BP-6506BENCHMARK:
NAILSET IN 15. OAK
ELEV.=175.35
=FINISHOF-D GARAGE FLOOR
FINISHI D FIRST FLOOR
TOp OIT FOUNDATION '
174.6
176.6
175.5
FINISHED BASEI`AENT FLOOR
167.75
INVER`1 AT FOUNDATION
172.80
INVERT INTO SEPTIC TANK
172.55
INVERT OUT OF SEPTIC TANK
172.30
INVERT INTO D-BOX
171.80
INVERT OUT OF D-BOX
171.63
? INVERT AT INLET OF FIELD
171.58
INVERT AT END OF FIELD
N/A
ELEVATION OF BOT. OF SYSTEN
171.0
ELEVATION OF G.W.T. (adjusted)
162.8
T.O.F. 175.5 -
FINISHED GRADE 174
172..60 ��
tr :,,.` �0•.�1 day y.
L= 12 S- , Ls :50' S= .01 -BO
,. 30.''
F /B /F IC7.75 I
SEPTIC ;..' 1Jeo' .:�..., ..
TANK
4" SOLID SDR
4" SCH 40 PVC SOLID PIPE
OR APPROVED EQUAL
SYSTE 'p"J"1300"' F H E
NOT TO SCALE
I
i EXISTING I-OPOGRAPHY, INCLUDING GENERAL TOPOGRAPHIC
AERIAL SURVEY AND ROADWAY CONTOURS, OBTAINED
FROM MILLERS FARM SUBDIVISION PLANS DATED 11/16/92.
SEE NOTE #15
t 6.5'
3.10,
15'
3 (2 -'-� 42'
4 5,5'
LEACHING AREA DETAIL
NOT TO SCALE
EXCAVATE ALL UNSUITABLE MATERIAL \60 01b I
WITHIN 5' HORIZONTALLY OF THE TRENCH
FROM THE PEA STONE COVER DOWN TO
EL. 164 (8.3'± below exist, grade)
EXCAVATION MAY BE REQUIRED TO EXTEND DEEPER ee
II' UNIFORM SUITABLE MATERIAL IS NOT ENCOUNTERED '
AT EL.164
1 l
\� \ \ \\
J \\ \ ZAA 80 � \�//►� -� �
O W 1
n3 • s
o�
F
9 /?3 0 \ \ \ \ \ ..S„
1,725�F.
a, ��� v� \ �D ► I O� 0
\ c' 'o'F.., \60
V
S_
/ 00 \
.•G
,gyp oy�� O
tZ 0 �0
309 y
1 \
1
�90
I
O
100' BUFFER TO ACT AS
'LIMIT OF CLEARING 9
ACTIVITY
!Z ///_ -1/9 _
71,63 171.58
- 12" min.
SPLASH SHIELD
INLET END PLATE
ALTERNATIVE POLYETHYLENE UNITS MAY BE USED.
OVERALL FIELD SIZE REMAINS THE SAME.
SETS OF 3 STANDARD
ILTRATOR UNITS
SOLID PIPE
iINATING AT "START'
E W /SPLASH _.
-D BELOW
3/4" - 1 1/2"
WASHED STONE
156
e®
LOT 15
04
MINIMUM FINISHED GRADE EL. ,173•
2- COVER LAYER OF
WASHED (PEA) STONE �_20 20'
COVER `�:.s.
- 1 WASHED STONE Fr
..e ` 'L:. :.: b : • ,, , y.
EL. =172.0 3" MIN. a.
t.
1_0
LIQUID LEVEL 6"EL.,- 171.58 t)OUBI
STAINI7„ 5 -�4. 0' 14 33' LAMF
I0 v-r I E ' 4
SEE L.!- 171.0 •' I r
SEE ; STAINI
DETAIL 30" DETAIL �- I n• GAS B,
I� 7-23---------..-SANDOVERDIG3 - _ �'' a'.►9 -6:.� p,�'_ .e__'q..p, �.e.p.♦ ,�:� -�
'----- IEL.164
TED GROUNDWATER TABLE 10.5'
EL. - 162.8
12" GROUNDWATER TABLE
161.77
P C T' 100 GAL. TIC TANK
152
e®
N
P
0
0
1
e
BASIS OF SAIN'ITARY DESIGN
BUILDING USAGE: 4 BDRM. RESIDENCE
SIZE OF TANK: 11500 GAL.
