BP-741 .,„ , BUILDING PERMIT
SPECIAL PERMIT PER 780 CMR 114. 0 PERMITS FOUNDATION ONLY
FIELD INSPECTION
Dartmouth Building Department Plat: 66
400 Slocum Road-P.O. Box 9399 Lot(s) : 2-78
North Dartmouth, MA 02747 Lot Size: 40, 209
Telephone 508-999-0720 Zone Dist. : SRB
Issued Date: 07/31/95 Permit No. : 74
Project Location: 25 Goldfinc Drive
Number Street
Subdivision Name: Songbird Acres (LOT 21)
Nearest Cross Street:
Applicant/Agent: Robert Mullins (Cherryfield Development Corp. )
Contact Person Phone #: ( ) 508-946-9118
Proposed Use: Residential
Residential,Commercial, Industrial, etc.
D j,+ I s ad To: _To Distal'
Type of Improvement,Add,Alter,New Coast.,Demo,Land/Move,etc.
FOUNDATION ONLY
indicate no.of bedrooms and bathrooms and other rooms
Owner(s) of Record: Kim & Douglas Rogers
Address: 16 Norwell Street, South Dartmouth, MA 02748
DATE TIME TYPE OF INSPECTION REMARKS INITIAL `
9-7 3' .31,a.,— z1AI r13 Vie,-e' 0IT T
9- 7_QV -'iiatn "nc -t. lam- -acz l'..--t -r te'4j_i__AC-
..:.
...,
BUILDING PERMIT
rOUNOMTION ONLY PFP 71.51:1i- CAR -114, PERM-PE-3
. _
rfartynuta aatidnq Dcmartint 1 Pl .stf, ii.1,:,
a41-14,
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40o Gfl.lcom 14.0,-,=7,4-P.O. bi-y.-- 92f.,a 1 LotfOr 1, '
WortU, 1\-73,1'tt4GUtr,, Mfl WL'71C7 Lot Sizm%
NT:Aephonc Stj?16 -r:-.“-.4'-y-07ji-.20 ; -.. 2 • 1 .;,+. caB ;
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_ a W-orw..,,,hm Streafl Mivffl ;"..6-pori-:, WI 0234.6
C.-outset Per on Phcne 11-.. t. ' ...jj..PP±1 ,: ".219 111L __. ,,,
liype of Lininf.ia Otv,m&r: C ) Cont:. ',':,kport . ;;.. “,:•en:t.e 3J3 CW:17-J165.!
‘"-tn-chila-c!. t ; Erg.rinert ; , Other: c',, 3
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'Perit ls5ad 1p : lo Anst.d“
ijp: .rj Itia;:re,',2W,t, iron, i:.St -. t:risrx,.i3c;',3ai.,: C:cr:,: ..*t.thi.,v;, 'fri.,,, 6'•-' ' '
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C c“.t-Ot heir CO 33 5 t , 7. TO I if4_. FEE,: •5, I'd1;:t OwnL-r1. -5. 2.- 1 1Drd : 1-, 1 m a De i.1.11 Rcicic
lid d r '-'s ' ......._._ .....:if,..__-0.p.c t.,Q) .L._:Fity:5::' :•:.,t„,. ..;„ ,3.-.,4,-,y-tl,ce.O.?b,_. _$701_ 10€:
fOnrTAA Lnlipja ,-..fl-h 78f..73 Llvlit 5th Ed, (1161_, Chap. 1
nttd?-r:applinzn..114..., Mat-ts.+ i.,..44n or. code and Wa : f,n flip,
i h'ert431,' Cel'i, 't f Y that. thi-,,k pr-opqFtn:.1 weriq is f,,,--,nid•nn-i 7,e-,:„; te? n.,,n„..rr.
of ee,...uro apohnvi.:- Leon i,-3-k.ho.-Erled 7a'J the dynnor- to mai.=. 1.-51 ,:,.
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flp.i.n-nyad/Issaed By. Joe l .-:72,'. fc.eed, 1 ,1f- ,>1 L.u'i-idIng la.1;,pectnr
- • - ,
COMMp4TS:
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, ,
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.... /
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Li ti;:;,i _i-..:5 1 Niti,, i i arcThi. I f'SIN I V 5-:iSS3E n-2-1 -1 S . I.i 1 . EFT, L.# CciP't 4
1
-- -
. '-� y
c n4ti o l; ` A,4„.aE&MIT NO.
