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LOT 31
85,851 s.f.
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LOCUS MAP - NOT TO SCALE
PARCEL A
"OPEN SPACE"
\g6
•
LOT 32
F/F/F= i n
/,pi• 7 - FINISHED GRAD = 178.0
T.O.F.= afl= ✓,'
176.45 12"
-
�, 176. :y•: f;,►: �c�:� r .i "i'�' •`,..: ,. '•r 175.80 175
r i 3' J.
t-0 = 8' S= 0 1
= 20 s= 0.02 G- L)QUD L VEL �i"K
r > 10- 1..
! 1A1rL 14"
MIK
F/B/F.= ' 4 5' 1500 GAL. SEPTIC TANK ' 4.25'
PVC
i72•7S� 10' GAS BAFFLE
OR EQUIVALENT
�= 10.5'
158
LOT 31 \
8 5,8 51 S.F. \
INISHED G
rrc�rr�- I' V I►
SYSTEM PROFILE
NOT TO SCALE
s-?' CLEAN COARSE
PEA SCONE
'6.76t FIN GRAD - L.176_76
12" MIN. 12"
---2"MIN. - -----MIT, I75.76_
4" PERF. 07
--END CAP PIPE 3 l" EL. 175.26
i-I� CLEAN COARSE WASHED STONE 6" L,174.7E
175.2614-
1
AND OVERDIG 5'
1 135"
EL.169.76
(INTERPOLATED)
EL. 163.5 '
1
i
i
40'
I�
30'
ri 28' 1 4 ROWS
LENGTHS) 4" SDR-35 PERFORATED PIPE
THS) OR EQUAL
2.5' ,
i
5 II
30' 20' 5'
FROM TANK-,-
5' ND CAP
(tyP'1 4" -11" CLEAN WASHED STONE
2ff W/PEA STONE COVER
5' SAND OVERDIG
LEACHING AREA DETAIL
NOT TO SCALE
E1 EV,.176.39 -' ' ' "
PROP. SCALE: I" = 30'
WELL
BASIS OF SANITARY DESIGN
BUILDING USAGE: 3 Bedroom Ca I IOGTD/bedroom
TITLE 5 SEWAGE FLOW: 330 GPD
SEPTIC TANK SIZE: 1 500 Gallons
GARBAGE GRINDER: None
WASHING MACHINE: Yes
PERCOLATION RATE: TP 179:6 MIN/INCH, TP 180:: <2 MIN/INC
DESIGN RATE: 10 MIN/INCH, CLASS II
LEACHING FIELD:
BOTTOM AREA: 20 ft. (width) x 30 ft,. (length) = 600 sq.ft
SYSTEM CAPACITY: 600 sq.ft x 0.60 gpd/s;q.ft. = 360 9N
DEEP TEST PIT INFORMATION
PERFORMED BY: KEN FORTIER / CHRIS HENRY
WITNESSED BY:, SUE GRIFFIN
DATE: 12-19-89
TP 179 EL. 170.5 TP 1180 IEL. 172
0 - 8" TOPSOIL 0 - 6" TOiPS01L
8" - 24" SUBSOIL 6" - 24" SUBSOIL
24" - 60" VERY FINE SAND, SILT 24" - 54" `VERY FINE SAND, SILT
MOTTLING EVIDENCE 54" - 124" MED. SAND, STONES
60" - 168" MED. COARSE SAND, STONES NO GROUNIDWATER OBSERVED
NO GROUNDWATER OBSERVED@ 168" EL. 156.5 ADD I' HANDICAP @ 124" EL. 161.67
ADD 1' HANDICAP PERC DEPTH 102" EL. 163.5
PERC DEPTH 124" EL. 160.17
SOIL EVALUATIONS:
D,aTE(S): 1/27,199 - 1/28/99
PERFORMED BY: Kenneth E. Fortier
WITNESSED BY: Susan Grim
DEEP OBSERVATION HOLE LOG
TP # 431A (Elevation = 173,41 )
Depth from
Soil
Soil Texture
Soil Color
Soil
Other: Structure, Stones,
Surface
Horizon
(USDA)
(Munselq
Mottling
Bouilders, Consistency, % Gravel
(Inches)
0-5"
O
5 - 11"
A
Sandy
1OYR314
Friable
Loam
11 - 24"
B
Sandy
1OYR5/6
Firm
Loam
24 - 66"
C,
Silt
2.5Y5/6
