44-137 BP-2023-1183
253 OLD WILSON RD COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
44-137-001 CITY OF NORTHAMPTON
Permit: New Build
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit # BP-2023-1183 PERMISSION IS HEREBY GRANTED TO:
Project# NEW HOUSE 2023 Contractor: License:
Est. Cost: 340000 CHARLES AMO
Const.Class: Exp.Date:
Use Group: Owner: W EWING JOHN
Lot Size (sq.ft.)
Zoning: SR Applicant: CHARLES AMO
Applicant Address Phone: Insurance:
P O BOX 716 (413)695-3500
GOSHEN, MA 01032
ISSUED ON: 09/12/2023
TO PERFORM THE FOLLOWING WORK:
NEW 26X36 HOUSE
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter: Footings:
Rough: Rough: House# Foundation:
Final: Final: Final: Rough Frame:
Gas: Fire Department Driveway Final: Fireplace/Chimney:
Rough: Oil: Insulation:
Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature: °
n
1A /
,G11,� II
Fees Paid: $862.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Office of the Building Commissioner
'iiCEIVED
IL, The Commonwealth of Massachuse s 1If
Board of Building Regulations and Sta •.r• FO c
�{i Massachusetts State Building Code, 78,1 CT bF czm� ICI° • LITY
,lvc�r�rNa,. A4'..f:YA ii BjtiONs U$
Building Permit Application To Construct,Repair,Renovate Oi-De s !,wiii.=r ar 2011
One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: n?P- - 3 - II i3 Date Appli-/•
(6,1
Building1L .,g \it Official(Print Name) Signature q D to
v �
SECTION 1:SITE INFORMATION
1.1 zPropertysCD r 's ` (c d� ^ A� 1.2 Assessors Map&Parcel Numbers 7
1.1 a Is this an accepted street?yes X u jnnoo Map Number Parcel Number
1.3 Zoning Information: 1.4'zery Dimensions: J 7S-
ci
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 S— ISSI. 22dia, l etS
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public a Private 0 Zone: Outside Flood Zone? Municipal 0 On site disposal system Ilg,
Check if yes❑
SECTION 2: PROPERTY OWNERSHIP'
AWL Owner'of Rec d a 1
_.. 0 11 e.J w ( V /'464 G CO 6 C�
Name(Print) City,State,ZIP
C) 1dL9 ( I ?3 ti?-d-- ct«-E, s- Crw(c L& l( su C (20'4-
No.No.and Street Telephone Email Address . N e r-
SECTION 3: DESCRIPTION OF PROPOSED WORK2(check all that apply)
New Construction It Existing Building❑ Owner-Occupied l\ Repairs(s) 0 Alteration(s) 0 Addition 0
Demolition ❑ Accessory Bldg. ❑ Number of Units t Other 0 Specify:
Brief Description of Proposed Work2: v���� � 2��- ��(kr.
�'ws{Pa c1 v� Z 6K ECo CO,b?f S+�(l.:z 2(-4 cAA-A .
w'A 1 c OUT` l3 f4i.,2 (,tit i'ct—L . 14_/S{t4 (( 5 P p 4 t S_( S f, .
SECTION 4:ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: Official Use Only
(Labor and Materials)
1. Building $ Z'l at,C O 1. Building Permit Fee: $ Indicate how fee is determined:
El Standard City/Town Application Fee
2.Electrical $ 2�1 UUt�. vV
0 Total Project Cost (Item 6)x multiplier x
3. Plumbing $ I Ce10C� d•U 2. Other Fees: $
4. Mechanical (HVAC) $ 2 !J, 100.00 List:
5.Mechanical (Fire / o a;
Suppression) $ 14(/n Total All Fees: $ Q G0i1
Check No. 164 Check Amount: Cash Amount:
6.Total Project Cost: $ 3,-0 oco.00 tll,Paid in Full 0 Outstanding Balance Due:
SECTION 5: CONSTRUCTION SERVICES
5.1 Construction Supervisor License(CSL)
Ch IA n.- c License Number Ex iratio Date
Name of CSL Holder
l 9, t List CSL Type(see below) 0
No.and Street Type Description
_ U Unrestricted(Buildings up to 35,000 Cu.ft.)
d(v 3�' R Restricted 1&2 Family Dwelling
City/Town,State,ZIP M Masonry
RC Roofing Covering
WS Window and Siding
II ''-- SF Solid Fuel Burning Appliances
LiI! IJ ( (—Lb Ck ;UC-11ic C° 11Y4 14 • Insulation
Telephone Email address 1<.)LT D Demolition
5.2 Registered Home Improvement Contractor(HIC)
C1p arz(� S zs
trl UXO HIC Registration Number pir on Date
HIC Couipan`N or HIC e 'sgi tram Name t , !-
[[ \\ t I.C1�--C C(not�a6Cai(�E/iS `E4 ZGtit•
o.and Street Email address �'
No.
w\iA 0(63 2 6c 3cwtr
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:OWNER AUTHORIZATION TO BE COMPLETED WHEN
`� OWNER'S AGENT OR CONTRACTOR APPLIES FOR� BUILDING PERMIT
T /
I,as Owner of the subject property,hereby authorize OA'r 4 S I`"'t IAA-0
to act on my behalf,in all matters relative to work authorized by this building permit application.
Print Owner's Name(Electronic signature) , . to
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 understanding.
