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44-014 (15) RECEIVED AUG - 4 2020 The Commonwealth of MassadhuseR;PT.OF SUILDINC INSPEC TIONS NORTHAMPTON.t11A 01 60' �0. + Board of Building Regulations and Salminrds------ �., Massachusetts State Building Code,780 CMR MUNICIPALITY Building Permit Application To Construct,Repair,Renovate Or Demolish a Revised May-2011 One-or Two-Fandly Dwelling This Section For Official Use Only Building Permit Number:(V— oZI1=8" Date Applied: Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property ddrgss: 1: Assessors Map&P cel Numbers f 2S ©11 W ti�c�n ed, �1or�t�C� e a' e p i�s1 �`7 U� LI a Is this an accepted street?yes ✓ no Map Number Parcel Number 1.3 Zoning Information: 1.4 PropeDimensions: lies dr, e 'al 22if 933!36 Cllds>er�a� �2 Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public W� Private C3 , Zone: _ Outside Flood Zone? Municipal 13On site disposal system Ila/ Check if yes❑ SECTION 2: PROPERTY OWNERSIiIP1 2.1 Owner'of Record: AIA R_S�s �t BcS��,t l. Macrae rlar2ncc c�lc Name(Print) City,State,ZIP Si 40Icr&t- OC b8113 5592 .eb�adt�e�l� mom,: No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction-0 Existing Building❑ Owner-Occupied ❑ `Repairs(s) ❑ Alteration(s) ❑ Addition ❑ Demolition IV Accessory Bldg.❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work': ''n SECTION 4:ESTIMATED CONSTRUCTION COSTS Estimated Costs: Item Labor and Materials) Official Use Only 1.Building S 1. Building Permit Fee:S Indicate how fee is determined: 2.Electrical $ ❑Standard City/Town Application Fee ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing S 2. Other Fees: S 4.Mechanical (HVAC) S List: 5.Mechanical (Fire $ Suppression) Total All Fees: rn eck No Check Amount Cash Amount: 6.Total Project C $ aid in Full ❑Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) License Number Expiration Date Name of CSL Holder List CSL Type(see below) No.and Street Type Description U Unrestricted(Buildings up to 35,000 cu.ft.) City/Town,State,ZIP R Restricted 1&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding SF Solid FueLBuming Appliances I Insulation Telephone Emai'.address D Demolition 5.2 Registered Home Improvement Contractor(HIC) tHC Registration Number Expiration Date HIC Company Name or HIC Registrant Name No.and Street Email address City/Town,State,ZIP Telephone SECTION 6: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...........0 SECTION 7a:ONNrNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES 1FOR BUILDING PERMIT r I,as Owner of the subject property,hereby authorize -P W ��2 r) "1-U3 n to act on my behalf,in all matters relative to work authorized by this building permit application. Print Owner's Name(Electronic Signature) I Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understandings. Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(RIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can he found at www.mass.aov/oca Information on the Construction Supervisor License can be found at www.mass.aov/dos 2. When substantial work is planned,provide the information below: Total floor area(sq.fr.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"maybe substituted for"Total Project Cost" I City of Northampton Massachusetts If tom. CI: i� ^ DEPARTMENT OF BIDING INSPECTIONS x 212 Main Street • Municipal Building ,e Northampton, MA 01060 HOMEOWNERS'EXEMPTION ELIGIBILITY AFFIDAVIT / .(insert ficll legal name), born _ (insert month, day,year),hereby depose and state the following: 1. I am seeking a building permit pursuant to the homeowners'exemption to the permit requirements of the Massachusetts State Building Code, codified at 780 CMR 110.85.1.3.1, in connection with a project or work on a parcel of land to which I hold legal title. 2. I am not engaged in, and the project or work for which I am seeking the aforementioned homeowners'. exemption, does not involve the field erection of manufactured buildings constructed in accordance with 780 CMR 110.83. 