BP-64337
�
I \
i
I
\
fl
100' TOT.P.'
LOT 19
FINISHED GARAGE FLOOR-
FINISHED FIRST FLOOR
TOP OF FOUNDATION'
FINISHED BAST MENT FLOOR
INVERT AT FOUNDATION
184 9t
186.9±
185.73
177.9+
184.70
INVERT INTO SEPTIC TANK
184.58
INVERT OUT OF SEPTIC TANK
184.33
INVERT INTO P-BOX
INVERT OUT OF D-BOX .
183.54
183.37
INVERT AT INLET OF FIELD
INVERT AT END OF FIELD
183.33
N/A
ELEVATION OF BOT. OF SYSTE
182.75
ELEVATION OF G.W.T. `
177.75
;exist.)
EXISTING TOPOGRAPHY, INCLUDING GENERAL TOPOGRAPHIC AERIAL
SURVEY AND ROADWAY CONTOURS, OBTAINED FROM MILLERS FARM
SUBDIVISION PLANS DATED 11-16-92.
FROM
4" SCH 40 CLEAN -OUT TO
WITHIN 4" OF FINISHED GRADE
FINISHED GRAgE I86t _
184,70 103.37
H.
157' S_- .005 -BO
184.33 .
184.58 e'
SEPTIC 183,54
TANK re
4" SOLID PVC
4" SCH 40 PVC SOLID PIPE
OR APPROVED EQUAL
SYSTEM PROFILE
NOT TO SCALE
SETS OF 3 STANDARD
^
IA11N
INFILTRATOR UNITS
W 14 SOLID PIPE
TERMINATING AT "START"
PLATE WISPIA.St1.
SHIELD BELOW
16,5'
3.0'
3/4" - 1 1/2" .
WASHED STONE
7.5'
'Y
187
87 '
2' 4', 2'
45,5'
LEACHING AREA DETAIL
NOT TO SCALE
BENCHMARK:
NAIL SET IN 10" OAK
ELEV.= 183,79
�15 i4313 �\
�6a 1410
SQ.
\$2 / P�ppOSE'D
�' PESERVE: �
CN
o. ,
0
to �46
ILI
LOT 14
W 3n
�82•
EXISTING
BENCHMARK:
TOP OF FOUNDATION
ELEV.= 185.73
PROP. WELL
LOT 14
/ 80
NO PERF. PIPE REQUIRED
WITH INFILTRATORS —
- 4" PERF. PIPE REQUIREC
WITH CONTACTORS
y
a
j
20" 20" O
T.P. 0372 EL.181,83 2p
K
MINIMUM FINISHED GRADE EL ' 184.8 �-
2' COVER LAYER OF •b_A.
y g ' s osal system shown' hereof shall
i- =� 3" 3" MIN, S•a 1, The sanitary sewage d P y
MIN, b - - WASHED (PEA) STONE accordance with the re uirements' of
COVER 4" PERF. PIPE" G" LIQUID [LEVEL I'-O 6' TITLE
onsVruoo fethens
- - 1+- WASHED STONE e Environmental Code an,i local
DOUBLE Board of Health regulations.
124" EL. 183.75 l0" o.q _STAINLESS
{I0.33j _:-. ,_... :... :.•.:...•...•, MIN.
-------'---2 An modification to this design must be approved ' in
CLAMPS
EL.,- 183.33. y
_ 14 writing by the engineer and the local Board of Health
i TEE 533' prior to implementation•
4.
{ 3, Contractor shall verify and check the BENCHMARKss shown
• 0'
(T 7,. ` +' to construction of the ''proposed
i7 i^ J i \ STAINLESS on thus plan prior
;a GAS BAFFLE system,
Rv EL: - 182.75
;. 5.—.i ;:P..,a:►':6:'J p:J• •-•�Jp•:4_.0. •,�."�-a;f;o''{: OR EQUIVALENT Information indicates soil condition,
S 30" SEE i :• ... Deep
E 4 D Test Hole Infor,
DE`!L I DETAIL percolation rate, and eater table elevation at the time
--od
testing and should be verified at
—10.5' and' location of actual g
8 3' SAWD�YEE3L>!G
the time of construction,
A0J STEDGROUNDWATER TABLE (G-1-98) EL. 177.75 S. The contractor shall notify the local Board of Health if
--- --------------------=---- --ELL 175.5 PR�C ACT I5� G La SEPTIC GROUNDWATER or thapERn
indicatED ed onSthiscdesigneplan. a "
WATER TABLE (4-19-98) _ higher elevation than . g P
EL 171.5
6, Notify the local Board of Health when the system is
ready for INSPECTION, prior to any'backfilling,':
7, If CONFIRMATION OF CONSTRUCTION is required by an
engineer, notify this office prior to any backfilling,
`�' �+ 8. The pipe between the house and the septic tank shall. be
BAICIS OF S ll AR 1�/ SIG 4" extra heavy duty cyst iron, Schedule 40 PVC, or other
suitable material acceptable to the approving aLthority
BUILDING USAGE: 4 BDRM: (RESIDENCE The Slope of this pipe must be a `minimum of-0 C1 (0 12
inches per foot), A slope of 1\4" per foot 3..s
SIZE OF TANK: 1500 GAL. recommended,
GARBAGE GRINDER: NO 9, The septic tank shal*i be 1500 gallons minimum, unless
CLOTHES WASHER: YES otherwise specified &TLETs aTEESof n an, proper eglength .
