BP-760I
LOCUS MAP SCALE:N.T.S. ,S.
PERi�, RATE' � Niic�/i1�1 `L.RC, RATE'
WATER TABLE, Sc,"(112, 1 TABLES g4ar C _ )
i
PERFORMED BYi r ITZGE ALD EKSINEERI�iG INC.
F' RC T E E EST PEf .�
SOIL EVALUATION PERFORMED BY: PLETER j, HAWES
WITNESSED BY, CHRIS P�ICHAU -BOARD OF Ell TH INSPECTOR {
1. All work must be in acco-rdance with tj�,r Massachusetts De a�t ,pnt o
Envi'ronmenial Protection Pe,g,Wa,t�.or�s 1� CAM, 41.00 15.00 (Title V)
and any local Board of Health Afodifica t i,= -ns
.2. No raodrfications shall .,be made, to this systern, aari,thout prior written %!
r
.
th
local
and o H�az,l ,
th oa" vo. tax,. the engineerc�nd � a f a� l h,�
pp .r
3. Engineer and the toard of Health must ;n-'Peot the campleted system
prior to back -filling.
DESIGN. DATA
4. Elevations shown. plat. are based on on twbdivilsion datum
�,
Design Pei C,s 2 M i / t.J G'� .� �_ S. Heavy equipme shall �a $�t be rZIM over °��,�te „
�A I
i 6. :ill unsuitable soil is to -g c cai�ated a�i1 the eachoin,, Area
Design Flow bed, ooms x 110GPD/Ioedr�oom=
o GAD
os shown air,, plan, €end baokf lZe with aea gravel tag° coarse sated
System Design+: F ?�0 GPD/d,'74 GPD/Sep',=; 4-4-G S,F .(m!ln) .s specified i 10 CA-IR 15.255(�}.
t, Ur r nr fir,,es end dust.
il�@ L eachin Field 2 x 24 w �i` O SoI-, 7. i�� tx,. hed crushed stone shall ot- f ,ea of �r, , �
9 8. rseptic tank, distribution box, etc.:sh it as ma�n:� fazct red try Rotondo �
•, 4 er nxctn€ r axctux9cr':�specifications.{
aans Inc. or ? proved egtial, and i talua:.> p f .
v Grout sha ZZ lie' used to arc a water t;.Yht seal at all joints where pipe
enters or leaves a concrete st, ucture.
9. Cutlet o? strihution lines shall be level fo— a minir?.um of the ;first hvo feat
o f their length as specificd i 310 C'MR '5.292(3). is
. r
a��. required
1
d - _ th ce�ka �. to= o Corr?�ali.�.y
Board o a3t�l ca t1. . a o ht
t^x st he obtained by ct nt-actor- upor, co iM`zetion of Work.
19. istribx Lion lixr-es to be ca,1P e:>d at t��.utict�
.s"cs-,t€m f_s nwt drFsigned for a ga7"tjt,0? grr.na":er.
.
— ' -- EXISTING CONTOURS RS I SEPTIC TANK '
CIBPROPOSED CONTOURS a
DISTRIBUTION BOX ;
RESERVE LEACH AREA r
TEST PIT
< �F
W {,JAT PER L INi
nccc o�°r_oocso� o°oo,�o°�oaa�o� �� -- ` U�ht 0 0 0 0,,0 0 0 0_0_o a
,�,,,..+.�., v �_ , �, , i 4
.. J� BOARD OF HEALTH ST-AMPS
i� o oy u c�ia r 1�? WASFCD 4�S D 4TONZ�y v c� ca u �o
..� o _ c� v Ut F v o o SEPTIC SYSTEM
OONSTRUCTION Of THIS F
r ' ' ' BE G�MPI� ED WI THREE (3,
` ENGINEERS AS -BUILT FIST
A TE OF APPROVAL,
PLAN & cER�rIFICA�riorI EtE��� � �I: r � � oT of r
y
STATEMENT REQUIRED CHANGED WITHOUT BOARD
TYPICAL LF N'I �- CT
OF HEALTH APPROVAL
Not To Sa o t 'VA
,
DOES NOT GUA Aaa
EFFEDT1vENEssoFANY BOARD OF HEALTH STAMPS
WSTALLATIN BOARD OF HEALTH INSPECTION ;
DhRTMOUTH BOARD OF HEAVE
RE Fn ���� EXCAVATED
This System Is Not Designed
For Garbage Grinder, Whirlpoul
r Other.High 11Uater Use Devices. APR 1997
z
BY.
THY. 0 0.
