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30 Septic Repair Contract 1999 Northampton Septic System Repair Loan Program Bill for Repair of Septic System Date: January 8, 1999 To: Northampton Board of Health From: David Dombrowski 210 Main Street P.O. Box 441 Northampton.,MA 01060 Northampton, MA 01061-0441 Repair of failed septic system at 30 Brisson Dr.. Florence in accordance with approved plans. Work was completed and a certificate of compliance was issued on May 5 1998 Approved cost $ 7,445.00 BOARD OF HEALTH MEMBERS JOHN T.JOYCE,Chairman ANNE BURES,M.D. CYNTHIA DOURMASHKIN,R.N. PETER J.McERLAIN,Health Agent (413)587-1214 FAX(413)587-1264 October 22, 1998 CITY OF NORTHAMPTON MASSACHUSETTS 01060 OFFICE OF THE BOARD OF HEALTH Northampton Septic Management Loan Program Mr. David F. Dombrowski 30 Brisson Drive Florence, MA 01062 Dear Mr. Dombrowski. 210 MAIN STREET NORTHAMPTON,MA 01060 I am please to inform you that the Board of Health has finally received the funding from the State for the septic repair loan program. We will be able to make payment of loan funds to you when you have completed documentation for the project. At this time the following will be required: Four(4) signed copies of the Betterment Loan Contract, (copies enclosed) sign each where indicated and return to the Board of Health office. Copies of paid receipts for your project from the contractors and engineers. Once the various city departments process the completed contract we will be able to distribute the funds to you. Please feel free to contact the Board of Health with any questions relating to this program. Very L✓` a Peter J. McErlain Health Agent oe4 170 cKAt i ✓ Urth 35R V GI ,, . - . .134.210121-ria, .2 ce) PROSESSED - _ _0504417 M-71 .ciMt _ <07' •-( 1 00 ;•e: _I-.- g ,;.9. _ ce 8 •ea oi_ ='el& -..41C, w 4if4,1";" °-g . _ t i' A --LIILI -.1 :A/III:II:/I70. • "2 ITIAjlti't II. • 4 43"4/ rOCE:- • AI- . , . - , , .:.-',- AI—. ,_ arc. 3-•0,57 ‘ ' •-. ' ' $:?!..;Orilt5E-1;77.11:73:0117 .8 cc • ; ft 1- . a .. . , .., _;.... ..- r , , . MNIMMIIIMI '' _ DAviD DOMBROWSKV 53-7158/2118 67170 . 23 SCHOOL STREET Si 994 3 NORTHAMPTON, MA 01060 3 I i pAY TO TH EigirCeld bk._ 3 ORDIR OF A . ., I _. A • / / 10a ' Pk . ii — XSX DOT TARS BE= ' FLORENCE SAVINGS BANK 1 P • 85 MAIN STREET • 44 C/34 3 3 2 FLORENCE MA 01 000 . C537. -314-114 M 504,4 1 C. iz<rpecti bi'd 1 < A 1 /./ FOo 13e 1 7 5 50tJ TDI? / /I/ IF I R.3 1: 2 L LB ? L saw: 05 24 5059a 211' 0 L 70 /00000 2 5000 os E FRZIi: L .SEC:F iY • I ".k`,( ' WFI' t IIt ;i , ii z re ix ?ON d x.::,°08 n La-SS-o'T hTBT l'0019 Q,12 s >O "K q - --!'I gNj nN^i 2 . F- _WQ d W N % O1 QZN a NO ¢i�a 41: L21 cC3LO1 t , I . o 4. d:-_---....____—_, im DAVID DOMBROWSKN� 53-71 /2118 0241 23 SCHOOL STREET NORTHAMPTON, M4 01060 1 V P7�AY TOTH ORDERO s. NIP :•• TD. /• /� . f • sAW ' .� .0 '.. �] , . .. .4 .iV i F..S e•• �e`IC 1 itii .1 V Mk •• •.: DOLLARS FLORENCE SAVINGS BA BS MAIN STREET Y FLORR�1EE�'t�NCE MR 01060 1 #W O Al FOR;. , i, eek, • I: 2I. L8 ? L6881 05 ''24 505982e 024L ,1'0000063500x' 327 WE STR_ET ' NORTH HATFIELD, MASSACHUSEfISUIU66 DO NOT API = STAMP OR SIGN BELOW THIS LINE' MAY 13 9B Pe,LII.,.., , ..,,I,e„rlon: n<F:. o 'INASP N i' 53-7160/2118 0 352 "DAVID 23 SbOAATRON'S 1" -- 53-7160/2118 RTHAMP NORTHAMPTON, M Q � NORTHAMPTON, MA 01060,, ,� Mai �� 19 98 J a P6,T°TF eLvEgnremend- .2r14( - $ 0810a . Nzm .IA Len./.dill d• •. k.it •- :6I L�i 'u (a1 L_� 1 DOLLARS 0 E� e • FLORENCE SAVINGS BA' ' es . STREET • . • WN FLORENCE MA 01060 / S :'Sepk:c Syscy. • FOR3O�xzTSSe (.J�zlye Q,IAd 4Aen .1. 1:12 L L87 16881: 05`. 24 50598 21r 035 2 .0000068.1000." enleffifia �j 02 — N {C ♦w]Yj al v.' ∎gE[ ea *1104 F Q S @ qg r ' Northampton ptic System Repair Loan Program Bill for Repair of Septic System Date: January 8, 1999 To: Northampton Board of Health From David Dombrowski 210 Main Street 30 Brisson Drive Northampton., MA 01060 Florence, MA 01062 City Contact# ' r @':';,•. Repair of failed septic system at 30 Brisson Dr Florence in accordance with approved plans. Work was completed and a certificate of compliance was issued on May 5 1998 Approved cost $ 7,445 Peter J.McErhin Health Agent FORM 7 CITY OF NORTHAMPTON BOARD OF HEALTH 210 Main Street Northampton,MA 01060 (413) 587— 1214 TEL (413) 586— 1264 FAX SEPTIC SYSTEM REPAIR PROGRAM / (cC II BETTERMENT CONTRACT This agreement is entered into by and between the City of NORTHAMPTON, by its Board of Health and Treasurer, and David F. Dombrowski (the Owner) this Day of Thee..a g/ 1998. WHEREAS, the Owner owns residential property, including improvements thereon, known as and numbered 30 Brisson Drive, Northampton Massachusetts (Assessors Map 42 Lot 116 , Page - ) and described in a deed dated May 29, 1997 and Recorded with the HAMPSHIRE COUNTY, Registry of Deeds in book 5122 Page 268 [filed as Document No. with the Registry District of Land Court ] (the "Property"); and WHEREAS, the Owner has petitioned the City of NORTHAMPTON to make finding pursuant to M.G.L. c 111; and WHEREAS, the NORTHAMPTON Board of Health has adopted an order requiring the Owner to repair, replace or upgrade the failed system to comply with the requirements of said Title 5; and WHEREAS, the Owner has pursuant to M.G.L. c. 111, , §. 127B 'A, applied to the City of NORTHAMPTON for financial assistance to repair, replace and/or upgrade the failed system; and WHEREAS, the Department of Environmental Protection ("DEP") has approved the City of NORTHAMPTON'S proposed program of offering betterment pursuant to M.G.L. c. 111, § 127B '/2 to homeowners to repair, replace and/or upgrade failed systems for financing under the Local Septic Management program, and the City of NORTHAMPTON has received a State Revolving Fund ("SRF") loan from the Water Pollution Abatement Trust (the "Trust") to finance said betterment program; and WHEREAS, THE City of NORTHAMPTON intends to provide financial assistance to the Owner in the form of a Betterment Agreement made pursuant to said M.G.L. c. 111, , § 1276 '/2 and funded from the SRF loan received by the City of NORTHAMPTON under the Local Septic Management program; and WHEREAS, the parties intend by this Betterment Agreement to cause repair, replacement and/or upgrade of the failed system to comply with Title 5 and other applicable public health and environmental laws and to complete other work directly or indirectly related thereto (the "Project" as described in paragraph 4 hereof); and 1 NOW THEREFORE, the parties, for and in consideration of mutual covenants and other good and valuable consideration, do hereby agree to the terms of this Agreement, as set forth below. 1. The Agreement The City of NORTHAMPTON hereby agrees to provide financial assistance in an amount up to $ 7,445 .00 to be advanced from time to time by the City of NORTHAMPTON to the Owner pursuant to the terms of this Agreement. The Owner promises to repay, interest as set forth herein, all sums provided to Owner by the City of NORTHAMPTON. Following notice to the Owner by the City of NORTHAMPTON collector of taxes of the amount of the betterment assessment, an amortization schedule shall be developed and incorporated as an attachment to this Agreement. Interest on the amounts advanced by the City of NORTHAMPTON to Owner shall be computed annually at the rate of FIVE percent ( 5 %) per annum on the outstanding principal balance, accruing from the 30th day after the City Assessor commits the betterment assessment to the City collector of taxes The amount to be repaid shall be included on and paid with the (quarterly, semi-annual or annual) municipal tax bill. Interest amount due hereunder on the tax bill shall be paid pursuant to an interim bill. All outstanding amounts due to the City of NORTHAMPTON by Owner if not prior paid, shall be due and payable on . [fill in date of term] Prepayment in full or in part of all amount advanced hereunder may be made by the Owner without penalty. This agreement represents the entire and integrated agreement between the parties hereto and supercedes prior negotiations, representations, or agreements, either written or oral. The Agreement may only be amended or modified by a written modification. 2. Installment Payments The City of NORTHAMPTON shall jointly make advances of funds to owner and contractor, pursuant to the terms of this Agreement, from time to time to pay for the project. Such advances shall be made solely for the purposes set forth in this Agreement. The obligation of the City to advance all or any part of the financial assistance for repair, replacement and/or upgrade of the failed system is subject to the following: (A) Inspection of the failed system by a representative of the NORTHAMPTON Board of Health or by a DEP Certified Septic System Inspector, as deemed necessary by the NORTHAMPTON Board of Health. (B) Submission by Owner or Contractor on behalf of the Owner of plans approved by the NORTHAMPTON Board of Health for the project. Owner shall solicit a bid or bids for the necessary field work and plan preparation from registered professional engineers or registered sanitarians, shall submit documentation of these bids to the NORTHAMPTON Board of Health, and Specify Owners choice of an engineer or sanitarian. 2 The NORTHAMPTON Board of Health may approve an installment payment NOT to exceed the amount of the selected bid. An installment payment for field work and plan preparation shall be made by check payable JOINTLY to and the engineer or sanitarian and shall be payable upon presentation and approval of the selected bid. (SEE FORMA ). (C) Submission by Owner or Contractor or behalf of the Owner of the bid or bids for the project in accordance with the plans from licensed (including, but not limited to, a Disposal System's Installer's Permit). Insured septic system contractors, which bids contain detailed breakdowns of the cost of the Project by tasks. ( SEE FORM B). (ID) Confirmation by the NORTHAMPTON Board of Health that the contractor for construction of the Project ( the "Contractor") selected by the Owner has a valid Disposal Installer's Permit in effect for the period covering the system upgrade financed under this Betterment Agreement. (E) Review by the NORTHAMPTON Board of Health of a Project Budget based on the bid submitted the Contractor (F) Execution of a construction contract between the Owner and the Contractor pursuant to the plans and specifications which have been previously approved by the NORTHAMPTON Board of Health. (G) Issuance by the NORTHAMPTON Board of Health of a Disposal Works Construction Permit with respect to the Project. 