C1N44_lc,sw &)(3to
Print Owner's or Authorized Agent's Name(Electronic Signature) D
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(HIC)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 be found at
www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps
2. When substantial work is planned,provide the information below:
Total floor area(sq. ft.) (including garage,finished basement/attics,decks or porch)
Gross living area(sq. ft.) c( 3 (Q Habitable room count S' '
Number of fireplaces Q Number of bedrooms Z
Number of bathrooms j-e-(AT
Number of half/baths O
Type of heating system kU IAAP Number of decks/porches Z
Type of cooling system I4j1.e(A-(- ?V k,t Enclosed Open Z.
3. "Total Project Square Footage"may be substituted for"Total Project Cost"
CITY OF NORTHAMPTON
SETBACK PLAN
MAP: 1 i g LOT: 13
LOT SIZE: Rot 5 01
REAR LOT DIMENSION: S'OO 14--
REAR YARD I `ct -
SIDE YARD 3 5+ - SIDE YARD Zr 4
r
FRONT SETBACK
FRONTAGE / , C
City of Northampton
J-744,
.? r� Massachusetts a�'?S`� sc�`t
NI 1
�i_ DEPARTMENT OF BUILDING INSPECTIONS ;�°
ry :*-
' 212 Main Street • Municipal Building yv�ti -C��
-- � Northampton, MA 01060 .
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, 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: '(i4-L`t. Da
The debris will be transported by:
Name of Hauler: C.--VAIIktz. S Av.„4-.)
Signature of Applicant: Date:
The Commonwealth of Massachusetts
I. _: _!t Department of Industrial Accidents
lfl= r I Congress Street.Suite 100
I M_ ,s7...., Boston. M'NA 02114-2017
i .,_
.. wow mass got/dim
11 utters'Compensation Insurance ARidas it:Builders!(bntractors lHectricians/Plumbers.
It)BE FILED%1111 IDE P}RMI.111M;Al'IHORI I' '.
Applicant Information Please Print Lrtibh
Name(Business(hganmrat►onllndiwdttal): C_AAl4VL`It-S AVoke 61-4- --0-)c—
Address: I 5. L 1 l i P L - 4 g ,-, Ipit 64 4,W 3 2-
City/State/Zip:6o- PQ ._ v (A ow 3 Z Phone#: 1 —bar E-3 s'V U
Arc yen an ealpbyeal Cheek the appropriate hot:
Type of project(required):
I.Q I ant a crtak yen with employees(full a d ut parr uwrt-' 7. New construction
20 I am a sole proprietors"paama8ipard have no cup o)1 swa working for me in M. Remodeling
any capacity-(No wsekers'comp.inautance requrrcd.)
10 I am or msuce in a homeowner doing all work myself(tic workers'coop. rattquired-]
9. 0 Demolition
4.0 I am a Ir,nteutsner and will be hum!etu"ractor conduct to condu all work on my prop.Tty. I will 10 Building addition
ensure that all contrstun ditto lase workers'compensatrun insurance or arc sole II a Electrical repairs or additions
proprietors with no employees
12.0 Plumbing repairs or additions
i0 lain a stencral contractor and 1 lute hued the sub contrackrn listed un the attached skeet 134:1 Roof repairs
soh-contractorsw'these soh-contractu has':employees and hasc orlon'comp.usurance.• P
14_0 Other
6.21we an a corporation and la officers hale ctcnrised their nght ut exemption per Mt,L r. —
IS2.i kit.and we have no anployres.(No workers'cue,.insurance requital]
'Any applicant that checks box al mire also fill out the section below shwwing their workers'cnaapensabon policy information_
`Honsiowten who submit this affidavit indicating they are doing all wink and then hire outside contactors mutt submit a new affidavit rations getal
(untrue curs that chccb this bus must attached an additional sheet showing the mane of the sub-contractors sad stale whether ar not thus"am its Yana
employees_ If the sub-onitracto s lase employsrs.they"must provide their worker'crimp.policy sunder_
I am an employer that is providing workers'compensation insurance for my employees. Below Is the policy and job site
information.
Insurance Company Name:
Policy#or Sell-ins.Lic.#: Expiration Date:
Job Site Address: City StateiZip:
Attack a copy of the workers'compensation policy declaration page(showing the policy number sad eipiradon date).
Failure to secure coverage as required under M(iL c. 152. Zr25A is a criminal violation punishabk by a fine up to S1,500.00
anti'or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a
day against the violator.A copy of this statement may be forwarded to the(Mice of investigations oldie DIA for insurance
coverage verification.
I do hereby certify under the ins and penalties of perjury that the information provided above is true cad 011$1101.
Si mature: Date. 7/ 14 Z
Phone#: L( l — (0 9 S -3_cC2)
Official use only. Do not write in this area.to be completed by city or town official
City or Town: PermitiLicense#
Issuing Authority(circle one):
I. Board of Health 2.Building Department 3.city limn Clerk 4.Electrical Inspector S.Plumbing inspector
' 6.Other
Contact Person: Phone#:
LU CENTER FOR
U EcoTechnologv.
we make green make sense J .
ENERGY EFFICIENCY PLAN (6/26/23 with Air-Source Heat Pump)
Project Address: TBD Old Wilson Rd, Northampton, MA
Conditioned Floor Area 936 ft2(includes first floor only)
Volume 15,775 ft3(includes insulated basement)
Building Type Single family detached
Bedrooms 2
Assumptions for Preliminary Home Energy Rating
CET has completed a Preliminary Home Energy Rating based on the construction plans you have provided. Any
energy features not listed below are assumed to meet the prescriptive requirements of the IECC 2021.