GARBAGE GRINDER: NO
CLOTHES WASHER: YES
ESTIMATED SEWAGE FLOW: 440 GAL /DAY
PERCOLATION RATE;: TP 168 9 MIN /INCH TP 17G 6 MIN /INCH
DESIGN PERC, RATE:; 10 MIN/INCH
LEACHING AREA:
16.5' WIDTH X 45.5" LENGTH 750.75 S.F.
SYSTEM CAPACITY:
750.75 S.F. X 0.6(0 GAL /SF /DAY= 450.45 GAL /DAY
DEEP TEST PIT INFO"IRMATION
s
PERFORMED BY: KEEN FORTIER / CHRIS HENRY
WITNESSED BY: SUF_ GRIFFIN
152 DATE: 12-1-88
TP IRA EL 17
FOR TOWN USE ONLY
2.4, PERC EL. 164.07, DEPTH 100"
0 - 50 TOPSOIL 8 :SUBSOIL
50" - 108" MED. PACKED SAND GRAVEL, SILT & STONES
108" - 138" COARSE SAND, GRAVEL & LARGE STONES
NO SEEPAGE AT 138"
TP._ 176 EL. 17',3.2 PERC EL. 164.07 DEPTH 102"
0 -10" TOPSOIL.
10 42" SILTY SUBSOIL
•• u
42 - 152 . PACKIED SAND, SOME SILT
NO SEEPAGE AT 152"
IN -SEASON WATER TABLE TP 380 4-19-89 (GND. EL.=172.1)
GROUNDWATER FOUND A,T 124" (EL.161.77)
ADD 1' HANDICAP (EL.16Z.77)
GENEKAL'1' E
1, The sanitary sewage disposal system shown hereon shall
be constructed in accordance with the requirements of
TITLE 'V of the State Environmental Code and local
E Board of Health regulations.
.ESS 2. Any modification to this design must be approved in
S writing by the engineer and the local .Board of Health
prior to implementation,
3. Contractor shall verify and check the BENCHMARK as shown
ESS on this plan prior to construction of the proposed
►FFLE system,
4, Deep Test `tole Information indicates' soil condition,
percolation .rate, and water table elevation at the time
and'location of actual testing and sho'ild be verified at
the time of ^onstruction.
i
5. The contractor shall notify the local 3oard of Health if
GROUNDWATER or PERCHEDWATER is encountered at a
higher elevation than indicated on thi3 design plan.
6, Notify the local Board of Health when the system is
ready for IN'PECTION, prior to any bacli;filling,
7. If CONFIRMA"ION OF CONSTRUCTION is required by an
engineer, notify this office prior to any backfilling,
S. The pipe betceen the house and the septic tank shall be
4" extra hea�'Y duty cast iron, Schedule! 40 PVC, or other
suitable matt-rial acceptable to the approving authority.
The slope o'� this pipe must be a minimum of 0.01 (0.12
inches per foot). A slope of per foot is
recommended,
9. The septic 'tank shall be 1500 gallons: minimum, unless
otherwise specified on this design pla'.n, and equipped
with INLET AND OUTLET TEES of, proper length
constructed of concrete, PVC;, or cast !�'ron. Septic tank
concrete strength is to be 5000 1,si at 28 days
conforming to all applicable ASSHT'O H-10 loading
requirements; unless otherwise specified,
10, If, any components of the proposed system are specified
as HEAVY DUTY, those components shall conform to all
state and local requirements for ASSHTO H-20 loading,
11. Septic tank, distribution box, and leaching pit (if any)
ACCESS MANHGLE COVERS are to be built 'up to within' 12"
of the finisyed grade unless otherwise specified on this
design plan.