@ 33"
lFirm, Sandy Loam
Loam
7.5YR518
deposits
& 2.5Y7/2
66 - 120"
CZ
Sandy
IOYR5/4
Firm, Sand deposits,
Loam
Crobbles, Stones, and
Rocks
BEDROCK DEPTH = > 120" ELEVATION = 163.41
SEEPAGE DEPTH = None ELEVATION = 163.41
ESTIMATED SEASONAL HIGH GROUNDWATER DEPTH = 33" ELEVATION = 170.66
DEEP OBSERVATION HOLE LOB
TP # 431B (Elevation = 172.51 )
Depth from
Soil
Soil Texture
Soil Color
Soil
Other. Structure, Stones,
Surface
Horizon
(USDA)
(Munselo
Mottling
Boultders, Consistency, % Gravel
(inches)
0-3„
O
3 - 10"
A
Sandy
IOYR3/4
Friable
Loam
Firm
10 - 28"
B
Sandy
IOYR5/6
Loam
28 - 60"
C,
Silt
1 OYR6/4
@ 46"
r7irm, Sandy Loam
Loam
10YR5/8&
deposits
2.5Y7/2
60 - 92"
CZ
Sandy
1 OYR5/4
Firm, Loamy Sand
Loam
deprasits, Cobbles and Few
Stones
BEDROCK DEPTH = > 120" ELEVATION = 162.51
SEEPAGE DEPTH = None ELEVATION = 162.51
ESTIMATED SEASONAL HIGH GROUNDWATER DEPTH = 46" `ELEVATION = 168.68
EXISTING
L-1-GEND PROPOSED
100----
CCONTOURS 1r0
91 x 9
SPOT ELEVATION
-
PROPERTY LINE
E.P --EDGE (OF PAVEMENT E.P.
STtONE WALL
_
tom'
WELL 0
❑
DEEFP TEST HOLE -
�___
LEACHING TRENCH
PLUMBING PIPE
GENERAL NOTES: new construction:
1. The sanitary sewage disposal system shcwn hereon steal' l` e C'� SST` LICTED I10 A.CCORDSNGE wit'I
the requirements of 1995 310 CMR 15 (TITLE V) of the State Environmental Code and local Beard of
Health regulations. Any MODIFICATION TO THIS DESIGN must be approved in writing by the
engineer and the local Board of Health prior to implementa'.i�n
2. Contractor shall verify and check the BENCHMARKS) s s;-:twn or, this plan prior to construction of
the proposed system.
3. Notify the local Board of Health when the system is ready for INSPECTION, prior to any backf lling. If
CONFIRMATION OF CONSTRUCTION (as -built) is required by an engineer, 3 day ad'ranced
notification is required for the survey.
4. DEEP TEST HOLE INFORMATION indicates soil condition, p:ercoiation rate, and water table elevation
at the time and location of actual testing and should be v rified at the time of construction. The
contractor shall notify the local Board of Health if GRO,,JNDWATER or PERCHED WATER is
encountered at a higher elevation than indicated on this des'gn plan.
5. TOP OF FOUNDATION, BASEMENT and FIRST FLOG P, elevations may be raised but NOT
LOWERED without the consent of the engineer.
6. Unless specified in the Basis of Sanitary Design, this system its NOT designed for the use of a c' arbage
grinder or other high water usage devices.