Building Envelope Specifications Used in Analysis
R-13 sealed interior foam board;
Foundation Walls 1 'A"foam board wraps over top of foundation wall;
Top of foundation wall sealed to sill plate or wall sheathing.
R-10 foam board at walk-out condition slab edge; Continuous thermal
Basement Slab break with insulation haunch per separate detail—no exposed top of
concrete wall outside foam board; Photo-document slab insulation.
Rim &Band Joists R-21 fiberglass batts, in contact with framing on 5 sides
Dense-packed cellulose or R-21 fiberglass baits (fully lofted and fitted
Exterior Walls around all obstructions with no gaps or compression, all cavities
completely filled with insulation and fully enclosed by rigid air barrier on
all sides).
Stairway Walls to Unfinished Attic R-15 fiberglass baits, with attic-side sealed sheathing, drywall, or foam
board and sealed top/bottom plates/blocking.
Windows U-value =0.27, SHGC = 0.26
Exterior Doors (Opaque), incl. Door to Attic R-5/U-0.20,fully gasketed with sweep.
High density 10" R-38 fiberglass baits or dense-pack cellulose in 2x10
Flat Main Ceiling (Unfinished Attic Floor) cavities with subflooring above, completely filling cavities and fitted
around all obstructions, in full contact with drywall ceiling below(no
strapping)
Flat Ceiling over Attic Stairway R-38 fiberglass baits or cellulose in 2x8 cavities, in full contact with
drywall ceiling below(no strapping).
Sloped Ceiling over Attic Stairway High density 8.25" R-30 fiberglass baits or cellulose in 2x10 cavities
with propavents, in full contact with drywall ceiling below(no strapping).
1.5 Air Changes per Hour or better(lower);
Continuously sealed thermal envelope from slab&foundation through
Blower Door Test/Envelope Airtightness sill plate to wall sheathing through wall top plates to ceiling sheetrock.
All sheetrock sealed to interior and exterior wall top plates and all
penetrations sealed.
Rater Field Checklist, sections 2&4 Meet all Checklist Requirements as verified by a HERS rater at pre-
drywall and final inspection
Plumbing & Mechanical Systems Specifications Used in Analysis
High efficiency ductless air-source heat pump(s), 12.5 HSPF, 23
SEER; Heat pump equipment must be installed by a Mass Save HPIN
Heating &Cooling Equipment contractor, and must be listed on the Mass Save Heat Pump Qualified
Products List;
No electric resistance baseboard, heaters, or radiant floor mats except
for short-duration timer switch operation (no thermostats).
ENERGY EFFICIENCY PLAN
Thermostats I 7-day programmable
Water Heating Equipment 4.0 Energy Factor heat pump water heater
Basis:Rheem PROPH50 T2 RH375-30
Duct Leakage I N/A
Selectable-speed high efficiency Energy Recovery Ventilator(ERV), I
Whole House Ventilation 84%Adjusted Sensible Recovery Efficiency and 29 watts at 45+ CFM
continuous ventilation.
Basis:Panasonic FV-10VEC2
EV Charging Dedicated 40-amp circuit with conduit to 240 volt exterior outlet box.
Lighting &Appliances Specifications Used in Analysis
Lighting 100% LED
Refrigerator ENERGY STAR certified
Dishwasher ENERGY STAR certified
Clothes Washer& Dryer ENERGY STAR certified
Range Electric
Preliminary Home Energy Rating Results
Based on the assumptions described above, we have calculated the following Preliminary Home Energy Rating results.
Preliminary HERS Index: 37
Estimated Mass Save Rebate: $15,000 (All Electric program incentive)*
Note that Confirmed Home Energy Rating results may vary from the Preliminary Home Energy Rating results due to
changes in building plans, energy features installed in the home, RESNET standards, software changes, and other
factors.
* Mass Save Residential New Construction requirements and incentive amounts can change at any time without notice
at the discretion of program sponsors. We anticipate, but do not guarantee, that current program requirements and
incentive amounts will apply to this project as long as it is completed and inspected within 12 months.
Preliminary Rater:John Saveson
Date:June 26, 2023
Job#:23-75153
Page 2 of 2-The Center for EcoTechnology-Tel(413)586-7350 ext.242-Fax(413)586-7351 -nreenhome(a cetoniine.orq
,. , sal- to, -1
CITY OF NORTHAMPTON,MASSACHUSETTS PENDING APPROVAL
41DEPARTMENT OF PUBLIC WORKS 253 OLD WILSON RD
ti _ 1) 125 Locust Street
11,W1' Northampton, MA 01060 Trench Permit Number: 2023-445
,� - 413-587-1570
�'_ _ Date Approved: Z
Fax 413-587-1576 pP
3
Expiration Date: �� -- 23
(for City Use Only)
❑UTILITY MARKS ONLY—NON TRENCH (Same form/fee)
®EXCAVATION/TRENCH PERMIT
ElPUBLIC PROPERY ®PRIVATE PROPERTY
Pursuant to G.L. c. 82A and 520 CMR 14.00 et seq. (as amended)
This permit must be fully completed prior to consideration.Submit completed form with permit fee to Northampton
Department of Public Works, 125 Locust Street,Northampton, MA 01060.
This permit is issued under the provisions of M.G.L.c. 82A, 520 CMR 14.00 and applicable sections of the Revised
Ordinances of the City of Northampton, including, but not limited to,Section 285-21.