3. I qualifij under the State Building Code's definition of"homeowner"as defined at 780 CMR 110.R5.1.2: Persons) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one-or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a home owner. 4. I do not hold a valid Massachusetts const7vction supervision license and, except to the extent that I quaiijij for and will abide by the Massachusetts State Building Code's requirements for the supervision of the project or work on my parcel, I am not engaged in construction supervision in connection with any project or work involving construction, reconstruction, alteration, repair, removal or demolition involving any activity regulated by any provision of the Massachusetts State Building Code. 5. I I engage an other person or personsfor hire in connection with the aforementioned project or work on Ify p p f f 1n"1 my parcel, I acknowledge that I ant required to and will act as the supervisor far said project or work. Signed under the pains and penalties of perjury on this day of 20 (Signature) i The Commonwealth of Massachusetts Department oflndustrialAccidents V, I Congress Street,Suite 100 Boston,MA 02X14-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print LcQibly Name(Business/Organizatio "id nG S�s C-)n 4. tq Address: S l D r 1vE. City/State/Zip: �rence— �� �I��n2 Phone#: 1-78 qCA 56-97— Arc you an employer?Check the appropriate box: Type of project(required): LQ 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 forme in 8. Remodeling any capacity.[No workers'comp.insurance required.) 9. -Demolition 3.01 am a homeowner doing all work myself.[No workers'comp,insurance required.]t 10 Q Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work an my property. I will ensure that all contractors either have workers'compensation insurance or are sole I LE]Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.❑1 am a general contractor and 1 have hired the sub-contractors listed on the attached sheet 13.❑ROof repairs These sub-contractors have employees and have workers'comp.insurance,t 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.Q Other 152,§1(4),and we have no employees.[No workers'comp_insurance required.) Any applicant that checks box YI 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-coutractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. Yarn an employer that is providing workers'coniperrsation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under 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 under thepains andpenalties ofperjury that the information provided above is true and correct Signature: Date: Phonc#: 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#: i The City of Northampton }r Building Department 212 Main Street Northampton,Massachusetts 01060 Phone(413) 5�9=2#62 Fax (413) 529-1433 CONSTRUCTION DEBRIS AFFIDAVIT (FOR ALL DEMOLITION AND RENOVATION PROJECTS) In accordance with the provisions of MGL c40, s54, a condition of Building Permit Number is that all debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c 111, S 150A. The debris will be disposed of in: Location of Facility_ The debris will be transported by: Name of Hauler_ _ �� � i l _ _ _ _ _ _ _ _ _ _ _ _ _ _ Signature of Applicant:__ LyJ __ ___ _DateAC � 1 CITY OF NORTHAMPTON SETBACK PLAN MAP:_ _ LOT:_ _ LOT SIZE: REAR LOT DIMENSION REAR PARD • n 4Jfa��� • ' zpP�-.