12. Septic tank and distribution•box shall be placed on a 6"
minimum compacted GRAVEL BASE to prevent heaving or
settling,
13, All joints must be watertight, sealed with asphalt
cement or other cement suitable for that specific
component;
14. If septic tank and leaching facility are located 25'
(minimum) from the building foundation, a foundation
drain may be installed at the owners discretion,
15. Excavate all UNSUITABLE MATERIAL in the area
surrounding the washed stone leaching ,Facility to the
limits specified in regulation 15.255 of Title V and
replace, with clean coarse sand and gr:xvel, free -f-rom
fines, clay, organics, stumps, and waste construction
materials.
16. If any leaching area EROSION CONTROL BARRIER WALLS are
shown on th`ss design plan, they shall, be constructed
watertight, without weepholes or iother 'pervious
construction, in accordance with all ,ipplicable local
building department regulations. ;?uture_ leaching
facility enla-gement may require the ex':;ension`.of these
:barrier walls., -
17. Top of foundi� ion, basement and first Floor elevations
may be raised but NOT LOWERED without.te consent of the
engineer,
18. Unless specified in the Basis of Sanit.iry Design, this
system is \''OT designed for the us(? of a garbage
grinder, clothes washing machine, ho{: tub, or ot.her
high water usage devices,
19. Top 8" of fil':'i is to be topsoil.
20. No HEAVY EQU�_IPMENT shall be run over the components or
the leaching area unless those items ai•e specified as
HEAVY DUTY.
21. RUBBER TIRE MACHINERY are not to be driven over the
prepared nat't�ral soil base or sand/stone bed during
system installation.
22. For proper iierformance, the septic tank should be
INSPECTED anr:ually and when the solids and scum dep"th
exceeds 1\3 of the liquid depth, or three years has
elapsed since the last pumping, they tank and the
leaching pit (if any) should be pumped.
23, Plumbing in the basement should be limited to a washing
machine (if the design allows for the increased water
flow) when the invert of the building' sewer pipe is
higher tha he finished b >�i nt floor, unless
otherwise gz- on this dtajY5®F�
x
K TH ��G 'Cl ! iN' TH t
'FE4 `,EIR Enn( CIVIL c
NO ¢ o, 35835
a
Qr�s%o*��
LEGEND
0g . ,SEPTIC YST SIG Ls
EXISTING PROPOSED.rIEVIEVITE
100--__CONTOURS 100 "I11� ROBERT KFOURY
a R U tr
91X 9 SPOT ELEVATION 91.1 SEE ME ;
ET
PROPERTY LINE AP 7 0� L ! .1 E;
F P----EDGE OF PAVEMENT E.P.
t.` STONE WALL MILLERS rARM
WELL O
--0-- DEEP TEST HOLE O. T
�-----� (LEACHING TRENCH
PLUMBING PIPE
r ALL REVISIONS DONE AFTER DUNE 30, /995'
WIERE PERFORNII=D BY.
` t
KENNETH It FERREIRA' ENGINEERING INC �
46 FOSTER ST. NEW BEDFORD, MA, 02740
508 992-0020 FAX- 992-3374-
2 WELL LOCATION LOT 17
1 S•A.S. ELEVATIONS
No, Description
Revisions
Land Survey Co., Inc. / Engineering Co., Inc. / Environmental Assoc., Inc.
172 William Street New Buford, Mass. 02740
Tel. #(508) 997-6494 FA #(508) 997-9656
K.E.F. 2-13-98
K.E.F. I-15-98 Job Number: SE 6514.16_ Drawn By: S.M.@. Drawing No.
By Date Scaler 1" 40' Checked By: K.R.F.6
514.16
Date: - 6/2G/96 Designed By: K.E.F.