/•oQ,t� `\ TOW OF DARTMOU W DATE ISSUED 7 3j---/-D
o, ' n c'I TOTAL COSTA-57.eV
amy / APPLICATION FOR--21 SS APPLICATION FEE JZI.L6,
\een Sy BUILDING PERMIT
FINAL PERMIT FEE ----0
r t rl „,a r-i,r,
kart:
• ,r�ir(er�a nP&u `GCQ� /Bill( . ( / / t
LOCATION OF UILDING / ,R _ ��) Oit ll7e C.y
01 Number & Street q�� ��� e L.va/ 01.1 Zoning District
02 Cross Streets(between) / and
03 Lot loly Plat(2- 2e, 04 Subdivision en-ci Lot c.2/
OWNERSHIP COST
05. ovate (individual, corporation, 36 Cost of Improvement .�0.�• . —
non-profit institution, etc.) 36.1 To be installed but not
06 ❑ Public (Federal, State, or local government) included in the above cost
TYPE OF CONSTRUCTION 36.2 Electrical
07 ❑ New Construction 36.3 Plumbing
08 ❑ Addition -Type of Room(s) 36.4 HVAC
09 ❑ Alteration 36.5 Other - Specify
10 oundation Only example: elevator
11 ❑ Demolition (#of units if residential) 37 TOTAL 51 arl ,UO
12 ❑ Moving (relocation) STRUCTURE
STATISTICS 38 ❑ Wood Frame
13 Number of Bedrooms 39 ❑ Masonry (wall bearing)
14 Number of Bathrooms (Total) 40 ❑ Structural Steel
Full-Tub 41 ❑ Reinforced concrete
3/4 - Shower 42 ❑ Other - Specify
1/2 - Toilet Only
RESIDENTIAL-PROPOSED USE DIMENSIONS
15 ❑ One-Family 43 Number of stories
16 ❑ Two or more families 44 Total square feet of floor area, all floors,
Number of units based on exterior dimensions
17 ❑ Garage
18 ❑ Shed 45 Total land area, square feet VS, ?city
19 ❑ Carport
20 ❑ Swimming Pool SEWAGE DISPOSAL
In GroundAbove-Ground t
21 ❑ Woodstove 46 ❑ Public or private company
22 ❑ Fireplace 47ate (septic tank, etc.)
23 ❑ Other - Specify I.
WATER SUPPLY
48 ❑ Public or private company
NON-RESIDENTIAL - PROPOSED USE 49 ovate, (well, cistern)
24 ❑ Amusement, recreational 25 ID Church, other religious PRINCIPAL TYPE OF HEATING FUEL
26 ❑ Industrial 50 ❑ Gas
27 ❑ Parking Garage 51 ❑ Oil
28 ❑ Service station, Repair garage 52 ❑ Electricity
29 ❑ Hospital, institutional 53 ❑ Coal
30 ❑ Office, bank, professional 54 ❑ Other - Specify
31 ❑ Public utility
32 ❑ School, library, other educational TYPE OF MECHANICAL
33 ❑ Stores, mercantile 55 Will there be central air conditioning? ❑Yes ❑ No
34 ❑ Tanks, towers 56 Will there be an elevator? ❑Yes ❑ No
35 ❑ Other - Specify
PARKING PER ZONING BY-LAWS
57 ❑ Enclosed 58 0 Outside
59 Does this building contain asbestos? ❑ YES ❑ NO If yes complete the following:
Name & Address of Asbestos Removal Firm: '
IDENTIFICATION - To be completed by all applicants PLEASE PRINT
r
60 Owner (print) /lt .— aste KrCM .f 0,--t• S��l-0%2 ---171;3
ME AILING ADDRESS TELEPHONE NO.
61 Signature__• _ DATE 6 ZJ'9r
je/0 /1� Builder's
62 Contractor Ip . r `� ' G '��9/��/ License No4�,/�3
MEd" /' /IAAILING R S TELEPHONE NO.
63 Signature l/!// U///(/Lj DATE o — 9.1--
64 Architect or Engineer (print)
NAME MAILING ADDRESS TELEPHONE NO.
65 Signature DATE
CERTIFICATION TO PERF M W9R
66 I/We hereby appoint fi tY,4 C/. ���jj /.° �i 1,o
NAME ADDRESS
as my/our agent for the purpose of applying for and obtaining a building permit for the work to be done described in this
application.. [/^�' / / t
Signature k-;-:S �-tn ems' Lt I� DATE.0'�—e!G'
ADDITIONAL INFORMATION /
67 Has A-1 or Determination been issued by Conservation Commission? ❑ YES ❑ NO
Submit copy of notification sent to DEQE and the State Dept. of Labor Industries and result of air sample analysis after
asbestos removal is complete.
68 Owner or A•-- - : tify under peril of the penalties of perjury that the information herein is accurate to the best of
my know -dg
`U/e.
Signatur: •4(___ DATE 7- 2 /
0-9t _
Owner or Agent
69 BOARD OF HEALTH REVIEW DATE
Inspector or Authorized Person
COMMENTS:
70 DPW - WATER Service No. SEWER Service No.
To be completed upon issuance of permit - (if applicable)
71 I will post rmit a ress s toble from street.
r Signatur DATE?-2 -9,5----
Owner or Agent
72 I have re -wed list of r -i ed .- p:ctinns
Signatu -yvit _ , C C DATES 026--n
Owner or Agent
1
73 FOR RESIDENTIAL PROJECTS OTHER THAN NEW DWELLINGS:
Are you a Home Improvement Contractor subject to the registration law(780 CMR-6)? YES NO
Are you claiming an exemption from the law by homeowner sign-oft? YES NO (if yes,submit required signed affidavit)
Contractor's Signature: Date
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND
(780 CMR-6) QUESTIONS or COMPLAINTS?
Call or write: Home Improvement Contractor Registration
One Ashburton Place-Room 1301
Boston, MA 02108
617-727-8598
Owner's Signature: Date:
RECEIPT FOR PERMIT ,
,--1
our . TOWN OF DARTMOUTH 7 & '
ms PERMIT''NO
gib r ,
4W No F 0
Date -7p 3 f// Qj /�
Received From/ AeX/ /// l ! f
'Owner 4;71 71, ad / ` le�diti•s
149cation r25 6oi fl( A )Kb.--'e^--
Type Off .-//La"
Amount Paid 0 iu`Gtf
Received By f(
.4, RECEIPT FOR PERMIT ,
an TOWN OF DARTMOUTH ( e
PERMIT NO.