3. Conditions of Payment Installment payments of the financial assistance are to be made by the City of NORTHAMPTON under the following conditions: (A) An installment payment for field work and preparation of plans shall be made to the Owner and engineer or sanitarian in accordance with Subsection (B) of section 2. (B) A reasonable time before the date on which any other installment payment is required to be made, the Contractor shall give notice to Owner and City specifying the total installment payment request. Such notice shall consist of a detailed request describing the value of the completed items of work. The amount of the request shall be equal the amount of the requested installment. The request shall be accompanied by a sworn certificate of the Contractor that all materials, subcontractors and employees have been paid prior work on the Project. The City of NORTHAMPTON may request the Owner to provide further documentation in support of a request for an installment payment. Upon approval of any requested installment payment, the City shall issue a check payable JOINTLY to Owner and Contractor, which check shall be forwarded by the City to Owner. 3 (C) The City may require as a condition of any installment payment that Owner submit satisfactory evidence that there are sufficient remaining funds to pay for completion of the Project in accordance with the approved plans. (D) Prior to making an installment payment the NORTHAMPTON Board of Health may cause the Project to be inspected to verify that the work items described in the request have been actually completed. In any case, the Contractor shall provided verification that the work referred to in the installment request has been completed in accordance with the approved plans. (E) Prior to paying the final installment, the Contractor shall provide verification that all work has been completed in accordance with the approved plans, a sworn certification that all materials, subcontractors and employees have been paid for work on or materials supplied for the Project and the NORTHAMPTON Board of Health shall have issued a Certificate of Compliance for the Project. 4. Scope of Work for Proiect The Owner and the Contractor, pursuant to the Disposal System Construction Permit issued by the NORTHAMPTON Board of Health, shall determine the Scope of Work necessary to bring the failed system into compliance with Title 5. Such Scope of Work may include, but not be limited to the following: (A) performing soil and percolation test and other necessary site analyses; specification of the failed system components to be repaired, replaced and/o upgraded; (B) design of the System or components thereof to be repaired, replaced and/or upgraded; (C) obtaining all applicable federal, state and local permits and approvals required to complete the Project; (D) seeking bids and awarding contracts for assessment, design, consulting and construction work and materials in accordance with applicable laws, regulations and requirements; (E) minimizing any disruption of utility service, and reasonably restoring the Property to as near its original conditions as is practicable; and (F) engaging such other service and procuring such other materials as shall be reasonably necessary to complete the Project in a good and workmanlike manner. All such work shall be performed pursuant to written contracts and agreements, copies of which shall be incorporated by reference into this agreement. 5. Town's Rioht to Inspect The Owner agrees to allow D.E.P., the City of NORTHAMPTON, including the NORTHAMPTON Board of Health, Health Agent and other officials, employees and agents to enter onto the Property, as is reasonably necessary and with reasonable notice, to test, examine and inspect the Project to verify the completion and adequacy of the work. 4 6. Covenant Not to Sue The Owner covenants and agrees not to sue the City of NORTHAMPTON for any claims of damage to loss of property of the Owner or others, or for breach of warranty regarding the performance or condition of the Project, or for injury, illness or death arising out of the performance of any contractors or agents engaged to perform the work. This Covenant Not to Sue provision shall have no application to causes of action which may have arisen prior to the execution of this Agreement, or to causes of action that are unrelated to this Agreement, or to causes of action against any person or entity other than the City of NORTHAMPTON. 7. Owners Representations and Warranties to the City of NORTHAMPTON The Owner represents and warrants to the City of NORTHAMPTON that: (A) Financial information. The Borrower's Affidavit furnished to the City of NORTHAMPTON by the Owner is accurate and complete; (B) Title. The Owner has good record title to the Property, subject only to the Encumbrances of Record; (C) Permits and Compliance With Law. The Owner has obtained or will obtain all necessary governmental permits for the Project. The On-site Sewage Disposal System for the dwelling on the Property, after completion of the Project, will comply with all applicable laws, regulations, codes and ordinances, including but not limited to Title 5; and (D) Insurance. The Owner and Contractor have procured or will procure insurance in such forms and in such amounts as shall be satisfactory to the City of NORTHAMPTON. Certificates of insurance shall be attached as Exhibits to this agreement. (FORM C) Each of the foregoing representations and warranties in this section shall remain in force until the financial assistance is repaid in full. The Owner shall indemnify and hold harmless the City of NORTHAMPTON from and against loss, expense, or liability (including cost of defending any claim), directly, or indirectly from the falsity, inaccuracy, or breach of any of the above representations and warranties. 8. Owner's Obligations During the term of this Betterment Agreement, the Owner agrees that the Owner shall comply with all of the terms and conditions of this and any related agreement and that the Owner shall: (A) Completion of Project. Cause the Project to be promptly completed in a manner in accordance with the approved plans and with Project Budget and in compliance with all laws, regulations, codes and ordinances and notify City of NORTHAMPTON when the project is complete. (B) Records and Cooperation with City. Keep complete records relating to the Project, which records shall be available for inspection and copying by the City of NORTHAMPTON, and cooperate fully with any audit of the Project if so requested by the City of NORTHAMPTON. 5 (C) Performance of Other Obligations. Perform all the Owner's obligation and agreement under any present or future mortgage or other Covenant or Agreement which encumbers the property. (D) Use of Financial Assistance. The financial assistance is provided for the public purpose of protecting the public health, safety, welfare and the environment. The Owner shall use the proceeds of the financial assistance solely for cost included in the Project Budget and ensure that the proceeds are not used for any other purpose. 9. Events of Default The Owner shall be in default under this Agreement upon the occurrence of any one or more of the following events: (A) Sale, Transfer or Assignment Without Approval. The Owner assigns or transfers any money advanced or to be advanced hereunder to any person or entity not approved by the City of NORTHAMPTON. (B) Cessation of Construction. The Owner or Contractor ceases construction of the Project for more than thirty (30) consecutive calendar days. The NORTHAMPTON Board of Health may waive this event of default upon application of the Owner and a demonstration that such cessation occurred because of an Act of God, governmental order or restriction, fire or other casualty, or other causes beyond the owner's reasonable control. (C) False Representation or Warranties. Any representation or warranty made herein which prove to be false or inaccurate in any material respect. (D) Breach of an Obligation. The Owner defaults in the performance of any of the Owner's obligations contained herein. 10. City of NORTHAMPTON'S Right On Default Upon Owner's default, the City of NORTHAMPTON shall have no further obligation to make any further installment payments and all amounts advanced by the City of NORTHAMPTON to the Owner shall become immediately due and payable. 11. Notice of Betterment Agreement Upon execution of this Agreement by Owners and the City of NORTHAMPTON a Notice of this Agreement shall be recorded by the City of NORTHAMPTON at the Hampshire County Registry of Deeds, as a betterment and shall be subject to the provisions of M.G.L. c. 80 relative to apportionment division, reassessment and collection of assessment, abatement and collection of assets, provided however, that the lien which shall arise pursuant to M.G.L. c. 111, § 127B 'A shall take effect by operation of law on the day immediately following the due date of such assessment or apportioned part of such assessment. The Betterment lien, if any, shall be deemed to secure all amounts advanced hereunder, together with interest thereon, and shall included costs of collection and reasonable attorneys fees, recording, filing fees and dismissal fees. 6 12. Improvements to the Property Any alteration or improvements to the Property resulting from the Project are the property of the Owner, and the City of NORTHAMPTON shall bear no responsibility for the condition of the improvement or its maintenance. 13. Cancellation of the Agreement by the Owner The Owner may by written notice to the NORTHAMPTON Board of Health, and the Treasurer of the City of NORTHAMPTON cancel Owner's further obligation for repayment under this Agreement at any time prior to the end of ten (10) calendar days following notice in writing to the City of NORTHAMPTON of the Owner's proposed successful construction bid, based on the Owner's evaluation of the proposed scope and cost estimate of the system upgrade derived from the filed work, project design and the successful construction bid. However, in the events of such cancellation, the Owner shall remain liable for repayment of all sums advanced by the city of NORTHAMPTON to Owner pursuant to this Agreement. All sums advanced by the City of NORTHAMPTON to Owner shall be repaid with interest and within the term set forth in paragraph 1 hereof. Upon application of the Owner, the NORTHAMPTON Board of Health may revoke the Order for Improvements, provided however, that the Owner shall remain liable to comply with the provisions of Title 5. 