1,
7. Where the building sewer pipe exits the foundation ABOVE ,the basement floor, an effluent a'grinder
pump conforming to 310 CMR 15.229 may be used to discharge A VOLUME OF LESS THAN e' 5% OF
THE DESIGN FLOW from any future basement bathroom / =ink facilities.
8. 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-2) loading.
9. The SEPTIC TANK shall be 1500 gallons minimum, unless ot''erwise specified on this design plan, and
fitted with PVC schedule 40 INLET TEE and OUTLET TEE WITH GAS BAFFLE of proper,
Septic tank construction shall conform to 310 CMR 15.226. The SEPTIC TANK OUTLET COVER is
to built up to within 6" of the finished grade unless otherwise specified on this design plan.
10. SEPTIC TANK, DISTRIBUTION BOX, and PUMP CHAMBEF (if any) shall be placed on a 6" rr,;inimum
compacted GRAVEL BASE to prevent heaving or settling. ALL SEAMS ARE TO BE WATERTIGHT,
sealed with asphalt cement or other cement suitable for that specific component.!
11. EXCAVATE ALL UNSUITABLE MATERIAL within five feet f,,orizontally of the leaching area f#rom the
pea stone cover down to elev=163.5 002 inches below the original existing grade.) Excavation may
be required to extend deeper if uniform suitable material is R.ot encountered. See notes 11a & 11b.
11 a. SOIL PREPARATION PROCEDURE FOR THE LEACHING FACILITY AREA shall . conform to 310
CMR 15.246 & 15.247.
11 b. Any EXCAVATION OF UNSUITABLE MATERIAL designatec'on the plan shall conform to Construction
in Fill requirements as outlined in 310 CMR 15.255 (1-6).
u
12. No HEAVY EQUIPMENT shall be run over the componentS or the prepared leaching area during
installation. RUBBER TIRE MACHINERY are not to be driven over the prepared natural soil 'base or
sand/stone bed during system installation.
13. TANK SEAMS, riser connections (if any), and all plumting joints are to be installec 100%
WATERPROOF. ALL JOINTS MUST BE WATERTIGHT, sealed with rubber joints, cement or other
suitable sealer for that specific component. Any groundwateror surface water entering the system will
severely limit the life span of the leaching area.
14. ANY LEACHING AREA (OR PUMP CHAMBER) VENTS sh211 be constructed of 4" solvent weld SCH
40 PVC, The twin 90 degree elbows comprising the "U" shal' not be glued. Any D-box vent pipe shall
utilize an inlet knockout. Vent to extend 24" min. above pro csed grade.
15. RESERVE AREAS that are shown within 25' of property lines may require impervious barrie ,s to be
installed (to conform to side slope requirements) during the'nstallation of the future reserve.!
16. For RESERVE AREAS that may be required to be installed aY a higher elevation than the prim��ry area
(due to any naturally occurring slopes in the topography), either a pump system or elevating the
building sewer & tank may be necessary.
i
17. ANY CLEAN -OUTS shown shall extend to within 3 inches cl finished grade and capped with; a SCH
40 threaded clean out fitting. ('
18. ANY VENTS shown shall be constructed of 4" Sch. 40 PVC. The twin 90 degree elbows on to'D of the
vent shall NOT be glued, allowing future inspection access. sheet metal screws are recomme`ided to
prevent unauthorized entry. Horizontal lengths of vent piping shall be sloped up toward the ve"it. Any
vents shown connected to the Distribution Box are to utilize an unused D-BOX INLET opening.
