�,,�► A�.'()"� r 6a. If New house and or addition to existing housing, complete the following: D1"h,0 rJ a. Use of building : One Family_ Two Family Other b. Number of rooms in each family unit: 17 ?(IUL Number of Bathrooms c. Is there a garage attached? p 6 &A4Nt�� d. Proposed Square footage of new construction. d 0 S F Dimensions a �' e. Number of stories? f. Method of he tinge #4c� td,� Fireplaces or Woodstoves !� Number of each g. Energy�C,onservaon ompl a ce' Y, Masscheck Energy Compliance form attached? h. Type of construction Jy i. Is construction within 100 ft.of wetlands? Yes -�(—No. Is construction within 100 yr. floodplain Yes K—' No j. Depth of basement or cellar floor below finished grade W Ay -'6 vio� I 0 1 rA -P 1 N k. Will building conform to the Building and Zoning regulations? )(11" Yes No . I. Septic Tank Ci 1r Sewer Private�,well_ Citywat�upply�_ n SECTION 7a-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR C/ONTRACTOR APPLIES FOR BUILDING PERMIT �t ca V (�/�7� 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. lv /Z l Signature of Owner Date l W f"lt � CGU as Owner/Authorized Agenthereby declare that the statements and information on the foregoing application are true and accurate,to the best of my— know7eZge and belief. Signed un er the pains and penalties of perjury. Print Name r / Sig natur Owner/Agent Date SECTION 8-CONSTRUCTION SERVICES 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder License Number " � �> 11ig Address Expiration Date 5610 Sig Telephone 9.Registered Home Improvement Contractor: Not Applicable ❑ �i�P�1 Ube M • c..( 4 / o I S3 Company Name Registon N tuber �'K 9 A-%4" S T PT)-Y-A TO) 6�� Address Expiration Date Telephone � u �7 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...... ❑ City of Northampton Massachusetts DEPARTIWNT OF BUILDING INSPECTIONS f�0, 212 Main Street • Municipal Building Northampton, MA 01060 Fee Calculator for Residential Properties Location : A-4- 1 � �'b ► � Square Footage Amount Basement @ .20 b 1�1- 1ST Floor @ .50 c0 TV • '~ 2"d Floor @ .50 '/2 Floors, Finish Attic, Garage @ .20 Deck / Porches @ .20 q � Total / �O T 1 File#MP-2019-0023 APPLICANT/CONTACT PERSON WRIGHT BUILDERS ADDRESS/PHONE 48 Bates St (413)586-8287(116) PROPERTY LOCATION 296 TURKEY HILL RD MAP 34 PARCEL 005 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildiniz Permit Filled out Fee Paid Tweof Construction:_ZPA-ADDITION FOR NEW BEDROOM AND KITCHEN New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 3 sets of Plans/Plot Plan THELLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON TUION PRESENTED: App �roved 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 G l 19/1(0 ( 16 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 the Office of Planning&Development for more information. File No. /h 0- f 3 Please type or print all information and return this form to the Building Inspector's Office with the $30 f fling fee (check or money order)payable to the City ofNorthampton 1. Name of Applicant: Wright Builders, Inc. Address: 48 Bates Street Telephone: 413-586-8287 2. Owner of Property: Nicole Nakashian & Jennifer Clarson Address: 296 Turkey Hill Road Telephone: (917) 921-6867 3. Status of Applicant: Owner Contract Purchaser Lessee Other (explain) Builder 4. Job Location: rz 4 fi i Z ty s _a _fi ,,.., ^°' •k1E4� _[�Y} � .''T' Tt 's 05,^ ``a r �Y Y r 1T► 3 z t', a,T •.;i_r:< "Mob '`" a i .. ,�Y .;u....ris ;.. Fw:<,c'.'�.,x{•n'n'gz i.r` ,. yn.,, y, ,i'-�} p•,{x ,y ..%mac+. zfis`?3.' ,sa .7jk: ix 3. FYI ..n e a < �saFie :a"z� R,aSIIISC 4 s rt s M. t ;>r, +. k.- ,, ,a, z.... a i tr�� g ,.s k;, ,k xre� +,. 4tt '@m✓>:. t `y... ux, LL __nR a" a..... .: Nfi 5. Existing use of Structure/Property: Single family residential 6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary): Addition for a new bedroom and kitchen remodel 7. Attached Plans: Sketch Plan X Site Plan Engineered/Surveyed Plans 8. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DONT KNOW X YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DONT KNOW X YES IF YES: enter Book Page and/or Document# 9.Does the site contain a brook, body of water or wetlands? NO X DONT KNOW YES W YES, has a pe nTft REICEi P&ed the Conservation Commission? Needs to be o tain �� Obtained . date issued: s AUG 1 5 2018 (Form Continues On Other Side) pp PT F BUIL G INSPECTIONS W:\DocumentsTORMS\ori ' \Buil {ipq 'gq Applicati n passive.doc 8/4/2004 10. Do any signs exist on the property? YES NO X IF YES, describe size, type and location: Are there any proposed changes to or additions of signs intended for the property? YES NO IF YES, describe size, type and location: 11. Will the construction activity disturb (clearing, grading, excavation, or filling)over 1 acre or is it part of a common plan of development that will disturb over 1 acre? YES NO X IF YES, then a Northampton Storm Water Management Permit from the DPW is required. 12. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION This column reserved for use by the Building Department EXISTING PROPOSED REQUI<P BY ZOO G Lot size 1.837 Acres 1.837 Acres Frontage 200 ft +/- 200 ft +/- Setbacks Front 174 ft 174 ft Side L: 110 ft R: 51 ft L: 110 ft R: 40 ft Rear 170 ft 170 ft Building Height One Story One Story Building Square Footage 2374 2654 %Open Space: (lot area minus building Et paved 72,109 SF = 90% 71,829 SF =89% parking #of Parking Spaces 5 5 #of Loading Docks NA NA Fitt: NA NA (volume It location) 13. Certification: I hereby certify that the information contained herein is true and accurate to the best of my knowledge. p 08/04/2018 Ap,pdticaWs M rsture NOTE.Issuance of a zoning permit does not relieve an applicant's burden to comply with aH zoning requirements and obtain all required permits from the Board of Health,Conservation Commission, Historic and Architectural Boards,Department of Public Works and other applicable permit granting authorities. W:\Documents\'FORMSbrigmal\Buddmg-Inspector\Zonmg-Permit-Application passive.doc 8/4/2004 DY F LRD` r= - tlz'r Maw, TISet. 34-005-001 1 296 TURKEY HILL RD 101-n/a 1.837 Nakashian Nicole&Jennifer Carson 296 Turkey Hill Rd Florence MA 01062 Book/Page: 11799/39 Sale Date: 2014/11/12 Living Units: 1 Style: Contemporary Story Height: 1 Exterior Wali: Frame Attic Living: None Basement: Full Year Built: 1979 Ground Floor Area: 960 Unfinished BSIKT Area: 0 Fn BS14T Living: 500 Tot Living Area: 1730 Rec Room: 0 x 0 Tot Rooms: 4 Bedrooms: 2 Full Baths: 2 Half Baths: 0 Mas Fire Place 0 Frame Fire Place 0 Heating Type: Central Air Land: $88,600 Building: $142,700 Tatar $231,300 n/a 2009/11/06 $215,000 Land+Bldg L n/a 2009/05/05 $242,618 Land+ Bldg L 2013/03/20 RENO BSMNT/RELO $38,300 Garage-Wd/Cb 1 1990 1 816 -Deserotorl,4rea 24 X41 Fr1B ..960 sgFt. 15 . ."5Fr B:o r Deck �J C:.5Fr �0 sgft 40 � 40 9G0 24 24 10. Wood Dai 10 240 TA- e IL talc+ia �F 41m"IL j Proposed ' 196.60 :. t }x 200 169.13 126.70 136.70 30.75 1.16.74 .08 . , 110.01 124.47 298.,10; 26.96 _ 156.02 n 298 272.22 51.19 272.22 FR y 2M 34 -036 300.00 125.00 163.21 85.49125.00 410: 1 E 362.17 85.49 31`6.54 80,050 sf 18 I 395.10 34 -005 � �r0� ° 395.10 Clarson & Nakashian 296 Turkey Hill Rd Florence, MA 01062 34 -006 405.88 Existing 469.55 34 -034548.81 296 TurkeyiII Rd on � n orence, A 01062 • W -PR �b Owner: z4t IFew • � �4127d'G�'.L�DiCR;s1iA"A�N.:.. ' � Rtsa�tw h'g,ca,•�.Aq w+w� ;s'taps Prolect Name _ Location: Date.• 'tlt2/tY� Revblonr. IL ' NW bp.�Nq Scale: f of noted. , r J Approvals: J7: Sheet No. 2- of 2 ht o* 2 e�-o V1 s�1».may,•1-.�:� ��1�4 ' V/•+`LrE9 Gtd1,• Oemer: vrr.oe.. P'-G-TP•1M INC1 . I at�gia,L9.►+eM � � � ...-1�}u. tee v99sp '13G3.1.Ik'FS7�151+(A .1. _ N - — — u e;i�r Prolect Name - ��" � � tT'VTUMY.1••t�lU wiw:n.ws _—,�.C%.Z.L`P.�.SSYS�=raG_._ �i,1�L.1.: . : Nom•.. .:.. F. _ 1Mn LOCatt00: .72E�sL'�.FY. L ' 1...t'.. itL�ars.�i_. ;...�:::+0.eH ►-e"'' ..;: .._ !x w..o m,:,".'' thi scalet V4 up 'M.gyry1 GL.ytt ..bPTle ti: � , r .� �UTURt'NFY�w1F+bewy or as noted. APProyab: ' s•uuuwf w�NveW. � � � . 1-_... ........ Sheet No. of Z The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 ' www mass.gov/dia V1'orkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Le ibl Name (Business/Organizationn/Individual): , 1 Address: �0 P r� ��• City/State/Zip: AAff Phone#: K�3ab -g-�-� Are you an employer?Check the appropriate box: Type of project(required): 1.❑I am a employer with employees(full and/or part-time).* 7. ❑ New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in $,&Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.❑I am a homeowner doing all work myself[No workers'comp.insurance required.]t lOOBuilding addition 4.[—]l am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions �,_.,� 12.E:]Plumbing repairs or additions proprietors with no employees. t am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.' 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors 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. M Insurance Company Name: , - Policy#or Self-ins.Lic.