14. Personal Obligation of the Owner In addition to those remedies available to the City of NORTHAMPTON regarding the assessment and collection of betterment, the Owner shall be personally liable for the repayment of the amounts advanced, plus interest thereon and the total direct and indirect costs incurred by the City of NORTHAMPTON in the contemplation and the performance of this Agreement or the property, the City of NORTHAMPTON shall permit the assumption of the personal liability hereunder by said purchaser or tranferee and shall release the personal liability of the Owner. The assumption and release of liability hereunder shall be in writing and shall be executed prior to the purchase or transfer by the Owner, the purchaser or tranferee of said City of NORTHAMPTON. 15. Notice Any notice required to be given under this Agreement shall be made in writing and shall be delivered by either in-hand delivery or by prepaid, certified first class mail with return receipt requested. (A) If notice is made to the City of NORTHAMPTON, it shall be made to: NORTHAMPTON Board of Health or the Mayor; or (B) If notice is not made to the Owner, it shall be made to: Notice shall be deemed given on the day it is hand delivered or three (3) days after the date of posting of first class mail. 7 16. Funding The obligation of the City of NORTHAMPTON are expressly contingent upon funding. In the event that funding for the City of NORTHAMPTON'S obligation in unavailable, upon notice to the Owner, this Agreement may be cancelled by the City of NORTHAMPTON and all obligations of the City of NORTHAMPTON shall be null and void. 17. Enforcement of Laws Nothing in this Agreement shall be deemed to stop or effect or a waiver, or otherwise act as a bar or defense, to any legal proceeding by the City of NORTHAMPTON relating to the System of the Property. 18. Severability In the event that one or more provisions of this agreement is deemed unenforceable by a court of competent jurisdiction, the Agreement, except as deemed unenforceable, shall remain in full force and effect. 19. Governing Law This agreement shall be governed by Massachusetts Law. 8 During the term of this Betterment Agreement, the Owner agrees that the Owner shall comply with all of the terms and conditions of this and any related Agreement and that the Owner Shall: IN WITNESS WHEREOF, the undersigned parties have signed this Agreement as an instrument under seal this day, of 1998. CITY OF NORTHAMPTON BY ITS BOARD OF HEALTH: Chairman AS TO INTEREST RATE: 5% A TERM OF 10 YEARS CITY OF NORTHAMPTON BY ITS TREASURER: Treasurer EXHIBITS 1. Designer Contract 2. System Plans and Design 3. Construction Contract(s) 4. Project Budget 5. Certificate(s) of Insurance 6. Disposal System Construction Permit 7. Other Applicable Permits, licenses and Agreements 8. Requisitions for payment and support documentation 9. Certificate of compliance OWNER: Print Name Print Name APPROVED AS TO FORM: City Attorney 9 Mayor No THE COMMONWEALTH OF MASSACHUSETTS Northampton MASSACHUSETTS Prr 3S � Application fur jElisposul `ig tent euttetrtlrtion Perlllit Application is hereby made for a Permit to Construct( )or Repair(xy)an On-site Sewage Dispo al System at: j Dix Location Address or Lot No. 30 Brisson Dr. Owner's Name.Address and lel. No. (414 / Dave Dombrowski 413-584-2361 30 Brisson Dr. , Northampton, 01060 Installers Name,Address,and lel No. Designer's Name,Address and Tel.No. NHTFer.p Cay.P•sse-1r e.o '•"C— F. B. Hatch 413-267-3696 3x7 sues,- sT 57 Munn Rd. , Monson, MA 01057 Nos is f4,,-G. '4D MA 043 6(0 Type of Building: Dwelling No. of Bedrooms 3 Other Type of Building Other Fixtures Garbage Grinder( No per Persons NOTE: Existing ) grinder to be removed Showers( ) Cafeteria( ) Design Flow 330 gallons per day. Calculated daily flow gallons. Plan Date August 1997 Number of sheets -2- Revision Date August 1997 Title Repair On-site Sewage Disposal System Description of Soil 0-11" loamy sand (Ap) , 11"-28" loamy sand (B) , 2B"-62" sand with 10% cobbles 6 20% gravel (C1) , 62" 120"+ sand (Eg) Nature of Repairs or Alterations(Answer when applicable)- Remove existing garbage qr down existing leach pit, construct new leach trench system, verify b in existing tank, if no baffles, install new baffles. Date last inspected: The undersigned V A No.29010 agrees to ensure the construction and maintenance of the aforedescribe R 'leGIVc434.< Agreement: . system in accordance with the p�lions of f the EnvinmmentalCode and not to place the sys 5efntb fif�re>1 nla Certificate of Compliance ha -e ssu, Board of lie Ith. s XSi ned • 'ii_ Date � v g s �a�' Date Application Approved by Application Disapproved for the following reasons Permit No Date Issued No THE COMMONWEALTH OF MASSACHUSETTS Northampton MASSACHUSETTS FEE 3 S cApplictttiun for �©ispusttl !gstenl (dunstructiun Permit •cation • hereby made for a Permit to Construct ( ) or Repair() .)an On-site Sewage Disposal System at: Type of Building: NOTE: Existing Dwelling No. of Bedrooms 3 Garbage Grinder( ) grinder to be removed Other Type of Building No per Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 330 gallons per day. Calculated daily flow gallons. Plan Date August 1997 Number of sheets -2- Revision Date August 1997 Title Repair On-site Sewage Disposal System Description of Soil 0-11" loamy sand (Ap) , 11"-28" loamy sand (B) , 28"-62" sand with 10% cobbles & 20% gravel (Ci) , 62" 120"+ sand (C?) Nature of Repairs or Alterations(Answer when applicable) Remove existing garbage q down existing leach pit, construct new leach trench -s stem verif h in existin• tank, if no baffles, install new baffles. Date last inspected' Agreement: The undersigned agrees to ensure the construction and maintenance of the aforedescribe system in accordance with the pr'sions fI' le ' fthe Environmental Code and not to place the sy Certificate of Compliance ha e ssu Board of He Ith. x5ved � �� at Date Application Approved by Application Disapproved for the following reasons eak No. 29010c ti3gsY al la 3 Permit No Date Issued Location Address or Lot No. 30 Brisson Dr. Owner's Name.Addtess and Tel.No. Dave Dombrowski 913-584-2361 30 Brisson Dr. , Northampton, 01060 Installer i Name,Address,and Tel No. n,� COvp•,,;�..U- CC '""C- 3-7 4;t3T sT AI0,L:8 Nw.�,e'L4D MA OLe7+u,0 Designer s Name,Address and Tel.No. P. B. Batch 913-267-3696 57 Munn Rd. , Monson, MA 01057 Type of Building: NOTE: Existing Dwelling No. of Bedrooms 3 Garbage Grinder( ) grinder to be removed Other Type of Building No per Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow 330 gallons per day. Calculated daily flow gallons. Plan Date August 1997 Number of sheets -2- Revision Date August 1997 Title Repair On-site Sewage Disposal System Description of Soil 0-11" loamy sand (Ap) , 11"-28" loamy sand (B) , 28"-62" sand with 10% cobbles & 20% gravel (Ci) , 62" 120"+ sand (C?) Nature of Repairs or Alterations(Answer when applicable) Remove existing garbage q down existing leach pit, construct new leach trench -s stem verif h in existin• tank, if no baffles, install new baffles. Date last inspected' Agreement: The undersigned agrees to ensure the construction and maintenance of the aforedescribe system in accordance with the pr'sions fI' le ' fthe Environmental Code and not to place the sy Certificate of Compliance ha e ssu Board of He Ith. x5ved � �� at Date Application Approved by Application Disapproved for the following reasons eak No. 29010c ti3gsY al la 3 Permit No Date Issued ARGEO PAUL CELLUCI Property Address: Owner's Name: Date of Inspection: Copy to: Witness: Name of Inspector: Company Address: COMMONWEALTH OF MASSACHUSEI I S EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION ONE WINTER STREET,BOSTON MA 02198(617)292-5500 TRUDY COXE SUBSURFACE SEWAGE DISPOSAL INSPECTION FORM PART A - CERTIFICATION 30 Brisson Drive, Northampton, MA Arielle & Tricia Walker Owner's Address: 30 Brisson Dr. , Florence, MA 01062 Board of Health, Northampton; Wr.9k4 .3udc&2r5 Number: SSDS-369 11 Thomas S . Leue Company Name: Homestead Inc. I em a DEP approved system Inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000) 1664 Cape St. , Williamsburg, MA 01096 Telephone: (413) 628-4533 c_ERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported 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 do not represent or warrant the operation or proper function of this system for any period of time. The system condition evaluation: Location Only INSPECTION SUMMARY: This inspection is in accordance with 15.301(2) whereby the facility is planned for a change in use or expansion for which a building permit or occupancy permit from the local building inspector is required. 1 . The system has sufficient capacity for the intended use? No Yes X Undetermined 2. The change in use or expansion will affect the building footprint? No Yes X N/A 3. All system components, including the reserve area, have been identified on site? No Yes X 4. The proposed construction, if any, will not be placed upon any system component? No Yes X N/A Signature'. s Date: October 29. 