V •, _"
o o No A
/ Date ,ry?( / r
Received From (f(gr /- >Q��j� (�P X h�
Owner 0I7A-A !/
Location < ✓'e .44.6 -Y-- ., -D
Type ea. Ma '2'/�' ,}�
Amount Paid i "" • (v ( 4 '4 S 3 I
Received By A.74 '"
t k` .
__= The Commonwealth of Massachusetts
a- -- (re Department of Industrial Accidents
— C?
Office alOYDSIIpB(IO1/S
F=-.= /tz, 600 Washington Street
' �'� Boston, Mass. 02111
Workers' Compensation Insurance davit
` It tit in aft Br-..- ram _ ':=Please:•,• • .r.r - _.. :.:- ,�: _ ..V,et: -
name: 6.af li��/Io ��//y /�/� a, / '.,V.a—:N:c.::.:
, �� /
o�ati �fi /��^ .v.�
city phone# 1Ge - /7
E I am a homeowner performing all work myself. -
I am a sole proprietor and have no one working in any capacity •
�...- ., ...:..:ro ..,......ieyr -.Mm..,vy.�i�!_at(3•wYn'i--.*as ✓n:y.a.sed 6W"7v-' ,. .•.. 73yLa.:1-se t--- --s4:r:
an ernpi/ooyeer providing,, ng workers'er censation for
may, employees working on this job.
company name: C //,�"/%'/ s
G ` • \ p/�`
addr/ess5::J/�� //y���7t-p_/7. �� 9S_
insurance co. %!i'f. 10"/r7/ Doficv.. / 5/ -02/2929- /-7
E I am a sole proprietor, general cnntractor, or homeowner(eccie one) and have hired the contractors listed below who hax'e
the following workers'�k compensationpeti polices:
company name: ( /1 ,,,Yo //o //an t. .
address:
i///2Z. .t, 7eyf ,J ' '/ -
elm: 144 jse��iv / T6 Dhone#r car `" �=9210
insurance co.Z1 v if,it; policy- e/-, ?in?_,.2/79aq --7./J
rnmoans name: a/ ,c<fl ,4CP Coifed 70it/1• - - -.
address: �/ - - -
situ: 4 �� // si - /-/1'i ohone�#: /_.Y� -�j1•l2y
jnsurance co. 0�a�7`�' / f/ 9/ ... . .._ooitev# loci- .7-.7 - 5!'),�iyAj4- -/ro23
Attach idditionatilieeiifttecessar -z=re- - - _
Failure to secure coverage as required under Section 25A of DfGL 152 can lead to the imposition of criminal penalties of a fine up to 51500.00 and/or
one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine ofS100.00 a day against me. I understand that a
copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
I do hereb cenrf}•under: • an . and p ••. - ofperj •that the information provided above is true and correct _
Sigra re //_!/� L i i / Date 7m-2,6- 9
Print name/ -ZI / C2y ;Pi-
Phone# Oratetf//—�1��
wcR
rofficial use onlydo not write in this area to be completed by city or town official --
city or town: permiMieense# Building Department Is
[Licensing BoardL
"check if immediate response is required [Selectmen's Office
1:F phone#; [Health Department
contact person:
[Other k=
Nta waaao t arwrc ....
Information and Instructions
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their
employees. As quoted from the "law", an employee is defined as even person in the service of another under any
contract of hire, express or implied, oral or written.
An employer is defined as an individual, partnership, association. corporation or other legal entity, or any two or more e
the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer. or the
receiver or trustee of an individual , partnership, association or other legal entity, employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance , construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer.
MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required.
Additionally, neither the commonwealth nor any of its political subdivisions shall enter into any contract for the
performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have
been presented to the contracting authority.
-' rat r- i. ' c- cy »�-z, ;.-.- _ _
Ippaicants
Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and
supplying company names, address and phone numbers as all affidavits may be submitted to the Department of
Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The
affidavit should be returned to the city or town that the application for the permit or license is being requested.
not the Department of Industrial Accidents. Should you have any questions regarding the "law" or if you are required
to obtain a workers' compensation policy, please call the Department at the number listed below.
City or Towns
Please be sure that the affidavit is complete and printed legibly. The Department has provided a'space at the bottom of
the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please
be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to
the Department by mail or FAX unless other arrangements have been made.
The Offr_e of Investigations would like to thank you in advance for you cooperation and should you have any questions.
please Jo not hesitate to give us a call.
_n
The Department's address, telephone and fax number:
The Commonwealth Of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, Ma. 02111
fax #: (617) 727-7749
phone #: (617) 727-4900 ext. 406. 409 or 375
•
Dartmouth Building Department
400 Slocum Road
P. U. Box 79393 50g-999-07c0
Dartmouth, MA 02747 FAX508-999-072R
c; TRTEMENT nF REQUEST FOR SPEC I AL
PERMIT PER 780 CMR 114 . 0 PERMITS
I , ,e,f04gMX1 hereby request a
' PLEASE PRINT
Foundation Only Permit pursuant to 780 CMR Section 114. 8. I
understand that I assume all responsibility for proper placement of
said foundation in accordance with 780 CMR 114. 8 Approval in Part
and Zoning and will , if required, make any necessary corrections
for failure to comply with the applicable code and regulations
incllluding but not limited to removal in its entirely of said
foundation. ,, //
Foundation located at : ag.. .—.A0 Pn z?.W
Signed under the pains and penalties of perjury as applicable in
the Commonwealth of Massachusetts.