#: MCX- 0 a"D O O S 3 0" Lf xpiration Date: 3 ' Job Site Address:M(0 1 y g:, l P�u , ✓ City/State/Zip:'FIA�%�CG MK 0104r Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify er the pains d penalties of perjury that the information provided above is true and correct Si nature: Date: D It S I Phone#: +"�� 3' �o T nq 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#: DATE(MM/DD/YYYY) ACOR" CERTIFICATE OF LIABILITY INSURANCE 03/22/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Jenna Rodrigue,CISR Elite NAME: Webber&Grinnell PHOIC,NN Etl: (413)586-0111 (AC,No): (413)586-6481 8 North King Street E-MAIL SS: jrodrigue@webberandgdnnell.com ADDRE INSURER(S)AFFORDING COVERAGE NAIC N Northampton MA 01060 INSURERA: Arbella Insurance Group 17000 INSURED INSURERS: A.I.M.Mutual Wright Builders,Inc. INSURER C: Attn:Jonathan Wright INSURER D: 48 Bates Street INSURER E: Northampton MA 01060 INSURER F: COVERAGES CERTIFICATE NUMBER: Master 2019 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR POLICY TYPE OF INSURANCE POLICY NUMBER MMIDDf EFF LI EXP LTR MMMIDD LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE FRI OCCUR PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 5,000 A 8500068268 03/01/2018 03/01/2019 PERSONAL BADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICYPEO LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: Employee Benefits S 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANY AUTO BODILY INJURY(Per person) $ A OWNED X SCHEDULED 1020070845 03/01/2018 03/01/2019 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ X AUTOS ONLY X AUTOS ONLY Per accident PIP-Basic $ 8,000 X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAR CLAIMS-MADE 4600068266 03/01/2018 03/01/2019 AGGREGATE $ 5,000,000 DED I X1 RETENTION$ 10,000 $ WORKERS COMPENSATION X STER ATUTE ERH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 500,000 B OFFICER/MEMBEREXCLUDED? NIA MCC20020005342018A 03/01/2018 03/01/2019 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Informational Purposes Only ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD City of Northampton Massachusetts ?•' y.. ' 'i� u` 3 N; 'I DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street •Municipal Building yJp Os` Northampton, MA 01060 Debris Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. The debris from construction work being performed at: .'� 9 b -(VA4�" P-)'w (mob, (Please print house number and street name) Is to be disposed of at: U xZl �� r.�'N P- (Please print name and location of facility) Or will be disposed of in a dumpster onsite rented or leased from: � A--rr (Company Name and Address) Sign ture of Permit Applicant or Owner Date If, for any reason, the debris will not be disposed of as indicated, the Applicant or Owner shall notify the Building Department as to the location where the debris will be disposed. 3 Commonwealth of Massachusetts ;? Title 5 Official Inspection Form ;+', Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 296 Turkey Hill Rd. .-- --- - -- — - ---.. - Property Address c/o Hanson Reality 2701 Boston Rd. Ste 120-B, Wilbraham, MA. 0109.5 =r Owner's Name dation is Florence Ma 01062 08/03/09 'ed for every _ _ _ _. -- _ .- _-. CityrTown State Zip Code Date of Inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. outfWhen A. General Information out forms computer. My he tab Inspector: 1 move your r-do not Christopher J. Le_mek 1e return Name of Inspector C. Lemek and Sons Construction, Inc. Company Name 49 Wood Drive Company Address Ludlow Ma. 01056 Cityrrown State Zip Code 413-583-6107 S112705 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: 0 Passes ❑ Conditionally Passes ❑ Fails ❑ Needs Further Evaluation by the Local Approving Authority All qlnsedor"S 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. Form 2%T: key rfiu Nharnpron 08-05.09 doc•68105 Tide 5 of=a:Inspection Form.Subs.+face Sewage Disoosx System.Pape 1 of 15 j Commonwealth of Massachusetts Title 5 Official Inspection Farm Subsurface Sewage Disposal System Form - Not for Voluntary Assessments 296 Turkey Hill Rd._ Property Address c/o Hanson Reality 2701 Boston Rd. Ste 120-B, Wilbraham, MA. 01095_ Owners Name tion is Florence _Ma 01062 08/03/09 _ i for every -- _—. - -...--- _ City/Town State Zip Code Date of Inspection B. Certification (cont.) Inspection Summary: Check A,B,C,D or E I always complete all of Section D A) System Passes: ® I 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.