2005 The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(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 Department of Environmental Protection. The original should be sent to the system owner and copies to the buyer,if applicable and the approving authority. Notes: (revised 9/2/98 Page 1 of 2 Homestead Inc. Leaching trenches, nominal 32 ft. long each. N a < a e > > > CC V) VI CC z Distribution Box 13' r Existing Septic tank ‘is_ .5.,/- •4, en n I N 2j Planned addition: 1 bedroom 1_..rll Existing House Outline --- - - gg � -i1 Note: No known drinking water sources within 100 foot radius. NORTH • NOF YAS , Date: Owner: 0' s+cy HOMESTEAD INC. As-Built Drawing ;+ c. Existing Septic System 10/29/05 Arielle & Tricia Walker o ntoE�ss Thomas S. Leue R.S. 30 Brisson Drive �° eeacaPest. Scale: 1 : 20' Revision Date: Florence, MA 01062 e+ ,x Williamsburg, nn 07096 Except as Noted c�1FBED SxI� 14731 628-4533 1 Peter 1.McErlain Health Agent CITY OF NORTHAMP BOARD OF HEALTH fl 210 Main Street ((��ff,„;��jj -MTh Northampton,MA 01060 a ( , (413) 587- 1214 TEL - 7 ``ICI (413) 586— 1264 FAX :oRTHAMPrpjP LTr; SEPTIC SYSTEM REPAIR PROGRAM APPLICATION PACKET FORMS 1. OWNER and PROPERTY INFORMATION APPLICATION — FORM 1 2. / LOT PLAN of DWELLING (Available from the City Assessor's Office)— FORM 2 V/ 3. CERTIFICATION of TITLE (Available from the City Assessor's Office.) — FORM 3 4. CITY TAX COLLECTOR'S CERTIFICATION — FORM 4 5. CITY ASSESSOR'S STATEMENT of PROPERTY VALUATION —FORM 5 t/- 6. STATEMENT OF FACT as to why the septic system needs repair/replacement— FORM 6 ✓ 7. BETTERMENT CONTRACT—FORM 7 t/ 8. CITY ENGINEER STATEMENT THAT SITE CANNOT CONNECT TO CITY SEWER— FORM 8 9. BUDGET FORM for ENTIRE CONTRACT— FORM 9 10. REVIEW by HEALTH AGENT and APPROVAL OF NORTHAMPTON BOARD OF HEALTH. PHASE II FORM A FORM B DESIGN CONTRACT PRICE QUOTES FORM. CONSTRUCTION CONTRACT PRICE QUOTES FORM. FORM C CERTIFICATES OF INSURANCE FORM. E. ARE THERE CURRENTLY ANY LIENS OR ATTACHMENTS RECORDED AGAINST YOUR PROPERTY? YES NO Explanation: -DD Stf- Af+xhed (Zepon A. Peter J.McErlain Health Agent FORM 1 Name of Owner(s): • CITY OF NORTHAMPTON BOARD OF HEALTH 210 Main Street Northampton,MA 01060 (413) 587- 1214 TEL (413) 586— 1264 FAX SEPTIC SYSTEM REPAIR PROGRAM OWNER HOUSEHOLD INFORMATION DA\/ i D fT -DOnZRoc,J1Z'1 Mailing Address: To. 130K 44± awnp-oru t1A . Oto0-OV97 B. Home Telephone: Property Location: Number of Occupants: 1/43-527-lig/ Work Telephone: 9/3-52'7-//O0 PROPERTY INFORMATION 30 -BR' 510js DR ve. Norzi%ampoN/ HA 0100 TynE� = Bedrooms: C. HAS A CERTIFIED INSPECTOR DETERMINED YOUR SYSTEM TO BE "FAILING"? YES NO ■ (ATTACH REPORT) D. HAS A PECOLATION TEST ANDIOR DESIGN BEEN PREPARED OR CONDUCTED? YES NO ■ IF SO PLEASE EXPLAIN BELOW. (ATTACH REPORT) SIGNATURE OF OWNER: DATE: /02.-Oa-17 Peter 1.McErlain Health Agent FORM 3 CITY OF NORTHAMPTON BOARD OF HEALTH 210 Main Street Northampton,MA 01060 (413) 587 — 1214 TEL (413) 586— 1264 FAX SEPTIC SYSTEM REPAIR PROGRAM REGISTRY CERTIFICATION OF TITLE I HEREBY CERTIFY THE ABOVE ARE ALL THE OWNER(S) OF RECORD FOR THE SUBJECT PROPERTY AND ARE LISTED AT THE HAMPSHIRE COUNTY REGISTRY OF DEEDS, NORTHAMPTON, MASSACHUSETTS IN: BOOK#: SIGNATURE: PRINT NAME: PAGE #: TITLE: n V ^fl I A Mn 1 a ant L m , DATE: ) Q 9 G PROPERTY LOCATION: I 30 t 4 ( STREET: 30 opo Jl Jr__ MAP t ,/a Y I LOT# OWNER(S) OF RECORD: rJ j� / 4CUxd -- 4-ryLbA15-60-41: ADDRESS: d '_77 » &)' ` /� AL4,Grn 4 ' &f to A / 6 ( I I HEREBY CERTIFY THE ABOVE ARE ALL THE OWNER(S) OF RECORD FOR THE SUBJECT PROPERTY AND ARE LISTED AT THE HAMPSHIRE COUNTY REGISTRY OF DEEDS, NORTHAMPTON, MASSACHUSETTS IN: BOOK#: SIGNATURE: PRINT NAME: PAGE #: TITLE: n V ^fl I A Mn 1 a ant L m , DATE: ) Q 9 G Peter J.McEriain Health Agent FORM 2 • CITY OF NORTHAMPTON BOARD OF HEALTH 210 Main Street Northampton,MA 01060 (413) 587 — 1214 TEL (413) 586— 1264 FAX SEPTIC SYSTEM REPAIR PROGRAM MAP OF PROPERTY FROM ASSESSORS OFFICE PLEASE ATTACH COPY OF ASSESSOR'S MAP TO THIS FORM. Peter J.McErlain Health Agent FORM 4 CITY OF NORTHAMPTON BOARD OF HEALTH 210 Main Street Northampton, MA 01060 (413) 587— 1214 TEL (413) 586— 1264 FAX SEPTIC SYSTEM REPAIR PROGRAM TAX COLLECTOR'S CERTIFICATION ITEM WATER ASSESSMENTS AMOUNT $ n.ye' PROPERTY LOCATION: 30 I3 \55ON5 TRIVc kfOrahowne+o'S $ 60— STREET: MAP ZR1550h5 pRv2 9.a LOT# . 16 OWNER(S) OF RECORD: DAVID F Dovhbrto0sk\ ADDRESS: 30 se,,550 N -D1,7 4 c N orck∎-vrin l,i ITEM WATER ASSESSMENTS AMOUNT $ n.ye' ' due, X1/1/97 SEWER ASSESSMENTS $ 60— REAL ESTATE TAXES $ //(9, 14 Jaidteat OTHER(Describe) $ -/Qi SIGNATURE:- gatant4t1) C& AWL lv Ile....,. I C ax o DATE: /00/97 COMMENTS: THE BOARD OF HEALTH WILL NOT LOAN MONEY TO ANYONE HAVING A BALANCE DUE. REMARKS L.4 c/ Pater I McErlain Health Agent FORM 5 CITY OF NORTHAMPTON BOARD OF HEALTH 210 Main Street Northampton,MA 01060 (413) 587 - 1214 TEL (413) 586— 1264 FAX SEPTIC SYSTEM REPAIR PROGRAM ASSESSOR'S STATEMENT OF VALUE PROPERTY LOCATION: , f 0,m4 A Np-r0 N . V\ P STREET: 30 13121550S -Dt ve MAP n LOT# I1 6 OWNER(S) OF RECORD: a,,q\i i O " 1AML3R,O Los ADDRESS: 36 3R 1 5507 1 DZIVC. THE ABOVE REFERENCED PROPERTY IS VALUED AT $ THE CITY OF NORTHAMPTON ASSESSOR'S RECORDS. 9 2, 500 . ACCORDING TO SIGNATURE: PRINT NAME: TITLE: DATE: J - 2 - 9 7 COMMENTS (If any required): Peter J.McErlain Health Agent FORM 6 CITY OF NORTHAMPTON BOARD OF HEALTH 210 Main Street Northampton, MA 01060 (413) 587— 1214 TEL (413) 586— 1264 FAX SEPTIC SYSTEM REPAIR PROGRAM STATEMENT OF FACT PROPERTY LOCATION: vi-R. 0006t- 5 BRIst5oNs 11>z An- NO>tilav" 9 6t- NAME(S) OF OWNER(S): DAV I D T 'Dorn biz°t.35kt 15.303: Systems Failing to Protect the Public Health and Safety and the Environment A. Criteria applicable to all systems: 1. there is backup sewage into the facility served by the system or any component of the system as a result of an overload and/or clogged soil absorption system or cesspool; YES 71 NO 2. there is a discharge of effluent directly or indirectly to the surface of the ground through ponding, surface breakout or damp soils above the disposal area or to a surface water of the Commonwealth; YES II NO 3. the static I quid level in the distribution box is above the level of the outlet invert; YES E NO The liquid depth in a cesspool is ess than six inches from the inlet pipe invert or the remaining available volume within a cesspool above the liquid depth is less than '/ of one days design flow; YES II NO 5. the septic tank or cesspool requi es pumping more than four times a year; YES 21C1 NO 1 1 6. the septic tank is cracked or is otherwise structurally unsound, indicating that substantial infiltration is occurring or is eminent; YES r I NO N 7. a cesspool, privy or any portion of the soil absorption system extends below the high groundwater elevation; YES II NO I I L%� // 8. other reason(s) as to /why system is n(o working or has failed: // / ,4,//e]`/C # *4e4 Aa Tertt/.J'•4!/ nilt 4//// Vl/ yell . ad1 h-%, 714fr%JQQ che51.)rn a r./r,/t Don I.J is Woo .57nc✓rf '4)CM? ('n/ie< i" e ft�fi.`4C/'vl,S»'e. a a” p,/ Now?At Sy4.1 4411 Bcck 'p /H/o lit /Vm.ca-. Tile S /Ated/AN Show4 ')w4 A,$0///, g Le¢ch✓I*. y . / 5 &avt apnox c=/d" , om /hr iter cp' /4,4'3 t%/i whe.J l3e'aefs wea< thrwveci tn ,oraie/u IS YOUR YEARLY INCOME $150,00.00 OR GREATER? YES PLEASE GIVE US AN ESTIMATE OF YEARLY INCOME OFF W-2 NO 4 30-10 .39, 7-`12 I OWNER(S) OF PROPERTY: TO THE BEST OF MY KNOWLEDGE THE INFORMATION IS TRUE AND CORRECT. By: By: Please attach any reports you may have on this septic system. Date: ._,: "' :--,2_i? /777_ Date: STOP DETERMINATION BY THE BOARD OF HEALTH SIGNED: SIGNED: Health Agent Chairman, Board of Health 2 Date: Date: No. FORM 11 -SOIL EVALUATOR FORM Page 1 of 3 Date: Aug. 14.1997 Commonwealth of Massachusetts Northampton , Massachusetts Soil Suitability Assessment for On-site Sewage Disposal Performed By: Paul B. Hatch. PE Witnessed By: Peter McErlain Date: Aug. I4. 1997 Location Address or Brisson Drive Lot# Owner's Name Dave Dombrowski Address.and 30 Brisson Dr. ,Northampton 01060 Telephone w 413-584-2361 New Construction Repair XXX Office Review Published Soil Survey Available:No Yes XXX Year Published 1981 Publication Scale 1:15840 Soil Map Unit Hg Drainage Class A Soil Limitations Surficial Geologic Report Available:No XXX Yes Year Published Publication Scale Geologic Material(Map Unit) Landfonn Glacial outwash Flood Insurance Rate Map: Above 500 year flood boundary: No Yes X Within 500 year flood boundary: No Yes X Within 100 year flood boundary: No Yes X Wetland Area: National Wetland Inventory Map(map unit) Wetlands Conservancy Program Map(map unit) Current Water Resource Conditions(USGS):Month Range:Above Normal Normal Below Normal Other References Reviewed: 333£5601 FORM I - SOIL EVALUATOR FORM Page 2 of 3 (5n)55c& Dr( Location Address or Lot No. Northampton On-site Review Deep Hole Number 1 Date: 8/14197 Time: 9:00 Weather Clear Location (identify on site plan) Land Use home recreation Slope(%) 1 Surface Stones None observed Vegetation Diciduous and coniferous Landform glacial outwash Position on landscape (sketch on the back) Distances from Open Water Body > 100 feet Possible Wet Area > 100 feet Drinking Water Well >100 feet Drainage way >100 Property Lines Other feet feet 10' DEEP OBSERVATION HOLE LOG* Depth from Surface(inches) Soil Horizon Soil Texture (USDA) Soil Color (Munsell) Soil Mottling Other (Structure,Stones,Boulders,Consistency,Y Gravel) 0-11" 11"-26" 28"-62" 62"-120"t Ap B C1 C2 LS LS S S 10YR3/2 10YR5/6 10YR5/8 10YR6/6 no no no no 10%cobbles&20%gravel 30%gravel 'MINIMUM OF 2 HOLES REQUIRED AT EVERY PROPOSED DISPOSAL AREA Depth to Bedrock not found Parent Matenal(geo ogic) Depth to Groundwater: Standing Water in the Hole: None Estimated Seasonal High Ground Water: Over 120 inches Weeping from Pit Face: None Brisson Dr. 0 20 SCALE 1" = 0' pipe center 3.25 below sill = 100.06 98.33 ground 98.99 fence x 97.15 low pt. 0 x 98.34 ground 100.00 sill existing 1200 g' septic tk. under O pool deck -. ___approx. loc. leach pit are 8.43 perc. FORM 11 - SOIL EVALUATOR FORM Page3 of 3 ? 'o as On Location Address or Lot No.iTTIXbdziPrea,Northampton Determination for Seasonal High Water Table Method Used: Depth observed standing in observation hole inches Depth weeping from side of observation hole inches X Depth to soil mottles >120 inches Ground water adjustment feet Index Well Number Reading Date Index well level Adjustment factor Adjusted ground water level Depth of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervious material exist in all areas observed throughout the area proposed for the soil absorption system? yes If not, what is the depth of naturally occurring pervious material? Certification I certify that on July 1995 I have passed the soil evaluator examination approved by the Department of Environmental Protection and that the above analysis was performed by me consistent with the required training, expertise and experience described in 310 CMR15.017. Signature )13.Al = Date August 14. 