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BP-344 BUILDING PERMIT FOUNDATION ONLY Dartmouth Building Department Plat : 66 400 Slocum Road-P. O. Box 9399 Lot (s) : 2-81 North Dartmouth, MA 02747 Lot Size: 40, 751 Telephone 508-999-0720 Zoning Dist. : SRA October 24, 1995 (typed) Permit No. : 34' Issued Date: 11 / 3 / 95 Clerk: JMH Project Location: 13 Goldfinch Drive Sneer Street Subdivision Name: Songbird Acres Lot 24 Nearest Cross Street : Applicant/Agent : Bob Mulling Address : 8 Wareham Street, Middleboro. MA 02346 Contact Person Phone #: (508)-946-9118 Type of License: Owner: ( ) Const. Superv. License #: (057185) Architect : ( ) Engineer: ( ) Other: ( ) Proposed Use: Residential Residential. Commercial. Industrial. etc. Permit Issued To: Install Type of Iaproveaent. Add. Biter. New Const.. Demo. Land/hove. etc. Foundation Onlyband for New Dwelling indicate no. of bedrooms bathrooms and other rooms Gross Area of Const. : Cost of Const. $ 3. 000. 00 Cost-Other Const. : TOTAL FEE: $ 50. 00 Owner(s) of Record : Robert & Louise Fournier Address : 77 Dartmouth Farms Trail, North Dartmouth, MA 02747 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 proposed work is authorized by the owner of record and I have been authorized by the owner to make this application as his author ' ed agen Signature of Owner/Agent . G' (1 -- —_ Address : J��fff54-7-/ ,J. �d/ Giz \- ��1 ******************** ***************** ************************** Signature: I Approved/Issued By: (Or el S. Seed, Local Building missioner COMMENTS: SPECIAL mERMIT 0 ORIGINAL 0 APPLICANT 0 ASSESSORS 0 CLERK 0 COPY Z , ow- • DJ i L". NG PER MI F Ot.ptil?c4 T 3($4 ONLY `i Uart:wout5 SknIdinq Department I Plat ,. 1 t+'+ll It l : � m. 0 Ro d i'., iF t3o-; " Y`s'r` 1 Lot y'fr i 2-81 i North h Dartoo .th. Ntt Lt 747 i Let is e . r _r .51 fr. iopilfitle 503 _ ) o Shra4'1 - 44I r< rKi E.A s it: `Pk"ii i 4Yy.d ea + j r c:'eel, s IE r._per5 tecat :00 A! I.:iit r)citc._.Dr �` •.ucu >:�. ..a. w); b .r)d1:' . _ it N'.n,E : onnbi ai Acres cot 24 t }e )r .. . Cross jttre.e)t a Orp ;cot/Flgent : Rob Nulling_ t ao-. c,s; 8 L16Aa h r _t-r ' tx _!a '- icbc f M` t;l, <,nt _. ._ Contact tact e -5.c r Phont ii^ (5613i -. q+-i a. 18 + ar€;:. of License ; Owner--; i 9 Coast- .,:iuper-v r zc•en a 4: 07571 '5A "c:ht tact l S t-_nuAneoc t i Other; „ • f Proposed One: Re,Odential R.. 6c 1p3 l3l. Lstaxrma 4i 13)'-x){ i a?¢. Permit issued fa : Install __..__. 'tape Nf YBS'>,a 4 -.¢ 0„ Fijp) Alkac., New Carat-. Lea,Lea, [_P.•+' N etc_ L. f r9tin a - c Qn 'tor New Dw z3 tnn et;MiccYa zz. 9Y 4ant ..wa cad w4t) .nne: w -.?ear ...,. Mress Area of Const Cost of Const, b ,0 0 0 .. Cost"{tY' 1,oC4^ l . ...�..�:. ,,,_.,.. 4}Jf=vi_ FEE: _.. 5i+rr ....._... Awbe ls) of DA :.cad: Robert E. Louise Fourpier Address ; 77 D ?rtmouth Farms Leads North Dartmnath. NA 02747 A1 .8 wo1^. shall coalptv with 780 CMR 5th Ed. :MGL _ tap. 1 2) and an, ether 4,1pplitrable Masse. Laws er codes and plant, on P l Ir. I hereeta, cart.. ify that the propose()&I wuri-k 3 , touthbri2ed by _I.EC owner of reco- d and _ have been auteet7cd by the 00fler tt wake this ,. ppl>catIon as 3sts _uthari >er, ;,grant. . K->.l-- ***** *t..:l ***A-ikY k-******* **** *** *41*'3i4'. *:%**Lt****,.