- 13) omments:13) 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. Answer yes, no or not determined(Y, N, ND) in the❑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. ND Explain: ❑ 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 ❑ obstruction is removed Form 2%Turkey Hill Nhampton 08-05.09moc-(KW We 5OHiciai Inspection Form:Subsirtace Sewapa Disposal System•Page 2 ci 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 296 —Turkey Hill Rd. — — - — Property Address _c/o Hanson Reality 2701 Boston Rd. Ste 120-B, Wilbraham, MA. 01095 — — — Owner's Name .s or every Florence Ma 01062_ 08/03/09 _ o -- -- -- - — -- Cityrrown State Zip Code Date of Inspection B. Certification (cont_) B) System Conditionally Passes (cont): ❑ distribution box is leveled or replaced ND Explain. ❑ 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 ❑ obstruction is removed ND Explain: 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 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. F; 29E Turkey HA Nhampinn 08-05-09 dm•091Cfi Tdle 5 Official Inspection Pam.SubsLsfam Sewaqe Drsposai System•Pape 3 W'S Commonwealth of Massachusetts Title 5 Official Inspection Form r� Subsurface Sewage Disposal System Form - Not for Voluntary Assessments cam' 296 Turkey Hill Rd. — — — — -- — — — -- Property Address Go Hanson Reality 2701 Boston Rd. Ste 120-B, Wilbraham, MA. 01095 Owner's Name is x every Florence _Ma _01062 08103/09 -- — — -- — -- — — --- CityfTown State Zip Code Date of Inspection B. Certification (cont-) C) Further Evaluation is Required by the Board of Health (cont): ❑ 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 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 ❑ z 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 Liquid depth in cesspool is less than 6" below invert or available volume is less than '/z day flow ® 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. Form 296 T vkey Hili Nhamplon 06-LS dw•ctan6 Ta*5 Off-c4 Inspection Form SuCsirracs Sewage 6.soosal System-Page 4 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form J. Subsurface Sewage Disposal System Form-Not for Voluntary Assessments s. 2_96 Turks Hill Rd. — — — — — — — — — — — .— — -- — —. Property Address c/o Hanson Reality 2701 Boston Rd- Ste 120-8, Wilbraham, MA. 01095 Owner's Name — — — — — — — — IIs I every Florence Ma _ 01062_ 08/03/09_ — -- — --• — — -- — - -- --- — -- btylTown State Zip Code Date of Inspection B. Certification (cont.) D) System Failure Criteria Applicable to All Systems (cont): Yes No ❑ 0 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. ❑ 0 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 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 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. F-xm..296 TLrkey Hill Nhamplon 06-05-09 doc•OSM Title 5 oflidal Inspeellon Form Scxhsnface Sewage Dispasal Syste-n•Page 5 015 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments _296 Turkey Hill Rd.— — — — — — — — — — — —. — — — -- — — — — — Property Address c/o Hanson Reality 2701 Boston Rd. Ste 120-B, Wilbraham, MA. 01095_ Owner's Name Is every Florence— _ — — — _ — — — Ma_ 01062 — 08/03/09 _ _ 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 ❑ to Were any of the system components pumped out in the previous two weeks? ❑ z 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 NIA) ® ❑ 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? 0 ❑ 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? ❑ 0 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: z ❑ Existing information For example, a plan at the Board of Health. ❑ ❑ Determined 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)] Forth 246 Turkey Kh Nhampton 08-05-N tloc•08M Tdle 5 Offc d Unpecwwi Form.Sibv.r!ace Sewage DsoosW System•Pape 6 of 16 Commonwealth of Massachusetts m Title 5 Official Inspection Form v Subsurface Sewage Disposal System Form- Not for Voluntary Assessments 296_Turkey Hill Rd.- -- ---- - - - - - - - - - - - - - - - - - - - - - - - - - - - Property Address c/o Hanson Reality 2701 Boston Rd. Ste 120-B, Wilbraham, MA. b1095 - -_- Owners Name ,ery _Florence _ _ _ _- - _ -_ -- _ _ Ma_ _ _01062_ _ _08103_/09 atyfrown State Zip Code Date of Inspection D. System Information Residential Flow Conditions: Number of bedrooms (design): 3- - - - Number of bedrooms(actual). - - - - - DESIGN flow based on 310 CMR 15.203(for example: 110 gpd x#of bedrooms): 330 _ Number of current residents: none, home not occupied 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 Water meter readings, if available last 2 ears usage well - - - - - 9 ( Y 9 (gpd)). Sump pump? ❑ Yes No unknown Last date of occupancy'. Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15-203): Gallons per day(gpd) Basis of design flow(seats/personslsq.ft., etc.): - - - - - - - - - - - - - - - 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. - - - - - - - - - - - - - - - Last date of occupancyluse: - Other(describe): - - - - -- - - - - - - - - - - - - - - - - - - - - - - crm 245 Turkey HN Wwnptoo 08.05M doe•08/06 T.le 5 Othclat mspection Form Subsurface Sewage Disposal System•Page 7 e 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 296 Turkey Hill Rd_ Property Address - --- ---- - - - - - - -- -- - - - --- - -- - - - - -- - - - clo Hanson Reality 2701 Boston Rd. Ste 120-8, Wilbraham, MA. 01095 Owner's Name ry Florence Ma 010_62 08103!0_9 --- -- - - - --- - - -- - - -- - - - - -- - -- - - - - - CitylTown State Zip Code Date cr Inspection D. System information (cont-) General Information Pumping Records: Source of information: - - - -- -- - - -- - - --- - - - - - - - - Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: ganons - - --- - - -- - - - - - --- - - - How was quantity pumped determined? - ------ - - --- - - --- - - -- - - Reason for pumping.- Type umping: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) ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): Approximate age of all components, date installed(if known)and source of information: SAS installed 0412612002_ records on file at Northampton Board of Health Were sewage odors detected when arriving at the site? ❑ Yes No 'orm 296 1urkey Mdi Nhamptor.08-05-05 dor-•06M 7 AW_5 0(fr,,a1 Inspection Form Subsur`ace Sewage D-.Vo 4 System•Page 0 of 15 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Foran-Not for Voluntary Assessments 296 Turk y HII Rd._ _ Property Address - - - - -- -- - - -- - - - - - - c/o Hanson Reality 2701 Boston Rd. Ste 120-B,_Wilbraham, MA. 01095 Owner's Name -- —— — — -- -- - -- - - -'Y - -- - - Florence Ma 01062__ 08/03/09 --�- - - ---- ------- - - - - - --- - - - - - City/Town State Zip Code Date of Inspection D. System Information (cont.) Building Sewer(locate on site plan): Depth below grade: Below slab in walkout basement feet Material of construction: ❑ cast iron ®40 PVC ❑ other(explain)- Distance explain)Distance from private water supply well or suction line: - - - - - - - - - - - - - - - feet Comments (on condition of joints, venting, evidence of leakage, etc.): Joints and venting appear No leaks visible Septic Tank (locate on site plan): Depth below grade: 12 in. feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑polyethylene ❑ other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No 96" t- x 48'" w x 48' D Dimensions: -96"-L -- -- --- - -- ---- - - 1" Sludge depth: Distance from top of sludge to bottom of outlet tee or baffle 1" Scum thickness - - - - - -- - - - -- - - - - Distance from top of scum to top of outlet tee or baffle 4- - - - - - - --- - -- - - -. Distance from bottom of scum to bottom of outlet tee or baffle 22 -- - - ---- - -- - - How were dimensions determined? ruler_ ,rm 296 T•,xkey Hir,Wampton 08-05409 doc•0&06 Tele 5 Otrr.iet lnspeaton Foran Subsu' Xe Sewage Disposal System•Pape 9 0`16 Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 29_6_Turkey Hill Rd ----- - -- - - - - - - - - - - - - - - -- - - - - - - - - - - ProRerty Address c/o Hanson Realit�r 2701 Boston Rd. Ste 120-B, Wilbraham, MA. 01095 OwneisName - - - -- ---- - - -- - - - - - - — ,ry Florence_ _ _ _ _ _ __ _ __ _ _ _ Ma— _ 01062_ _ 0_8103109_ 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.): liquid leve I ok : baffles appear to be ok Grease Trap(locate on site plan): Depth below grade. feet 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 Comments (on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): 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): orm 296 Turkey Him Nhampton D6-05-05 Coc-6806 Title 5()Huai inspection form 5-bsulace Sewage Drsposal System-Page 10 of 15 Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 296 Turkey Hill Rd_ Property Address -- ---- - - - - - - - -- - - - - - - — - - -- - - - -- - - - — - - c(o Hanson Reality 2701 Boston Rd- Ste 120-B_Wilbraham, MA._01_09_5_ Owner's Name Florence Ma_ 01062_ 08/03/09- _ _ GitylTown State Zip Gude date of Inspection D. System information (cont.) Tight or Holding Tank(cont.) 