with INLET AND C P Per g
ESTIMATED SEWAGE FLOW:40 GAL/DAY constructed of concrete, PVC, or cast iron. Septic tank
concrete strength i to be 5000 psi' at :8 days
PERCOLATION RATE: TP 149 5 MIN /INCH TP 150 2 MIN /INCH conforming to all applicable AssHTo H-lo' loading;
requirements, unless otherwise specified,-
I DESIGN PERC. RATE: 10 MIN
CINCH 10, If an components of p p y ' P
the propose s stem are ecified
LEACHING AREA: as HEAVY DUTY, thos? components shall conform to all
state and local requirements for ASSHTO H-20 loading..
• 16,5' WIDTH X 45,5' LENGy., and leaching pit (if any)
7H= 750.75 S.F. 11. Septic tank, distribution bo
ACCESS MANHOLE COVER', are to be built up to wi?:hin 12`-
\,�/ of the finished grade unless otherwise specifieii on this -
Y� SYSTEM CAPACITY; design plan.
-' '"F
750.75 S.F. X 0.60 GAL /S/DAY= 450.45 GAL /DAY
12, Septic tank and distribution box shall be places on a:6" fi
minimum compacted G`'L BASE to prevent hewing or
settling.
>60 _
i LIMIT 13, All joints must be watertight, sealed' with asphalt,
�i cement or other cerpent suitable for that, specific
DEEP TEST
PIT'
IT ' 1 v iT ' component
\ O" O' ` ieachin facility are loc ►led 25'
14. If septic
tank and g y
WANDS/ \I PERFORMED BY: KEN FORTIER / CHRIS HENRY (minimum) from theuatathe ownefoundation,
stdoiscretion'undation-
16 60 drain may be installe
o ' �` \ WITNESSED BY: SUE GRIFFIIN UNSUITABLE MATERIAL in `t ze area
_ \ • TP 149: 11-15-88 TP, is. Excavate all .
DATE' I50' II-16-88 �d stone leaching facility to the
,64 --- � surrounding the washy,
limits specified in r" 15.255
ulation of Tile V and
,66 TP 149 EL, 184.C3, PERC EL. 177.1, PERC DEPTH 90" replace pwith clean r�oarse sand and gravel, f -ee •from
0 - 42" TOPSOIL 9 SILTY ```UBSOIL s stumps, and waste construction
168 / '� i 42 - 158" TIGHT MED, SAfti1D, LOOSE COARSE SAND fines, organic P ,
?0 i ,- fE—R �Oi \ DEPOSITS, SOME. SILT &STONES 16, If any leaching area EROSION CONTROL BARRIER WALLS, are
�- ........... \ IN -SEASON WATER TABLE TP a#372 EL. 181.83 4-19-89 shown on this desi!,n plan, they shall be he co�stru�ted
\ \ , waterti ht withoutordancehwith ail aotlicableerlocal ?2\ \ \ GROUNDWATER AT 124"' (EL. 1:71.5) g pp
/- construction, in acc
regulations. Future
re - leaching
162 building department g
TP 150 EL. I P81,7, PERC EL. 172.2, PERC DEP j H 114'4 facility enlargement y q
��� LOT 13 ,
Tay require the extension of these
3.02 A ` I 0 - 36" TOPSOIL 8 SUBSOIIL
barrier walls,
��
36" - 80" SANDY SILT W/RUST DEPOSITS 17, Top nt and. first Floor 01evations
\ / may be raised but NOA LOWERED without the consent of the \ \ I 80" - 148" LOOSE COARSE SAND,GRAVEL, STONES engineer,
s of Sanitar Desi n, this
18. Unless specified in the Basis y g
system is NOT designed for the use of a garbage
grinder, _1,g: as - hot tub, or other
164 - high water usage devices;
/ ` / \\ \ ,�:..• / ,CAD
166'./�°' * 19. Top 8" of fill is to be topsoil,
/`'"' ♦4Y~� 20. No HEAVY EQUIPMENT :hall be run over the compc vents ar, A L
Iv,o"s •, �+ the leaching area unless those items are specified as
I 4170 HEAVY DUTY.