y
YOUR DR;V°j
�
,.THE BUILDIPIG gPROGRESS DURING
TEE®FTWORK
,e
d and�-..1��..a: e..�. �t �e�`v ,'"��
.s � f
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! mow. Wnu id'Y "4,l +, y`"i�i asiYW £" 'a d.. Er"-M F%� F _ h fw!$ l
a �* gyu tto ,py +�a �q q��
..ate xc '.r`r..1''S-r. e ,,.5 F y r..v Sd fir. e,r ti Est 4 !! &61 tho &Z$r"�°p.g f RL .xvg
�� ti, �E feam's and �� 3� a s s -ehen� Vie �.:
he rc Uia crfjeAn
,ard specific
$ sV :
;4 r4 07dU Fire Stops ASM-E-8•34. `
D -,At < undaflon Imp
3
s construction
tr
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RECORD FLAN
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1�
a. .w:..:-
}... _,....-r_-.r'a&. .,.. L .-. d'k saw
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ndorsed
_N r pp IliUSA t x
Ct
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�9
:
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on Site
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FIN
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W NI Z �I
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45,
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kUeo o o p o
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ka
LQJ
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zi
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gz
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tu
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Lo
1
Z
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+A
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t
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LLI
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it
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1
FINISHED GARAGE FLOOR
FINISHED FIRST FLOOR
TOP OF FOUNDATION'
FINISHED BASEMENT FLOOR
INVERT AT FOUNDATION
INVERT INTO SEPTIC TANK
174.E
176.6
175.5
167.75
172.80
172.55
INVERT OUT OF SEPTIC TANK
17230
INVERT INTO D-BOX
171.80
INVERT OUT OF D-BOX
171.63
INVERT AT INLET OF FIELD
171.58
INVERT AT END OF FIELD
N/A
ELEVATION OF BOT, OF SYSTEN
171.0
ELEVATION OF G.W.T. (adjusted)
162.8
T.O.F. 175.5
FINISHED GRADE 174
fL='12' 5c •UL L: 50' S= .01 -BO
0
F /B/F 187.75 - I SEPTIC 'J8O
:1
TANK
..:.�. 4" SOLID SDR-3
4" SCH 40 PVC SOLID PIPE
OR APPROVED EQUAL
SYSTEM PROFILE
NOT TO SCALE
EXISTING TOPC)GRAPHY, INCLUDING GENERAL TOPOGRAPHIC
AERIAL SURVEY AND ROADWAY CONTOURS, OBTAINED
FROM MILLERS FARM SUBDIVISION PLANS DATED 11/16/92.
SEE NOTE #15
EXCAVATE ALL UNSUITABLE MATERIAL
WIT11IN 5' HORIZONTALLY OF THE TRENCH
FRRM THE PEA STONE COVER DOWN TO
EL, 164 (8,3'± below exist. grade)
.,_.. ..•r,n., ...v nr nrnnnrn Tn TCAin ngPD17D
18.7 4 ►---18.7 '
4' 2
45,5'
LEACHING AREA DETAIL
NOT TO SCALE
LOT 17
�O
\60
62 11001 .
O
100' BUFFER TO ACT AS
LIMIT OF CLEARING 8
ACTIVITY
in. qrwe= I (Ad - IN.
1;63 171.58
12" min.
H
SPLASH SHIELD
INLET END PLATE
ALTERNATIVE POLYETHYLENE UNITS MAY BE USED.
OVERALL FIELD SIZE REMAINS THE SAME.
6 SETS OF 3 STANDARD
INFILTRATOR UNITS
14" SOLID PIPE
:RMINATING AT "START"
.ATE W /SPLASH _.
iIELD BELOW
_ 3/4" - 1 1/2"
WASHED STONE
LOT 16
3.66 AC.±
GII
'0'
\ 156
cgs
•a
GRADING
.0
154
LOT 15
MINIMUM FINISHED GRADk
EL, =173±
_
2" COVER LAYER OF
�-20'20'-20
Q
1 L TES
WASHED (PEA) STONEGENE
I
COVER
WASHED STONE
�',' 'O:'!�• •p?• A'-?'
... `. ...a • . �, ,. ,
-
-
_
1720
3"
MIN.
�a
1.
The sanitary sev�ge disposal system shownhereon shallEL.
0"
LEVEL
6"
be constructed is accordance with the requirements --ofOUID
{Sib
T-T
TITLE V of the State Environmental Code and local
Y�
EL.,- 171.58
QQUBLEBoard
of Health regulations.
14
`eSTAINLESS
2,
to this desi2"
Any modification gn must be approved in .5'-a
L:
5,33'
CLAMPS
writing by the ei=<gineer and the local Board of Health `
I10"
4 7,•
4. 0'
?
°:
5'
prior to impiemen�ation, -
i
4.