SCE k ?� P,E, STAMP
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a ` � anoaooucs0000pao ocr0000 0 N
a �� top SU 5R.v
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_ ILID10 M. ;v CLIENT, LONG REALT
s1_
a ®e NEW , E'DFOF ), MA 02740
I I�AT L, T —1� s *5PI D ACRES LGT
C4 II � I D - I 4 �T'I DAB TM TH
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PL. STAMP
LIMIT CIE EXCAVATION MP � EI I� EE"a�IP � � DESI I� S i% ;.. I
Tt
j{
DATEt `2 -- 22--
7 �� 1-7
_ }
CON
T ;CT l:"R N# LEE fi "H
800 MECI3ANICALS & PRIMARY FUEL,
Furnace (hot air) Fuel gas (natural or propane), fuel oil, electricity, other (specify) y'
oiler (heating)- Fuel gas (natural or propane), uel oilelectricity, other (specify)
HVAC (combined unit) - primary fuel, natural gas, propane, electricity, other (specify)
= Air conditioning (separate unit)
None of the above to be provided
: Hot Water Gas Electric Fuel Oil V Other
900 SPRINKLERS FOR STRUCTURES OVER 7500 SQUARE FEET and certain multifamily residential
Required, --plans provided, --plans not provided, whv?
_ Not required, not to be installed, Whv?
1000 REQUIRED OFF-STREET PARKING for ZONING & Architectural Access
= NOT .-APPLICABLE
Parking Plan submitted To = Building Department = Planning Board Date submitted
Number of spaces - indoors outside 1.�? total provided _ 02
Handicap spaces - required _ yes _no. If yes, how many as a part of the total required number.
Is Route 6 (State Road) Entrance permit required? yes no =. If ves has it been issued ves no
Submit copy of application and/or permit as soon as available.
1100 IDENTIFICILTION (print or type except as noted)
Current owner name " a n7
address
phone N
If corporation, officer in charge
Architect/Engineer - for overall design
Company name
.Address
Phone number
Certified by State of Massachusetts as
Certification number
NOTE Signatures and seals on all fans, affidavits and other documents SHALL BE originals and not
reproductions.
Arclutect/Engineer - project supervision and reports
Company name
Address
Phone number
Certified by State of Massachusetts as
Certification number :.
NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and n(ot
reproductions.
General Contractor (if Homeowner, state homeowner
%here then complete section 1300)
Company name Address !
oak
q q -7
Phone number / l — < d
Construction Supervisors license number
NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and n(at
reproductions.
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1200 FOR RESIDENTIAL REMODEL WORK ONLY
Are you a Home Improvement Contractor subject to (780CMR - 6) ? Yes_ No If no go to nextt section!
Are you claiming exemption from the requirement? Yes �No If yes, submit the required affaidavit!
Remodel contractor name (please print)
Address
Registration number (if none state 'none")
Phone number
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS 'TO THE
GUARANTEE FUND! QUESTIONS OR COMPLAINTS call or write:
Home Improvement Contractors Registration
One .Ashburton Place - Room 1301
Boston.:MA 02108
(617) 727-8598
Owners name (print)
Signature
Date .
1300 OWNER SIGN OFF
I, the undersigned, am the owner of record or authorized lessee (provide documentation) and I haveaTeviewed
the application herein submitted. I state that to the best of my knowledge and belief that the information rovideed in this
application is true and correct and that the permit requested he issued. p a
Further I understand that the permit will expire in six months, from the date of issue, if no work is ib gun or
six months after the last inspection if work has begun and that the permit may be extended for six months if nro work is
a :r T_ .. i .._ ;n Wr-iting. I understand that the permit may be extended only three.,`rimes by
written request. I understand that once the permit expires a new application may be required, including fees and current
Alteration of existing, no increase in gross square feet. A separate Refuse Deposal DeclaraGlion required.
other requirements (including Zoning).
j� `
= Demolition - describe structure
V
Name to 1�Y1
'S
Number of dwelling units Number of bedrooms A separate Refuse U)isposal
Signature
Declaration required.
a ove signature is my voluntary act and is signed under the pains and penalties of perjury.
Date 3 02/ `l7
Moving - (Provide copy of D.P.W. moving license) Type of structure
'
from where (plat/lot or address)
VV'ho is authorized to/ pi kup the permit at the Building Department? lease ring 0 N �ea 6
•Address 6S� j�eckMe /eve N,g. Phone C�- 76 6 %
to where(Plat/lot or address)
Number of dwelling units Number of bedrooms per dwelling unit
1400 HOMEOWNER EXEMPTION -ONE: &TWO FAMILY ONLY
Re -roofing - (for existing only, is included in new construction)
FOR H011E OWNERS WHO INTEND TO PERFORAI AND BE RESPONSIBLE FOR THEIR OWN PROJECT
Number of square feet Number of layers already existing
109.1.1 Licensing of Construction Supervisors: Except for those structures governed by Construction Control
in Section 127.0. effective July 1, 1982. no individual shall be engaged in directly supervising persons engaged in
Number of lavers when complete
construction, reconstruction, alteration, repair, removal or demolition involving the structural elements of buildings or
structures. unless he or she is licensed in accordance with the rules and regulations promulgated by the BBRS entitled
A separate disposal declaration REQUIRED
Rules and Regulations for Licensing Construction Supervisors.