�.d by �� SIDE YARD SIDE PARD I FRONT:SETBACK_ _ d FRONTAGE_-,_,___ I On Jul 17, 2020, at 8:29 AM, DUFFY-WILLARD PAVING EXCV <duffywi I lard @ comcast.net> wrote: Good,Morning Eric, The proof of insurance and facility hauling debris to are no problem. We will haul the debris ourselves using our own trucks. We do not hold a Construction Supervisors License as it is not required for our line of work, I believe that is why as the homeowner you can apply for the demo permit yourself. I can have our insurance company send you a Certificate of Insurance which you can add to the permit. We will be hauling to Valley Recycling on Easthampton Road, Northampton. I do not know if you have to list both buildings separately. You might list it as "Remove clubhouse and locker room facilities" I'll have our insurance Co. email you our policies today. Tom Duffy Willard Paving & Excavating (P) (413) 586-1477 (F) (413) 586-9210 duffywiIlard@comcast.net On 07/17/2020 2: 2 AM Ericsson Broadbent <ebroadbent @ mac.com> wrote: Hi Tom, from whall I can tell, the regular building permit is the right form to use for a demolition: http://northamptonma.gov/DocumentCenter/View/220/Building-Permit--- One-and-Two-Fa ily-Homes-PDF The form requires a bit of info that you or someone at D&W would provide - such as license, c nfirmation of Worker's Comp Insurance, facility where debris will be taken and how hauled, etc. Once we get rolling you can let me know how best to coordinate this - e.g. I can fill in as much as I know and hand it over to you, or vice versa - whatever works best. Also, do you know if we need a permit for each building, or is this something I shout ask Carolyn Misch? Thanks for allour! help, Y P -Eric DATE(MMIDDIYYYY) AC" CERTIFICATE OF LIABILITY INSURANCE 07/22/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must 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 NAME: Christina Barrett Aquadro&Associates PHONE (413)586-7373 A/c No): (413)584-0859 A1C No Ext 355 Bridge St.,P.O Box 357 E-MAIL christina@aquadroinsurance com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Northampton MA 01061INSURER A Travelers Indemnity Co, 25658 INSUREDINSURER BL A. M Mutual Insurance Companies AIM001 Duffy Willard Paving&Excavating Inc. INSURER C Duffy Willard Trucking LLC INSURER D: Po BOX 60137 INSURER E Florence MA 01062 INSURER F COVERAGES CERTIFICATE NUMBER: CL18122709674 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 MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR POLICY EFF P LI Y EXP LIMITS LTR TYPE OF INSURANCE IN POLICY NUMBER MM/DD/YYYY MM/DD/YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A 300,000 CLAIMS-MADE � OCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ 5,000 A 680OJ976472 03/17/2020 03/17/2021 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER'. PRO- LOC PRODUCTS-COMPlOPAGG $ 2,000,000 X POLICY JECT � $ OTHER COMBINED SINGLE LIMIT $ 1,000,000 AUTOMOBILE LIABILITY Ea accident ANY AUTO BODILY INJURY(Per person) $ A OWNED X SCHEDULED I BA2D347138 08/01/2019 08/01/2020 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS PROPERTY DAMAGE HIRED NON-OWNED Per accident $ X AUTOS ONLY X AUTOS ONLY $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ $ DED RETENTION$ PER OTH- WORKERS COMPENSATION I STATUTE I J ER AND EMPLOYERS'LIABILITY YIN 1,000,000 ANY PROPRIETORIPARTNER/EXECUTIVE ❑ NIA VVMZ-800-8006793-2020 03/1712020 03/17/2021 E L EACH ACCIDENT $ B OFFICER/MEMBEREXCLUDED9 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 (Mandatory in NH) If yes,describe under E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I 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 ACCORDANCE WITH THE POLICY PROVISIONS. ERICSSON BROADBENT AUTHORIZED REPRESENTI".VE1 ©1988-2015 ACORD CORPORATION- All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Green Environmental Consulting, Inc 180 Pleasant Street, Suite 213 tel/fax 413-341-3418 Easthampton, MA 01027 www.GecEnviro.com July 23, 2020 Matt Murphy Western Mass Environmental, LLC 93 Wayside Avenue West Springfield, MA 01089 RE: Pre-Demolition Afibestos Survey 254 Old Wilson Road (Club House and Locker Room Building) Florence, Massachusetts 01062 Dear Mr. Murphy: Pursuant to your reque t, Green Environmental Consulting, Inc (GEC) performed a pre-demolition asbestos survey of the cl b house and locker room building at the above-referenced former golf course. Fieldwork associated with the project was performed on July 8, 2020 by Massachusetts-licensed Asbestos Inspector, David Abad (Lic.