SIGNATURE OF OWNER 0 AUTHORIZED ALiENT DATE
TOWN OF DARTMOUTH BUILDING DEPARTMENT
TELEPHONE 508-999-0720 FAX 508-999-0738
`f O
iy
(X2Fire Chief Dist. 1, 2 ,6 ❑ Board of Appeals
CTan Collector ❑ D.P.W. Engineering
Board of Health ❑ D.P.W. Water/Sewer
- Conservation Comm. ❑ Cross Conn./Water Div.
Selectmen-Licensing ❑ Planning Board
— Town Clerk 4 9-1-1 Police Department
The following is forwarded to your office for your information
only - no response is required. PLEASE PRINT
The Building Department is in receipt of an application for
Plat Q /Lot -�2 , Address �� a�, �
.0111
b �r ��L/�%1i✓ 9 - /
Y C�T�// �co �/� to L'G✓���
CONTACT PERSON& HONE# demo.construct, alter. occupy, etc.
•
a(n) �i1<r/s-/ Sat(' 7 4.o .
The plan was received by this office on (p -Gj S .
date
This office will review said plans and subject to availability of potable
water, where required, the provisions of Zoning By-law per MGT, Chapter 40A and
M53C 780 CxR 5th Edition will have available to issue or will deny a permit for
the above-mentioned work within 30 days of date of receipt.
The applicant has been advised that your office as indicated above may
require them to apply for licenses or permits subject to your jurisdiction and
that they should contact your office, as indicated, for specific information.
It is not necessary to respond to this notice unless there is a specific
issue at hand or you wish to forward material or information required for
permitting. When required, an Occupancy Permit will not be issued until all Town
Agencies have had the opportunity to "sign off" that the work under their
jurisdiction is complete to their satisfaction.
To The Applicant:
Be advised that this notice will be sent to the Agencies checked above as
they may have separate jurisdiction for your project. Any questions about the
Agencies Regulations & Policy should be addressed to the individual Agency.
Your signature acknowledges your receipt of a copy of this notice.
5
/
.APPLICANT.TELEPHO. (PLEASE PRINT SIGNATVRE DATE
LICENSED CONTRACTOR'S N.AMETELEPHONE(PLEASE PRINT DATE
BUILDING PERMIT
FOUNDATION ONLY PER 780 CMR 114. 0 PERMITS
Dartmouth Building Department Plat : 66
400 Slocum Road—P. O. Box 9399 Lot (s) : 218 s3
North Dartmouth, MA 02747 Lot Size: 40, 209
Telephone 508-999-0720 Zoning Dist. : SRB
July 26, 1995 (typed/)) Permit No. : '7
Issued Date: -Z /j Clerk: soh
Project Location: 25 Goldfinch Drive
Nu.ber
Subdivision Name: Sonobird (Lot 21 )
Nearest Cross Street :
Applicant/Agent : Robert Mullins (Cherryfield Development Corp. )
Address: 8 Wareham Street, Middleboro, MA 02346
Contact Person Phone #: ( ) 508-946-9118
Type of License: Owner: ( ) Const. Superv. License #: (05-7185)
Architect : ( ) Engineer: ( ) Other: (
Proposed Use: Residential
ential• Commercial. Industrial. eta.
PermitIssued To: -- -----T$ install-------
- --
Type of lope ove.ent• add. • New Genet.. Des.. Land/Movo• etc.
Foundation Only
indicate no. of bedroeee and bathroe.e and other rows
Gross Area of Const. : Cost of Const. $5, 000. 00
Cost—Other Const. : TOTAL FEE: $ 50. 00
Owner(s) of Record: Kim & Douolas Ropers
Address: 16 Norwell Street, South Dartmouth, MA 02748
All work shall comply with 780 CMR 5th Ed. (MGL Chap. 142) and any
other applicable Mass. Laws or codes and plans on file.
I hereby certify that the propo ed work is authorized by the owner
of record and I have been hori ed by t owner to make this
application as his Agentrized a / /J
Signature of Owner/Agent : /J/,
Address:
********************* *** ******* *** *************************
Signature:
Approved/Issued By: 1 S. Reed, Local Bu3 ing Inspector
COMM NTS:
ORIGINAL 0 APPLICANT El ASSESSORS 0 CLERK 0 COPY
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400 Slocum Road • P.O. Box 9399
North Dartmouth, Massachusetts 02747
CC/ 27
:ONSERVATION COMMISSION A-1 SITE INSPECTION FORM (5o8)999•0722
Q%{tr c3.• \awes 1419114.
Name of Person Making Request Date
124 k\a tter,n S. �;nA woe ever ?at vet
Address of Applicant Stree Location of
Property
yes bra , if k oz'144, •345o Lo+ 21
City\Town, State, Zip Plat and Lot Number
M4-ois1 v 4 a1 dweNnc3
Telephone ( Day & Evening ) Proposed Use of Land
( Dwelling, Addition etc . )
a CMCA GI sautes ?e4ocw6kIerugt" /
Owner Name Signature a Owner or
Owners Represent .t ive
124Wau kornGa. f `�
Addres- ,^ 4 ) �� Signa ure App icant
NUJ �'SreFkd+ 0a0 -aii5o
LOCATION OF PROPERTY : Please attach a site plan . If a site plan
is not available , a hand drawn map showing the exact
location and size of property to be inspected is acceptable .