/ °"' " RUBBER TIRE MACiiINY are not to be driven over the
186-� / \ \ \ ,� t �,�/ ' _ - '^•_- prepared natural sail, base or sand/stone bEid during
21,
\
system installation
` 7
., ,
i 1 a N L us nce t:•hould be ry
/ \�80 I = -' ,,,LERsnR 22, For proper .perform'- , the septic tank
5
\ �, , INSPECTED annually -nd when the solids and scum depth
—� \�82 I" 1 exceeds 1\3 of th? liquid depth, or 'three years' has `
\ ' �g0� /6� I- a° 11 `r elapsed since the last pumping,` the tank and the
\\ ~ \ \ \ \/86 I • �' '� leaching pit {if. any; should be pumped,
188 ,b
This System is Not Designed
188,
ool
F®r Garbage Grinder, Whirlpool i '
K
�186 Device,. A
Or O�.her High Water Use t
L p— `T T SCALE
184 - � �
� r
Ins
.EVE TIC SYSTEM LSIGNAN Lb{
,\
r
/ OF + s
S 1� �6 �/ ,,s,c ��s�pFMgss PROPOSED
I ,a5o ,g 180 162 ELEVATIONS LUST NOT BE � Kr~Al�ETH tiL �� 9 EXISTING
`,� ENNETii f3,
\ 1t�4 Q Fr<RI�A o -oR�RO N I om" 0
TOIM,GEP*
15 s CHANGED WITHOUT BOAR �.2 716 CI IOo---- cC NTouRs loo
No. 835 _.
E HEALTtj APPRON'A
SPLASH SHIELD END PLATE
INLET END PLATE
ALTERNATIVE POLYETHYLENE UNITS MAY BE USE[
OVERALL FIELD SIZE REMAINS THE SAME.
,g2 18 No
0
66, - 182
LOT 12
31
182
MINIMS MULT
'• �, �� 385
SEE NOTE #I 5
rUM t CTiFiCA T#V
EXCAVATE ALL UNSUITABLE MATERIAL
STATEEIFIJ MQUin 0
�o
WITHIN 5' HORIZONTALLY OF THE TRENCH
FROM THE PEA STONE COVER DOWN TO
EL, 475.5 ( 6.5'+below exist. grade)
EXCAVATION MAY BE REQUIRED TO EXTEND DEEPER
CONSTRUCTION OF THIS SEPTIC SYSTEM l
IF UNIFORM SUITABLE MATERIAL IS NOT ENCOUNTERED
MUST BE COMPLETED WITH THREE (v)
AT EL. 175.5 1
OF THE DATE OF APPROVAL
LISTED DEPTH OF EXCAVATION WAS DETERMINED
YEARS
AT SITE INSPECTION OF DEEP HOLE ON 6-1-98
0ONSTRUCTION OF THIS SEPTIC SYSTE
SITE G R D I G P L N
�� �T RE COMPLETED WITH THREE (v)
nF TH.F MATE OF APPROVAL
SCALE: 1" = 40'
BOARD OF HEffTH 11S ECTIOM
REQUIRED WHEN EXCAVATED
Lot 12
l�D p
KJ Kj
N N
ro
a_
u le
M r
O
o
h
ME
f_ 0
03
CLL4 pm.van=
Mgt
TECHNICAL IMAGE PPio0uCT6
0
ui
431.66' >,
O
O
to
OD
240.00' 7--
1
0
/1
9S 00,
Loft 14
�1RREi
�a �i'gb.�i i
FINISHED
FIISI� RST' FLOOR
TOP OF FOUNDATION
FINISFIEO BASEMENT FLOOR
INVERT AT FOUNDATION
186.9
185.8
178.05
183.55,
INVERTINTO SEPTIC TANK
183.25
INVERT OUT OF SEPTIC TANK
183.00
INVERT INTO D-BOX
181.30
INVERT OUT OF D-'BOX .
181.13
.INVERT AT- INLET OF FIELD
181.08
INVERT AT END OF FIELD
N/A
ELEVATION OF BOT. OF SYSTEIV
180.5
j
ELEVATION OF G.W.T.
1171.5
100' TOT.P.'
LOT 19
FINISHED G
55 FrIn
-7 L- 15' S, L= 155' S= •011 -BOX
183.GO �•. .
178.05 ? 183.25
,.r,, ;1 SEPTIC 181.30
TANK re
4 SOLID PVI
14" SCH 40 PVC SOLID PIPE
OR APPROVED EQUAL
SYSTEM PROFILE
NOT TO SCALE
EXISTING TOPOGRAPHY, INCLUDING GENERAL TOPOGRAPHIC AERIAL
SURVEY AND ROADWAY CONTOURS, OBTAINED FROM MILLERS FARM
SUBDIVISION PLANS DATED 11-16-92.