#A1071927). The purpose of GEC's survey was to identify asbestos-containing materials (ACMs) prior to the planned demolition of the buildings. In accordance with state and federal asbestos regulations, identified ACMs are required to be removed prior to any demolition/renovation activities. Asbestos Sampling/Results Thirty-one (31) samples of suspect asbestos-containing materials (ACMs) were collected and submitted to an accredited laboratory for analysis using Polarized Light Microscopy with Dispersion Staining (PLM/ DS). Materials determined to contain one percent or greater asbestos are considered to be ACMs. Materials determined to contain trace or less than one-percent (<1%) asbestos are considered to be asbestos-containing waste materials(ACWMs). The following materials were determined to be asbestos-containing materials(ACMs): Estimated • Quantiity .- Joint Compound I Club House - Bar Area ( 2586 Sq. Ft. I 02874 - 02A&02B t I i Pre-demolition Asbestos Survey 254 Old Wilson Road, Northampton, MA (Club House and Locker Room Building) The following materials were sampled and determined to be asbestos-containing waste materials (ACWM's): Table No. .- Location Estimated Reference Sample Quantiity .- Exterior Window Glazing Club House - Front of Building in Bar (Old Double Hung Area, Storage Room, Kitchen and 8 Each 02874 - 15A &15B Windows) Bathroom The following materials were sampled and determined not to be asbestos-containing materials(less than one-percent asbestos): Table Reference� Location Number(s) Club House- Bar Area, Kitchen, Ladies 02874 - 01A&018 Room and Men's Room Black Rubberized Floor and Club House- Bar Area, Ladies Room, 02874- 03A, 03B, 04A& associated Mastic Men's Room and Basement 04B Bar Carpet Mastic Club House - Bar Area 02874- 05A White w/ Brown Ceiling Formica Club House - Kitchen 02874- 06A (Yellow Mastic) White w/Brown Ceiling Formica Club House - Kitchen 02874 - 07A (Brown Mastic) Sub-Floor Paper Club House - Kitchen 02874 - 08A (Black) Sub-Floor Paper Club House - Kitchen 02874 - 09A (Tan) Sub-Siding Paper(Black) Club House- Exterior 02874 -10A&10B Roof Paper (Porch Side) Club House- Exterior 02874 -11A&11B Roof Shingle Club House- Exterior 02874 - 12A&12B (Porch Side - Architectual) Roof Paper(Front Side) Club House- Exterior 02874 -13A&13B Roof Shingle (Front Side- 3 Tab) Club House- Exterior 02874 - 14A &14B Picture Window Glazing (Windows w/Roll out Sides) Club House- Exterior 02874 - 16A & 16B Exterior Window Glazing Club House- Exterior 02874 - 17A (Roll out Windows) Page 2 of 4 Pre-demolition Asbestos Survey 254 Old Wilson Road, Northampton, MA (Club House and Locker Room Building) • • AReference Sample Location •- I I II Num.- Exterior Window Glazing Club House- Exterior 02874 - 18A (Verical Sliders) Roofing Shinglesl Locker Room Building 02874-19A&19B Refer to Attachment No. 1 for laboratory results, including detailed descriptions of sampling locations, as well as chain-of custody records for samples collected. Samples were collected in a statistically random manner,per EPA guidelines. Limitations This report is intended for the sole use of the Western Mass Environmental, LLC. This report is not intended to serve as a b dding document nor as a project specification and actual site conditions and quantities should be fieldverified. The scope of services performed in execution of this evaluation may not be appropriate to satisfy the needs of other users, and use or re-use of this document, the findings, conclusions, or recomme dations herein is at the risk of said user. Although a reasonable attempt has been made to locate suspect ACMs in the areas