The map shall include the following information: street
name, house number on abutting lots, property bound
locations, and any natural or man-made- features which will
allow the inspector to find the site . Uze the space
provided below to draw a map or attach an extra sheet .
Property boundaries should be clearly marked in the field
prior to requesting site inspection .
v
'ld30 OMIIO, ^ ["infl !.`I_
aC e Liu UZ nfl LS,
l
Wetlands exist on (North, South, East, West) of site.
_ Edge of wetland has been marked on site by Inspector. Flag numbers -
Any activity (clearing, digging, removal of vegetation, etc. ) in a wetland
or within 100 feet of a wetland requires a permit from the conservation
Commission. . No work shall begin until permit is received.
_ A Notice of Intent should be filed with the Conservation Commission before any
work begins on site.
A.Request for Determination should be filed with the.¢onservatio4i Comdii(ssio�t:
—�'beefo a
'before any work begins on site. "`=
I/ o wetlands or other areas subject to the jurisdiction of the Conservation
7-
Commission exist on•site or within 100 feet of site. No forms need to be .
. "filed with the- Conservation Commission. � .
_ A survey plan of the wetland delineation should be submitted to the
Conservation Commission office.
other Comments: :.,�
-• . .
•
• ' • '
Note: The A-1 Site Inspection is a procedure outlined in the Dartmouth Wetlands
Protection Bylaw. It is a service available for the purpose of identifying ,
wetland areas on a site. The issuance of this completed site, 'Inspecti,on istrjoT.;..
a final determination of wetland boundaries or their jurisdictional status under
the Massachusetts Wetlands Protection Act (MGL,. Ch.s131 .$401 or thq Dartmouth
Wetlands Protection Bylaw. Only the issuance of •a Determination of Applicabirity •
or order of Conditions by the Conservation Commission finalizes the determination
of wetland boundaries and\or their jurisdictional status under these Laws. The
completion of this Site Inspection is not an authorization to proceed with work.
This site inspection expires three (3) years from the date of issuance (shown
below) .
All filing forms are available in the Conservation Commission office, room 107
at the Dartmouth Town Hall, 400 Slocum Rd. from 9AM - 4PM Mondays and 8:45AM -
4:30PM Tuesday through Friday.
Site Inspection Fees:
1-5 Acres $50.00; 5-10 Acres $75.00; 10-100 Acres $200.00;
Above 100 acres $400.00
The conservation Inspector will flag the wetland edge for sites from 1-5 acres
only. The Conservation commission reserves the right to refuse to perform a site
inspection on areas less than 5 acres where abnormal site conditions would
require an excessive amount of time be spent by the Conservation Inspector in
making a determination of the wetland areas present. Sites over 5 acres must
be flagged by a wetland scientist, botanist or other qualified person prior to
submitting of site inspection. The conservation Inspector will then review the
flagging in the field and make adjustments where necessary. The conservation
commission may require proof of the qualifications of the person performing the
delineation on sites larger than 5 acres.
( se' Iy - 9y AfitEct, �
Date of Issuance Conservation officer
(Rev. 9-1-94 MJO)
THE COMMONWEALTH OF MASSACHUSETTS
� BOARD OF HEALTH
No '
`� 4 3 L.. .A. OF Th .2b.Y1o'k FEE 76
Disposal ,rr nrkn Cnunntrxutiun Permit
Permission is hereby granted l.:ep:K!t,!t.<,C-ce.ec
to Construct ( /V) or Repair C ) In4iv dual Sejwage Disposal System
at No t?4C
Street c 5 .1
as shown on the application for Disposal Works Construction Permit No Dated -17-P5
/}� Board of Health
DATE 9' '� /
SOIL. DATA
DAM h�www N Pf" RFORMED DY! ''AV tEP.A.t-t� �c WITNE S�aED �Y=
TP tom$ TE' t�q WT- �io2
(z o t tG� .too I► lt!.
"1,09'4 NL" wp�tL
24 VAFL�AgI,� huPho
MAD M>✓o
lob l0r-7.1.2
AAI,-,,: torah TTe-ecG LAC;,
�ZD.-�• : l'` t �J 10 M � � • 2.°•"C �: l t � l �i r^ � �L .
W 4` K1aV'@ q lr.' do LJe.-C�
L�
TOP VIEW
5. 5' DIA. OUTLET
GRO55 SECTION VIEW
DISTRIBUTION BOX
NOT TO SCALE
END VIEW
III.
1-- GEND
LOT INFORMATION
Subdivision Name:
wt.aG le le•D
/S.GCL+GS
iQo EXISTING CONTOUR
Date:
2 - l a1- 0l �-•
PROPOSED CONTOUR
Lot:
Zi
PIPE INVERT ELEVATION
Owner:
G t leev_
t-, VtCLO 9 AA r,:gN : -
STARTING UNIT ADDITIONAL UNITS
TEST PIT
Assessors Plat:
(.vffl
Lot #: Z-'1q:)
5ffrTIG TANK
Zoning District:
7 V_
1--.Ls
.. ..
..
..........
El DISTRIBUTION BOX
Aquifer District:
W PROPOSED WATER SERVICE LINE
Other Overlay Districts:
1 A
_ _.. ODSERVED GROUNDWATER
FIRM Zones
G
TADLE ELEVATION
Special Permits Or
Variances:
RE SERVE AREA
4' SCREENED VENT -----
% Of Lot Coverage:
' _,
1
�o1v
COPTIONAL
'SELECT' BACKFILL. 1' BROKEN 3' MINIMUM
STONE OR SCREENED GRAVEL
PLOT PLAN,
SCALE, V---'�o
bco
oe
\ I / / 4o,20q h • �
n�E wE�� /
ENGINEER'S AS -BUILT O
PLAN & CE R
.71FICATION h
STATEIVIEWF REQUIRED
�— ....
of
This S% a h
E stern Is Not Designed
For art-iage Grinder, Whirlpool w �
r Other [high Water Use Devices.