Fee: $250 Check#:8448 Date Issued:6/9/2023
Name of Applicant Primary Phone#
CHARLES AMO 413-695-3500
Street Address Emergency Phone#
19 LILY PND LANE
City/Town State Zip Email
GOSHEN MA 01032
Name of Excavator Primary Phone#
SAME
Street Address Emergency Phone#
City/Town State Zip Email
Name of Property Owner(s) Primary Phone#
JOHN EWING
Street Address Emergency Phone#
253 OLD WILSON RD
City/Town State Zip Email
NORTHAMPTON MA 01060
Insurance Certificate# Policy Expiration Date
ON FILE
Thi-23 LkJ32 -23
NoSEwEe
Name&Contact Information of Insurer
ON FILE
Dig Safe #& Start Date from Dig Safe Ticket:
2023-231-2024
Project Description/Location of Work. Provide the following:
® Description of purpose and exact location of proposed work including description of what is
to be laid or repaired in the proposed trench (e.g. water pipe, sewer pipe, drain pipe, gas line,
power line, communication lines, etc.)
Sketch or drawing showing all proposed work.
®Anticipated Start of Work Date.
Description:
253 OLD WILSON RD
NEW CONSTRUCTION HOOK INTO CITY WATER
INSTALL SEPTIC SYSTEM AND FINISH
DRIVEWAY
CE ROBERTS WILL DO WATER TAP
Check if applicable:
❑ Emergency
® Work on Private Property
® Work in Public Right of Way
❑ Work within State Layout(attach State Permit)
❑ Work within 50' of a Public Shade Tree(see attached Public Shade Tree Regulations)
❑ Tree removal required(see attached Public Shade Tree Regulations)
❑ Tree .rotection,trimmin:,or root 'runin: required see attached Public Shade Tree Regulations
Po214
❑ Work within 100' of a wetland or 200 Ft.of a stream or river (attach Permit)
❑ Work within floodplain (attach permit)
❑ Public Water/Sewer/Drain Entry Permit(attach permit, if available)
❑ Driveway Permit(attach permit, if available)
❑ Pole and Wire Petition(attach approval)
By signing this form, the applicant, owner and excavator all acknowledge and certify that they are
familiar with, or, before commencement of the work, will become familiar with, all laws and
regulations applicable to work proposed, including OSHA regulations,M.G.L. c.82a,520 CMR
14.00 et seq.,and any applicable municipal ordinances, by-laws and regulations,and they covenant
and agree that all work done under the permit issued for such work will comply therewith in all
respects and with the conditions set forth below.
The undersigned owner authorizes the applicant to apply for the permit and authorizes persons
duly appointed by the municipality to enter upon the property to monitor and inspect the work for
conformity with the conditions attached hereto and the laws and regulations governing such work
for the duration of the construction.
The undersigned applicant, owner and excavator agree jointly and severally to reimburse the
municipality for any costs and expenses incurred by the municipality in connection with this
permit and the work conducted thereunder, including but not limited to enforcing the
requirements of state law and conditions of this permit,inspections made to assure compliance
therewith, and measures taken by the municipality to protect the public where the applicant,
owner or excavator has failed to comply therewith, including police details and other remedial
measures deemed necessary by the municipality.
The undersigned applicant, owner and excavator agree jointly and severally to defend, indemnify,
and hold harmless the municipality and all of its agents and employees from any and all liability,
causes or action,costs and expenses resulting from or arising out of any injury,death, loss or
damage to any person or property during the work conducted under this permit.
By signing this form, the applicant, owner and excavator acknowledge that they have read and
understand all the information set forth in and referenced within this application package and that
they agree to comply in all respects with the requirements therein.
7I (C� Z S
Applicant Date
Excavator Signature(if different) Date
Owner Signature(if different) Date
To be completed when approved permit is picked up.
Pg 314
3v signing below,the applicant acknowledges and agrees to all the conditions of approval stated below and
fatidates this Hermit.
Applicant Date
or City Use--Do not write in this section
Department Approvals/Comment I
Water: 6/14/2023 I
Sewer/Storm Drain: 6/13/2023
FPC: 6/21/2023
Streets: 6/10/2023 I
Traffic Signals: 6/12/2023 I
Building Commisioner. 7/5/2023
201❑ Subject to 5-yr. pavement moratorium Road last paved:
❑ Special Conditions: _. .
Fee
® $250 Permit Application received(Check payable to the City of Northampton)
❑ Waived. Reason:
❑Tree mitigation: _
Permit pproval
Director of Public Works Date
Pg.1/4
Nip
Massachusetts Department of Environmental Protection
-- Bureau of Resource Protection -Wetlands
WPA Form 2 — Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
A. General Information
Important:
When filling out From:
forms on the Northampton
computer, use Conservation Commission
only the tab
key to move To: Applicant Property Owner(if different from applicant):
your cursor-
do not use the John Ewing
return key. Name Name
297 Old Wilson Road
•
Mailing Address Mailing Address
Florence MA 01062
City/Town State Zip Code City/Town State Zip Code
' X\
1. Title and Date (or Revised Date if applicable)of Final Plans and Other Documents:
Septic Plan, Timothy Maginnis, lots 5/6 253 Old Wilson Road 06/10/23
Title
Title Date
Title Date
2. Date Request Filed:
July 12, 2023
B. Determination
Pursuant to the authority of M.G.L. c. 131, §40,the Conservation Commission considered your
Request for Determination of Applicability,with its supporting documentation, and made the following
Determination.