BOARD OF HEALTH STAMPS
r E
BOARD OF HEALTH STAMPS
�I OWN OF DA f 4UTH
g I. REVIEWED
- And Changes Must ;
I
Be Resubmitted
SEE REPORT
of Review p 011999
Bar Dds
P.E. STAMP SEPTIC SYSTEM DESIGN PLAN E
cwtf OWNER: ROBERT KFOURY
'� E u• ASSESSORS MAP & LOT: MAP 70, LOT 13-31WICIERS
CIVILFARM)
9Fcr� • STREET LOCATION: MILLERS DRIVE
°`L= GINEERING FIRM:
enneth R. Ferreira Engiheering, Inc. '
P.L.S. STAMP 46 Foster Street„ New Bedford, MA. 02740
'IH OF
Tel. (508) 992-0020 rax: (508) 992-33i74
Mqs�
KENRNETH DATE: 3-3-99 Scale:130
FERREIRA
No.287le CONTACT PERSON: KFVIN SILVA
ADDRESS: Same as above
TEL:
SE 6514.31
d /
/d
]LOCUS
& JIM
V,
,
LOCUS MAP - NOT TO SCALE
\g6
LOT 32
PARCEL A
"OPEN SPACE"
t�/.7-�7 FINISHED GRAD
T.O.F.=
!@9.9 176.45 12"
176. :>�: r, �: i �:t f. •t ' � •, .,�,,.. ,• ,:.'.:; ;0 175.80 175.62
x 3- -
j:
20' S= 0.02 6- LK"D LEVEL r-o N' = 18' S= 0.01
s > 10' y
► LIIN 14" i
MIN.
F/B/F.= ' 4 5' 1500 GAL. SEPTIC TANK
4: 4.25'
PVC
lip 7s 10' GAS BAFFLE
OR EQUIVALENT
10.5'
l � -
� 136.p0,
I � �
l
158
1
160
LOT 31 \ /
85,851 S.F. \
•
i � e
�rO
LOT 32
PROP.
wEu
30' 2
17 5.4 6
-. I _ �. •.. • .
D-BOX
175.40
SYSTEM PROFILE
r
NOT TO SCALE
' 40'
INIaHED GRA
s-?' CLEAN COARSE
PEA SCONE
'6.7�_
L. 176-76
12" MN.
12"
! 4" PERF.
- -ENn CAP PIPE
I"
--li
EL. 17 5.2 6
i
CLEAN COARSE WASHED STONE 6"
L,174.7E
175.26 I
I
5' _^
AND OVERDIG 5' �
135"
I
I
EL.169.76
(INTERPOLATED)
=----------t-
------=----------------- EL. 163_5_2
BASIS OF SANITARY DESIGN
BUILDING USAGE: 3 Bedroom �^a I I(OGPD%bedroom
TITLE 5 SEWAGE FLOW: 330 GPD
SEPTIC TANK SIZE: 1 500 Gallons
GARBAGE GRINDER: None
4 R5 OF 4" SDR-35 PERFORAT
PERFORATED PIPE
WASHING MACHINE: Yes
(28' .ENGTHS) OR EQUAL
PERCOLATION RATE: TP 179:G MIN/INCH, TP IISO: <2 MIN/INC
DESIGN RATE: 10 MIN/INCH, CLASS II
LEACHING FIELD:
FROM ANKH
BOTTOM AREA: 20 ft. (width) x 30 ft. (length) = sq.ft
7
600
4'"•12" CLEAN WASHED STONE
W/PEA STONE COVER
SYSTEM CAPACITY: 600 sq.ft x 0.60 gP�d/sq.ft. = 360 SPd
GENERAL NOTES : new construction:
1 The sanitary sewage disposal sys,, .,-. �no.tin he•eon s a:' C��'S' ='_'C`F Ili AGCO .D�;,NCE wi
the requirements of 1995 310 CMR 15 (TITLE V) of the S=',e-"''"rcnmental Code and loo it Board c
Health regulations. Any MODIFICATION TO THIS D !CN must be approved in w7it'ng by th
engineer and the local Board of Health prior to implemer t'o
2. Contractor shall verify and check the BENCHMARKS) as s',ONn on tt 's plan prior to construction c
the proposed system.
3 Notify the local Board of Health when the system !s ready nor INS,FEC T ION, prior to any backfilling.
CONFIRMATION OF CONSTRUCTION (as -bunt) is re ,-ired by an engineer, 3 day advance
notification is required for the survey.