identified, the inspection techniques used are inherently limited in the sense that only full demolition procedures will reveal all building materials of a structure and, therefore, all areas of potential ACM. Caution should be used during renovation/demolition activities. GEC's inspection did not include the following areas: • Electrical syste s and/or components (due to safety issues inherent with sampling such systems). The Massachusetts Depa tment of Environmental Protection (DEP), as well as the U.S. Environmental Protection Agency (EPA) currently recognize Polarized Light Microscopy (PLM) analysis as an acceptable analytical method for determining the Asbestos content in non-friable, organically bound (NOB) materials. However, comparative studies between PLM analysis and Transmission Electron Microscopy (TEM) analysis have shown that PLM analysis may yield false negative analytical results for NOB's such as floor tiles. GEC recommends that, prior to renovation activities, one sample from each homogeneous area of mastic and other non-friable organically bound (NOB) materials that originally tested negative by PLM undergo confirmatory analysis by EM, utilizing ELAP-198.4 TEM Method for Identifying and Quantifying Asbestos in NOB bulk samples. Page 3 of 4 Pre-demolition Asbestos Survey 254 Old Wilson Road, Northampton, MA (Club House and Locker Room Building) Conclusions/Recommendations Asbestos-containing materials (ACMs) were identified during GEC's survey. Identified ACMs should be removed, handled, and disposed of properly, in accordance with applicable state and federal regulations prior to disturbance. Window glazing the Club House building was determined to contain trace or less-than one-percent asbestos. Although materials that contain <1% asbestos are not by definition asbestos-containing materials, certain regulatory requirements still apply. These requirements include the Occupational Safety and Health Administration's (OSHA) employee exposure requirements and MassDEP regulations for "Asbestos-Containing Waste Material" (ACWM). ACWM is not subject to MassDEP notification requirements but is required to be managed as prescribed by 310 CMR 7.15(15)through 310 CMR 7.15(18). Planned activities involving asbestos-containing waste materials (ACWM's - Table No. 2) should be performed in accordance with the requirements of the OSHA construction standard (29 CFR 1910.1101) and current MassDEP regulations (310 CMR 7.15) including, but not limited to the following: • use of wet methods,to reduce exposure and prevent asbestos fiber migration and contamination of surfaces in the work area • Avoid dry sweeping, shoveling, or other dry clean-up methods • Use of disposable protective clothing and respiratory protection • Waste containing any amount of asbestos should be kept segregated from demolition or renovation debris or material that does not contain asbestos and must be handled, packaged, labeled and disposed of as ACWM. Solid waste that has been contaminated or mixed with material containing any amount of asbestos cannot be sent to a solid waste facility that accepts construction and demolition debris. Any suspect asbestos-containing material that is discovered during building renovation/demolition that is not included in this report should be assumed to contain asbestos until further bulk sampling and analysis is performed. If you have any questions regarding this report, please contact us at(413) 341-3418. Sincerely, Green Environmental Consulting, Inc Is n� Q A L David Abad Adam Lesko Senior Project Manager President Page 4 of 4 EMSL Analytical, Inc. EMSLOrder: 042016344 Customer ID: GECL78 200 Route 130 North Cinnaminson,NJ 08077 Customer PO: Tel/Fax:(800)220-3675/(856)786-5974 http://www.EMSL.com/cinnasblab@EMSL.com Project ID: Attention: EMSLReports@gecenviro.com Phone: (413) 341-3418 Green Environmental Consulting, Inc. Fax: (413) 341-3419 180 Pleasant St Received Date: 07/09/2020 9:50 AM 2nd Floor, Suite 213 Analysis Date: 07/10/2020-07/13/2020 Easthampton, MA 01027 Collected Date: Project: Pine Grove Golf Course-02874-Old Wilson Road, Florence, MA Test Report:Asbestos Analysis of Bulk Materials via EPA 600/R-931116 Method using Polarized Light Microscopy Non-Asbestos Asbestos Sample Description Appearance %Fibrous %Non-Fibrous %,Type 02874-01A BarArea-Sheetrock Brown/White 20%Cellulose 80%Non-fibrous(Other) None Detected Fibrous 042016344-0001 Homogeneous 02874-01 B BarArea-Sheetrock Brown/White 15%Cellulose 85%Non-fibrous(Other) None Detected Fibrous 042016344-0002 Homogeneous 02874-02A BarArea-Joint White 100%Non-fibrous(Other) None Detected Compound Non-Fibrous 042016344-0003 Homogeneous 02874-02B-Joint Bar Area-Joint White 100%Non-fibrous(Other) None Detected Compound Compound Non-Fibrous Homogeneous 042016344-0004 02874-026-Joint BarArea-Joint Tan 98%Non-fibrous(Other) 2%Chrysotile Compound 2 Compound Non-Fibrous Homogeneous 042016344-0004A 02874-03A BarArea-Black Various/Black 100%Non-fibrous(Other) None Detected Rubberized Flooring Non-Fibrous 042016344-0005 Homogeneous 02874-03B BarArea-Black Various/Black 100%Non-fibrous(Other) None Detected Rubberized Flooring Non-Fibrous 042016344-0006 Homogeneous 02874-04A BarArea-Black Yellow 100%Non-fibrous(Other) None Detected Rubberized Flooring Non-Fibrous 042016344-0007 Mastic Homogeneous 02874-04B BarArea-Black Yellow 100%Non-fibrous(Other) None Detected Rubberized Flooring Non-Fibrous 042016344-0006 Mastic Homogeneous 02874-05A BarArea-Bar Carpet Yellow 100%Non-fibrous(Other) None Detected Mastic Non-Fibrous 042016344-0009 Homogeneous 02874-06A Kitchen-White Tan 100%Non-fibrous(Other) None Detected w/Brown Ceiling Non-Fibrous 042016344-0010 Formica Mastic- Homogeneous Yellow 02874-07A Kitchen-White Yellow 100%Non-fibrous(Other) None Detected w/Brown Ceiling Non-Fibrous 042016344-0011 Formica Mastic- Homogeneous Brown 02874-08A Basement-New Black 65%Cellulose 35%Non-fibrous(Other) None Detected Front Section- Fibrous 042016344-0012 Sub-floor Paper- Homogeneous Black 02874-09A Basement-Original Black 80%Cellulose 20%Non-fibrous(Other) None Detected Section-Sub-floor Fibrous 042016344-0013 Paper-Tan Homogeneous Initial report from:07/14/2020 07:55:52 ASB-PLM-0008-0001-1.78 Printed:7/14/2020 7:55 AM Page 1 of 3 EMSL Analytical, Inc. EMSL Order: 042016344 Customer ID: GECL78 200 Route 130 North Cinnaminson,NJ 08077 Customer PO: Tel/Fax:(800)220-3675/(856)786-5974 http://www.EMSL.com/cinnasblab@EMSL.com Project ID: Test Report:Asbestos Analysis of Bulk Materials via EPA 600/R-93/116 Method using Polarized Light Microscopy Non-Asbestos Asbestos Sample Description Appearance %Fibrous %Non-Fibrous %Type 02874-10A Exterior-Sub-siding Black 40%Cellulose 60%Non-fibrous(Other) None Detected Paper-Black Non-Fibrous 042016344-0014 Homogeneous 02874-10B Exterior-Sub-siding Black 40%Cellulose 50%Non-fibrous(Other) None Detected Paper-Black Fibrous 10%Glass 042016344-0015 Homogeneous 02874-11A Exterior-Roof Paper Black 5%Glass 95%Non-fibrous(Other) None Detected -Porch Side Non-Fibrous 042016344-0016 Homogeneous 02874-11 B Exterior-Roof Paper Gray/Black 100%Non-fibrous(Other) None Detected -Porch Side Non-Fibrous 042016344-0017 Homogeneous 02874-12A Exterior-Architectual Black 20%Cellulose 75%Non-fibrous(Other) None Detected Roofin Shingles- Non-Fibrous 5%Glass 042016344-0018 Porch Side Homogeneous 02874-12B Exterior-Architectual Gray/Black 10%Cellulose 75%Non-fibrous(Other) None Detected Roofin Shingles- Fibrous 15%Glass 042016344-0019 Porch Side Homogeneous 02874-13A Exterior-Roof Paper Black 100%Non-fibrous(Other) None Detected -Front Side Non-Fibrous 042016344-0020 Homogeneous 02874-13B Exterior-Roof Paper Black 100%Non-fibrous(Other) None Detected -Front Side Non-Fibrous 042016344-0021 Homogeneous 