SEE 30"
�I
SEE
EL.:- 171,0
r
10.0'
',
STAINLESS
3,
Contractor shall 'verify and check the BENCITIARK as shown
on this to construction of i.he
n
DETAIL
plan prior proposed
`
_
DETAIL
>
�'
GAS BAFFLE
system.
y
g;
1
1_
7.23'
------_-_ SANpOVERDIG___ ___�---___,--`__
I
iEL.164
�::: `d: ►'..-a • p -> :> -•:a •o.,_.-.ti �.'a.;>
`
4,
and
Deep Test Hole information indicates soi:. condition,
_
10.5'
I
and water table elevatioi".
percolation rate,thetime,
Tt L? GROUNDWATER TABLE
EL• = 162.8
and.'location of actual testing and should bo verified at
12�
GROUNDWATER TABLE-,161.77
the time of construction,
`
ACT
0 00 GAL.
�• SEPTIC
5.
The contractor shill notify the local Board'of er Health `if
GROUNDWAT(v' or annCindicatED ed
INK
onsthiscouni des.gnePR"
higher eleevvation ihaplan.
6.
Notify the loca Board of Health when th! system is
ready for INSPECTION, prior to any backfill{ng,
7,
If CONFIRMATION OF CONSTRUCTION is required by an
engineer, notify this office prior to any b<.ckfiliing.
152
'- �•
BASIS ®� IT��Y �S�G
[I `�jy
8.
The pipe between the house and the septic tank shall r be
\
4" extra heavy duty cast. iron, Schedule. 40 i1'VC, or other
BUILDING USAGE: 4BDiiRM.
suitable material acceptable to the approving authority,
RESIDENCE
The slope of this pipe must be a minimum oi' 0,01 (0,12
SIZE OF TANK: 1500 GAL,
inches per foot). A slope of 1\4" Pc`r foot is
GARBAGE GRINDER: NO
recommended,
CLOTHES WASHER: YES
9,
The septic tank 'shall be 1500 gallons minimum, unless
this design
/
otherwise specified on plan, z.nd equipped
ESTIMATED SEWAGE FLOW: 440 GAL/DAY
P OUTLET TEES of with INLET AN.. proper length
PVC, iron.
J
constructed of co?.crete, or cast i Septic tank
PERCOLATION RATE: TF' 168 9 MIN/INCH TP 176 6 MIN/INCH
concrete strength: is to be 5000 psi a'.:t 28 days
conforming to all applicable ASSHTO H- 10 loading
/
DESIGN PERC. RATE: 10 [MIN/INCH
requirements; unless otherwise specified,
/
LEACHING AREA:
10.
If, any component€ of the proposed system aT`e specified
as HEAVY DUTY, those components shall coni•orm to all
state and local requirements for ASSHTO H-20 loading,
N
I
16.5' WIDTH X 45,5' LEPJGTH= 750.75 S.F.
11.
Septic tank, distribution box, and leaching pit (if any)
p
ACCESS MANHOLE COVERS are to be built up tip within 12"
Q
SYSTEM CAPACITY:
of the finished ge'ade unless otherwise specified on this
design plan. I'
750.75 S.F. X 0.60 G�'aL/SF/DAY- 450,45 GAL/DAY
12.
Septic tank and distribution' box shall be p: aced on a 6"
minimum compactec GRAVEL BASE to prevent! heaving or
settling,
1
i1
13,
All joints must be watertight, sealed Mith asphalt
�r T
TEST �j��
T
cement or other cement suitable for that specific
I1
..r
®
1 �o
component.
PERFORMED BY: KEN F'pRTIER/ CHRIS HENRY
14•
.If septic tank and leaching facility are located 25'
(minimum) from the building foundation, a foundation
\
WITNESSED BY: SUE GR"
!IFFIN
drain may be installed at the owners discretion.
' 152
DATE: 12-1-88
15.
Excavate all I'NSUITABLE MATERIAL in i the area
TP 168 EL. 17 .4, PERC EL. 164.07, DEPTH 100"
surrounding the Washed stone leaching facility to the
limits specified in regulation 15.255 of Title V and
0 - 50TOPSOIL a SUB -OIL
an coarse sand and
replace with clr gravely free from
50"-_108", MED. PACKED) SAND, GRAVEL, SILT a STONES
fines, clay, organics, stumps, and waste construction
'
108 138 COARSE SAND, GRAVEL a LARGE STONES
materials.