1997 33525603 FORM 12 - PERCOLATION TEST Location Address or Lot No. 30 Brisson Drive COMMONWEALTH OF MASSACHUSETTS Northampton, Massachusetts Percolation Test* Date: Aug. 14, 1997 Time: 11:15 Observation Hole# one Depth of Perc 15" Start Pre-soak fill test hole with End Pre-soak 25 gallons in less Time at 12" than 15 minutes Time at 9" assigned rate of Time at 6" 2 minutes/inch Time (9"-6") 2 minutes Rate Min./Inch 2 minutes *Minimum of 1 percolation test must be performed in bo reserve area. Site Passed X Site Failed Performed By: Paul B. Hatch, PE Witnessed By: Peter McErlain Comments: 33525604 Peter J.McErlain Health Agent FORM 7 CITY OF NORTHAMPTON BOARD OF HEALTH 210 Main Street Northampton,MA 01060 (413) 587— 1214 TEL (413) 586— 1264 FAX SEPTIC SYSTEM REPAIR PROGRAM BETTERMENT CONTRACT This agreement is entered into by and between the City of NORTHAMPTON, by its Board of Health and Treasurer, and -Dn.ica (the Owner) this 19t' Day of copy. 1998. WHEREAS, the Owner owns residential property, including improvements thereon, known as and numbered Massachusetts (Assessors Map 4/L Lot 11i. , Page ) and described in a deed dated MA9 a9+• 1999 and Recorded with the HAMPSHIRE COUNTY, Registry of Deeds in book Si xS— Page 26S [ filed as Document No. with the Registry District of Land Court] (the "Property"); and WHEREAS, the Owner has petitioned the City of NORTHAMPTON to make finding pursuant to M.G.L. c111; and WHEREAS, the NORTHAMPTON Board of Health has adopted an order requiring the Owner to repair, replace or upgrade the failed system to comply with the requirements of said Title 5; and WHEREAS, the Owner has pursuant to M.G.L. c. 111, , §. 127B Y2, applied Cit of NORTHAMPTON for financial assistance to repair, replace and/or upgrade system; and WHEREAS, the Department of Environmental Protection ("DEP") has approved the City of NORTHAMPTON'S proposed program of offering betterment pursuant to M.G.L. c. 111, § 127B '/: to homeowners to repair, replace and/or upgrade failed systems for financing under the Local Septic Management program, and the City of NORTHAMPTON has received a State Revolving Fund ("SRF") loan from the Water Pollution Abatement Trust (the 'Trust")to finance said betterment program; and WHEREAS, THE City of NORTHAMPTON intends to provide financial assistance to and fOwnerfmme form of a Betterment Agreement made pursuant to said M.G.L. c. 111, , § the SRF loan received by the City of NORTHAMPTON under the Local Septic Management program; and WHEREAS, the parties intend by this Betterment Agreement to cause repair, replacement and/or upgrade of the failed system to comply with Title 5 and other applicable public health and environmental laws and to complete other work directly or indirectly related thereto (the Project" as described in paragraph 4 hereof); and 1 THEREFORE, the parties, for and in consideration of mutual covenants and other good and valuable consideration, d� hereby agree to the terms of this Agreement, as set forth below. 1. The Agreement The City of NORTHAMPTON hereby agrees to provide financial assistance in an amount up to $ .00 to be advanced from time to time by the City of NORTHAMPTON to the Owner pursuant to the terms of this Agreement. The Owner promises to repay, interest as set forth herein, all sums provided to Owner by the City of NORTHAMPTON. Following notice to the Owner by the City of NORTHAMPTON collector of taxes of the amount of the betterment assessment, an amortization schedule shall be developed and incorporated as an attachment to this Agreement. Interest on the amounts advanced by the City of NORTHAMPTON to Owner shall be computed annually at the rate of FIVE percent ( 5 %) per annum on the outstanding principal balance, accruing from the 30th day after the City Assessor commits the betterment assessment to the City collector of taxes. The amount to be repaid shall be included on and paid with the (quarterly, semi-annual or annual) municipal tax bill. Interest amount due hereunder on the tax bill shall be paid pursuant to an interim bill. All outstanding amounts due to the City of NORTHAMPTON by Owner if not prior paid, shall be due and payable on . [fill in date of term] Prepayment in full or in part of all amount advanced hereunder may be made by the Owner without penalty. This agreement represents the entire and integrated agreement between the parties hereto and supercedes prior negotiations, representations, or agreements, either written or oral. The Agreement may only be amended or modified by a written modification. 2. Installment Payments The City of NORTHAMPTON shall jointly make advances of funds to owner and contractor, pursuant to the terms of this Agreement, from time to time to pay for the project. Such advances shall be made solely for the purposes set forth in this Agreement. The obligation of the City to advance all or any part of the financial assistance for repair, replacement and/or upgrade of the failed system is subject to the following: (A) Inspection of the failed system by a representative of the NORTHAMPTON Board of Health or by a DEP Certified Septic System Inspector, as deemed necessary by the NORTHAMPTON Board of Health. (B) Submission by Owner or Contractor on behalf of the Owner of plans approved by the NORTHAMPTON Board of Health for the project. Owner shall (1.) solicit a bid or bids for the necessary field work and plan preparation from registered professional engineers or registered sanitarians, (2.) shall submit documentation of these bids to the NORTHAMPTON Board of Health, and (3.) Specify Owner's choice of an engineer or sanitarian. 2 The NORTHAMPTON Board of Health may approve an installment payment NOT to exceed the amount of the selected bid. An installment payment for field work and plan preparation shall be made by check payable JOINTLY to and the engineer or sanitarian and shall be payable upon presentation and approval of the selected bid. (SEE FORMA). (C) Submission by Owner or Contractor or behalf of the Owner of the bid or bids for the project in accordance with the plans from licensed (including, but not limited to, a Disposal System's Installer's Permit). Insured septic system contractors, which bids contain detailed breakdowns of the cost of the Project by tasks. (SEE FORM B). (D) Confirmation by the NORTHAMPTON Board of Health that the contractor for construction of the Project (the "Contractor") selected by the Owner has a valid Disposal Installer's Permit in effect for the period covering the system upgrade financed under this Betterment Agreement. (E) Review by the NORTHAMPTON Board of Health of a Project Budget based on the bid submitted the Contractor. (F) Execution of a construction contract between the Owner and the Contractor pursuant to the plans and specifications which have been previously approved by the NORTHAMPTON Board of Health. (G) Issuance by the NORTHAMPTON Board of Health of a Disposal Works Construction Permit with respect to the Project. 3. Conditions of Payment Installment payments of the financial assistance are to be made by the City of NORTHAMPTON under the following conditions: (A) An installment payment for field work and preparation of plans shall be made to the Owner and engineer or sanitarian in accordance with Subsection (B) of section 2. (B) A reasonable time before the date on which any other installment payment is required to be made, the Contractor shall give notice to Owner and City specifying the total installment payment request. Such notice shall consist of a detailed request describing the value of the completed items of work. The amount of the request shall be equal the amount of the requested installment. The request shall be accompanied by a sworn certificate of the Contractor that all materials, subcontractors and employees have been paid prior work on the Project. The City of NORTHAMPTON may request the Owner to provide further documentation in support of a request for an installment payment. Upon approval of any requested installment payment, the City shall issue a check payable JOINTLY to Owner and Contractor, which check shall be forwarded by the City to Owner. 3 (C) The City may require as a condition of any installment payment that Owner submit satisfactory evidence that there are sufficient remaining funds to pay for completion of the Project in accordance with the approved plans. (D) Prior to making an installment payment the NORTHAMPTON Board of Health may cause the Project to be inspected to verify that the work items described in the request have been actually completed. In any case, the Contractor shall provided verification that the work referred to in the installment request has been completed in accordance with the approved plans. (E) Prior to paying the final installment, the Contractor shall provide verification that all work has been completed in accordance with the approved plans, a sworn certification that all materials, subcontractors and employees have been paid for work on or materials supplied for the Project and the NORTHAMPTON Board of Health shall have issued a Certificate of Compliance for the Project. 4. Scope of Work for Proiect The Owner and the Contractor, pursuant to the Disposal System Construction Permit issued by the NORTHAMPTON Board of Health, shall determine the Scope of Work necessary to bring the failed system into compliance with Title 5. Such Scope of Work may include, but not be limited to the following: (A) performing soil and percolation test and other necessary site analyses; specification of the failed system components to be repaired, replaced and/o upgraded; (B) design of the System or components thereof to be repaired, replaced and/or upgraded; (C) obtaining all applicable federal, state and local permits and approvals required to complete the Project; (D) seeking bids and awarding contracts for assessment, design, consulting and construction work and materials in accordance with applicable laws, regulations and requirements; (E) minimizing any disruption of utility service, and reasonably restoring the Property to as near its original conditions as is practicable; and (F) engaging such other service and procuring such other materials as shall be reasonably necessary to complete the Project in a good and workmanlike manner. All such work shall be performed pursuant to written contracts and agreements, copies of which shall be incorporated by reference into this agreement. 