Project Description (if applicable):
Construction of a septic system to serve house located outside jurisdictional areas. 949 of
disturbance associated with grading and installation of the system to be located within the 50-100 foot
buffer zone. An additional 696 square feet of area within the 50-100 foot buffer to be converted to a
lawn area.
Project Location:
253 Old Wilson Road Northampton (Florence)
Street Address City/Town
44 116
Assessors Map/Plat Number Parcel/Lot Number
wpaform2.doc•Determination of Applicabilky•rev.4/22/2020 Page 1 of 5
BureauMassachusettsofResource DepartmentProtection of EnvironmentalWetlands Protection
-
WPA Form 2 - Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
B. Determination (cont.)
The following Determination(s) is/are applicable to the proposed site and/or project relative to the Wetlands
Protection Act and regulations:
Positive Determination
Note: No work within the jurisdiction of the Wetlands Protection Act may proceed until a final Order of
Conditions(issued following submittal of a Notice of Intent or Abbreviated Notice of Intent)or Order of
Resource Area Delineation (issued following submittal of Simplified Review ANRAD)has been received
from the issuing authority(i.e., Conservation Commission or the Department of Environmental Protection).
❑ 1. The area described on the referenced plan(s) is an area subject to protection under the Act.
Removing,filling, dredging,or altering of the area requires the filing of a Notice of Intent.
❑ 2a. The boundary delineations of the following resource areas described on the referenced plan(s)are
confirmed as accurate. Therefore, the resource area boundaries confirmed in this Determination are
binding as to all decisions rendered pursuant to the Wetlands Protection Act and its regulations regarding
such boundaries for as long as this Determination is valid.
® 2b. The boundaries of resource areas listed below are not confirmed by this Determination,
regardless of whether such boundaries are contained on the plans attached to this Determination or
to the Request for Determination.
This determination does not confirm exact boundaries due to the age of the delineation
❑ 3. The work described on referenced plan(s) and document(s) is within an area subject to
protection under the Act and will remove,fill, dredge, or alter that area. Therefore, said work
requires the filing of a Notice of Intent.
❑ 4. The work described on referenced plan(s) and document(s) is within the Buffer Zone and will
alter an Area subject to protection under the Act. Therefore, said work requires the filing of a
Notice of Intent or ANRAD Simplified Review(if work is limited to the Buffer Zone).
® 5. The area and/or work described on referenced plan(s) and document(s) is subject to review
and approval by:
Northampton
Name of Municipality
Pursuant to the following municipal wetland ordinance or bylaw:
Northampton Wetlands Ordinance C 337
Name Ordinance or Bylaw Citation
wpaform2.doc•Determination of Applicability•rev.4/22/2020 Page 2 of 5
Massachusetts
BureauofResource DepartmentProtection of EnvironmentalWetlands Protection
-LIP_Il
WPA Form 2 — Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
B. Determination (cont.)
❑ 6. The following area and/or work, if any, is subject to a municipal ordinance or bylaw but not
subject to the Massachusetts Wetlands Protection Act:
❑ 7. If a Notice of Intent is filed for the work in the Riverfront Area described on referenced plan(s)
and document(s), which includes all or part of the work described in the Request, the applicant
must consider the following alternatives. (Refer to the wetland regulations at 10.58(4)c. for more
information about the scope of alternatives requirements):
❑ Alternatives limited to the lot on which the project is located.
❑ Alternatives limited to the lot on which the project is located, the subdivided lots, and any
adjacent lots formerly or presently owned by the same owner.
❑ Alternatives limited to the original parcel on which the project is located, the subdivided
parcels, any adjacent parcels, and any other land which can reasonably be obtained within
the municipality.
❑ Alternatives extend to any sites which can reasonably be obtained within the appropriate
region of the state.
Negative Determination
Note: No further action under the Wetlands Protection Act is required by the applicant. However, if the
Department is requested to issue a Superseding Determination of Applicability, work may not proceed
on this project unless the Department fails to act on such request within 35 days of the date the
request is post-marked for certified mail or hand delivered to the Department.Work may then proceed
at the owner's risk only upon notice to the Department and to the Conservation Commission.
Requirements for requests for Superseding Determinations are listed at the end of this document.
❑ 1. The area described in the Request is not an area subject to protection under the Act or the
Buffer Zone.
❑ 2. The work described in the Request is within an area subject to protection under the Act, but will
not remove, fill, dredge, or alter that area. Therefore, said work does not require the filing of a
Notice of Intent.
❑ 3. The work described in the Request is within the Buffer Zone, as defined in the regulations, but
will not alter an Area subject to protection under the Act. Therefore, said work does not require
the filing of a Notice of Intent, subject to the following conditions (if any).
The applicant shall remove the asphalt strip formerly part of the driving range and allow the area
to revegetate.
❑ 4. The work described in the Request is not within an Area subject to protection under the Act
(including the Buffer Zone). Therefore, said work does not require the filing of a Notice of Intent,
unless and until said work alters an Area subject to protection under the Act.
wpaforrn2.doc•Determination of Applicability•rev.4/22/2020 Page 3 of 5
Massachusetts Department of Environmental Protection
L
Bureau of Resource Protection -Wetlands
WPA Form 2 - Determination of Applicability
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
B. Determination (cont.)
❑ 5. The area described in the Request is subject to protection under the Act. Since the work
described therein meets the requirements for the following exemption, as specified in the Act and
the regulations, no Notice of Intent is required:
Exempt Activity(site applicable statuatory/regulatory provisions)
❑ 6. The area and/or work described in the Request is not subject to review and approval by:
Name of Municipality
Pursuant to a municipal wetlands ordinance or bylaw.