3.0'
16,5'
30''
I
1.5.0
te,? 8.7
2, 4• 2'
45.5'
LEACHING AREA DETAIL
NOT TO SCALE
BENCHMARK:
NAIL SET IN 10" OAK
ELEV,=183.79
�D IC2
015��3
240 00'
95.00' /--
. oR�vE
to
ILI
e 00'
�Q.
\ / W.t x3P71
SETS OF 3 STANDARD
-ILTRATOR UNITS
4" SOLID PIPE
NNATING AT "START"
113 " MIN - . - WASHED 1PEA) STONE 3 3 MIN y -- .. . ",
,a
4"PERF.PIPE I_p" S'e Ir `°"' `` be constructed in accordance with the requirements `, of
COVER u
181.08" .. t�" WASHED STONE 6 " LIQUID LEVEL 6" TITLE V of the State Environmental Code and local
124" EL._ Q 10 DOUBLE Board of Health regulations. =
,, r 181;5
(10.3,3J---- _ •:....:..:........,� --- MIN. Q. STAINLESS j:
2. An modification to this design must be approved in
�- E ,
a CLAMPS y
e-5- --- r-- L. 181.08,: 14 writingb the engineer and the local Board of Health
r TEt; 533 t ,y entation, e
4. 0' .l prior to implementation.
1 12" ,.�' 4, 5'
10' 7 i �' 4• 3. Contractor shall verify and .check the BENCHMARK as shown
END PLATE i 1 1 STAINLESS on this plan prior to construction of the proposed
SPLASH SHIELD i .v.f i \ system,
EL? * 180-5' ,, GAS BAFFLE
INLET END PLATE , SEE 30" 5 5'`P �!::.-a''o.:::.r ;4.:p: �:� i.e.a: a..,f.o.i. OR EQUIVALENT
EE 0 4, Dee Test Hole Information indicates soil condition,
P
Sr IDETAIL` 1 DETAIL i percolation rate, and water table elevation at,the time
ALTERNATIVE POLYETHYLENE UNITS MAYBE USED. I S3 SAWD4VEWG7, lO.5' and' location of actual testing and should be verified at
the time of construction, I
OVERALL FIELD SIZE REMAINS THE SAME.17 ,
ADJUSTED GROUNDWATER TABLE EL,172,5'" 5, The contractor shall notify the local Board of Health if
--------------------- =--- EL'172.2
r GROUNDWATER
-- or PERCHED 'WATER is encountered at a ,
WATER TABLE v 1500 GAL' SEPTIC TANK higher elevation than indicated on this idesign plan.
EL 171.5
6• Notify the local Board of Health when the system is
ready for INSPECTION, prior to any backfilling,'
7, If CONFIRMATION OF CONSTRUCTION is required by, an
engineer, notify this office prior to any backfiafi.th
ISOF
%� (� ®ESI�� .8. The pipe between the house and the septic tank shall 'be
P� 4' extra heavy duty cast iron, Schedule 40 PVC, or other
suitable material acceptable to the approving authority,
BUILDING USAGE: 4 IBDRM; RESIDENCE The slope of this pipe must be a minimum of 0.01 (0,12
inches per foot). A slope of 1\4" per foot is
SIZE OF TANK: 15i00 GAL, recommended,
GARBAGE GRINDER: (AO
9, The septic tank shall be 1500 gallons minimum,, unless
CLOTHES WASHER: YES otherwise spe='ified on this design plar, and equipped
with INLET AND OUTLET TEES of proper length
ESTIMATED SEWAGE (FLOW; 440 GAL/DAY constructed of concrete, PVC, or cast iron. Septic tank
concrete strength is to be 5000 psi at 28 days
PERCOLATION RATE: `TP 149 5 MIN /INCH TP 150 2 MIN /INCH conforming to all applicable ASSHTC x-lo loading,
requirements, unless otherwise specifies,
DESIGN PERC, RATE: 10 MIN /INCH
ents of the proposed s steam are specified'
10. If any compor P F Y P
LEACHING AREA: as HEAVY DUTY, those components shall ;conform to all
state and local requirements for ASSHTO H-20 loading,
`.'V 16.5' WIDTH X 45,5' LENGTH, 750.75 S.F. 11. Septic tank, distribution box, and leacl inq pit (if any)
G �-- ACCESS MANHOhE COVERS are to be built up to within 12"
1TE W/SPLASH. � SYSTEM CAPACITY: of the p e finished grade unless otherwise :pecified on this
ELD BELOW design Ian,
750.75 S.F. X 0.60 GAL/SF/DAY, 450.45 GAL/DAY 12. Septic tank ar?d distribution- box shall 7)e placed on a 6"
minimum compacted GRAVEL BASE to prei'ent heaving for
settling.