5. Town's Right to Inspect The Owner agrees to allow D.E.P., the City of NORTHAMPTON, including the NORTHAMPTON Board of Health, Health Agent and other officials, employees and agents to enter onto the Property, as is reasonably necessary and with reasonable notice, to test, examine and inspect the Project to verify the completion and adequacy of the work. 4 Irr Covenant Not to Sue The Owner covenants and agrees not to sue the City of NORTHAMPTON for any claims of damage to loss of property of the Owner or others, or for breach of warranty regarding the performance or condition of the Project, or for injury, illness or death arising out of the performance of any contractors or agents engaged to perform the work. This Covenant Not to Sue provision shall have no application to causes of action which may have arisen prior to the execution of this Agreement, or to causes of action that are unrelated to this Agreement, or to causes of action against any person or entity other than the City of NORTHAMPTON. 7. Owners Representations and Warranties to the City of NORTHAMPTON The Owner represents and warrants to the City of NORTHAMPTON that: (A) Financial information. The Borrower's Affidavit furnished to the City of NORTHAMPTON by the Owner is accurate and complete; (B) Title. The Owner has good record title to the Property, subject only to the Encumbrances of Record; (C) Permits and Compliance With Law. The Owner has obtained or will obtain all necessary governmental permits for the Project. The On-site Sewage Disposal System for the dwelling on the Property, after completion of the Project, will comply with all applicable laws, regulations, codes and ordinances, including but not limited to Title 5; and (D) Insurance. The Owner and Contractor have procured or will procure insurance in such forms and in such amounts as shall be satisfactory to the City of NORTHAMPTON. Certificates of insurance shall be attached as Exhibits to this agreement. (FORM C) Each of the foregoing representations and warranties in this section shall remain in force until the financial assistance is repaid in full. The Owner shall indemnify and hold harmless the City of NORTHAMPTON from and against loss, expense, or liability (including cost of defending any claim), directly, or indirectly from the falsity, inaccuracy, or breach of any of the above representations and warranties. 8. Owner's Obligations During the term of this Betterment Agreement, the Owner agrees that the Owner shall comply with all of the terms and conditions of this and any related agreement and that the Owner shall: (A) Completion of Project. Cause the Project to be promptly completed in a manner in accordance with the approved plans and with Project Budget and in compliance with all laws, regulations, codes and ordinances and notify City of NORTHAMPTON when the project is complete. (B) Records and Cooperation with City. Keep complete records relating to the Project, which records shall be available for inspection and copying by the City of NORTHAMPTON, and cooperate fully with any audit of the Project if so requested by the City of NORTHAMPTON. 5 . (C) Performance of Other Obligations. Perform all the Owner's obligation and agreement under any present or future mortgage or other Covenant or pct vcbict\exc abets the pcvcectl (D) Use of Financial Assistance. The financial assistance is provided for the public purpose of protecting the public health, safety, welfare and the environment. The Owner shall use the proceeds of the financial assistance solely for cost included in the Project Budget and ensure that the proceeds are not used for any other purpose. 9. Events of Default The Owner shall be in default under this Agreement upon the occurrence of any one or more of the following events: (A) Sale, Transfer or Assignment Without Approval. The Owner assigns or transfers any money advanced or to be advanced hereunder to any person or entity not approved by the City of NORTHAMPTON. (B) Cessation of Construction. The Owner or Contractor ceases construction of the Project for more than thirty (30) consecutive calendar days. The NORTHAMPTON Board of Health may waive this event of default upon application of the Owner and a demonstration that such cessation occurred because of an Act of God, governmental order or restriction, fire or other casualty, or other causes beyond the owner's reasonable control. (C) False Representation or Warranties. Any representation or warranty made herein which prove to be false or inaccurate in any material respect. (D) Breach of an Obligation. The Owner defaults in the performance of any of the Owner's obligations contained herein. 10. City of NORTHAMPTON'S Right On Default Upon Owner's default, the City of NORTHAMPTON shall have no further obligation to make any further installment payments and all amounts advanced by the City of NORTHAMPTON to the Owner shall become immediately due and payable. 11. Notice of Betterment Agreement Upon execution of this Agreement by Owners and the City of NORTHAMPTON a Notice of this Agreement shall be recorded by the City of NORTHAMPTON at the Hampshire County Registry of Deeds, as a betterment and shall be subject to the provisions of M.G.L. c. 80 relative to apportionment division, reassessment and collection of assessment, abatement and collection of assets, provided however, that the lien which shall arise pursuant to M.G.L. c. 111, § 127B 'A shall take effect by operation of law on the day immediately following the due date of such assessment or apportioned part of such assessment. The Betterment lien, if any, shall be deemed to secure all amounts advanced hereunder, together with interest thereon, and shall included costs of collection and reasonable attorneys fees, recording, filing fees and dismissal fees. 6 Improvements to the Property Any alteration or improvements to the Property resulting from the Project are the property of the Owner, and the City of NORTHAMPTON shall bear no responsibility for the condition of the improvement or its maintenance. 13. Cancellation of the Agreement by the Owner The Owner may by written notice to the NORTHAMPTON Board of Health, and the Treasurer of the City of NORTHAMPTON cancel Owner's further obligation for repayment under this Agreement at any time prior to the end of ten (10) calendar days following notice in writing to the City of NORTHAMPTON of the Owner's proposed successful construction bid, based on the Owner's evaluation of the proposed scope and cost estimate of the system upgrade derived from the filed work, project design and the successful construction bid. However, in the events of such cancellation, the Owner shall remain liable for repayment of all sums advanced by the city of NORTHAMPTON to Owner pursuant to this Agreement. All sums advanced by the City of NORTHAMPTON to Owner shall be repaid with interest and within the term set forth in paragraph 1 hereof. Upon application of the Owner, the NORTHAMPTON Board of Health may revoke the Order for Improvements, provided however, that the Owner shall remain liable to comply with the provisions of Title 5. 14. Personal Obligation of the Owner In addition to those remedies available to the City of NORTHAMPTON regarding the assessment and collection of betterment, the Owner shall be personally liable for the repayment of the amounts advanced, plus interest thereon and the total direct and indirect costs incurred by the City of NORTHAMPTON in the contemplation and the performance of this Agreement or the property, the City of NORTHAMPTON shall permit the assumption of the personal liability hereunder by said purchaser or tranferee and shall release the personal liability of the Owner. The assumption and release of liability hereunder shall be in writing and shall be executed prior to the purchase or transfer by the Owner, the purchaser or tranferee of said City of NORTHAMPTON. 15. Notice Any notice required to be given under this Agreement shall be made in writing and shall be delivered by either in-hand delivery or by prepaid, certified first class mail with return receipt requested. (A) If notice is made to the City of NORTHAMPTON, it shall be made to: NORTHAMPTON Board of Health or the Mayor; or (B) If notice is not made to the Owner, it shall be made to: Notice shall be deemed given on the day it is hand delivered or three (3) days after the date of posting of first class mail. 7 Funding • The obligation of the City of NORTHAMPTON are expressly contingent upon funding. In the event that funding for the City of NORTHAMPTON'S obligation in unavailable, upon notice to the Owner, this Agreement may be cancelled by the City of NORTHAMPTON and all obligations of the City of NORTHAMPTON shall be null and void. 17. Enforcement of Laws Nothing in this Agreement shall be deemed to stop or effect or a waiver, or otherwise act as a bar or defense, to any legal proceeding by the City of NORTHAMPTON relating to the System of the Property. 18. Severability In the event that one or more provisions of this agreement is deemed unenforceable by a court of competent jurisdiction, the Agreement,.except as deemed unenforceable, shall remain in full force and effect. 19. Governing Law This agreement shall be governed by Massachusetts Law. 8 wring the term of this Betterment Agreement,the Owner agrees that the Owner shall comply with all of the terms and monitions 0f trs and any related Agreement and that the Owner Shall: IN WITNESS WHEREOF, the undersigned parties have signed this Agreement as an instrument under seal this day, of , 1998. CITY OF NORTHAMPTON BY ITS BOARD OF HEALTH: OWNER: Chairman Owner AS TO INTEREST RATE: 5% A TERM OF 10 YEARS Print Name Print Name CITY OF NORTHAMPTON APPROVED AS TO FORM: BY ITS TREASURER: Treasurer City Attorney EXHIBITS 1. Designer Contract 2. System Plans and Design 3. Construction Contract(s) 4. Project Budget 5. Certificate(s)of Insurance 6. Disposal System Construction Permit 7. Other Applicable Permits, licenses and Agreements 8. Requisitions for payment and support documentation 9. Certificate of compliance 9 -114 n' M Nw / awl Yt1 a lctL S MWi SJN)N .14244 Peter J.McErlain Health Agent FORM 8 CITY OF NORTHAMPTON BOARD OF HEALTH 210 Main Street Northampton,MA 01060 (413) 587- 1214 TEL (413) 586- 1264 FAX SEPTIC SYSTEM REPAIR PROGRAM CITY ENGINEER STATEMENT OF SEWER CONNECTION IT IS THE DETERMINATION OF THIS DEPARTMENT THAT THE PROPERTY IN QUESTION IS UNABLE TO BE CONNECTED TO THE CITY SEWER SYSTEM AT THIS TIME, FOR THE FOLLOWING REASON(S): SIGNATURE: PRINT NAME: k ku Engineer 4(oAC.E, A0),481 iat5 c • TITLE: Assn 4. L` DATE: r• 5 hi PROPERTY: 30 LBR(550N -DR\VC /16%n7 Inp/oN, MA. 0/06a STREET: 303tiZL55o1S -D2ty� MAP ^ a_ T LOT# ��/ b OWNER(S) RECORD: ,�, 1 DAY I D }—• o 3�a ADDRESS: /5k7/ 3iz1550k �21)1C Nvnf�/,6 mrioN//i%%�. 