_ Replacement doors and windows - (for existing only) (only where doors and windows exist aind will not be
Exception: Any Home Owner performing work for which a Building Permit is required shall be exempt from
the provisions of this section: provides that if a Home Owner engages a person(s) for hire to do such work ,that such
enlarged) EGRESS dimensions must be maintained. Enlarged or new windows in an existing dwcelling will be
Home Owner shall act as supervisor:
considered as an Alteration, otherwise will he included in new construction. (see Code section 401.10 for
For the purposes of this section oniv, a "Home Owner" is defir_ed as follows: Person(s) who owns a parcel of land
on which he; she resides or intends to reside. on which there is, or is intended to be, a one or two family dwelling, `attached
residential and Article 8 for commercial)
or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in
two-year period shall not be considered a Home Owner.
—
Temporary structure -includes when allowed, trailers, tents and the like and only for limited periods of time.
— Tpo ry
If you are applying under this section sign below:
Describe
Signature
500 CONSTRUCTION PLANS
Your signature carries certain responsibilities, including but not necessarily limited to, general liability
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— None submitted. Whv".
NOTICE TO LICENSED CONTRACTORS: The Building Code provides in the Rules and Regulations section that any
licensed Construction Supervisor, whether or not they have taken the permit are responsible for code compliance. (see
2/Submitted. usually three sets required. Four sets for food serviceluses. Number of sets subimitted 3
of section 5)
600 SITE PLAN
j150o COST
❑ Not required, why?
Cost of Improvement 5
Submitted With this
When? When? _Previously, date application
Items to be installed but not included in the above cost: Electrical 5
Plumbing
700 UTILITIES
HVAC
Water supply - required _ ves _ no, public ? _ yes ' no, on site well? _ yes no,
Other
existing? _ yes — no
c/
TOTAL i 3 3�C%. 0 C>
•
If required and not existing have necessary permits been issued? _ no _ yes, date
(M.G.L. Chapter 40, section 54 provides that no building permit may be issued unless a water supply, when
The following section for official use only.
required, is available. See Code 780 CMR section 114.1.2)
INSPECTORS' REVIEW
Sewage disposal - required yes _ no, public sewer _ yes _ no
Date plan reviewed
,_
private septic - on -site V yes _ no. Submit copy of permit as soon as available.
30 days to review period expires '
OK to issue date
�w•C usea (wut require inspection prior to installation new
), (provide manufacturers
instructions). Location(s) (list)
'✓/Fireplace(s) - (includes flue) List location(s)
V r,_r✓ q O�U d �Y7
u Game Court - describe (include overall dimensions)
Tent, Trailer (Mobile Home) or Other - describe
300 COMMERCIAL PROPOSED PROJEC IUSE - INCLUDING THREE FAMILY OR MORE AND EXEMPT USES
THIS SECTION NOT APPLICABLE
("The following descriptions are based on the Massachusetts State Building Code Article 3, AS NOTED) (See the
Code)
a Assembly - restaurant, lounge, theater, school, etc. (see Code Section 302.0) Describe
Business - office, assembly with less than 50 occupants - indicate Medical or other professional (see Code
Section 303-0) ,
— Educational - structure for training including child day care for those overt years 9 months (see Code Section
304.0)
_ Factory / Industrial (see Code Section 305.0)
— High Hazard - (see Code Section 306.0)
- Institutional - hospital, nursing home, infant day care (see Code Section 307.0)
.'Mercantile - retail stores (see Code 308.0)
_ Residential - three or more family, hotel (see Code Section 309.0)
Storage - includes garages (see Code Section 309.0)
Utility & MiscelIaneous Structures - includes tents and agricultural structures (see Code Section 311.0)
— New tenant for any of the above, indicate above (see Code Section 119.0 and Zoning By-law section 35)
Tent or Trailer - temporary purpose?
= Other
Describe the proposal briefly, INCLUDE number of dwelling
units
also (existing condition and bedrooms or occupant bad as applicable,
400 TYPE OF CONSTRUCTION OR WORK TO BE PERFORMED
v iVew Construction and/or Addition total gross square feet 5 (n j' 1
(For commercial only total gross cubic feet) indicate
It will be considered new construction if there an increase in square footage in addition to any
alteration(s).