Name Ordinance or Bylaw Citation
C. Authorization
This Determination is issued to the applicant and delivered as follows:
❑ by email delivery on ❑ by certified mail, return receipt requested on
August 18, 2023
Date Date
This Determination is valid for three years from the date of issuance (except Determinations for
Vegetation Management Plans which are valid for the duration of the Plan).This Determination does not
relieve the applicant from complying with all other applicable federal, state, or local statutes, ordinances,
bylaws, or regulations.
This Determination must be signed by a majority of the Conservation Commission. A copy must be sent to
the appropriate DEP Regional Office(see https://www.mass.gov/service-details/massdep-rgonal-offices-
by-community)and the property owner(if different from the applicant).
Signatures are made in accordance with M.G.L. c.110G and pursuant to the board's electronic
signature authorization vote recorded on June 5, 2020 in Book 13653, page 165 at the Hampshire
Registry of Deeds.
Signatures:
Kev%vv Lake,
C. M000ry Maronn,vv Pau.L Four-Moore'
DLwi4 Reckhow
August 18, 2023
Date
wpaform2.doc•Determination of Applicability•rev.4/22/2020 Page 4 of 5
Commonwealth of Massachusetts
* ° ' City/Town of Northampton Number
a
`-iz Number
.. --.
� pcisitips:Asal System Construction Permit
�"'
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using this form, check with
the local Board of Health to determine the form they use
Permission is hereby granted to:
Important:When Charles Amo Choice Builders
filling out forms Name Name of Company
on the computer
use only the tab
key to move your Address
cursor-do not Goshen MA 01032
use the return City/Town State Zip Code
key.
ten to perform the following work on an on-site sewage disposal system:
a Construction
X
❑ Repair or replacement
gin
❑ Repair or replacement of system components
253 Old Wilson Rd
Facility Address
Florence MA 01062
City/Town State Zip Code
John Ewing 413-326-3510
Owner Telephone Number
The work to be performed is further described in the Application for Disposal System Construction
Permit. The applicant recognizes his/her duty to comply with Title 5 and the following local provisions
or special conditions:
Installation based on septic plan 6/10/23.
Installation per MDEP Determination of Applicability dated 8/18/23.
No garbage disposal.
Final installation inspection prior to back-fill.
• •nstruc ion must be completed within three years of t e date below.
App., •. b Date
Commissi• er
T,Ile
t5fonn2a doc•06/03 Disposal System Construction Permit•Page 1 of 1
, 1
To the best of my knowledge these plans are drawn
to comply with owners and or builders
specifications end any changes made on them alter
prints are made wit'be done at the owners and I or
builders expense and responsibility.The contractor
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shalt verity at dimensions and enclosed drawing. OLAUomMOMlD*ArTM6 ANDDn500 Is not liable for
errors once construction has begun.While every p
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to avokt mistakes,the maker can sat guarantee ci "e.
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SCALE:
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FOR RFERENCE TO LOTS 5A AND 6A LEGEND
• SEE LAND OF JOHN W. EWING LOCUS (nts) Design Flow,
'.e+.. BOOK 13824, PAGE 178
"„. PLAN BOOK 246, PAGE 30 l '1 PROPOSED SEPTIC TANK 3 bedroom de NI/
y oo sign f 110 mod/bedroom=330 qpd
'*n+m ASSESSORS MAP 44, PARCEL 137 No g4rbegw aspawl
ZONING DISTRICT - SR n PROPOSED PUMP CHAMBER 1 Daily flow•330 qpd-NO GARBAGE ALLOWED
\y • ,w°y ;••2. -- Septic Tank Required,
_ - EXISTING PERC TEST 330 god x 200 X=660 matrons
LAND OF JOtIN W.EWING, `� '
DEED BOOK 4268,PAGE 191 224,24i• - _ rtp srs 'I._ ./• '•• ® EXISTING TEST PITS Use Proposed 1,500 gallon septic tank
SEE PLAN BOOK 179,PAGE 191VI \' \i' rr` -•r: i 1-
P/L ' PROPOSED CONTOURS Stone and pipe requirement
Parc.Rate,•7 mpl-Class I soil
ASSESSORS MAP 44, PARCEL 116 y ` ' __'y -——- Effluent load) to noes I:011=.66 goal/sq.Pt.
EXISTING LOT 4 I 27 EXISTING CONTOURS 2 9P "sq.fpipe 5 78, 330 d/.68 s Ft/motion•485.3 sq.ft.for atom and SAS
\y 109,122* SQ. FT. \j/ \I \y _ 40 MIL POLY BARRIER 485.3 se,ft.x 40X•19432 sq.ft.
2.505t ACRES
/ _ ELJEN REQUIREMENT NEW CONSTRUCTION=400 sq.ft.required
/ —P./6— PROPERTY LINE
/a c�1, /• A" 100'BUFFER ZONE LIMIT Size of Leaching Facility for Ellen:
v/i .1, \l 0 20 \V \/ \y — 3 bedrooms•15-343 modules required
• /" \ 110 50' BUFFER ZONE UMIT EIJen B43• f 26.76•q,ft./nodule
r LOT O \�/A, TT- R Wnlnun number of nodules 5-B43 notlules per bedroom-Per Ellen Office.