3 /4" - 1 1 /2" 160
i-
WASHED STONE l 13• All joints must be watertight, sealed with asphalt
LIMIT
LOT 14
PROP, WELL
LOTIL
BENCHMARK:
TOP OF REBAR SET A7
PROPERTY CORNER
ELEV.=
18 ; oo
cement or other cement suitable for that specific
component.
°\ o. DEEP TES PIT I OR �.1TI0 ,
and leaching facility are located 25
--- 14, if septic tznk a g y
16 SANDS \ PERFORMED BY; KEN FORTIER / CHRIS HENRY cminimum) frc- the building foundation , a foundation
drain may be installed at the owners discretion.
ENGINEERS S"G���T WITNESSED BY;
0 SW GRIFFIN 4 PLAN CERTIFIGATIO DATE, TP 149: I I-15F-88 TP 150• I I-16-88 1.5. Excavate all. UNSUITABLE MATERIAL in the area
\
• surrounding the washed stone leaching facility to the
66 \ \ STATEMENT REQUIRED TP 149 E1L, 184.E, PERC EL. 177.1 PERC DEPTH 90 , limits specified in regulation 15.255 of Title V and
\ \ replace with clean coarse sand.and gravel, free -from
\6s
_ _ 0 - 42" TOP & SILTY SUBSOIL fines, clay, organics, stumps, and waste construction
materials.
/ _ \ 42 - 158" 'TIGHT MrED, SAND, LOOSE COARSE SAND
Ff \7O E� _GN \ DEPOSITS, SOME SILT S STONES 16. If any leach'ng area EROSION CONTROL B).RRIER WALLS are
\ IN -SEASON WATER Tk'BLE TP #372 EL. 181.83 4-19-89 they shown on thi�ithoutn Pwee,holes sorll :other
servious
GROUNDWATER AT 124•" (EL. 171.5) watertight, p P
construction, in accordance with all applicable local
building department regulations, Future . leaching
TP 150 EL. 181.7, PERC EL, 172.2, PERC DEPTH 114� facility enla gement may require the ext ension of these
LOT 13 1 \ \
3.02 A \ ` i 0 - 36" TOPSOIL 6 SUBSOIL - barrier walls
• ` \ 36 ---80" SANDY S11-T W/RUST DEPOSITS 17. Top of foundation, basement and first floor 2levati,on11 s
may be raised but NOT LOWERED without the consent of the .
/ \ I 80" 148" LOOSE CQ)ARSE SAND, GRAVEL, STONES
\ \ \\ \ engineer,
\ J 18. Unless specified in the Basis of Sani.ta.ry Design, this',"
system is VOT designed for the uso� of a garbage
R _.,w::.. �,;_. hoi. tub
164 grinder, -ewe= - , , or other
I \ J / \ \ \\ \ \ .gY.•pow high water usage devices. '.
166 ��/�� •"'* 19. Top 8" of Ella is to be topsoil.
20, No HEAVY EQU
-°'�PMENT'shall be run over the components or
the leaching area unless those items'aa'e specified as
�• \ \ / / --_ \ �_ �� _ -1%0 d// '"y HEAVY DUTY.
21. RUBBER TIRE MACHINERY are not to be driven over the
r 186 \ \ \ �� F ���✓� - - "''' prepared nat�,ral soil base or sand/si.one bed during
182 \ f \ \ ` 8 system installation..
N, \ \le0 I „��eae rnR L US 22. For proper rerformance, the septic 'tank should be
�. �} INSPECTED anually and when the solids and scum depth
�8 &2 ; «o �' exceeds 1\3 of the liquid depth, or three years has
4 ; ned elapsed sine the last pumping, th s tank and the
\� o is Not es �° Teaching pit Qif any) should be pumped.
stem iri o®i
Grinder►�1h P
Foe8rb r Use ®Vices.
b
�ij it l�Nate �oF,k,
®r other 9 ,h° I ��' NNc s c� �tizNo�,�ysnb
<
* dN $P� 1 s F;. o ENNETH F
\r RREIP��\ FERREIRA
�Q!�RD ®� HEALTH tSP�.Cii
- i 8s REQutR�..D V-1HI t"s EXCAVATED 1� ` , '°` r . �� i s y ° IL
No. 3 835
8
R V
�\
8 Al
� �i 4 LOCUS �P --
� T� ELEVATIONS T TO SCALE �I
NS MU
a ST NOT BE
CHANGED WITHOPUT BOARD
SEPTIC LEGEND SYSTEM DESIGIVohEALTH APRO ALL
,
g
82 EXISTING PROPOSED I
180 s'�
moe
CD
�,
1 I
N �
\ O
I ' �
C> rT
I � l
CD
y \ 1
p
40
CP
�� � 1/� �i � �,m a
� v
CID
ricC� CD
r+ 0. / / y m
a y n rn a CD
-bw Z: —4 1
CD
CO
r+ , r
J ceo
f'
1300 OWNER SIGN - OFF
I, the undersigned, am the owner of record or authorized lessee (provide documentation) and I have reviewed
the application herein submitted. I state that to the best of my knowledge and belief that the information provided in this
application is true and correct and that the permit requested be issued.