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 Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 inches 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.), D box is ok, no leaks or cracks_ D box _46 in. below _ _ Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No Alarms in working order: ❑ Yes ❑ No r,298 Turkey H.V Nhamton 08-05-09.doc•08M6 Title 5 offal M"cton Form Subsurtace Sewage DsMsal SYVerm•Page 7:N'5 Commonwealth of Massachusetts Title 5 Official Inspection Farm Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 296 Turkey Hill Rd._ Property Address --- - - -- --- -- - --- - --- - - - - - - - c/o Hanson Reality 2701 Boston Rd. Ste 120-8, Wilbraham, MA. 01095 Owner's Name :ry Florence_ _ ___ _-_ ___ _ _ _ _ _Ma __ 01_06_2__ 0_8!03/09_ _ _ _ CityfTown state Zip Code Date of Inspection D. System Information (cont.) Comments (note condition of pump chamber; condition of pumps and appurtenances, etc-).- Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS not located, explain why' Type.- El ype:❑ leaching pits number: - -- - - - - - ❑ leaching chambers number. - -- - - - - - ❑ leaching galleries number: - -- - - - - ❑ leaching trenches number, length - - - - - - - - ® leaching fields number, dimensions: 5 lines 20 ft. X 40ft ❑ overflow cesspool number. - - - - - - - - ❑ innovative/alternative system Type/name of technology: - - - -- - - - - - - - - - - - - - - -- - - - Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): no sign of hydraulic failure, soil dry, vegetation should be cut from leach field Orn 296 Turkey Hite NnanPtor.OB-O-D9 dx•DeAk Tills 5 OKieW Inspeawn F o m.Subsurface Sewage D,sPOsd System•Page-2 Of 15 Commonwealth of Massachusetts = Title 5 official Inspection Form r Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 296 Turkey Hill Rd. Property Address — —— — - — — — —— — —— — —— — — — — — — — — — — — — — c/o Hanson Reality 2701 Boston Rd. Ste 120-B, Wilbraham, MA. 01095 6;n is Name ery Florence - - _ _ _- _- _ ___ _ _ Ma.- 0_10_62 _ 0_8/D3/09_ Cityrrown State Zip Code Date of Inspection D. System Information (cont.) 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 Q Yes ❑ No 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.): •.n 296 Turkey Hill Wampton 08-05-09 doc•08106 Title 5 o9ioaf hspectwn Form Svb unlace Sewage DiSpoSW System,Page 13 d'.5 Commonwealth of Massachusetts Title 5 official Inspection Form Subsurface Sewage Disposal System Form-blot for Voluntary Assessments 296 Turkey Hill Rd_— — — — -- —_ _ — -- — — — _ --- -- — -- -- — Property Address clo Hanson Reality 2701 Boston Rd. Ste 120-B, Wilbraham, MA. 01095 Owner's[Jame -- —— —— ,ry Florence— — _ —, — — _— Ma01062 _ 08103109_ CIty[rown State Zip Code Date of Inspection D. System Information (cant.) Sketch Of Sewage Disposal System: Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. A S ejUc�' �Ct�tS t 6,f zAI!t Dgj1;e a..il i f r / "6t;) L' G aAOt I i � 7 ar�� l r !'1F7rrt- 1N��OG' I 35 y[A, rf,�%- moo• � 1? 'n 2%Turkey Hill 1,4vo pton 08-05-09 am•08M Tale 5 Official Wispsce,m Fcnr. Subsurface Sewage Disposal System•Page 14 of'5 Commonwealth of Massachusetts W r Title 5 Official Inspection Form _i Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 296 Turke�r Hill Rd. — Property Address c/o Hanson Reality 2701 Boston Rd. Ste 120-B, Wilbraham, MA. 01095— owner's Name -- -- --- -- n is )r every Florence Ma 01062 08/03/09 - -- CitylTown State Zip Code Date of Inspection D. System Information (cont.) Site Exam: 0 Check Slope ❑ Surface water Z Check cellar ❑ Shallow wells Estimated depth to ground water: 8.55 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: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health-explain: ❑ Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: �:Jl rc�oundwaterwatch.usgs.goov 07/30/09 data , Northa_pton — — — You must describe how you established the high ground water elevation: Forty 243 Turkey Hill NhaMr4on 08-05-0?doc•08M Trt*5 Official hspearon Form.Sut.