-'
NO SEEPAGE AT 138"
16.
If any leaching 'area EROSION CONTROL BARRIIR WALLS ` are •'
shown on this &,sign plan, they shall be'; constructed
TP176 EL. 173.2 PERC EL. 164.07 DEPTH 102"
watertight, Without weepholes or other pervious
construction, in accordance with all applicable local
0 -10" TOPSOIL
building department regulations. Futui a leaching
facility enlargem`nt may require the extension; of these
10" - 42" SILTY SUBSOIL
barrier walls.
42" - 152" W,-D. PACKED SAND, SOME SILT
17,
Top of foundatioi=, basement and first floor elevations
NO SEEPAGE AT 152"
may be raised but NOT LOWERED without the consent of the
®
IN -SEASON WATER TABLE TP ;380 4-19-89 (GND. ELr= 172.1)
engineer.
GROUNDWATER FOUND AT 124;" (EL.161.77)
ADD V HANDICAP (EL.162.77)
18.
Unless specified in the Basis of Sanitary i)esign, this
system is NOT designed for the use of a garbage
grinder, clothes washing machine, hot .tul, or other
high water usage eevices,
°" ,/ •"•,
19.
Top 8" of fill is to be topsoil.
;
%a""°�.••n m _
20.
No HEAVY EQUIPMEAT shall be run over the ccmponents or,
the leaching are, unless those items are specified as
HEAVY DUTY.
21.
RUBBER TIRE MACI:INERY are not to be driven over the
BOARD o HEALTH I�IsEczioN
_ --
r f✓�I
prepared natural soil base or sand/stone! bed during
system installati`cn• I
M1
REQUIRED WHEN EXCAVATED
x
the tanl'.
K<<�
22.
For proper erfermance, septic should ,be
P P P
the depth
Ili`LQCUS
INSPECTED annual)y and when solids andiscum
1' g'
exceeds 1\3 of the liquid depth, or three years has.$
1•; Y'i
elapsed a lastpumping,the tank and the
psed since t1:<
should be um ed.
leaching pit (i£ �nY P P
,
This System Is foot Designed
23.
Plumbing in the basement should be limited to a washing
i
•
For Garbage Grinder Whirlpool
machine (if the 8esign allows for the increased water
I
nvert of the building se4 er pipe is
flow- when the i g P P
Or Other High Water Use Devices.
g
�� �; t
higher th finished b floor,' unless
otherwise ro®ff,; n this
;�_
800 t,, ECHANICALS RIMARY FUEL
Furnace (hot air,- Fuel gas (natural or propane), fuel oil, electricity, other (specify)
Boiler (heating)- Fuel gas (natural or propane), fuel oil, electricity, 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 Other
goo SPRINT LERS - FOR STRUCTURES OVER 7500 SQUARE FEET and certain multifamily residential
I
Required, --plans provided, plans not provided, why?
Not required, not to be installed, Why?
1000 gEQUIRED OFF-S`TREET PARSING - for ZONING & Architectural Access
NOT APPLICABLE
= Parking Plan submitted To Building Department Planning Board Date submitted
j Number of spaces - indoors outside total provided
I, H-ndicap spaces - required _ yes _no. If yes, how many as a p?rt of the total required number.
Is Route 6 (State Road) Entrance permit required? yes = no If yes has it been issued yes no 7.
Submit copy of application and/or permit as soon as available.
1100IDENTIFICATION (print or type except as noted)
Current owner - name
address6,13
C.ra-'
r
phone #
If corporation, officer in charge
Architect/Engineer - for overall design
Company name
Address
Phone number
i
Certified by State of Massachusetts as
Certification number
NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and not
reproductions.
Arcli ted/Fngmeer - 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 rand not
reproductions.
General Contractor (if Homeowner, state homeowner here then complete section 1300)
Company name 2?
Address ` �/ / t1 �.✓ �ld%`�/�i3'1 s
Phone number
Construction Supervisors license number----
NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals ,and not
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 fto next section!