0>062-30 IT IS THE DETERMINATION OF THIS DEPARTMENT THAT THE PROPERTY IN QUESTION IS UNABLE TO BE CONNECTED TO THE CITY SEWER SYSTEM AT THIS TIME, FOR THE FOLLOWING REASON(S): SIGNATURE: PRINT NAME: k ku Engineer 4(oAC.E, A0),481 iat5 c • TITLE: Assn 4. L` DATE: r• 5 hi Peter J.MCErlain Health Agent FORM 9 CITY OF NORTHAMPTON BOARD OF HEALTH 210 Main Street Northampton,MA 01060 (413) 587— 1214 TEL (413) 586— 1264 FAX SEPTIC SYSTEM REPAIR PROGRAM PROJECT BUDGET ESTIMATED COST OF: PERCOLATION TEST &DESIGN: $ 635 .00 CONSTRUCTION OF SYSTEM: $ 46jg .00 TOTAL AMOUNT REQUESTED: $ 7) `I S .00 STOP AMOUNT APPROVED BY THE BOARD OF HEALTH $ 7 9Y) .00 PAYMENT SCHEDULE: SHALL BE 100% AT COMPLETION AND APPROVAL OF DESIGN. SHALL BE 50% UP FRONT TO BEGIN CONSTRUCTION. SHALL BE REMAINING 50%WITHIN 30 DAYS DAYS OF LETTER OF COMPLIANCE FROM THE NORTHAMPTON BOARD OF HEALTH. SIGNED AND APPROVED BY: Northampton Board of Health DATE: a a Peter MErlain, Health Agent PROPERTY LOCATION: I 14012.4YirrvirOINS STREET: 30 'B2135CN VILIVe., MAP `i LOT # AA OWNER(S) OF RECORD: DAV I O "Dow,b2.0 O5 Vk ADDRESS: � ( 30 '3ni550N NOiL V%o"pfDi-s, v14. 0)060— ESTIMATED COST OF: PERCOLATION TEST &DESIGN: $ 635 .00 CONSTRUCTION OF SYSTEM: $ 46jg .00 TOTAL AMOUNT REQUESTED: $ 7) `I S .00 STOP AMOUNT APPROVED BY THE BOARD OF HEALTH $ 7 9Y) .00 PAYMENT SCHEDULE: SHALL BE 100% AT COMPLETION AND APPROVAL OF DESIGN. SHALL BE 50% UP FRONT TO BEGIN CONSTRUCTION. SHALL BE REMAINING 50%WITHIN 30 DAYS DAYS OF LETTER OF COMPLIANCE FROM THE NORTHAMPTON BOARD OF HEALTH. SIGNED AND APPROVED BY: Northampton Board of Health DATE: a a Peter MErlain, Health Agent Peter J.McErlain Health Agent FORM A CITY OF NORTHAMPTON BOARD OF HEALTH 210 Main Street Northampton,MA 01060 (413) 587 — 1214 TEL (413) 586— 1264 FAX SEPTIC SYSTEM REPAIR PROGRAM ENGINEER or REGISTERED SANITARIAN PRICE QUOTES PROPERTY LOCATION: 30B1Si550N TDs'tve- ( }ic np+ol4 i MA-. oioCa NAME(S) OF OWNER(S): VAV) D LhnbtEot;DsKi The following information is required. You must contact three (3) engineers or registered sanitarlans to get prices on designing this septic system. Price needs to include backhoe work and soil evaluation costs. COMPANY NAME: ha s I • Price l r Quote . g PHONE NUMBER: ._ : - •g ADDRESS WHO YOU SPOKE WITH: COMPANY NAM E: ADDRESS: NUMBER: $ ;3'i. .00 WHO YOU SPOKE WITH: 7? �i? �i� st_. COMPANY NAME: �� Price $ i0 ADDRESS: PHONE NUMBER: WHO YOU SPOKE WITH: Quote COMPANY NAME: ADDRESS: PHONE NUMBER: _ WHO WHO YOU SPOKE WITH: Price Quote COMPANY NAME: ADDRESS: PHONE NUMBER: WHO YOU SPOKE WITH: Price Quote PLEASE CHECK WHICH ENGINEER or SANITARIAN YOU PLAN TO USE. Peter J.McErlain Health Agent FORM B CITY OF NORTHAMPTON BOARD OF HEALTH 210 Main Street Northampton,MA 01060 (413) 587 — 1214 TEL (413) 586— 1264 FAX SEPTIC SYSTEM REPAIR PROGRAM CONSTRUCTION CONTRACTOR PRICE QUOTES PROPERTY LOCATION: 30 &IZ.;ssot rTD Na ISoailtkynei-o,,l, MA _ Dt06Z NAME(S) OF OWNER(S): DAv l D DomloRou.)4 ._ The following information is required. You must contact three (3) construction contractors to get prices on septic system Installation costs. Price needs to include construction work required to complete Installation In accordance with approved design plans. COMPANY NAME: • J . ,.W C, rice ADDRESS: 1 OM PHONE NUMBER: i WHO YOU SPOKE WITH: Chair/it s /b&Let'') i/ P $ 6) svo. .00 COMPANY NAME: ' ADDRESS: t PHONE NUMBER: WHO YOU SPOKE WITH: % __To__ Price jnI Quote 3. 4. COMPANY NAME: ADDRESS: PHONE NUMBER: WHO YOU SPOKE WITH: Price Quote COMPANY NAME: ADDRESS: PHONE NUMBER: _ WHO YOU SPOKE WITH: COMPANY NAME: ADDRESS: PHONE NUMBER: WHO YOU SPOKE WITH: Price Quote Price Quote $ .00 u $ .00 S .00 .00 PLEASE CHECK WHICH CONSTRUCTION CONTRACTOR YOU PLAN TO USE. 61 v Quo��S. Parr J.McErlain Health Agent FORM C CITY OF NORTHAMPTON BOARD OF HEALTH 210 Main Street Northampton,MA 01060 (413) 587— 1214 TEL (413) 586— 1264 FAX SEPTIC SYSTEM REPAIR PROGRAM OWNER and CONTRACTOR CERTIFICATES of INSURANCE PLEASE ATTACH CERTIFICATES TO THIS FORM and ATTACH TO BETTERMENT CONTRACT. e ACORD me �`- ^ ,°% .1 !. h^A9` � � y DATE IMM M'I 01/15/1998 iA - O FORMATION UPON THE CERTIFICATE DOES NOT AMEND,EXTEND OR BY THE POLICES BELOW. PRODUCER 413)527-5520 FAX (413)527-5970 R (413)527-5520 • pifford & Perras Insurance Agency, Inc. 5 Campus Lane Easthampton, MA 01027 Mtn: Cindy Szafir EXt: 17 INSURED Hampshire Construction Co. Inc. & Hatfield Equipment Co. Inc. 327 West Street N Hatfield, MA 01066 ONLY AND CONFERS NO RIGHTS HOLDER.THIS CERTIFICATE ALTER THE COVERAGE AFFORDED COMPANIES AFFORDING COVERAGE COMPANY Masswest Insurance Company A . COMPANY Travelers Property Casualty B COMPANY - - c COMPANY D Co ERAG 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 MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO POLICY EFFECTIVE POLICY EXPIRATON, LIMITS LTR TYPE OF IXSUMXLE POLICY NUMBER DATE IMMNDIIYI I DATE(MAMMY) GENERALIIABILT' X COMMERCIAL GENERAL LIABILITY CLAIMS MADE X .OCCUR 07/01/1997 A OWNER'S&CONTRACTOR-S PROT CP1700412'.. _... _. _ I GENERAL AGGREGATE $ 2,000,000 I .. (PERSONAL 07/01/1998 PRODUCTS-COMPIOP AGG $ 2,000,000 5 1,000,000 S 1,000,000. 50,000 5,000 &ACV INJURY -- -- EACH OCCURRENCE FRE DAMAGE(My one Orel r MEDEXP(Any One Person) IS AUTOMOBILE LIABILITY '.. ANY AUTO ALL OWNED AUTOS '... SCHEDULED AUTOB. HIRED AUTOB .. - '.. NON-OWNED AUTOS _ COMBINED SINGLE LIMIT BODILY INJURY Per Persm) BODILY INJURY Per accident) '.. PROPERTY DAMAGE 5 $ S S GARAGE LIABILITY ONLY-EA ACCIDENT S pTXE0. AUTO ONLY IT THAN NW AUTO ',. _._ EACH ACCIOEN f r __. . _... __. --- AGGREGATE S EXCESS UMBRELLA EACH OCCURRENCE S 1,000,000 A X .UMBRRELLLA FORM UM800046 07/01/1997 07/01/1998 AGGREGATE f... F S UMBRELLA py. Ari RKEJERTHAENSATI NAND ''..WORKERS COMPENSATION NAND TORY LIMITS ER St• 500, EMPLOYERS'LIABILITY EL EACH ACCIDENT b 500,000 B ' THE PROPRIETOR( INCL DTOUB337N877297 ',. 04/29/1997 , 04/29/1998 EL DISEASE POLICY LIMIT $ 500,000 PARTNERS/EXECUTIVE EL DISEASE-EA EMPLOYEE S 500,000 OFFICERS ARE •..', EXCL'., OTHER DESCRIPTION OF OPERA EONBILOCATONSNEHICLESSPE CIAL ITEMS - el -115'15 _.... ` '9F David Dombrowski 30 Bri sson Dr Northampton, MA 01060 u N± da D O E,TiL SHOOULLD ..x r"'"n ANY OF THE ABOVE DESCRIBED EXPIRATION DATE THEREOF,THE )0 DAYS WRITTEN NOTICE :'.:55. 'iiSa. , ,f: .'mt.$7✓Al";.� ' . POLICIES BE CANCELLED BEFORE THE ISSUING COMPANY WALL ENDEAVOR TO MAIL TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, SHALL IMPOSE NO OBLIGATOR OR LIABILITY ITS AGENTS OR REPRESENTATIVES. ";' BUT FAILURE TO MAIL SUCH NOTICE OF ANY KIND UPON THE COMPANY, AUTHORIZED R RESENTAT aiti. 3S `3Il"r, �� ,a' -. +- OROCORPORATION p0• .,.,as, 7988 o, c x-.. .... r CO- r;L .+� 6 yt�],+ it -zo 5147 CV l ?� "sot ---r^^ A4N �N DATE sswo ON L - .FI ATE I I Z I I A A MA ROE INFO RT MA ONLY AND T CONFERS A RIGHTS UPON THE CERTIND ALTER THE THIS COVERAGE DOES NOT THE POLL POLICIES SEL ALTER THE COVERAGE AFFORDED BY THE POLICIES BEL• .. ..., PsoouDEB pole A. Frank Insurance Agency, Inc . p0 Box 455 Sunderland, MA 01375 COMPANIES AFFORDING COVERAGE COMPANY A Quincy Mutual INsUPED David F. Dombrowski PO Box 441 COMPANY B COMPANY C Northampton, MA 01061 MPANY i D I e,la TISTOfir- IFY ESO INSU11.Hr ED BE"W HAVEB4iq tr DN ME THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIO NDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Lro TYPE OF INSURANCE POUCY NUMBER DATE IMMTOTYI POLICY twits WTE IIMTW/YI GENERAL LIABILRY COMMERCIAL GENERAL LIABILITY icy HP273481 5/21/97 GENERAL AGGREGATE S PRODUCTS-COMPAP AGG S _� PERSONAL S ADV INJURY I F4. CLAIMS MADE n OCCUR EACH OCCURRENCE E 1011,0 I A X OWNERS&CONTRACTORS TROT Personal Liabi 5/21/98 FIRE DAMAGE(SS One nn% S MEDEXP/AnyonA person) $ I 00 IS AUTOMOBILE LIABILITY ANY NUO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON OWNED AUTOS COMBINED SINGLE LIMIT S S BODILY INJURY (Pm paSOii SODA Y INJURY (Pm at enq S PROPERTY DAMAGE E GARAGE LIABILITY ANY AUTO MJTO ONLY-EA ACCIOLNT S ■ OTHER THAN AUTO ONLY EACH ACCIDENT S ■ AGGREGATE S , A EXCESS LIAB$TTY k UMBRELLA FOAL. OTHER THAN U AS ELIA FO RN H P273481 5/21/97 EACH OCCURRENCE B I 000 0 0 5/21 /98 AGGREGATE ' 3 ,000 LIL S WORKERS COEEN$ATCN AND EMPLOYERS'LIABILITY THE PROPRIETOR/ f�IINCL PAPTHERSTSECUTV£ QFFlWFS ARE: Li TORYLMT! ER ,. in EL EACH ACCIDENT S S . 1E EL DISEASE-Ph ICY LIMIT EL DISEASE•FA EMPLOYEE S _ OTHER DESCRIPTION OF OPERATONS/LOCATIONSNEHCLES/SPECIAL ITEMS YTS ' .LP4d sa f'..c+'.Fw5 i M�i ..,.., .e... .tim..w8'N;L 66 Bx`'ew N A.,,,, CANCELLED BEFORE THE Board of Health City of Northampton City Hall Northampton MA 01060 SNWLO ANY OF TXF ABOVE OF POLJCJES SE • EXPIATION DATE THEREOF. THE ISSUING COMPANY Will ENDEAVOR TO YYL 20 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE IEFI, BUT FAILURE TO MAIL SUGN NOTICE SMALL IMPOSE NO OPLSATION OR W BILRY RN KMC UPON THE COMP AGENTS OR REPRESENTATIVES, $_` J s".;',,. .MM4 Nt, C{Z THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH of Nc �rn- APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT Rc air ( 1 �perade [ 1 Abandon f 1 - ❑Complete System ❑Indivlduai Components FEE .526_ Application tor a perms to Conatrwet ( p _ ✓ 30 %IcS6N De., fLDtzENCE „o" ✓ 7(L1i'A- WA'LKFFL 1. So sttSSosLwrie. e Fvot?6NW e,ddrese � 57,4-3R�9 Tdeph me x m.p:a„at> DU y /Wig- b IC') tier r vl , N t°" e�( V 5g6- f (�r� e� > s dress (/ i /'I Tempdnnen Tele hone n Lot Size Sq.feet Garbage Grinder (40 Showers ( ), Cafeteria ( ) Type of Building: Dwelling—No.of Bedroom ✓ Other—Type of Building No.of persons Other fixtures Design Flow(min. equtr d) N/A-gpd Calculated design flow---------_gpd Design flow provided gpd Plan: Date l D �/ Number of sheets ,QReev�ision Date Title ,Ve..t/-.:2' — hc* p/t f.0-</r^ "-"'/ - Description of Soil(s) N/A-- Date of Evaluation Soil Evaluator Form No! Name of Soil Evaluator N�.1-- ONOFREPAIRSOR4LTER4TIONSdL =L- '...:. V (rug— e. DESCRIPTION / s3 / LIA-pAt br' F4.0.0 llr...