**-«-A -rn 5Ygnatu : ) 4-Iprr ,; c e I s seed £- r : Joel S. -Reed.. Local I.ui iding is'r_np8+'if t- i on€r I C OMMENi ,,, . SPEC} AL. €-LRMl1 g i I l R ICINAL, 3i AP} I t, ANT d. i i i -;c's ii .i t i U - _ __ _ _ _ _ Plat (GG Lot —4/ Address / 3 c dv Required approval Approvals received please (X) approvals Please (X) approvals and required for this project Initial as received DATE INITIALS Zoning Building Comm. Board of Appeals Water Card Sewer Card Board of Health Bond Selectmen Conservation Fire Chief Cross Connections Licensed Contractor Controlled Const. Affid. Other information required tier n 01 k/ �-i YID .. �oTk y , M © MIT NO. —G'r r c \• �'1 TOW_ TMOUT DATE ISSUED .l)f 0 '' o, TOTAL COST So. a a i yl APPLICATION FOR ''o v LESS APPLICATION FEES"-/2el aea- BUILDING PERMIT FINAL PERMIT FEE a'5100 p HUNG FEE i of n S/ce'` , 14 N / I 1Q NO W6DN t / jtzvi C 70Yr LOCATION OF BUILDING 01 Number & Street / ? 92��a,I c✓%i.n 01.1 Zoning District 02 Cross Streets` ts(between) and �% 03 Lot l�Co Plat e/ 04 Subdivision /1.;6.i�� "e7k,3 —0 Lot cy OWNERSHIP COST 05 Rate (individual, corporation, 36 Cost of Improvement �� — 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 IDNew Construction 36.3 Plumbing 08 ❑ Addition -Type of Room(s) 36.4 HVAC 09 ❑ Alteration 36.5 Other - Specify 10 oundation Only 37 TOTAL example: elevator Jam/ 11 ID Demolition (#of units if residential) 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 Vie-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 0 Garage - 18 ❑ Shed 45 Total land area, square feet 90 ) 19 ❑ Carport 20 ❑ Swimming Pool SEWAGE DISPOSAL In-Ground Above-Ground_ 21 ❑ Woodstove 46 ❑ Public or private company 22 0 Fireplace 47 mate (septic tank, etc.) i 23 ❑ Other- Specify WATER SUPPLY 48 ❑ Public or private company NON-RESIDENTIAL - PROPOSED USE 49 nvate, (well, cistern) i 24 ❑ Amusement, recreational 25 ❑ Church, other religious PRINCIPAL TYPE OF HEATING FUEL 26 0 Industrial 50 ❑ Gas v 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 ❑ Outside 59 Does this building contain asbestos? ❑ YES rRicTO If yes complete the following: ' Name & Address of Asbestos Removal Firm: IDENTIFICATION - To be completed by all applicants PLEASE PRINT /---� �- // ' - J/ ✓>nL/✓7liA2f Corn✓ ./ 60 Owner (print) ci;.�- 4 4 2.v�hi,-- ✓� .0.;,,,L/a-o.--/1z %9L 'egg// C NAME MAILING ADDRESS TELEPHONE NO 61 Signature . ,Z w� 1? s� DATE //9,4-0- y�>'A/ Ow• 6J', Builder's 62 Contract (print) �N ;- 2J G'D S/2, 2� e ?�PNENO. LicenseNo,��s-2/ / N- MAILIN DD 5 ' .e✓�/' lj/ TELEPHONE NO. 63 Signature, C DATE 4G�O4gr 64 Architect or Engineer (print) NAME MAILING ADDRESS TELEPHONE NO. 65 Signature DATE CERTIFICATION TO PERFORM WORK / 66 I/W ��e hereby appoint .> i//iLJ i�� ////� /QL'. . NAME ADDRES 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..- Signature DATE /82,,,<-14 j S ADDITIONAL INFORMATION 67 Has A-1 or Determination been issued by Conservation Commission? .— O 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 ntTcer n der , ' f the penalties of perjury that the information herein is accurate to the best of my know dge. i� Signatu / --/ DATE - 0 2, _ 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 u e of permit - (if applicable) 71 I will post�rmit and addr s(o e nisi m street. L`>/ ----'"------ Signature 1 - �� DATE ner or Agent T 72 I have recq'ved list of re speed ss Signature\� //"/1 DATE /L �5/ Owner gent 73 FOR RESIDENTIAL PROJECTS OTHER THAN NEW DWELLINGS: ry 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-off? YES_ NO (if yes.submit required signed affidavit) r` 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 TOWN OF DARTMOUTH __, j // _.., . PERMIT NO. — //—nCIL No ,. j /7 6 ya Date I a It Received From l r �{ tOwner ( /ia f tx ,cJ(i LL- i i -C t".