Further I understand that the permit will expire in six months, from the date of issue, if no work is begun or
six months after the last inspection if work has begun and`that the permit may be extended for six months if no work is
anticipated if I request such an extension in writing. I understand that the permit may be extended only three times by
written requestI understand that once the permit expires a new application maybe required, including fees and current
other requirements (including Zoning).
d
Name
Signature _
eve signature is my voluntary act and is signed under the pains and penalties of e u
P rJ ry.
Date
Who is authorized to pickup the permit at the Building Department? (please print) - Ig A) 11 2�t
Address CA a ry, Q�a= 0,&d Phone 7 r cJ
1400 HOMEOWNER EXEMPTION - ONE & TWO FAMILY ONLY
FOR HOME OWNERS WHO INTEND TO PERFORM AND BE RESPONSIBLE FOR THEIR OWN PROJECT
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
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
R:�1es and Regulations for Licensing Construction Supervisors.
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
Home Owner shall act as supervisor.
For the purposes of this section only, a "Home Owner" is defined 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 intender iu v , a ore or o family dweliin attached
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.
If you are applying under this section sign below:
Signature.
Your signature carries certain responsibilities, including but not necessarily limited to, general liability
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
2.15 2 of section 5)
1500 COST
Cost of Improvement $
Items to be installed but not included in the above cost: Electrical S-- C�
Plumbing ($
HVAC
Other
TOTAL $ / . U0
_ Alteration of existing, no increase in gross square feet. A separate Refuse Disposal DeciaraWon required.
Demolition - describe structure
Number of dwelling units Number of bedrooms A separate Refuse li?isposal
Declaration required.
Moving - (Provide copy of D.P.W. moving license) Type of structure
from where (plat/lot or address)
to where (plat/lot or address)
Number of dwelling units Number of bedrooms per dwelling unit
Re -roofing - (for existing only, is included in new construction)
Number of square feet Number of layers already existing
i
Number of layers when complete j
A separate disposal declaration REQUIRED
Replacement doors and windows - (for existing only) (only where doors and windows exist amd will not be
enlarged) EGRESS dimensions must be maintained. Enlarged or new windows in an existing dwelling will be
considered as an Alteration, otherwise will be included in new construction. (see Code section Z401.10 for
residential and Article 8 ft.-- commercial)
Temporary structure - includes when allowed, trailers, tents and the like and only for limited periods of time.
Describe
500 CONSTRUCTION PLANS
None submitted. Why?
Submitted, usually three sets required. Four sets for food service uses. Number of sets submiitted
600 SITE PLAN
❑ Not required, why?
Submitted When? Previously, date ❑ With this application
700 ITTUXIIES
Water supply - required _ yes _ no, public ? _ yes _ no, on site well? 'yes _ mo,
existing? _ yes _ no
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 suipply, when
required, is available. See Code 780 CMR section 114.1.2)
Sewage disposal - required _ yes _ no, public sewer _ yes _ no
private septic - on -site/ ---*'^yes _ no. Submit copy of permit as soon as available.
i
Arch:...-,�m�..H:.� _ project snpervision and reports
800 MECHANICAIS & PRIMARY FUEL
. a Furnace (hot air) - Fuel gas (natural or propane), fuel oil, electricity, other (specify)
Company name
Boiler (heating)- Fuel gas (natural or propane), fuel oil, electricity, other (specify)
Address
HVAC (combined unit) - Primary fuel, natural gas, propane, electricity, other (specify)
Phone number
Certified by State of Massachusetts as
Air conditioning - (separate unit)
Certification number
El None of the above to be provided
NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and not
Hot Water Gas Electric Fuel Oil Other
reproductions.
goo SPRINICLERS - FOR STRUCTURES OVER 7500 SQUARE FEET and certain multifamily residential
General. Contractor (if Homeowner, state homeowner here then complete section 13(�o)
Required, --plans provided, plans not provided, why?
Company name
Not required, not to be installed, Why?