/ 129,907* SQ. FT. �O v� `•7 / 4vi — —WETLAND BOUNDARY 3 Minimum basil area required•400 sq ft.-NEW CONSTRUCTION
2.ALE: 1 ACRES J� \ �' Number of modules proposed•13 843 chambers
V \l' ( I \I/ SCALE: 1'w 30' ./ \ , / /.— — P. -wwrwww
_ / � W. \ ,,! ,ry, / $ EROSION CONTROL WATTLES 3 rows with 5 modules/row•15 nodues
sTt�"r'� ��s-�py�•,3 t p LENGTH of nee•23'
• \V \)' \� / i -\ �. .— �' •�. /^oo, "r.�}.y �J�./�j TREE LINE
\ LATERAL TO EDGE SPACING•Lateral spacing•as
ram^',• x // \ \ ? // - / �° ./
' FIRE HYDRANT WIDTH•18'
sir i / \ uture lawn (696 sq.ft.+/-) / / / ___
106' BUFFER CrY\ •
/// Size of Leaching Facility Provided)
�, (A �, t1.1
a� N / —W—W— PROPOSED WATER LINE
5 i ` 'WJ \\ 50' BUFFERS i t/ • ' • 4 23'L X 18'W•414 sq.ft PROPOSED
x\ —'—'—' / ,ram / PROPOSED OVERHEAD WIRES
y I \ '� � � 400 sq ft.required-414 sp ft.proposed
Erosion(control wattles y, •
\ / (Utilities) 4(4 sq.Ft.-400 sq ii.•14 sq Pk over dealgrrd
/ ' t DESIGN FLOW•330 GPD
P,(L (ant ter)ce strew boles) t`` , \ // V`; \ FUTURE LAWN (696 sq ft+/-)
x/ \V \� • `t ,�� \ \ NO GARBAGE DISPOSAL ALLOPVED
I I 1, ,�• % \ Proposed 1500 gallon septic took /
�4, UNDERGROUND SUPPLY--HEAVY DUTY
\ ( .� � � x FINAL COVER /BREAKOUT FILL
;? Proposed' �, / / (411.76 sq. ft. +/-) Construction notes
• Tart pit/e 3 see-Pon ` e / �w.o0 '
\ `/I / / \ ` `,!r p/ 1. Property lines are mown for rsirente only. Al setback rpuirrnanh of Title-5 shall be met.
IV Test qT#4/pert teat /�� 7 I A:,,,,,,....".„. ,..�'� `` r �90.00 /i. LOT S •NOT FOR CONVEYANCE •
1, / `[\\l NAIL IN 4'TREE-ELEV.100.00 Property(Mee by Randal kw PLS-Handel L.Eaton and Aseociates.Inc.
1 'E•, ��� /• —x 141,788t$O, FT.
40• _ /
e(/,k� I `>� I 2y ,{' f 3.2546IL ACRESL 2 YNtWW delineation by Ward Smith,Pr°1essiond Wetland Scientist-2015.
• % GT �' 4!1'� f� .M NOT A BUILDABLE LOT
R }Ii 1�1�R,1%i 27N+/- 1.5'Fora main G1r
r '1 S8 r il!v R////[E
\ al� � )L[1.' S�` r1n�N� ,`r T�//�i[ ` / 3. Distribution box pipes to be a minimum 4'pvc Sch.40 gelid pipe.
\ • \ � �e, ll` 219 0 D1'fI( 1 /Ir ` / (TO BE CONVEYED BY JOHN EWING TO THE CITY OF NORTHAMPTON
/ \\ \ �.•.(I • \ ■M�M9H 'I y�e'��'` ��'� ,( AND COMBINED WITH ADJOINING LAND OF THE CITY) Distribution box°oust pion to be brio level for at least two feet.
a--.-..-
Teat I `\ in.-� \ ■■■ ` r411'ii�,1 / 4. Water Ilns,electric line and telephone lines ors ohoww for reference only.
PointSS,.',D,3� FlNAL COVER BREAKOUT FILL
D .- .' er— ��'/�n i'Test pR 6/page lest B / , Water In entry rimy vary.
�o Test pit#5I test �j,7�\ (739 sq.it. +/-) �, �y4e�a•`^^y1�m�'S�
�� , •V•`)Xt� ----mom • `•1F� 6. Exposed ea0 to be graded,loomed,seeded and hay mulch immediately
B(/ ,Sp 1 Proposed' �,� 2 , :,; ' Test pit 7 ``MMMLLYYYY �_ upon completion to ovoid eo0 erosion.
*7.t1$ water Me \ /'F Distribution box-K' S43'09 36"w .
S48'S3 46Y/ -yam 1 39' ''- '4) P/4 225.73' 296.63' 6. Ail work to be done In accordance with the State Environmental Code Title-5.
9948' vvJJ 41 S3'T J / /0 mG 549'O.1 42Y1 IMPERVIOUS BARRIER DETAIL Into) 7. Location and configuration°t house Is shown for reference only.
HydroM� .� • Qt� •a Actual sire,configuration and location may vary.
OLD IN/L SON ROAD 0 nil poly barrier(3 elves) This system is designed for o garbage Therefore, garbage
NOR�� Installation to be supervised Ye, 9^e g ge disposal. 4°9 ge
A MP Ton/ by designer disposal is not alloyed
MA SSA CHUSE T TS 9. Septic tank Nwdd be inspected and cleaned at least every three years.
AS-BUILT DIMENSIONS - - -
ECO+ 13 w _ IS Elevations shown are minimum elevations and for reference only.
CONTRACTOR TO TAKE TWO TIES FROM REFERENCED POINTS w M,•,' r, Slope=3.1 min.