If project is an addition to existing structure Total gross square feet of existing
FOR C0MMMCIAL ONLY
Will this project be subject to CONSTRUCT)ON CONTROL (over 35,000 cu.ft.) _Yes
see Code section 127.0). Designer to submit Code Synopsis. No. (If yes
WiIT this project require Peer review (over 400,000 cu.ft.) ' Yes
APFLICANT TO PROVIDE No (see Code Appendix I)
OK to issue subject to requested submittals (see project review worksheet) date
DENIED see project review worksheet date
HOLD reason date
HOLD Subject to Zoning Board of Appeals action
Comments
I
Inspectors signature
DateMA ,a 2 5 1997
Applicant informed of above -Date time
staff (fax, phone, in Iperson)
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Over six months since approved for issue - DEEMED abandoned!
Advise applicant. Hold 90 days for return then dispose if not picked up.
I
Inspector
'Date
Advised applicant Date Time
staff (by phone, fax or in person)
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OMCEIINSPECTORS NOTES
TOTAL FEE
I
Gross -rea -°new construction Total Sq. Ft.
` I
alteration Total Sq. Ft.
Permit is issued to
Comments/notes on permit
9�—
I
I
i
i
I
1600 TO THE APP11CANTAUMMRALAND APPROVAL
Date of Application submission s
Plat Lot Street
Aquifer Zone
Owner
Owner mail address
Owner phone #
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OTIIER INVOLVED .-AGENCIES - The following agencies require separate jurisdictional permits or approval for
your
proposed project. CONTACT TOEM FOR REOIIIRED ME S,SIONS.
® TAX COLLECTOR = `Approved __ HOLD By
Date
Q Conservation Comm = Approved By
Date
D.P.W. water = Approved By
Date
❑ D.P.W. sewer _ Approved By
I'I
Date
0 D.P.W. cross connection _ ved Appro
Date
0 D.P.W. engineering _ Approved
Date
t? Board of Health well = Approved
Date
❑ Board of Health septic _ Approved
Date
Q Board of Health food service _ Approves
Date
g FIRE DISTRICT lI - II - IIII = Approved
Date
0 Planning Dept = Approved
Date
Other _ Approved
Date
t)ther - Approved-,
Date
CMmenu
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Prnlect summary new constructioni alterationidemo
sewage disposal - publiciprivate
[After add interior wails] [add rooms] [add footprint]
water supply - publiciprivate well
[pooll [garage.shedl [game court] (food service]
Descrtoe
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To the Various depar menu:
This notice has been forwarded to you for your information and any appropriate action. Should you have any
tlyeirions please advise. If any reason to withhold the requested permit is
found, please advise. Your assistance
cpoperttion is appreciated.
and
The Building Department
Date sent for review
B-
TOWN OF DARTMOUTH BUELDING DEPARTMENT
'TELEPHONE 508-999-0720 FAY 508-999-0738
APPLICATION FOR ZONING AND
Instructions
The applicant shall complete this application to the best of their ability prior to submission. -leaving roo item unanswered. The
Department staff will he available during regular business hours to assist as necessary. NIA should be-, inserted for those sections
-hich do not apply. A properly completed application wiH help avoid unnecessary delays. PSAW M09 tm _ =A
(for office use only)
Application fee $
received by — Date 1-3
BK
Total Permit Fee $ Permit # . P"
100 LOCATION OF PROJECT MAR 2 4
CURRENIT ACCESSORS' PLAT w �v LOT o - `Qd ZONING DISTRICT
OTHER ZONING OVERLAY DISTRICTS if applicable
NUMBER &. STREET 0Cz ," N ,f w e
NEAREST CROSS STREET'2v
SUBDIVISION NAME & LOT # V a "V � � � _j 9e'e-r— S �7
or BUSINESS NAl`1E
PREVIOUS TENANT r OWNER � �� / ' � 2
200 RESIDENTIAL - PROPOSED PROJECT - one & two family residence only
THIS SECTION NOT .APPLICABLE
Sincle famih• - number bedrooms _3 _ number baths °?02
_ Two family number bedrooms unit 1 number baths unit 1
number bedrooms unit 2 number baths unit Z
Accessory apartment Total gross sq. ft
Fe/kccessory structure -?7 21—e Z 6 �!q
Y
_ Garage - detached - attached to dwelling, dimensions L R'
= Carport - detached - attached to dwelling, dimensions L W
9
= Shed - dimensions L R'
Gazebo - dimensions L W _
= Swimming pool above around in -ground Size total square feet
Chimney - # of flues