Address 1W 1
1000 REQUIItED OFF-STR= PARIONG - for ZONING & Architectural Access
Phone number } � � i '� � .:5 1 .y 'L
= NOT APPLICABLEf''
_
Construction Supervisors license number cv�
= Parking Plan submitted To Building Department `. Planning Board Date submitted
i,
NOTE Signatures and seals on all plans, affidavits and other documents SHALL B!+•' original and not
Number of spaces -indoors outside total provided
reproductions.
H-ndicap spaces - required _ yes _no. If yes, how many as a p?rt of the total required number.
1200 FOR RESIDENTIAL REMODEL WORK ONLY
Is Route 6 (State Road) Entrance permit required? yes no � If yes has it been issued yes no
Are you a Home Improvement Contractor subject to (780CMR - 6) ? Yes _ No — If no go to next section!
Submit copy of application and/or permit as soon as available.
Are you claiming exemption from the requirement? Yes —No -If yes, submit:`the required affidavit!
1100 IDENTIFICATION (print or type except as noted)
Current owner -name b
Ren_odel contractor name (please print)
B
/ � � �'" :Z 7 a /
Address
address
`�
Registration number (it none state "none")
phone # �
If corporation, officer in charge
Phone number
PERSONS CONTRACTING WITH UN GISTERED CONTRACTORS DO NOT THAVE ACCESS TO THE
Architect/Engineer - for overall design
GUARANTEE FUND. QUESTIONS R COMPLAINTS call or write:
Home Improvement Contractors Registration
Company name
One Ashburton Place -Room 1301
Boston, MA 02108
Address
(617) 727-8598
Phone number
Owners name (print)
Certified by State of Massachusetts as
Signature
Certification number
Date
NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and not
reproductions.
Woodstove - used (will require inspection prior to installation), new (provide manufacturers
The following section for official use only.
instructions). Location(s) (list)
INSPECTORS' REVIEW
O Fireplace(s) - (includes flue) List location(s)
J
Date plan reviewed 4.
C Game Court -.describe (include overall dimensions)
30 days to review period expires
C Tent, Trailer (Mobile Home) or Other - describe
C OK to issue date
3W COM14iERCL41, - PROPOSED PROJECIyUSE '- INCLUDING THREE FAMILY OR MORE AND EXEMPT USES
I,
= OK to issue subject to requested submittals (see project review worksheet) date
C THIS SECTION NOT APPLICABLE
Z DENIED see project review worksheet date
(The following descriptions are based on the Massachusetts State Building Code Article 3, AS NOTED) (See the
J HOLD reason d ate
Code)
-
HOLD Subject to Zoning Board of Appeals action
Assembly - restaurant, lounge, theater, school, etc. (see Code Section 302.0) Describe
Comments
= Business -office, assembly with less than 50 occupants -indicate Medical or other professional (see Code
Inspectors signature DauF`b°R
P11998
Section 303.0)
C Applicant informed of above - Date time staff (fax, phmne, in person)
C Educational - structure for training including child day care for those over 2 years 9 months (see Code Section
304.0)
sssssssssssssssssssssssssssss:::::sssssssssssssssssssssss:::::sssssss:sssssssssss***s*isssssrsis:ssssssssss
7 Over six months since approved for issue - DEEMED abandoned!
C Factory / Industrial - (see Code Section 305.0)
I
Advise applicant. Hold 90 days for return then dispose if not picked up.
C High Hazard - (see Code Section 306.0)
Inspector D site
C Institutional - hospital, nursing home, infant day care (see Code Section 307.0)
Advised applicant Date Time staff •
ne, (by P ,fax or m nersom)
pho
Mercantile - retail stores (see Code 308.0)
sssssssssssssssssssssssssssssssss::ssssssssissssissssssssssssssssssssssssssssss:ssssssssss�:ssssssssssss:
I C Residential - three or more family, hotel (see Code Section 309.0)
OFFICEVNSPECTORS NOTES
7 Storage - includes garages (see Code Section 309.0)
TOTAL FE
C Utility & Miscellaneous Structures - includes tents and _agricultural structures (see Code Section 311.0)
Gross area - new construction Total Sq. Ft.
C New tenant for any of the above, indicate above (see Code Section 119.0 and Zoning By-law section 35)
alteration Total Sq. Ft.
_ Tent or Trailer - temporary purpose?
Permit is issued to
Other
-
Describe the proposal briefly, INCLUDE cumber of dwelling units and bedrooms or occupant load as appEcab
also � tiMg condition �
Comments/notes on permit
p
400 'TYPE OF CONSTRUCTION OR WORK TO BE PERFORMED
,"New Construction and/or Addition - total gross square feet
(For commercial only total gross rabic feet) - indicate
It will be considered new construction if there an increase in square footage in addition to any
aiteration(s).