02874-14A Exterior-Front Side- Black 20%Glass 80%Non-fibrous(Other) None Detected Roof Shingle-3 Tab Non-Fibrous 042016344-0022 Homogeneous 02874-14B Exterior-Front Side- Black 15%Glass 85%Non-fibrous(Other) None Detected Roof Shingle-3 Tab Fibrous 042016344-0023 Homogeneous 02874-15A Exterior-Old Double White/Red 2%Fibrous(Other) 98%Non-fibrous(Other) <1%Chrysotile Hung-Front of Non-Fibrous 042016344-0024 Building-Kitchen- Homogeneous Bathrooms-Exterior Window Glazing 02874-15B Exterior-Old Double Gray 100%Non-fibrous(Other) <1%Chrysotile Hung-Front of Non-Fibrous 042016344-0025 Building-Kitchen- Homogeneous Bathrooms-Exterior Window Glazing 02874-16A Exterior-Picture Gray 100%Non-fibrous(Other) None Detected Window Glazing-Roll Non-Fibrous 042016344-0026 Out on Side Homogeneous 02874-16B Exterior-Picture Gray 100%Non-fibrous(Other) None Detected Window Glazing-Roll Non-Fibrous 042016344-0027 Out on Side Homogeneous 02874-17A Exterior-Exterior Black 15%Cellulose 75%Non-fibrous(Other) None Detected Window Glazing-Roll Fibrous 10%Glass 042016344-0028 Outs Homogeneous 02874-18A Exterior-Exterior Gray 40%Cellulose 60%Non-fibrous(Other) None Detected Window Glazing- Fibrous 042016344-0029 Vertical Sliders Homogeneous 02874-19A Exterior-Locker Black 15%Cellulose 75%Non-fibrous(Other) None Detected Room Building-Roof Fibrous 10%Glass 042016344-0030 Shingle Homogeneous 02874-19B Exterior-Locker Black 15%Cellulose 75%Non-fibrous(Other) None Detected Room Building-Roof Fibrous 10%Glass 042016344-0031 Shingle Homogeneous Initial report from:07/14/2020 07:55:52 ASB—PLM-0008-0001-1.78 Printed:7/14/2020 7:55 AM Page 2 of 3 EMSL Analytical, Inc. EMSL Order: 042016344 Customer ID: GECL78 200 Route 130 North Cinnaminson,NJ 08077 Customer PO: Tel/Fax:(800)220-3675/(856)786-5974 http:/&vww.EMSL.com/cinnasblab@EMSL.com Project ID: Analyst(s) Andrew Coward(11) Samantha Rundstrom, Laboratory Manager Mark Shuts(9) or Other Approved Signatory Nancy Stater(2) O/ufunke Akintunde(10) EMSL maintains liability limited to cost of analysis. The above analyses were performed in general compliance with Appendix E to Subpart E of 40 CFR(previously EPA 600/M4-82-020"Interim Method"),but augmented with procedures outlined in the 1993("final')version of the method.This report relates only to the samples reported above,and may not be reproduced,except in full,without written approval by EMSL. EMSL bears no responsibility for sample collection activities or analytical method limitations. Interpretation and use of test results are the responsibility of the client. All samples received in acceptable condition unless otherwise noted.This report must not be used by the client to claim product certification,approval,or endorsement by NVLAP, NIST or any agency of the federal government. EMSL recommends gravimetric reduction for all non-friable organically bound materials prior to analysis. Estimation of uncertainty is available on request. Samples analyzed by EMSLAnalylical,Inc.Cinnaminson,NJ NVLAP Lab Code 101048-0,AIHA-LAP,LLC-IHLAP Lab 100194,NYS ELAP 10872,NJ DEP 03036,PA ID#68-00367,LA#04127 Initial report from:07/14/2020 07:55:52 ASB-PLM-0008_0001-1.78 Printed:7/14/2020 7:55 AM Page 3 of 3 OrderID: 042016344 �(� 6'U 1(o Lj{,� �J Page 1 of 3 nalysis Type: Asbestos Chain of Custody PLM Record Turnaround Time: 96-Hour Green Environmental Consulting, Inc 180 Pleasant Street-Suite 213 Easthampton, MA 01027 Project info: Phone/Fax (413)341-3418 Send Results To: Project Name: Results to: Pine Grove Golf Course emslreports@gecenviro.com rroject Number: Invoice to: 02874 mary@gecenviro.com Project Address: Comments Special Instructions: Old Wilson Rd. Florence, MA Sample Number Sample Location Sample Description 02874-DIA Bar Area Sheetrock 02874-01B Bar Area Sheetrock 02874-02A Bar Area Joint Compound 02874-02B Bar Area Joint Compound 02874-03A Bar Area Black Rubberized