-. ax Sewage D-smsal Symen•Page 15 of 15 CITY of NORTHAMPTON PUBLIC HEALTH DEPARTMENT BOARD OF HEALTH MEMBERS:Donna Salloom, —Joanne Levin,MD, Chair Suzanne Smith,MPH,MD— William Hargraves—Cynthia Suopis,PhD STAFF:Merridith O'Leary,RS,Director— Title V Related Contractors Name Address Telephone * Service Type Duffy&Willard Northampton 586-1477 IN D3 Engineering; Roland Dupuis Florence 586-2293 RPE SE Greg's Wastewater Removal South Deerfield 665-3989 T5 PH James Gracia Easthampton 527-8318 RPE Heritage Surveys Southampton 527-3600 RPE SE Henry Kocot&Sons South Deerfield 665-2735 IN Karl's Site Work;Karl Konieczny Hadley 549-5396 IN PH Environmental Planning Associates South Deerfield 665-7903 RS SE Loven Excavating&Construction; Dave Loven Westhampton 527-5184 IN Tim Maginnis Westhampton 527-5291 RS SE T5 Turkey Hill Environmental;Tom Martin Westhampton 527-5311 SE T5 James Paciecnik South Deerfield 530-5369 PH Barry Searle Southampton 238-0446 RS SE Bill Sieruta Holyoke 532-8525 RPE IN SE T5 Walt Thayer Hatfield 247-5564 IN Hilltown Environmental; Mark Thompson Chesterfield 296-4499 RS SE Cold Spring Environmental;Alan Weiss Belchertown 323-5957 RS SE T5 Whitely Septic Southampton 527-1835 PH T5 Amherst Civil Engineering Amherst 256-3400 RPE SE Ron Lauren Home Construction Southampton 527-6980 SE T5 Bob Cook Excavating Bernardston 648-5365 IN J.W.Cotton Co. Hatfield 247-9608 IN Jeff Donovon Chesterfield 296-4770 IN J.C.&Company;Jim Dimos Northampton 527-5232 IN PH *Service Type Description T5=Title V Inspector - Licensed by DEP to perform Title V inspection of a septic system SE=Soil Evaluator - Authorized to perform perc test/soil evaluations ( RPE=Registered Professional Engineer - Authorized to design septic systems � U5 e es RS=Registered Sanitarian - Authorized to design septic systems s�+1 G PH=Pumpers/Haulers - Licensed by Local Board of Health to pump and remo septic tank effluent IN=Installers - Licensed by Local Board of Health to install and/or repair septic systems or their components eve'loillom 212 Main Stree4 Northampton,MA 01060 Ph(413)587-1214 Fax(413)587-1221 City of Northampton Health Department Title V(RS, IN,TS,SE,PH) List Name Address Telephone * Service Type Barry Searle Southampton 238-0446' RS SE' D3 Engineering; Roland Dupuis Florence 586-2293 RPE SE Gregs Wastewater Rempval South Deerfield 665-3989 T5 PH James Gracia . Easthampton 527-8318 RPE Heritage Surveys Southampton 527-3600 RPE SE Henry Kocot&Sons South Deerfield 665-2735 IN Karl's Site Work; Karl Konieczny Hadley 549-5396 IN PH Environmental Planning Associates South Deerfield 665-7903 RS SE Loven Excavating&Construction; Dave Loven Westhampton 527-5184 IN Tim Nlagmnis' WestMirptOn 527=529. RS' SE =T5 Turkey Hill Environmental;Tom Martin Westhampton 527-5311 SE T5 James Paciecnik South Deerfield 530-5369 PH Bill Sieruta Holyoke 532-8525 RPE IN SE T5 Walt Thayer Hatfield 247-5564 IN Hilltown Environmental; Mark Thompson Chesterfield 296-4499 RS SE Cold Spring Environmenta l;;41an'Weiss Belcherfown 323-5957 RS SE T5 . Whitely Septic Southampton 527-1835 PH T5 Amherst Civil Engineering Amherst 256-3400 RPE SE Ron Lauren Home Construction Southampton 527-6980 SE T5 Bob Cook Excavating Bernardston 648-5365 IN J.W.Cotton Co. Hatfield 247-9608 IN Jeff Donovon Chesterfield 296-4770 IN J.C.&Company;Jim Dimos Northampton 527-5232 IN PH *Service Type Description T5=Title V Inspector - Licensed by DEP to perform Title V inspection of a septic system SE=Soil Evalator - Authorized to perform perc test/soil evaluations RPE=Registered Professional Engineer - Authorized to design septic systems RS=Registered Sanitarian - Authorized to design septic systems PH =Pumpers/Haulers - Licensed by Local Board of Health to pump and remove septic tank efflent IN=Installers - Licensed by Local Board of Health to install and/or repair septic systems or their components CS Beam 1016.11.0.10 296 Turkey Hill Rd 9-18-18 kmBca im 2016.9.0.3 Florence Ma. 5:01 mMateriais DatacA W lofl Member Data @ ' /1*evt Description: Member Type: Beam Application: Floor a Top Lateral Bracing: Continuous Bottom Lateral Bracing: 0.00 Standard Load: Moisture Condition: Dry Building Code: IBC/IRC Live Load: 40 PLF Deflection Criteria: L/360 live, L/240 total Dead Load: 10 PLF Deck Connection: Nailed Member Weight: 9.2 PLF Filename: 9 ft 2in Bea Other Loads Type Trib. Other Dead (Description) Side Begin End Width Start End Start End Category Replacement Uniform(PSF) Top 0' 0.00" 10' 0.00" 12' 0.00" 0 10 Live Additional Uniform (PLF) Top 0' 0.00" 10' 0.00" 294 0 Live 10 0 0 O m 10 0 0 Bearings and Reactions Input Min Gravity Gravity Location Type Material Length Required Reaction Uplift 1 0' 0.000" Wall SPF#3/Stud 2x or 4x End-Grain(650psi) N/A 1.500" 2147# 2 10' 0.000" Wall SPF#3/Stud 2x or 4x End-Grain(650psi) N/A 1.500" 2147# Maximum Load Case Reactions Used for applying point loads(or line loads)to carrying members Live Dead 1 1491# 655# 2 1491# 655# Design spans 10' 1.750" Product: Douglas Fir-Larch (N) SS 4 x 12 1 ply PASSES DESIGN CHECKS Minimum 1.50"bearing required at bearing#1 Minimum 1.50"bearing required at bearing#2 Design assumes continuous lateral bracing along the top chord. Design assumes maximum unbraced length of 0.00'along the bottom chord. Allowable Stress Design Actual Allowable Capacity Location Loading Positive Moment 5445.'