If project is an addition to existing structure - Total gross square feet of existing
C FOR COi1EMIERCI4L ONLY
Will this project be subject to CONSTRUCTION CONTROL (over 35,000 cu.fL) Yes No. (If yes
- see Code section 127.0). Designer to submit Code Synopsis..
Will this project require Peer review (over 400,000 cu.ft.) Yes No (see Code Appendix n
APPLICANT TO PROVIDE
sssssssssssssssssssssssssssssssssssssxssssssssss::ssssssssssssssssssss::ssssssssssssssssassss:sssssssss
1600 TO THE APPLICANTJREFERgAL AND APPROVAL
Date of Application submission _
Plat ;& LoteStreet
Aquifer Zone
Owner J' M rf�_'nn0 LJ' 'Y7?
Owner mail address
Owner phone # (� �'c•.
s:sssssssssssssssss#sssssssssssss:ssssssssssssss:ssssssss*ss*see:sssss::::sssssssssss*ss*s*sss*ssssssssss
OTHER INVOLVED AGENCIES - The following agencies require separate jurisdictional permits or approval for your
proposed project. CONTACT THEM FOR REOLi�Ep S�MIS.SIONS.
® TAX COLLECTOR Z Approved HOLD By Date
❑ Board of Appeals Approved By Date
onservation Commission C Approved By Date
❑ D.P.W. Water Approved By 17 D.P.W. Sewer _ Approved By Date
❑ D.P.W. Cross Connection E Approved By Date
❑ Treasurer (Bond) p Approved By Date
❑ D.P.W. Engineering = Approved By Date
E13
iard of Health (well) Approved By
Date
ard of Health (septic) C Approved By Date -
❑ Board of Health (food service) _ Approved By Date
17 Planning Board (parking)�e Approved By Date
® FIRE DISTRICT (I - II - Iin ,Z Approved By
sssssssssssssssssssssssssssssss sslsafsssssssss Date
BUILDING DEPARTMENT APPROVAL:
DONING
❑ BUILDING INSPECTORBUILDING COMMISSIONER
❑ CONTROL CONSTRUCTION AFFIDAVIT
ssss:ss:sss:sss:�:sssssss:ss:sssss:ssssssss:ssssssssssssssssssssssssssssss::====*==*t*sssss::::::sssss::
PROJECT summARY:
new construction/ alteration/demo sewage disposal - public/private
[Alteriadd interior walls] [add rooms] [add footprint] water supply - public/private well
[pool] [garage;shed/deck] [game court] [food service]
x A t
Describe +_ ,
ssssssssssssssssssssssssssssssssssssssssssesssssssssssssssssssssssssssssss:sees::::sssss s sssss::::::sssss
To the various departments:
This notice has been forwarded to you for your information and any appropriate action. Should you have any
questions please advise. If any reason to withhold the requested permit is found, please advise. Your assistance and
cooperation is appreciated.
The Building Department - Date sent for review By
TOWN OF DARTMOU -.B SING DEPARTMENT*
TELEPHONE 508-999-0720 FAX> 50&=999-073&
APPLICATION FOR ZONING AND BUILDINGPERMIT
Instroetiam
The applicant shall complete this application to the best of their ability prior to submission, leaving no item ®avnswered. The
Department staff will be available during regular business hours to assist as necessary. N/A should be inserted ffor those sections
which do not apply. A properly completed application will help avoid unnecessary delays. Mft Fffog An is nrid
(for ollriee me miy) ❑ FOUMMIION ONLY
Total Cost $ Received By Date Reed �.
Less Application Fee $_� -
Total Permit Fee $ Permit # Iscmed, Date
100 LOCATION OF PROJECT TOTAL LAND AREA SQUARE FEET 15 X W��
CURRENT ACCESSORS' PLAT C LOT 1-3 -1-3 ZONING DISTRICT
OTHER ZONING OVERLAY DISTRICTS , if applicable
li-
NUMBER &STREET m
NEAREST CROSS STREET
SUBDIVISION NAME & LOT # i / Z e 9 :� a IS
or BUSINESS NAME % 6 ' 1 l
PREVIOUS TENANT / OWNER J' 1�
r^;
200 RESIDENTIAL - PROPOSED PROJECT - one & two family reside nce only .a
THIS SECTION NOT APPLICABLE
L Single family - number bedrooms number baths / `'
Two family
-number bedrooms unit 1 number baths unit 1
number bedrooms unit 2 number baths unit 2
C Accessory apartment Total gross sq. ft. 16-q 9 5 r"a
Accessory structure:
Garage - detached - attached to dwelling, dimensions L W
C Carport detached - attached to dwelling, -dimensions L W
Shed -dimensions L W
Deck - dimensions L W
= Gazebo - dimensions L W
Swimming pool above ground in -ground Size
Chimney - cumber of flues