Are you claiming exemption from the requirement? Yes —No If yes, submit the required affidavit!
Rea -,)del 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
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 request. I understand that once the permit expires a new application may be required, including fees and current
other requirements (including Zoning).
Name
d
Signature u
The abov signature is voluntary act and is signed under the pains and penalties, of perjury.
Date. �!
Who is authorized to pickup the permit at the Building Department? (please printl <� '
Address Phone
1400 HOMEOWNER EXE31[PTION - 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 b Construction
in Section 127.0, effective July 1, 1982, no individua g Yarsonsen Control
1 shall be in directly supervising persons engaged ed in
construction nl
reconstructio 8 n, alteratio
n, repair, removal P mo al 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
Rules 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 heishe resides or intends to reside, on which there is, or is intended to be, a one or two family dwelliniz, 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 liabWty
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NOTICE TO LICENSED CONTRACTORS The Building Code provides in the Rules and Regulations section that anv
licensed Construction Supervisor, whether or not they have taken the permit are responsible for code compliance. (s
2.15.2 of section a")ee
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1500 COST
Cost of Improvement $
Items to be installed but not included in the above cost: Electrical 5
Plumbing
HVAC
Other
TOTAL j f' C/
e
Alteration of existing, no increase in gross square feet. A separate Refuse Disposal Declaraidon required.
Demolition - describe structure
Number of dwelling units Number of bedrooms A separate Refuse IDisposm
Declaration'requilred.
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
Number of layers when complete
A separate disposal declaration REQUIRED
i
= Replacement doors and windows - (for existing only) (only where doors and windows exist mnd will not be
i
enlarged) EGRESS dimensions must be maintained. Enlarged or new windows in an existing dwwellkng will be
i
considered as an Alteration, otherwise will be included in new construction. (see Code section;a3401.10 for
residential and Articl- 8 ft. commercial)
Temporary stricture includes when allowed, trailers, tents and the like and only for limited periods of time.
Describe
500 CONSTRUCTION PLANS
_ None submitted. Why?
bmitted, usually three sets required. Four sets for food serviceluses. Number of sets subimitted !
600 SITE PLAN
I
❑ Not required, why?
bmitted When? Previousiv, date e4ith this application
700 UTILITIES
Water supply- required es no public ? " Zyes q Y P 4�..�'es _no, on site well_q no,
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 supply, when
required, is available. See Code 780 CMR section 114.1.2)
i
Sewage disposal - required _ yes _ no, public sewer _ yes no
private septic on -site - es no. Submit copy of permit as soon as available.
= Woodstove used (will require inspection prior to installation), new (provide manufacturers
instructions). Location(s) (list) -
Fireplace(s) - (includes flue) List location(s)
= Game Court - describe (include overall dimensions)
C Tent, Trailer (Mobile Home) or Other - describe
i
300 COMMERCIAL - PROPOSED PROJECTIUSE _ 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
Vie)
j Assembly - 'restaurant, lounge, theater, school, etc. (see Code Section 302.0) Describe
I
Business - office, assembly with less than 50 occupants indicate Medical or other professional (see Code
j Section 303.0)
— Educational - structure for training including child day care for those over 2 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 & Miscellaneous Structures - includes tents and agricultural structures (see Code Section 311.0)
= Ne-w tenant for any of the above, indicate above (see Code Section 119.0 and Zoning By-law section i g Y on 3
— Ten
t or Trailer - temporary purpose?
_ Other
Describe the proposal briefly, INCLUDE r umber of dwelling units and bedrooms or occupant load as applicable,
also e3:isting condition
400 TYPE OF CONSTRUCTION OR WORK TO BE PERFORMED
New Construction and/or Addition - total gross square feet f Z42 115�_
(For commercial only total gross cubic feet) - indicate
- It will be considered new construction if there an increase in square footage in addit
ion
� alteration(s). to any
If project is an addition to existing structure - Total gross square feet of existing
FOR COMMERCIAL ONLY
WW this project be subject to CONSTRUCTION CONTROL (over 35,000 cu.ft-) 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 1)
APPLICANT TO PROVIDE
The following section for official use only.