- . , ^M-0.taY-n,..;. . ea... OV ,.r am-rt. The undersigned agrees to;Wall the above described Individual Sewage Disposal System in accordance with the provisions of TALE 5 and further agrees not to place the system in operation until a,Ceerti Certificate of Compliance has been issued the Board of Health. Signed}/ 1h * r/D( I r i i' Wnt/K-ol` Date"•ji S W f-r7' 6d1(,DFP-S, /KG. Inspections FORM 1 - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 No. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH FEE CERTIFICATE OF COMPLIANCE Component(s) ❑Complete System Individual Com Description of Work: ❑ P The undersigned hereby certify that the Sewage Disposal System:Constructed( ),Repaired( ).Upgraded( ).Abandoned( ) by: at has been installed in accordance with the provisions of 310 CMR 15.00 (Title 5) and the approved design plans/as-built plans relating to ap. icatior No's dated . Approved Design Flow (gpd) Installer Designer: Inspector Date The issuance of this certificate shall not be construed as a guarantee that the system will function as designed. FORM 3 - CERTIFICATE OF COMPLIANCE DEP APPROVED FORM 5/96 v 05/B8/2006 10:2U 41J0Cf7a o WRIGHTA BUILDERS 1 N C O R P 0 R A T E 0 48 BA-ES STREET NORTHAMPTON, MASSACHUSETTS O'000 FAX To: Ernest Mathieu Fax q: 5874221 From: Carlene Millett CC: Date: 5-8-06 Pages: 3,incl. cover Re: Perry/Walker Certificate of Compliance 0 Urgent ❑ Please Review ❑ Per your Request XPlease Reply 0 Please Recycle Note: Ernest, 1 am faxing you the"As Built-plan,as submitted by the installer,Duffy Willard,as well as the Septic Permit,in case it will help you. Please let me know if you need any more information from us. 1 can be reached at 413-5Se-8287 X 33. Thank you, Carlene Telephone: 586-8287 Fax: 587-9276 Email: klamonde@wright-builders.com ObII \H -dd n 0 r/clek IIn tea/ %/c' A \-.s u-oz/logo Iv 'nirO..) 4-�1 / 4 -± 0) w X -H d S"otl mow bond 0,7 a7 4-1 C Y 1 1 `1 N_ "")'1d()S. cnd/N 61 0-4 b 1 )dam/ bM ; )7 ?geed � C� 0017W t$ fc E o o s iv (iouf_e 3Q 'CO rd B?NT1L1/d.hf18 8IZ698SEIDi EZ:LO 900Z,S8l59 .,,-,r.nrcT4, n7:01T 4QR7/R9/50 @sloe 2@tlb am:zo 4.SUO,-VG LP No. 24.JI-'s _Y2— THE COMMONWEALTH OF MASSACHUSETTS FCE _ O ✓ BOARD OF HEALTH OF Nenti-riarin--' APPLICATION FOR DISPOSAL SYSTEM CONSTRUCTION PERMIT r ) .Abandon ! ) -❑Complcm syncm C Individual Cumpoeents -., / 30 gR(cra PR. 1 fcoRENCE ," T(-f�'A- wed-wil- y- St) ge_ICSON$IA" V"`" "` rvitAPIvw Msr flrc P nmrn�Ms Aurfy /W-``(t „ Pyr�b rr IC7 �Qern vfpl N ttN n at Orrm v 586- / i We' Mott..1 Tdo M1wrX Type of Building: Dwelling—No.of Bedroom ✓ S Other—Type of Building No.of persons Lot Size Sq.feet Garbage Grinder (p0 Showers ( ). Cafeteria Other fixtures �� Design Flow(mist, cgmrgd) N`a-gpd Calculated design flow gpd Design Dow provided gpd Plan: Date 1,2 08 0,s Number of sheets - cvialnn.Date Title Iin;�•S — �n c�_,T= jars_. Description of Soil(e) `— // Soil Evaluator Form No 7 Name of Soil Evaluator .41 — Date of Evaluation "—it DESCRIPTION OF REPAIRS OR ALTERATIONS 0/144-44673‘40 / sal Mir Sea P ,4 4s_ —_� _ /K 8 :` n. .. The undersigned agrees M install the dime detaibod Individual Sewage Dispersal System in accordance with the provisions of 1RLE 5 and further agrees not to past the sysnvn in opperaaaa untie Cer$ifIcale of CwrgFanrs Ms been iuucdd the Beard of Health. Signed . L'.a..: 'r I hfoK WkWee12 Dal iry b o r Inspection FORM 1 - APPLICATION FOR DSCP DEP APPROVED FORM SME No. THE COMMONWEALTH OP MASSACHUSETTS FEE BOARD OF HEALTH CERTIFICATE OF COMPLIANCE Description of Work: ❑ Individual Component(s) 9 Complete System The undersigned hereby certify that the Sewage Disposal System:Constructed( ).Repaired( ).Upgraded ( ).Abandoned( ) by: at has been installed in accordance with the provisions of 310 CMR 15_00(Title 5) and the approved design plansias-built plans relating to application No._ dated . Approved Design Flow (gpd) Installer Designer: Inspector Date The issuance of this certificate shall not be seen ucd as a guarantee that the system wIl function as designed. FORM 3- CERTIFICATE p► COMPLIANCE OEP APPROVED FORM S196 ******QUOTATION****** WALTER R.THAYER JR. EXCAVATING CONTRACTOR BOX 205, 84 KING STREET HA1I 1ELD,MASS., 01038 Thank you for the opportunity to offer this proposal for your anticipated work. SCOPE OF WORK; SEPTIC SYSTEM REPAIR Repair system as designed by PB Hatch in August 1997. Please consider my quote of: 57.350.00 TERMS; Work will be billed as completed. Full payment due within 10 days of billing date. Quote Is good for 30 days. QUOTED BY: ACCEPTED BY: Please return signed copy to above address . Thank you. • Nos �z THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF N APPLICATION FOR OSAL SYSTEM CONSTRUCTION PERMIT Application for a Permit o Construct ( ) Repair f 1 Upgrade ( I Abandon ( ) - ❑Complete Sasmm fl Individual Components ✓ 111101A- 3D gAKso4'" A=;` r"e.6NW 5-13='3gIry.a e- Off,-0z ✓ 3o g( .I sbN D& R-mteNC? fi.P Pool '. DvPAPy /wi1;P-p-b v 516- ,'I LOIL`ARDI 9araenC fype we ling Building:—N f Dwelling—NO.,of Bedrooms — (/ Other—Type of Building No.of persons Other fixtures re.Mon. = Lot Size _Sq-feet Garbage Grinder ( 410 Showers ( ). Cafeteria ( ) /x%/ pd Calculated design flow�_ gpd Design flow provided_ —gpd Design Flow (min. equn d) Revision Date D S Number of sheets Plan: Date - B� Q .3® _ �d �Q.- Title /VLUr V �"+s°' � �.'-"""_�-- soil Evaluator Description of Form Date of Evaluation ."--'�`f y f Soil Evaluator ili�.�— Dv 9 Soil Evaluator Form No.— Name o .of va 0- .7 - DESCRIPTION OF REPAIRS OR ALTERATIONS_ µn o.'as_ � a ra4. �V d-y- �� The undersigned agrees to install the above described Individual Sewage Disposal System in accordance with the provisions of TITLE 5 and further agrees not to place the system in operation until a Certificate of Compliance has I �d l th Board of Health. �y( TQ iG !(�V�1�GF Datif S. D:, INZ. Signed Inspections_ FORM 1 - APPLICATION FOR DSCP DEP APPROVED FORM 5/96 z- - o Leaching trenches, nominal 32 ft. long each. m N co u m a a a o W W W a a < a 0 cc cc ce re D CC> DC CC CC 3 Lal U.1 U1 LU z CD z CC Distribution Box o 3 N y m 13' • Existing Septic tank D d - , M 94. z M n IN I ° lik" tiGI Planned addition: 1 bedroom •Ill Existing House Outline DI i A N CL Di Note: No known drinking water sources within 100 foot radius. NORTH d a t . .. ... ._ I Owner: 1 .3r LLW.% 1 T Tens .T..'.I... .Tn ..... A 'Date: L1v1vLUJ1 U' uxL.• Existing Septic System 10/29/05 Arielle & Tricia Walker .�/- utooksta ° Thomas S. Leue R.S. a 30 Brinson Drive tz 1664 Cape St. " Scale: 1 : 20' Revision Date: Florence, MA 01062 / ' '\+� 6'fi�F` wiili I 1 F 01096 Except as Noted "'heir ey T7 selam • 2127/a& Sheet 7Qont(.arzvfitorzx, 1164 01060 7d. 413-517-1214 lax 413-517-1221 Title VCertification of Compliance TO BE FILLED OUT BY THE SYSTEM INSTALLER INSTALLER SIGN-OFF Pursuant to 310.CMR 15.00 of the State Environmental Code: Title V,Minimum Requirements for the Subsurface Disposal of Sanitary Sewage,Section 15.021 (3),the Installer of a system is required to sign this form as a condition for issuance of a Board of Health Certificate of Compliance for the onsite septic system. This is to certify that the onsite sewage disposal system that I installed as: new construction L/ repair(existing system) at SO S.5'USSi iOQ (Address) 011 L2AP(E VOr- (Dare) DWCP number has been constructed in compliance with 310 CMR 15.00, and all local requirements.Any changes to the oricinal approved plans have been reflected on an as-built plan that has been submitted to the Board of Health. 6 7 F ex./Ca/ % r/c(�r..:i AN OioG 1 (Print Installer's name) (Street.City,and Zip Cale) dA (enamre) NOTE:This certification represents no warranty,expressed or implied as to the functioning or lonee ty of the on-site subsurface disposal system.Rather,the plan and installation are in compliance with all applicable rules and regulations as are in effect at the time of plan submittal. AL No. a00c. yZ THE COMMONWEALTH OF MASSACHUSETTS ,, ''FEEoo�-OD OL /}'i' ,lrna.(y7lt'1 BOARD OF HEALTH f�'4�elga eSa DISPOSAL SYSTEM CONSTRUCTION PERMIT Permission is hereby granted to Construct ( ) R-pair Upgrade ( ) Abandon ( ) an individual sewage disposal system at 30 L , ; . ;., S. — ! W � as described in the application for Disposal System Construction Permit No. 26115=q Z -dared /2/oe/os • Provided: Construction shall be completed within three years of the date of this permit.All local conditions must be met. Date 1r2/ 0ol 06 Board of Health LIZ p "�� ('_ /I/nt FORM 2 - DSCP DEP APPROVED FORM 5/96 yA„_} late� -cony) V J&. �CJJJr_�_-rr. y� Vutdue FORM 1255 i REV 5/961 H& HOnn56 WARREN'4 PUBLISHERS -BOSTON City of Northampton BOARD OF HEALTH ad a3'WO Ernest J.Mathieu,R.S.,M.S.,C.H.O. Dlreetor of Public Health 212 Main St Registered Sanitarian Northampton,MA 01060 MA Reg.#S51 Tel.(413)587-1213 Certified Health Officer Fax 1/413)587-1221 MA Reg.X325 e-mail: ernailueu@northarnotonma.gov HATFIELD EQUIPMENT CO. , INC. Mr. Dave Dombrowski 30 Brisson Drive Northampton,Massachusetts 01060 RE: Septic Dear Dave: SITEWORK CONTRACTOR 327 WEST STREET NORTH HATFIELD, MASSACHUSETTS 01066 (413)247-5711 FAX(413) 247-3305 January 9,1998 Thank you for the opportunity to offer this proposal to supply all necessary labor, equipment and materials to perform the following work The complete scope of the work to be performed by HATFIELD EQUIPMENT CO., INC. shall be: Repair septic system as required in plan designed by P B Hatch,Dated August 1997 . Repair septic system according to plan with 2 exceptions: 1)Completely remove drywell and back fill with clean material. 2)Extend the 4 leach trenches 10 feet towards building for 30 feet each leach trench. We are pleased to quote the sum of. $6,810.00 (Six thousand Eight Hundred Ten 00/00 Dollars.) Terms of the contract are: The work shall be invoiced upon completion of the work with Net due and payable within 10 days —no discounts or retainages allowed. This proposal may be withdrawn by HATFIELD EQUIPMENT CO., INC.if not accepted within thirty(30)days. ACCEPTED: SUBMI 1 1 ED: Pj7 , P, Dave Dombrowski Charles J. berlein Jr. Vice President HATFIELD EQUIPMENT CO.,INC. Dated: Dated: join Luz/ 1 NO? ) Qri4rJ 5-0, Ay. p-�.6 ca -41" - i'a L-�'A" Pb s;D-K p)AT"f& /✓A9 /3ec J f ed'J 441 % °'zir' - 9,L "' (vi/p ,Jp, 61 99