# 9136.'# 59% 5' Total Load D+L Shear 17501 47254 37% -0.06' Total Load D+L LL Deflection 0.0888" 0.3382" U999+ 5' Total Load L TL Deflection 0.1084" 0.5073" U999+ 5' Total Load 0.5D+L Control: Positive Moment DOLS: Live=100% Snow=1151% Roof=125% Wind=160% This member has been designed in accordance with NDS 2005 All product names are trademarks of their respective owners Copyright(C)2016 by Simpson Strong-Tie Company Inc.ALL RIGHTS RESERVED. "Passng is defined as when the member,floor joist,beam or girder,shown on this dmvnng meets applicable design criteria for Loads,Loading Conditions,and Spans listed on this sheet.The w Y 3 � t � �� � � a yl i ENERGY CONSERVATION APPLICATION FORN'I FOR L.OW-RISE RESIDENTIAL NEVA' CONSTRUCTION and ADDITIONS 780 CMR Appendix J Applicant Name: Uj 1, v Q UI t1bGT", Site Address: �� Applicant Address: S CityiTown: NO tq-;ht A4111 1*116 Use Group: St M 1 Lo Date of Application Applicant Phone: Applicant Signature: Compliance Path(check one): ❑ Prescriptive Package(Limited to 1-or 2-family wood frame buildings heated with fossil fuels only) Package(.A through KK from Table J5.2.1b): Heating Degree Days(HDD,,)from Table J5.2.1a: (For items d.through i,,full in all values that apply from Table J5'.lb::) a. Gross Wall Area sq.ft f. Wall R-value R- b. Glazing Area' sq.ft. g. Floor R-value R- c. Glazing%(100 x b-a) % h. Basement wall R- d, Glazing U-value U- i. Slab Perimeter R- e. Ceiling R-value R- j. Heating AFUE ❑ Component Performance:"Manual Trade-Off'(Limited to wood or metal framed buildings only) Climate Zone(from Figure J6.2.2) ❑ Zone 12 ❑ Zone 13 ❑ Zone 14 Attach Trade-Off Worksheet from Appendix J,[and RYA Trade-Off Worksheet,if applicable] ❑ MAScheck Software Attach Compliance Report and Inspection Checklist printouts ❑ Home Energy Rating System Evaluation Attach Home Energy Rating Certificate(HERS rating score must be 83 or higher) ❑ Systems Analysis OR ❑ Renewable Energy Sources Attach Mass Registered Architect or Engineer Analysis ALTERNATIVE FOR ADDITIONS ONLY: a.Gross Wall+Ceiling Area/bow-S41. b.Glazing Area' rf�sq.ft, c. Glazing%(100 x b =a) U.)"/a ADDITION with Glazing% (c.) up to 40%may use 730 CNIR Table J1.1.2.3.1 below: MAXIMUM U•Value MINIMUM R•Values Fenestration CeilingWall floor Basement wall Slab Perimeter.Depth 0.32 R-49 R-20 R-30 R-15 Continuous R-10.211 1 Glazing Area may be either Rough Opening or Unit dimensions. 2 Based on NERC listing. Applies either to every unit,or to area-weighted average of all units. 3 R-30 ceiling insulation may be used in place of R-37 if the insulation achieves the full R-value over the entire ceiling area (i.e.-not compressed over exterior wails,and including any access openings.) ❑ "SUNROOM"addition(greater than 40%glazing-to-wall and ceiling gross area) Attach"Consumer Information Form"from 780 CMR Appendix B. Official's dame. Official's Signature: Application Approved ❑ Denied ❑ Date of Approval/Denial: Reason(s)for Denial: (provide additional details as needed on back side) a t. .. � ��� ice: .. � . � + �..s � � ,t � � Commonwealth of Massachusetts Division of Professional Licensure 0 Board of Building Regulations and Standards Cons rt ti) rvisor CS-016370 T ires: 07/28/2019 i THOMAS P Lt/CIA;; 480 N WESTFII!J-D O 4.. FEEDING HILLA �>i ?` Commissioner i r Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, M useits 02118 Home Improv dor Registration i Type: all WRIGHT BUILDERS,INC. J' (°'P,, Eviration: 101536 006J25J2020 48 BATES STREET (� ee NORTHAMPTON,MA 01060 al - f e. Update Address and Return Card. SCA 1 o 20M-W17 '. �..rar�owkalfiPo�✓dga�aak� Office of Consumer Affairs&Business Reguisdon HOME IMPRO ENT CONTRACTOR Registration valid for individual use only before the espaation If found return to: Ex&Iradon Office of ConsurnerAffairs and Business Regulation _ 06252020 1000 Washington -Suite 710 WRIGHT BUI L Boston,MA,921 9. JONATHAN A.W 48 BATES STREET` ; NORTHAMPTON,MA Y1060 Undersecretary valid without signature