% 1 Ord-( c� �� 4 ,7 6 ; ton i kyr - � "" Amount Paid. 1 ^ (/� / Receive�6�`-Fr < 't RECEIPT FOR PERMIT L. ): lm-,T=A ' TOWN OF DARTMOUTH MIT NO. Ns _Dat (i�e -( fX_ V l�Y� Received From ,2 ' j ` Owner 4-6-1A// ,/K ' fiLoCation 12) - ---*. ,.. _._Ili - cji ____XL , • tic Type i , lc ,i T Amou t Paid_� u /' ' J. r/�g r Receive \ The Commonwealth ofMassachusetts '-1"�+ = it Department of Industrial Accidents 'xi Of/iceollavesllneioos 2 c— 600 Washington Street QC='.c .t om. 4.7 g = Boston, Mass. 02111 L Workers' Compensation Insurance Affidavit 'Apniicant-inforntMI n : -- name: (..C.io r ../ -- 7.4--9 • iocation- �/i�/��i,:// ///�-� city /!< n/��.�il.-li�/2 EI am a homeowner performing all work myself. nhonr I am a le proprietor and have no one working in any capacity r am an employer roviding workers' compensation my P forployees working on this job. company named• ,.r� � �; r��• . . address: /� �p*� 7�y., insurance co. /��f' �. x / notiev#G1� . /o7e al- / ❑ I am a sole proprietor, general cnntractor, or homeowner(circle one) and have hired the contractors listed belcw who haze the following workers' compensation polices: company name: address: .. . <-::.. . city: nhoneilk insurance co. - -- _ nniicv.it:_ .. -- --- -at company name: - address: city: - insurance co. Attach addi6o polity# - pal sheet ifaeeessarr-. . .__- _ .,d »„ Failure to secure coverage as required under Section 25A of JIGL 152 can lead to the imposition of criminal penalties of a fine up to S 00.00 and/or one sears' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that a cope of this statement may be forwarded to the Once of Investigations of the DIA for coverage verification. I do her r cenffi•under t e ens n enalties o perjurr that the information provided above is true an correct Sigratsrg. �/ _ � �// Date /Oj�. Print name /o „% 6'�/i✓J Phone# �� -. �` 9//" ` official use only do not write in this area to be completed by city or town official city or town: permit/license# Building Department ` cneck if immediate response is required ['Licensing BoardE Lt QSdretmen's Office c- . contact person: ['Health Department phone#; riOther i:- • . t 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 every 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 o 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. f-t 1ppiicants Y 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 Iisted below. ar " „ max u X City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided &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 Offi.e of Investigations would like to thank you in advance for you cooperation and should you have any questions. please ;o not hesitate to give us a call. 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 TOWN OF DARTMOUTH BUILDING DEPARTMENT TELEPHONE 508-999-0720 FAX 508-999-0738 TO: Fire Chief Dist . 