GULTEG CONTACTOR CHAMBER 5Y5TD15
ELE TI t'S MUST NOT BE
'111HOU1 KADUD_ --
'1____.__ ..._.1z_. _.1_11317" .. _ Q.
UP Ht LT
I l! Q,
CAPACITY (gallons) 7s 112 170 400
*ALLOWANCE WITH J' OF STONL COVER OVER CHAMBER";
THE AP="ROVAe._ BY OFFICE r
DOES NOT GI IARAN TIEE THE
EFFECTIVENESS OF ANY
INSN LATION
DARTMOUTH FC)ARO OF HEALTH GENERAL NOTTE)
1) THIS SYSTEM- SHALL BE INSPECTED WHEN LEACHING AREA IS FULLY EXCAVATED
BOARD QP = AND WHEN ALL COMPONENTS ARE IN PLACE. WHEN THE 5Y5T�M 15 READY rOR .INSPECTION,
HEALTH' INSPECTIOA? THE CONTRACTOR SHALL NOTIFY THE LOCAL BOARD OF HEA' TH•
REQUIRED WHEN EXCAVAT
ED 2) WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DU5 AND FINES.
3) ALL ELEVATIONS ARE BASED ON ELEVATION DATUr°,
DESIGN DATA 4) HEAVY EQUIPMENT SHALL NOT BE ALLOWED TO OPERATE OVER THE LIMITS OF THE
OF THE SEWAGE DISPOSAL SYSTEM DURING THE COURSE or CONSTRUCTION OF THE
4'-10. I 1 �I SYSTEMS.
I II 3.5'dia. I � ........�,
/ L_ JI 1 / = \\ DESIGN PERG RATE: 1• IN ZD 5� NO FIELD
outlet
I knockouts SHALL BE MADE WITHOUT outlet I I inlet MODIFICATIONS TO THE SEWAGE DISPOSAL SYSTEM
DESIGN FLOW= ' 2 BEDROOMS x 110 GPD/BDM = ��� GPD REQUIRED PRIOR WRITTEN APPROVAL OF THE ENGINEER AND THE LOCAL 1,30ARD OF HEALTH.
L — — — — — — — — — — — — - Lt / / / �tJL� D{Z l V I SYSTEM DESIGN= USE GULTEG CONTACTOR MODEL # 12CI
G) UNLESS OTHERWISE NOTED ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN
PLAN VIEW 1r" �b i / /// I ALL UNITS WITH A-� OF CRUSHED STONE ACCORDANCE WITH TITLE V OF THE STATE ENVIRONMENTAL Gc)DE AND ANY
_ APPLICABLE LOGAL 'REGULATIONS.
15'dia. cover 10'x14• t`2 r I 51DEWALL= 06-b.qLONG x D•otly DEEP X 251DE5 X .�A- G/5F 64•1ka GPD
1• cov
6•x9• t 7) SEPTIC, TANK. DISTRIBUTION BOX. ETC. SHALL BE MANUFAGTURE-D BY A. ROTONDO + SONS
taper �- cover er �.
l4• BOTTOM= (6b.a= LONG x (o•?, WIDE x G/SF GPD OR APPROVED EQUAL.
V, / // •9 -
:v
ENDS= — WIDE x — DEEP x 2 ENDS x — G/5F GPD 8) GROUT TO BE USED AT ALL POINTS WHERE PIPES ENTER OR LEAVE ALL CONCRETE
3• sr,e,. c1 t A �� STRUGTURES IN ORDER TO PROVIDE A WATERTIGHT SEAL.
1'-7.5. 1'-1• �ti4 �t.Ccv:l1A1 �\ 3a�.Gi�l GPD PROWIDED
10•
5'-4" 1 4'-G' 9) ALL 5HIPLAP JOINTS IN THE SEPTIC TANK SHALL BE SEALED W� TH NEOPRENE GASKETS
7' 4'-0• OR ASPHALT CEMENT.
liquid
level
10) EXCAVATE ALL UNSUITABLE MATERIAL IN LEACHING AREA AND B4GKFILL WITH GLEAN
3"watls 1 FINISH GRADE GRAVEL AND COARSE SAND.
3•
= tt � . Co
GROSS SECTION MW FINISH GRADE OVER TANK ARROWS STAMPED ON UNITS 11) THIS SYSTEM IS NOT DESIGNED FOR A GARBAGE DISPOSAL UNIT.
'
ELEV. = 11(p.f� MUST POINT TOWARD D-BOX.