( A - B -C - 0 -E -F - G-H -I) NG Title-5 sand '. w •`• 11. Contractor and homeowner to determine foal grades.
AND RECORD DISTANCES ON PLAN. Pole/ 1 ,18r„ ,r;•• NIve byfxun :i,•,-
Y ' 'r }` ,+! ' 'Existln .. 12. Contractor to clearly mark top of proposed distribution box for future reference.
Title-5 sand shall tanOst of on-site or imported material. The fill —' • . '_• r g groom
Water tightness material MNI be clean coarse washed eared or other coarse granular _ _ ' oR _•'1;y_wv Mr,le'eve Mrnw.xl ror
'A'to'D'• •B'to rg.• 9 material free from clay,fines,duet,organic matter,large stones, 'se^"""' "°"du',xrw"a'use ash Ir�lReel is. There are no known wells located within 100'of proposed soil absorption system. SEE PLAN
'A•tP'E'• 'Tr to•E•• The proposed 1,500 gallon septic tank and 1,000 gallon prep chaeoer are each two hid-seam tanks. m unary stumps,frozen dumps of earth,wood,tree brooches,
'A'to'F'• 'B'to•F•= and waste construction debris. It shall not canlain any material larger 14. A DEED NOTIFICATION IS REQUIRED TO INFORM FUTURE OWNERS OF THIS PROPERTY THAT
Contractor to seal all sears and pipe openings In both tanks to prevent groundwater Intrusion thou 2 inches. A sieve analysis using the/1 eieve shall be performed
'A'to'H'• '1'to•N•• during periods of high groundwater events. an a representative sample of the fill. Up to 451E by weight of the NI AN ELJEN GSF IS IN USE AT THIS SITE.
sample may be retained on the/4 sieve. Mixtures and layers of different
'A'to'I' 1•to'I' dosses of soil shall not be used. Ian Specified Sara IS THE DESIGNER MAST INSPECT AND APPROVE THE 40 NIL POLY BARRIER PRIOR TO BACKFILL.
INSTALL TITLE-6 SAND IN I'LIFTS FOR PROPER COMPACTION. REVISIONS
COMPACT WIINN HAND TAMPER OF TRACKED VEHICLE. Subsurface sewage disposal system design
Proposed sewer pipe 1. Euminate pump chamber
4' pvc solid pipe Contractor to supply lab analysis of Ttle-5 sand dated no Dlen specified Sand
Eljen GSF Geotextlle Sand Filter - B43 Modules
odd 1e'to both ends,12'to both sides 2. Elevate SAS 2'(M'4'above ESNVT)
Top of Foundation 0 Elev 107.00 S•,02 Kin.) odd
between rows and 12'underneath system SITE: Lot # 5 / # 6
Magnetic tape Proposed distribution bo (Anti-siltation
apsiar tired fabric
two sides) Lab analysis required 253 Old Wilson Road
— p Ihspec Ion portFlorence, MA 01062
•
R ...- -.r«�,......,..,..K •..:.r•�u....M-,n..,.. ,r"•`N. .4,.• .. ..,. .. .,,,,,... -. ..,_ mane-.v.... ,,,_ _y p o poly barrier I Elev.ta4.oe Mao 44- Parcel # 137
i'ILI® e�,a,T ,v -' p ,e,,, lope=3,1 Owner: John Ewing
f i 4.7 if • Proposed i'e
--_ 0 0
•!"•y, a,Feii: :3Fi; 7Fi; :k7Ei ;,9F,' i;7 bey Address: 297 Old Wilson Road
iI Proposed 1, 4' pvc solid pipe (S=.OD ,sr��� .' r:<'X:A:' ' p ! r y .af y .!aimykrm�7
Proposed 3 bedroom 1,500 pal. y..N , Bocpfsl material,T!`' .'"/Y wy,, '• �� •, •Ir i Ba".. - m''. ".)l 'r' 4)'14,e,t4g4 i x 'y . ��"4a Florence, MA 01062
house septic tank • f.`• ('.y.,r,..l11'`n;r.•': 147.9r Y ' �1' ' s r •y,•'). ,,y,,• ..y,.! •`•' ._.,ease„"""-._,•.._. ° M'-li Y, „ ,� /.r7/��, {l y, r'4,;:. y:'. i'.,,,:-., ,' :r:;;:. :1 y: ::�.
,. „_,_ , ,, n-i ,-n_ „ _- ' _"--' _ _ lit, P�p-=1i II 11 II_II=i1 I lI 1i-1111 R Ii.i�-�i-T,•',
-U I1 R elti 1l-D-II=11=H=Il=lI-II-R=1INEWIRMINGIBMIT ,' .. •_..
—ESNVT f 21' II
_DESIGN!ELEV 98.30_ _„ III � ll
— — — — mwrt n dNbulbn bee a Dan 104]7 a A!! �` _ ai I EYAWTT24•-Lcsi6N TUEV-48,5o — — REVISED JUNE 27, 2023
Invert out tank Clev. 104.42 --- -� APPROVED
Invert out building PROFILE ( nts) v.invert out distribution box a En 104.20
Area to be excavate-
NORIHAMPTON BOARD OF HEALTH
Gas baffle/Effluent tee
Invert in pIpse OEnv.1W.Oe enx 20're x 26') Bottom of Specified Sand 0 Env.102.50
Replace with Title-5 sand Bottom of Modules 0 Elev.103.50
Elev. 104.90 +/- Invert In took Lob analysis required Signature Dote
Elev. 104.67