1, 2 ,) ❑ Board of Appeals 'Tax Collector ❑ D .P.W. Engineering pz, Board of Health ❑ D .P.W. Water/Sewer kConservation Comm. _ Cross Conn./Water Div. —i Selectmen-Licensing — Planning Board Town Clerk 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 3n pj.apcation for Plat Lot �o� , Address //. i✓o/%jro /el edgy/, by / .o, /247�-✓ to .. , CONTACT PERSON&TELEPHONE# demo.oonstruco.alter. occupy, etc. a(n) r7 //' 7_• ,, . The plan was received by this office on //� �, �{ • ate This office will review said plans and subject to availability of potable water, where required, the provisions of Zoning By-law per MGI. Chapter 40A and MS3C 780 C:"R Sth 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 si ture acknowledges your receipt of a copy of this notice. APPLICANT.TELEPHONE(PCFASE PRI SIGNATURE DATE LICENSED CONTRACT.OR's NAVE TELEPHONE(PLEASE PRINfl DATE REQUEST FOR ASSIGNIENTTOF HOUSE NUMBER I , N Owner 2s) of Property ,�,, � o,„r ;;N„n,.;,,, Present Address 8-4.41„ .X;„ X /yi �.1/bi.� e5c;&: Telephone Number House Location: Plat Lot ,2-B/ Subdivision ,� 1 ";� Lot 0.7y Corner Lot ? Yes No Street yU��,7/0A - Single Family i/ Multi Family Condominium # of Units Site Plan Submitted ? No Date Submitted !/ijiir�'s� Signature of Owner House Number Assigned 13 GOLDFINCH DRIVE Date Assigned 10-23-95 Date Assessors Notified 10-23-95 Date Building Dept. Notified 10-23-95 Date Owner Notified -Supe 'tnte+nien ,_Department of Public Works Dartmouth Building Department 400 Slocum Road P. U. Box 79399 588-999-0720 Dartmouth, MA 02 747 FAX 508-999-0738 STATEMENT - OF REQUEST FOR SPECIAL PERMIT PER 780 CMR 114 . 0 PERMITS I , 7� j'�//Y7 ' hereby request a PLE SE 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 including but not limited to removal in its entirely of said foundation. j/�J Foundation located at : ..415 Ga/7ll Signed under the pains and penalties of perjury as applicable in the Commonwealth of Massachusetts. . 1/24 � �Csa` %//c��jv�' SIGNATURE OF OWNER IOR AUTHORIZED AGENT DATE BUILDING PERMIT FIELD INSPECTION FOUNDATION ONLY SPECIAL PERMIT PER 780 CMR 114. 0 PERMITS Dartmouth Building Department ' rh " Epp_, Plat: 66 400 Slocum Road-P.O. Box 9399 Lot(s) : 2-81 North Dartmouth, MA 02747 Lot Size: 40, 751 Telephone 508-999-0720 Zone Dist. : SRA Issued Date: 11/03/95 Permit No. : 344 Project Location: 13 Goldfinch Drive Number Street Subdivision Name: Songbird Acres (Lot 24) Nearest Cross Street: Applicant/Agent: Bob Mullins Contact Person Phone #: ( 508) -946-9118 Proposed Use: Residential Residential, Commercial,Industrial,etc Permit Issued To: Install 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: Robert & Louise Fournier Address: 77 Dartmouth Farms Trail , North Dartmouth, MA 02747 DATE TIME TYPE OF INSPECTION REMARKS INITIAL ` ? ( -,,l as_ ,i ,Jf iv42 /-/9-9G .? ,?ofr,.,., ev�j 1-./44 tb 01 0 s, c-s r Liz 2 - - ,2`a€z2 I.4 - • , i - 6 U C' • co 2 o 0, .6 . 0 O > s �., O J ; V 0 0 ja e e o n ¢ m 4 M U b U 2. r D ,," :IP, 2 1Y- . \\N 3 � 4 ? pQI- cc' N -aa u d Hwa 73�4 � S I g �j On N N� V Cn sg `e 3 11. UJ O u O O. b —112 o9 le ' 0 ) o F v v 6 v �y 2 4 d U r o v ( p , 2 . c. i k.- -2 (3 Cra Be =la.0 0 ;o1 --J 0 ,,4 et ® ague l $ = 2< -2 ® s ke g R gm r G , +,r 400 Slocum Road • P.O. Box 9399 North Dartmouth, Massachusetts 02747 CONSERVATION COMMISSION A-1 SITE INSPECTION FORM (508)999-0722 .j% er' cj. %Awcs Jo/19194 Name of Person Making Request Date I24 tLu41 srn 9.• �,; D;ve , acc QOA Address of Applicant Street Location of Property 4rek i We o1.140 .34So La} 2f City\Town, State, Zip Plat and L t Number 994-015'1 494 ' 314,4 Sittv4ca1 diatiki tc,, Telephone ( Day Si Evening ) Proposed Use of Land e, (Dwelling, ddi ion etc . ) t gicharA Gt 4afl Z4oc.AIOlegTrueSia 7,,,.A/ Owner Name Signat_ure o Owner or Owners epresent tive 124• Watn3 'n G'. T{� " Md res 1 ( M14 OZ1� .3c� Signature o Applicant �► 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 . One 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 . • 08 o biLi oo no:; I,u€ a . Una LULN KVASUDI 1.:VnflsoSa.ua £aOsa:...ava ............ .. ...... '--.... ........—. --.•— 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.conservation Comlifssi.on. —�'before anp work begins on site. U/ No wetlands or other areas subject to the jurisdiction of the Conservation_ 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: ' ` • • I • • ( 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 Sitq 'Insppc•tion is 21OT•;.. . a final determination of wetland boundaries or their jurisdictional status under the Massachusetts Wetlands Protection Act (MGL; Ch.e131 .S40) . or thq Dartmouth wetlands Protection Bylaw. only the issuance of t Determination of Applicability 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. - tf Afa) Date of Issuance conservation Officer (Rev. 9-1-94 MJO) DARTMOUTH BUILDING DEPT 9 3- ZONING REVIEW . D TO:(C ENGINEER PLANNINGbEM 4'MXNT Q'ILE/NOTEBOOK ><BOARD OF HEALTH / () 5 9, SNSERVATION COMMISSION 43.. PLAT (OI// LOT �j p��0 i STREET SAME )��ia-cr ��- . OWNER'S NAME at A8dfaleBD1VISIO & LOT # 02 v CONTACT PERSON UMt- . c TELEPHONE # DESIGN PROFESSIONAL AGENCY J ; Yb THlis PLAN WAS PREPARED BY A _ SANITARIAN _ LAND SURVEYOR i/PROFESSIONAL ENGINEER (INDICATE CIVIL, STRUCTURAL OR ARCHITECTURAL OTHER CHECK APPROPRIATE ANSWER WHERE PROVIDED. CROSS OUT INAPPROPRIATE ANSWER tfter review of the site plan or the not,�dlgcation, I find t following: 1. Zoning District S'I2 6 C� ��R5 �d�o C/Va(ccant Lot X yes _ no Date.of Lot Creation (,40-c'( Zoning District appropriate 2'Yes _ No 2. Street _ Existing, _ Public, _ Private, _ Ancient Way "paper" has it been Bonded yes _ no Street complies ?Yes _ No 3. Frontage j SO Lot,Area 4/C) 7-57 complies jyes _ no complies Y yes _ no Percentage of Lot Coverage L(U % maximum allowed. See # 8. 4. Current required setbacks for this site are (,C) Front 26 other sides. "Grandfathered" setbacks (are) (aretot) allowed, for vacant lot only, at , ,7T3front. Zosides and 20 rear, per 19WZoning for Main Use. Exempt setbacks existing _ yes jauo Exempt setbacks will exist due to "Grandfather" Rights _ yes ')1 no 5. Off-Street Parking Driveway complies yes _ no complies X yes _ no x 6. Cellar Slab elevations _ N/A ' required complies yes ( no Height of foundation from bottom of footing to top of wall or it Varies from to (over) 7. Accessory Structure(s) indicated _ yes Xno. Setbacks comply _yes _ no 8. Aquifer Zone ( . 7. -4—'2—"r Maximum imp of area. 9. F.I.R.M. Zone elev ePanel # 250051 00 (S'P date @ 11-- Comment 10. Other Overlay District V�� Comment 11. Zoning Board of Appeals action X not required is required for the W granted - Case # for _ Variance _ Special Permit 12. Certified "As Built" REQUIRED including top of foundation elevation in actual elevation numbers, not assumed. 13. Submit further information )cNo _ Yes. If yes, refer to item(s) # . 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 i Building Department Permits) required yes no 17. 0 er ) , - Submitted by, David J.Silqira Building Commissioner & Zoning Enforcement Officer Date -22 7i ZONIREVI.TWO v 6% 90 z4 r �Z SOIL DATA DATE- PERFORMED BY= BY:nj TP Imo 17.0 n TP — 1-;2 k 11-n r) WT- -,�b ocv C) It. VA. e.I&P,7tJ GI.A� 4 I �j SuQ��tl. \/A Zk&g►1.