SEPTIC TANK DWELLING
FINISH GRADE t \ G?.O NOT TO SCALE 1,0'f 21 ' �Ol.�(,.� I �•� D T Mo '� K&
_
• B.O. P P CLIENT:
13�a TOP OF�OV�
FOUNDATION Q 4 =
A Zlo 2 l °l ol ` 2
O�� /tAl
"2�p
o
O
EL �2 OF 3/8 STONE �®
�` PEA ��VTd PM
• -- e - . - ' �' GALLON 1\ 6r •Ov 1 VI). AAo ` ..... dl !v .......*...' r, i� r •� s
REINFORCED CONCRETE
-� 2' OF 3/4' - 1 1/2•
I i SUB SURFACE SEWA
-
Q SEPTIC TANK 1t�7.'l� I ItZ.67D OF D6►a�� t�•11 �•
1 � 4.2� DISTRIBUTION it�j'tot7 . CRUSHED WASHED STONE }ate D15f'O 5AL SY STEM
- CSEE NOTE #2) ' z -
��A�tr BOX I SEE NOTE #11 �� I ALL AROUND
"Ltd tta4 �-QCtL'k-TL� �� � �� . _ _ _ — — — — — _ — — — — — — — _ _ LIMIT OF EXCAVATION-- J B.O.H. NOTES P.L.S. STAMP CONTACT: ft-X&Vi t��V� u>✓
N (
y' LEVEL STABLE BASE AT:
CJ.
13 Weby Road
' / �C?� ✓ / / New Radford MA
2745
Thw U
caoa� qqe-212s
FAX G708) 998-7554584
M (
T CIA and Environmental Engineering
1 I N O L Land Use Planning
NOT TO SCALE
_. a .. DATE: C2 DWC. No.
MAY 2 4 1995
a- �'�.1Rp Is3lT€
DARTMOUTH BUILDING DEPT
ZONING REVIEW
TO: :"'GINEER SkINING DEPARTM. NT `
liI<LE/NOTEBOOK "'CARD OF HEALTH ' - L f
CONSERVATION COMMISSION
*************************************************************)*****************
PLAT (;76 LOT o2-,"73 STREET NAME � lC//I ��'� /
OWNER'S NAMEafir41ah .,/�?.P SUBDIVISION & LOT #,.56 6IrCLig'Ye oe
CONTACT PERSON3nan TELEPHONE # 9 9 0242_5-
DESIGN PROFESSIONAL AGENCY Silk C
THIS 4N WAS PREPARED BY A _ SANITARIAN _ LAND SURVEYOR
ROFESSIONAL ENGINEER (INDICATE CIVIL, STRUCTURAL OR
ARCHITECTURAL OTHER
CHECK APPROPRIATE ANSWER WHERE PROVIDED, CROSS OUT INAPPROPRIATE ANSWER
After review of the site plan for the above noted location I find the following:
1. Zoning District 5 R$ c.-
Vacant Lot X yes _ no
Date of Lot Creations--6 4q Zoning District appropriate (Yes _ No
2. Street X.Existing, _ Public. Private, _ Ancient Way
"paper" has it been Bonded yes _ no Street complies Yes _ No
3. Frontage 2. 0 i- co N Lot Area fie �`�'o
complies 4 yes _ no complies yes _ no
Percentage of Lot Coverage YO % maximum allowed. See # 8.
4. Current required setbacks for this site are 60 Front 2 a other sides.
"Grandfathered" setbacks (are) (ate=rtet) allowed, for vacant lot only, at5S front,
zo sides and aD rear, per 19iY Zoning for Main Use. Exempt setbacks existing
yes _ no Exempt setbacks will exist due to "Grandfather" Rights _ yes _ no
5. Off-Street Parking Driveway
complies dyes _ no complies X. yes _ no
6. Cellar Slab elevations _ N/A required complies _ yes no
Height of foundation from bottom of fgyoting to of wal r it Varies
from to i-TP.c`Ow�
(over)
7. Accessory Structure(s) indicated _ yes Lno. Setbacks comply _
8. Aquifer Zone 1--23-.— Maximum impervious cover is--4-n lot area.
9. F.I.R.M. Zone C.. elegy Panel # 250051 00 / Sig date (oz( j3
Comment
10. Other Overlay District [/7
Comment /— ///
11. Zoning Board of Appeals action X not required is required for the
Wa granted - Case # for _ Variance _ Special Permit
dit
12. Certified "As Built" REQUIRED including top of foundation elevation in
actual elevation numbers, not assumed. //
13. Submit further information _ No 4, Yes. If yes, refer to item(s) # b
14. Project will require further review when new, revised or requested information is
submitted to any agency.
15. This Zoning review does not indicate compliance with any other Agency.
including, but no: limited to the Massachusetts State Building Code.
16 Building Department Permit(s) required Kyes _ no
17. : u �t Lr r'(
rJ. ,, .V
CE- Si— 1 - A _ o el
ubmittednby,
I
David J•Silve a
Building Commissioner &
Zoning Enforcement Officer Date (— 5-9 5
ZONIREVI.TWO
S OIL. DATA
pttTE► �i�p. t.o\A1 I"WoRMED BY► 1;AVAe ? �c• WITNF 55ED BY= 474 v-( I td
n- p''�' - - .`
Tp - + VI1 1 _. �I TI — t1201 1+A_ Inn WT - �th940
�o�,o1L
Zit
A t t2.c�2
Gt,A� 31,
1 lo• r.
to
�DaJt7
tom .(.Z Q6
to fA
60
TOP VIEW
�, 5' DIA. OUTLET
tdLP.lp
CRO55 SECTION VIEW
DISTRIBUTION BOX
NOT TO SCALE
m;-
--------------
I
I I
4'-10.
II5'dia. I L
outlet
I I
L---------------L
PLAN VIM
6'x9' 18'dia. cover 10'x
1' cove
taper cover _E4.
............