Flooring 02874-03B Bar Area Black Rubberized Flooring 02874-04A Bar Area Black Rubberized Flooring Mastic 02874-04B Bar Area Black Rubberized Flooring Mastic 02874-05A Bar Area Bar Carpet Mastic 02874-06A Kitchen White w/Brown Ceiling Formica Mastic (Brown) 02874-07A Kitchen White w/Brown Ceiling Formica Mastic (Yellow) 02874-08A Baseement - New Front Section Sub-Floor Paper(Black) Se; '� C� OrderID: 042016344 UL-1 KS I b -) L4 tj Page 2 of 3 Analysis Type: Asbestos Chain of Custody ; �� PLM Record Turnaround Time: 96-Hour Green Environmental Consulting, Inc 180 Pleasant Street-Suite 213 Easthampton, MA 01027 Project Info: Phone/Fax (413)341-3418 Send Results To: Project Name: Results to: Pine Grove Golf Course emslreports@gecenviro.com Iroject Number: Invoice to: 02874 mary@gecenviro.com Project Address: Comments Special Instructions: Old Wilson Rd. Florence, MA Sample Number Sample Location Sample Description 02874-09A Baseement - Original Section Sub-Floor Paper(Tan) 02874-i0A Exterior _T Sub-Siding Paper(Black) 02874-10B Exterior _T Sub-Siding Paper(Black) 02874-11A Exterior Roof Paper(Porch Side) 02874-11B Exterior Roof Paper(Porch Side) L02874-12A Exterior Architectual Roof Shingles (Porch Side) 02874-12B Exterior Architectual Roof Shingles (Porch Side) 02874-13A Exterior Roof Paper(Front Side) 02874-133 Exterior _T Roof Paper(Front Side) 02874-14A Exterior - Front Side Roof Shingle (3 Tab) 02874-148 Exterior- Front Side Roof Shingle (3 Tab) 02874-15A Exterior- Old Double Hung - Front of Exterior Window Glazing Bldg, Kitchen, Bathrooms sy 7r�rol�l r ! f,OS�.I OrderID: 042016344 U �t,{"I Page 3 of 3 fz� � Asbestos Chain of Custody 1 Analysis Type: PLM Record Turnaround Time: 96-Hour Green Environmental Consulting, Inc' 180 Pleasant Street-Suite 213 Easthampton, MA 01027 Project Into: Phone/Fax(413)341-3418 Send Results To: Project Name: Results to: Pine Grove Golf Course emslreports@gecenviro.com rroject Number: Invoice to: 02874 mary@gecenviro.com Project Address: Comments Special Instructions: Old Wilson Rd. Florence, MA Sample Number Sample Location Sample Description 02874-1SB Exterior - Old Double Hung - Front of Exterior Window Glazing Bldg, Kitchen, Bathrooms 02874-16A Exterior _T Picture Window Glazing (Roll Out on Side) 02874-168 Exterior Picture Window Glazing (Roll Out on Side) 02874-17A Exterior Exterior Window Glazing (Roll Outs) 02874-ISA Exterior Exterior Window Glazing (Vertical Sliders) 02874-19A Exterior - Locker Room Bldg _T Roof Shingle 02874-19A Exterior- Locker Room Bldg Roof Shingle Sampled By: Date: Received By: R quished By: Date/Time: Received in Lab By: Grate/Tify'j : _7/3/2 �n2ry / The rY1 J Berkshire Open Space fe'�1\) Design \ 'r -q-6A�N /-z O Group,Inc. as 5)9'10'X•[ axnvure.vwvnmgµ.wnrnuurv0lmo TOWktI $ I Nt315u.raw Nl3l sez-)m5 I m)5 w 3,0 � S,O\ IAS I 2WB 6)Sa.ft `1 `G 2 I .tmrcni Lob I — ----- i°w ,Nna Pa xro^°X I numeW �` ffitd EUnwent 5 \ �. rmwa )9 IIYLat' )a Yx uam. N°) —3)3a' war uv o""3 Iw 3e mroaar. 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P DRIVEWAY EXISTING GRAVEL AREA TO BE REMOVED.ANY j INFRASTRUCTURE DISCOVERED i REMOVE CATCH BASIN O TO BE LOAMED&SEEDED AFTER TRANSFER OF LAND AND INSTALL CULVERT SEE SHEET C.4 SHALL BE DISCONNECTED BY I AND LEVEL SPREADERTHE OWNER. i' NEV,TREE PLANTINGS SEE PLANTING PLAN SHEET C4 I -- I EXISTING CELL TOWER --- —' NEW DRYWELL,TYP OF &GRAVEL SS DRIVE TO REACCEMAIN NEW CULVERT AND LEVEL SPREADER \ LOT3 ',�, SPECIAL PERMIT APPLICATION FOR - y FLAG LOT&CLUSTER LIMIT OF CLEARING I (Appy— acre) ------ t LOTS 1 I I \ I lOT4 Site Plan c ZONINGTABLE - - -- -- 4 Offm W, 01 awl aw 11 C.3 me .. lb _.� CIS C)'78 ")O(v Y592- Eric Broadbent 2bfuaUb�.n+ Cu, mac. toyn Ljello Spoke t iff ./cc, I=ia�d �bo A apP< end ,�(� 1 ► a-C Land cer4, -of h"YrLa Jas' 2xew r m a f jav,-f ha-2'n-,4 tip p6r�, �k -6:- Uo ` Aa.o tis i�� MUC - Ill ea�a let we } e tai VRVI-I