� G t.& t�rCD1U i'1 S 1Zo I I O.0 tUo I I t 0a.1(:j view LA ��rc : �`' � �s► eta MttJ. Q.+n.-�� : t" old w &v,- z t 1 A►- • O -12 5. 5" DIA. OUTLET 5'd►a. outlet I tq •1072 -7 >s TOP VIEW OR055 SECTION VIEW DIST 4'-10• 5'-4' R,\IBUTION NOT TO 5GALE to$ tt�.c7 ► A O WA. 1Zo� W T @ I O ta;'• amw PLAN W-V; r •Ya• /-18'dla. cover GR-O55 SEG'f(ON VEY'1 :)EPTIG TANK NOT TO SCALE LEGEND 100 EXISTING CONTOUR 0 PROPOSED CONTOUR PIPE INVERT ELEVATION TEST PIT SEPTIC TANK DISTRIBUTION BOX W PROPOSED WATER SERVICE LINE OBSERVED GROUNDWATER TABLE ELEVATION RESERVE AREA PLOT PLAN SCALE, 4)V 3rMXKM T+ I __J Nr La -� -n , / \ woo, END VIEW / \ / \ �/0, LCT Zjq---- L°TZ Ace, 'l C�2 l s oQ. ' 0Qa0Fos-a9 l no QPa'tr��-rt v� Wow CZ�ii � w�L �o.p� u5 QQnR�� 3 ISO \ \ 1 Pao � knockouts '• Inlct tv tT o xGb.Ve.T� too rt�P t�o.o lO'xl4• cover .•:� -I` 4 • 120 -T VQ1VS100 i +3- � OVISH ER TANK BE FINISH GRADE DWELLING TOP OF FOUNDATION EL BOX . •: _ ., ... - LEVEL STABLE BASE G' LOT INFORMATION Subdivision Name: Date: Lot: 24- Own e r : rat rr-t.D Assessors Plat: Lot; Zoning District: Z: V2 Aquifer District: KA It-\ Other Overlay Districts: FIRM Zone: G Special Permits Or Variances: t`l& Of Lot Coverage: C? 0% �ff N � l � I 1� Co /�'•� ,� CCURT C:. = T!.lGU 11 DESIGN PERC RATE: 1' IN 2c-2 I lit r L2 - I - to L� SELECT' BACKFILL• 1' BROKEN STONE OR SCREENED GRAVEL 4' SCREENED `,'ENT -`—'- COPTIONAL) 3' MINIMI.'k" ` GULTEG GONTACTOR GHAM59 SYSTEM s MODEL: 75 ? 4 12- -�- 180 330 DIVENSIQf4S L 85" 8=" 90" 90" W 27" 2=" 36" 52" H ! 12" 1'" 20.5" 1�30.5" -- - h ► 6 " ; 11.3" 14" 1 2 4" CAPACITY (gallons) 7,5 112 1 170 1 400 j ALLOWANCE WITH 3" OF STONE COVE'' OVER CHAIrIBEP+S DESIGN FLOW: BEDROOMS x 110 GPD/BDM GPD REQUIRED SYSTEM DESIGN: USE t GULTEG CONTACTOR MODEL # 11-c,7 ALL UNITS WITH 4 OF CRUSHED STONE SIDEWALL='l1.-I1�2LONG x o•ato DEEP X 251DES X •C�0 G/SF = -•(oQrGPD BOTTOM: "111� LONG x to.�,WIDE x .-7;� G/SF = 'L(vQ-:.21 GPD ENDS: tO- "7:;' WIDE x o .q 6 DEEP x 2 ENDS x . C�a G/ SF = •. $Q� GPD "�"f �'•`C� GPD PROVIDED ARROWS STAMPED ON UNITS MUST POINT TOWARD D-BOX. �-- FINISH GRADE I SEE NOTE #11 t L- LIMIT OF E' -•� — _ _ ._ _ — _ — _ _ _ _ _ _ _ _ _ _ _ _ _ _ �XGAVATION — w-T E trE-1V : 1 I I t�-) NOT TO SCALE E N E FN%\ A L N 0 1) THIS SYSTEM SHALL BE INSPECTED WHEN LEA011NG AREA IS FULLY EXCAVATED AND WHEN ALL COMPONENTS ARE IN PLACE. ft- N THE SYSTEM IS READY FOR INSPECTION. THE CONTRACTOR SMALL NOTIFY THE LOCAL B (-)ARD OF HEALTH. 2) WASHED CRUSHED STONE SMALL BE FREE OF ;%LL DIRT. DUST AND FINES. 3) ALL ELEVATIONS ARE BASED ON t� , �, l.. • ELEVATION DATUM. 4) HEAVY EQUIPMENT SHALL NOT BE ALLOWED TO OPERATE OVER THE LIMITS OF THE OF THE SEWAGE DISPOSAL SYSTEM DURING TH COURSE OF CONSTRUCTION OF THE SYSTEMS. 5) NO FIELD MODIFICATIONS TO THE SAL SYSTEM SMALL B SEWAGE DISPc E MADE WITHOUT PRIOR WRITTEN APPROVAL OF THE ENGINEER ANC THE LOCAL BOARD OF HEALTH. G) UNLESS OTHERWISE NOTED ALL SYSTEM G OMP C'NENT S SMALL BE INSTALLED IN ACCORDANCE WITH TITLE V OF THE ' STATE ENVIF ONMENTAL GORE AND ANY APPLICABLE LOCAL REGULATIONS. 7) SEPTIC TANK. DISTRIBUTION BOX. ETC. SMALL BE MANUFACTURED BY A. ROTONDO + SONS OR APPROVED EQUAL. 8) GROUT TO BE USED AT ALL POINTS WHERE PIP-S ENTER OR LEAVE ALL CONCRETE STRUCTURES IN ORDER TO PROVIDE A WATERTIG'IT SEAL. , 9) ALL SHIPLAP JOINTS IN THE SEPTIC TANK SHALL BE SEALED WITH NEOPRENE GASKETS OR ASPHALT CEMENT. 