INSPECTORS' REVIEW
Date plan reviewed
30 days to review period expires
OK to issue date
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
Inspectors signature Date MAY 13 199p
Applicant informed of above - Date time staff (fax, phone, in per -son)
= Over six months since approved for issue - DEEMED abandoned'
Advise applicant. Hold 90 days for return then dispose if not picked up.
Inspector Date
Advised applicant Date Time staff (by phone, fax or in person)
OFFICE\INSPECTORS NOTES
TOTAL FEE /
Gross area - new construction �Z 0 Total Sq. Ft. - r�
alteration Total Sq. FL
Permit is issued to
Comments/notes on permit
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1600 TO THE APPLICANTIREFIMAL ANI) APPROVAL
Date of Application submission (t l
s
ry
0-1
Plat Lot Street
Aquifer Zone
Owner 1 r f
Owner mail address
Owner phone #
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OTHER INVOLVED AGENCIES - The following agencies require separate jurisdictional permits or approval for your
proposed project. CONTACT THEM FOR REO JUMD �MLiSIONS.
® TAX COLLECTOR �— Approved - HOLD By
Date
❑ Board of Appeals Approved By Date
❑ ,. onservation Commission LE Approved By
Date
❑ D.P.W. Water Approved By �^ 17 D.P.W. Sewer _ Approved By Date
❑ D.P.W. Cross Connection Appro led By
Date
❑ Treasurer (Bond) a Approved By _
Date
❑ D.P.W. Engineering ,
g g -- Approved �yv
Date
7 oard of Health (weln Appro ed By
Date
Board of Health (septic) '_- Approved By Date
❑ Board of Health (food service) _ Approve By
Date
❑ Planning Board (parking) _ Approved By
Date
FIRE DISTRICT (I - II III) _ Approved By Date
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BUILDING DEPARTMENT APPROVAL:
❑ ZONING
❑ BUILDING INSPECTOR/BUILDING COMhIISSIONER
❑ CONTROL CONSTRUCTION AFFIDAVIT'
PROJECT SUMMARY:
new constructiont alteration/demo sewage disposal - public/private
[Alter)add interior walls] [add rooms] [add footprint] tP ] water supply -public/private well
[pool] [garage,%shed/deck] [game court] [food service]
Describe
To the various departments:
This notice has been forwarded to you for your information and any appropriate action. Should you have any
questioris please advise. If any reason to withhold
cooperation is appreciated. the requested permit is found, please advise. Your assistance and
coope
Id
The BuildingDepartment - Date sent for
p review
BY -_
J_
TOWN OF DARTMOUTH B ING D P.
TELEPHONE 508-999-0720 FAX:508-'99-0738
APPLICATION FOR ZONING AND BUILDING PERMIT
The applicant shall complete this application to the best of their ability prior to submission, leaving no item unanswered. The
Department staff will be available during regular business hours to assist as necessary. N/A should be inserted for (those sections
which do not apply. A properly completed application will help avoid unnecessary delays. Me&= Flilimg An in od
(foe office me only) 0 FDUNDAMON ONLY
Total Cost $ ,, Received By Date Rec'd
Less Application Fee $
Total Permit Fee $ Permit # issued Date
100 LOCATION OF PROJECT TOTAL LAND AREA SQUARE FEET
CURRENT ACCESSORS' PLAT LOT ` ZONING DISTRICT
OTHER ZONING OVERLAY DISTRICTS, if applicable
NUMBER &STREET �-�
0
NEAREST CROSS STREET / rL'� Awl
SUBDIVISION NAME & LOT #
or BUSINESS NAME
PREVIOUS TENANT /OWNER
sr
200 RESIDENTIAL - PROPOSED PROJECT - one & two family residence only
i
THIS SECTION NOT APPLICABLE
Single family - number bedrooms number baths `
Two family - number bedrooms 'unit 1 number baths unit 1
number bedrooms unit 2 number baths unit 2
Accessory apartment Total gross sq. ft.
Accessory structures
Garage - detached - attached to dwelling, dimensions L W r
= Carport detached - attached to dwelling, dimensions L W
I
Shed dimensions L W
Deck - dimensions L
Gazebo - dimensions L W
— Swimming pool above ground in -ground Size
Chimney - number of flues