=T
3
Ill-
7.5'
10'
5'-4' 4•-G'
7' 4'-0'
liquid
Level
3'walls 1
3'
CRO55 5EGTION VIEW
SP-PTIG TANK DWELLING
NOT TO SCALE
TOP OF
FOUNDATION
q' tito' Z' dot a' 2 2l0 4' EL = t\"l L7C7
_ 4
"ltGAC t-t t ttC.t SAC t t,\-t�
LEGEND
-._----�----laO-- EXISTING CONTOUR
_.__. :__.K•-...•-.- PROPOSED CONTOUR
----- -�'`"� PIPE INVERT ELEVATION
TEST PIT
5EPTIG TANK
U D15TRI13UTION BOX
W PROPOSED WATER SERVICE LINE
0hCIFIevFn C.R[)I1NI)WATFR
LOT INFORMATION
Subdivision Name: ate-9 /S,Gt2.rG�
Date: lot -a-
Lot : Z i
a
Owner: DrcVcG't-O PMe-, KIr
Assessors Plat: loin Lot
Zoning District: GAS - 9.7
Aquifer District:
Other Overlay Districts: CIA
FIRM Zone: G
Special Permits Or Variances:
Of Lot 'Coverage:i°10
L2 - \%7 -log -1- L0
4' SCREENED VENT
COPTIONAL)
'5ELEGT' BACKFILL. 1' BROKEN 3' MINIMUM -�
STONE OR 5GREENED GRAVEL
O O,
�—
a h
W
CULTEC CONTACTOR CHAMBER 5Y5TEM )
CAPACITY (gallons) 75 112 170 400
+ALI.OWANCE WITH 3- OF STONE COVER OVER GHAMHE16
s ,
_ G N AL N1rIT 5'
1) THIS SYSTEM SHALL BE INSPECTED WHEN LEACHING AREA IS FULLY EXCAVATED
AND WHEN ALL COMPONENTS ARE IN PLACE, WHEN THE 5Y5TE`1 15 READY FOR INSPECTION,
THE CONTRACTOR SHALL NOTIFY THE . LOCAL BOARD OF HEALTH•
2) WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT. DUST AND FINES.
3) ALL ELEVATIONS ARE BASED ON M hL ELEVATION DATUM.
4) HEAVY EQUIPMENT SHALL NOT BE ALLOWED TO OPERATE OVER THE LIMITS OF THE
DESIGN DATA OF THE SEWAGE DISPOSAL SYSTEM DURING THE COURSE OF GON5TRUGTION OF THE
SYSTEMS.
DESIGN PERG RATE: 1' IN ZD 5) NO FIELD MODIFICATIONS TO THE SEWAGE DISPOSAL SYSTEM SHALL SE MADE WITHOUT
DESIGN FLOW: 12 BEDROOMS x 110 GPD/BDM GPD REQUIRED
PRIOR WRITTEN APPROVAL OF THE ENGINEER AND THE LOCAL nOARD OF HEALTH.
= ���
SYSTEM DE51GN: USE It GULTEG CONTACTOR MODEL # 1 ZGJ °'G) UNLESS OTHERW15E NOTED ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN
1 AGGORDANGE WITH TITLE V OF THE STATE ENVIRONMENTAL CODE AND ANY
ALL UNITS WITH A- OF CRUSHED STONE APPLICABLE LOCAL REGULATIONS.
51DEWALL= 06*�7.0iLONG x 0•0tl DEEP X 251DE5 X 3 A- G/SF GPD
7) SEPTIC TANK. DISTRIBUTION BOX. ETC. SHALL BE MANUFAGTUREP BY A. ROTONDO + SONS
BOTTOM: $;.q LONG x t0•72I WIDE x G/5F GPD OR APPROVED EQUAL.
ENDS: — WIDE x — DEEP x 2 ENDS x — G/5F = — GPD 5) GROUT TO BE USED AT ALL POINTS WHERE PIPES ENTER OR 'I EAVE ALL CONCRETE
STRUCTURES IN ORDER TO PROVIDE A WATERTIGHT SEAL.
�yc� 6ts✓V:tIA1�, 3AQj,Gi�I GPD PROVIDED
9) ALL 5HIPLAP JOINTS IN THE SEPTIC TANK SHALL BE SEALED WTH NEOPRENE GASKETS
OR ASPHALT CEMENT.
10) EXCAVATE ,ALL UNSUITABLE MATERIAL IN LEACHING AREA AND B�,GKFILL WITH GLEAN
GRAVEL AND COARSE SAND.
FINISH GRADE
OVER ' TANK 11) THI5 SYSTEM IS NOT DESIGNED FOR A GARBAGE DI5P05AL UIN' IT.
FINISH GRADE ARRO4M MUSTWS
STAMPED
ON UNITS D--BOX.
ELEV. = t 1�.t�
FINISH GRADE 1 \ G7.C� W"� Z, ' �OL�G'�� �•r% ® .t. MO
j72' OF 3/8' PEA5TONE
1 GiOt7 GALLON
1 hj. A1v
'
\\ •OO
REINFORCED CONCRETE
'
I
i
`.
SEPTIC TANK
11?7.'t� ::
• t
DISTRIBUTION 1 �'t00
i
IIZ•�O
CRUSHED WASHED STONE
C5EE NOTE #2)
BOX
I
SEE NOTE #11
\ t 01.00
I
ALL AROUND
—
LIMIT OF EXCAVATION
•
4• •: :.
• • • : • ---.LEVEL STABLE BASE
— — — —
— — — — — —
6
SYSTEM
PROFILE. -
NOT TO
5CALE