10) EXGAVATE ALL UNSUITABLE MATERIAL IN LEAGHINC. AREA AND BAGKFILL WITH GLEAN GRAVEL AND COARSE SAND. 11) THIS SYSTEM 15 NOT DESIGNED FOR A GARBA GI DISPOSAL UNIT. 2' OF 3/8' PEASTONE I I 2' OF 3/4 • - 1 1/2 • CRUSHED WASHED STONE I (SEE NOTE #2) ALL AROUND Lar Z4 - Gco �u B.O.H. STAMP B.O.H. NOTES I y, 22.199K- c., ei t izv DA.-TMOVT to K,& . , 2 �4 ()F a ss veveruoo PrAe:IdT 0 3-2-165 t4°• ,. SUBSURFACE SEWAGE E)15PC)5AL SYSTEM p•L.S. CONTACT: A T: 1 4: 1.3 Wary ltm)d 3 Nov Bedford MA 02745 FAX (50&) IMA-75N CIA =d Environmental Eng!-tiecrtng Land Use Planning DATE: 4 -2:;5 -&Ic-2 DP'C. No. IMC l.Vl•ImV.Nvcnk,. 4Vir€C .IOa • BOARD OF HEALTH No el-5-9 1,.L.4k - of 6tmow � FEE S7Jr °J Disposal Harks Qtnnstrurtiun Wrath Permission is hereby granted to Construct (� j or Repwir ( ) an Individual S wage Disp sal System 1 at No "tat "...XStre-..... Gi 1SL16 b o— PP P m3 7/i� 9- as shown on the application for Disposal Works Construction Permitit No Q C 7 Dated DATE (i / % 95 Board"� of Health • • a LOT INFORMATION 5 OIL DATA LEGEND' Subdivision Name: DATE= Z-1-a�I _PERFORMED BY= l�112Gts21,.t p s-�16- WITNESSED BY: Date: - tc - R A- 100 EXISTING CONTOUR — ��>o TP -- i 2 t WT Lot: 24- � P Zo. O o I Zo. o t Zo.O o 00 PROPOSED CONTOUR '�Owner: oQho I t� _ t ta.?'� t lq ,� PIPE INVERT ELEVATION w t!, Assessors Plat: Co(o Lot f : _ gj STARTING UNIT ADDITIONAL UNITS Ilew TEST PIT • . �% ti • • • • • • • 7-4-7-4-vAZ �So tl"1.� Zoning District: _ Q� - .............. ........... .........:., ,.:. ; �4,�,tJ- ap SEPTIG TANK --- . .. .. ... GIA Aquifer District: k A , E3 DISTRIBUTION BOX - L2 Aa 17, It�.O 'l2 tlQ-,O Other Overlay Districts: t1 f �, Mpt�, MtuM W PROPOSED • WATER SERVICE LINE FIRM Zone: G ��t✓� l!j �L'C OBSERVED GROUNDWATER TABLE ELEVATION Special Permits Or Variances: fa& $ O f Lot Coverage: e : � � t/d 1 �� oy, RESERVE AREA � t t �. o E g — 4 SCREENED NT ---•- COPTIONAL) t 110.0 1 o "SELECT' BAGKFILL• 1' BROKEN 3' MINIMUM --� Zo LOV, a • STONE OR SCREENED GRAVEL • 1 µto. uv W&V?T 1W. ENGINEERS AS �►'t� . l t a.S tiv t�lt1.�. Q.e.-�� . � �ti1 � , -BUILT KID vie.• IZ�" �-�� °``�-".�PLAN �� CERTIFICATION SINIEMENT REQUIRED PL T P O O LAN- h SCALE= 1'46end .. ...... . ...... ...... ...... ..... T1� , ys, . m S 0 L WhirlpOOI ao� r-or Garbag Grinoer Or Other High Weler Use DeviCeS I I I 2o'w � D �t�•�1 , yr �21 c Tlp c> A� "T BE �7vz• ... r rkai., is TOP VIEWU ST N SOUE10ARD + I - OUTLET OF HEALTH APPR0,11AI 5. 5 DIA. L _j GULTEG GONTACTOR GHAM13EP. 5Y5TEM5 t,o n ,,' + + END VIEW MODEL: 75 125 180 � 330 f BOARD 0'' HEALTH INSPECT't(.w DIMENSIONS L 85" 85" 90" 90" t t�1,CTLOT 2 REQUIRED CEXCAVATE':. W 27" 28" 36" 52" �, Q-,• " " " _ \ H 12 18 20.5 30.5 24 C, � � I �� CAPACITY (gallons) 75 112 170 400 GR O 5 5 SECTION VIEW o (9 ) • 01A. QG• \ t 1� f #ALLOWANCE WITH 3" OF STONE COVER OVER CHAMBERS o THE APPROVAL BY THIS OFFIC'.- • DOES NOT GUARANTEE THE EFFECTIVENESS OF ANY D1STP\1E3UT10N11 E30Xl lQ' co F ��- ��-- ;:U,T : L Lr LY INSTALLATION Not To SCALE '�- DARTMOUTH BOARD OF HEAL17 GENE PN\AL NOTES CCJS �� ' - OQ0�� W�1.1�A�l V5 j ��/� J a.__SLUE: -:;�cY 1� THIS SYSTEM SMALL B • j'' ; o E INSPECTED WHEN LEACHING AREA (S FULLY EXGr\VATED ��? AND WHEN ALL COMPONENTS ARE IN PLACE. WHEN THE SYSTEM IS REArY FOR INSPECTION, \ Ln' 1.:CU 114, L THE CONTRACTOR SHALL NOTIFY THE LOCAL BOARD OF HEALTH. f f- \ C�\. 2) WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT. DUST AND FINE• 3) ALL ELEVATIONS ARE BASED ON tM . �, L. , ELEVATION DATUM. I lot I o 4) HEAVY EQUIPMENT SHALL N S OF T DESIGN DATA NOT BE ALLOWED TO OPERATE OVER THE LIM{ . HE I ••: :�:•: �Z� _ OF THE SEWAGE DISPOSAL SYSTEM DURING THE COURSE OF CONSTRUCTION OF THE 4•-10• I I ` 5Y STEMS. • / L s DESIGN PERG RATE 1 IN 'Lc? 5 dia. I knockout Inlet 5) NO FIELD MODIFICATIONS TO THE SEWAGE DISPOSAL SYSTEM SMALL BE MADE WITHOUT outlet I I DESIGN FLOW: BEDROOMS x 110 GPD/BDM = 3�o GPD REQUIRED PRIOR WRITTEN APPROVAL of THE ENGINEER AND THE LOCAL BOARD OF HEALTH. _emu I �� : ' ---------------J= = l� � SYSTEM DESIGN USE GULTEG CONTACTOR MODEL � l'T.� G) UNLESS OTHERWISE NOTED ALL SYSTEM GO `:_ED IN COMPONENTS S SHALL BE INSTAL LNt1To�TCXGdV�.T1 ACGORDANGE WITH TITLE V OF THE STATE ENVIRONMENTAL CODE AND Af Y PLAN V �r , MQ, ALL UNITS WITH A OF GRUSHED STONE i�o•c� APPLICABLE LOCAL REGULATIONS. • , •AJoo� ' 18'din. cover 10'x14' _ I 4rco.�0 �. tR.� SIDEWALL= 11-_1C2LONG x 0.96 DEEP X 25IDES X .�c2 G/SF = 14-. (oA-GPD 1. 6 x9 cover •••:::. ; 7) SEPTIC TANK. DISTRIBUTION BOX. ETC. SHALL BE MANUFACTURED BY A. R.7TONDO �- SONS .; ••; . / , taper �-- cover Q. 126 BOTTOM: 11.I� LONG x to.-,;5' WIDE x � G/SF = 2lvQ-.'L� GPD OR APPROVED EQUAL. > ID 9.1 Ve � ENDS: to• 3 WIDE x 0.96 DEEP x 2 ENDS x . �o G/ SF = q • $$ GPD 8� GROUT T O BE U -- SED AT ALL POINTS WHERE PIPES ENTER OR LEAVE ALL GONCRETE 31,-1• �`---� STRUCTURES IN ORDER TO PROVIDE A WATERTIGHT SEAL. �'� •� GPD PROVIDED 1'-7.5' 10' / 5'-4' 4•_G• .Z° 9) ALL SHIPLAP JOINTS IN THE SEPTIG TANK SHALL BE SEALED -WITH NEOPR:"-NE GASKETS 7' 4'-0- •-,r, . �,. .. OR ASPHALT CEMENT. .. , ,„. is sys em is designed �s, n the sci A. liquidf ications detailed in Sec . 3.4e Title S rate 3 l0) EXCAVATE ALL UNSUIT love 3'wa!is Environ�ntal Code of 1977, in sizing this ABLE MATERIAL IN LEACHING AREA AND BAGKFILL WI'-H GLEAN �., i� syste-n the use of these specs is advantageous GRAVEL AND COARSE SAND. ' 3 FINISH GRADE in comparison to specifications Cara' ; i1 • sled OVER TANK - 1 ��•O specifications CROSS SEc11oN VEW FINISH GRADE Sec. 15.242 Title V State Eiiviro�_-,,t ntal Cede ilk THIS SYSTEM IS NOT D `wc•" ' _. of 1995. This lot is granted tn; s rivilece ARROWS STAMPED ON UNITS DESIGNED FOR A GARBAGE DISPOSAL UNIT..::..-* ELEV. _ �Z'L �' P- MUST POINT TOWARD D-BOX. i under a gr_andiather.ing clause. S ; on uodiv�s_ Approval Date : 12 - �� - �� - v�- 61ocbA,1je,t� SEPTIO. TANK D `jI LLIN G FINISH GRADE ISot NOT TO SCALE LoT ZA- - �C� G� l �.� �►G�� DA Z�T�MOVT t tA& S B. 0. H. STAMP P. E. STAMP CLIENT. - TOP OF i. I � F yr A i ICE` i r,C 111111111111111 R 0 L ,4 C L��i�•�ClfiV 2 OF 3/8 PEASTONE r r, ®F' �y` �� 1D�VerL'0 PtAE:: EL - �Z�2. 2 0-77 � 0 10 �• '� i - l Epp GALLON t . I ..t, �' C' G1 '[ ' • GIV } • i REINf ORGED CONCRETE _, . .. I i :;� I �'} o 14p. 32 l . , . �1�. . o . _ �� SUB BUR FACE SEWAGE I Z F' 3/4 1 1/2 SEPTIC TANK CRUSHED WASHED STONE r • DISTRIBUTION k ,� ., DISPDSAL SYSTEM l CSEE NOTE #2) ! ��• B OXI SEE NOTE11 �/ 7• IAROUND //gsrLV0 ALL � . . ; _ — — — — — — — — _ — — — — — — — LIMIT OF EXCAVATION ON _ — B.D.H. NOTES P.L.S. STAMP CONTACT 16rZ.�e.�•l �-��v • LEVEL STABLE BASE 13 we-y rom Mev decrard MA 0274-15 ..a FAX C506) 9r.s-"N E)YE)TEM PP---\0F1LE Ctv1 and rwronmentai rng!3►rertng Land Use Mrrilh9 NOT TO SCALE DATE: �; -1- 5 �41� DWG. No.