4. DEEP TEST HOLE INFORMATION indicates soil condition percciation rate, and water table elevatio
at the time and location of actual testing and should be verified at the time of construction. Th,
contractor shall notify the local Board of Health if GROUNDWATER or PERCHED VrIATER i
encountered at a higher elevation than indicated on this c-sign plan i
5. TOP OF FOUNDATION, BASEMENT and FIRST FLCOR elevations may be raised but NO'
LOWERED without the consent of the engineer.
i
6. Unless specified in the Basis of Sanitary Design, this syste� is NOT designed for the use of �a garbag
grinder or other high water usage devices.
7. Where the building sewer pipe exits the foundation ABOVS the basement floor, an effluent a grinde
pump conforming to 310 CMR 15.229 may be used to discharge A VOLUME OF LESS THAN 25% Of
THE DESIGN FLOW from any future basement bathroom / sink facilities. !'
8. If any components of the proposed system are specified -s HEAVY DUTY, those compon"ants steal
conform to all state and local requirements for ASSHTO P,-20 loading.
I
9. The SEPTIC TANK shall be 1500 gallons minimum, unless ztherwise specified on this design plan, an(
fiL,ed with PVC schedule 40 INLET TEE and OUTLET TCE WITH GAS BAFFLE of proper length
Septic tank construction shall conform to 310 CMR 15.22E• The SEPTIC TANK OUTLET COVER i;
to built up to within 6" of the finished grade unless otherwise specified on this design plan.!
j
10. SEPTIC TANK, DISTRIBUTION BOX, and PUMP CHAMBER (if any) shall be placed on a 6"'minimurr
compacted GRAVEL BASE to prevent heaving or settling. ALL SEAMS ARE TO BE WATERTIGHT
sealed with asphalt cement or other cement suitable for th It specific component.
11. EXCAVATE ALL UNSUITABLE MATERIAL within five feet horizontally of the leaching area from the
pea stone cover down to elev_I63.5 002 inches below th= original existing grade.) Excav ltion may
be required to extend deeper if uniform suitable material is not encountered. See notes 11 �i & 11 b.
l I 1 DEEP TEST PIT INFORMATItON 1 �a CSOILMR REPARATION FOR THE LEACHINJ FACILITY AREA shall .conform to 310
5.246 &5
PERFORMED BY: KEN FORTIER / CHRIS HENRY 11 b. Any EXCAVATION OF UNSUITABLE MATERIAL designated on the plan shall conform to Cor!'struction
WITNESSED BY: SUE GRIFFIN in Fill requirements as outlined in 310 CMR 15.255 (1-6).
LEACHING AREA DETAIL f' DATE: 12-19-89
12. No HEAVY EQUIPMENT shall be run over the components or the prepared leaching area during
TP 179 EL. 170.5 TF� installation. RUBBER TIRE MACHINERY are not to be driven over the prepared natural soi' base or
NOT TO SCALE 180 �L. 172 P P
0 - 8" TOPSOIL sand/stone bed during system installation.
0 - 6" TOPSOIL
8" - 24" SUBSOIL 6" - 24 SUBSOIL 13. TANK SEAMS, riser connections if an bin joints are to be installed 100%
(' y}, and all plug 9
24" - 60" VERY FINE SAND SILT 24" - 54'" VERY FINE SAND, SILT WATERPROOF. ALL JOINTS MUST BE WATERTIGHT, sealed with rubber joints, cement or other
MOTTLING EVIDENCE 54" - 12 suitable sealer for that specific component. An roundwaW or surface water entering the system will
MED. SAND STONES P P y g Y
/HEADWALL 60" - 168" MED. COARSE SAND STONES severely limit the life span of the leaching area.
4 INV. OUT= 166.50 NO GROUDWATER OBSERVED
NO GROUNDWATER OBSERVED@ 168" EL. 156.5 ADD I' H
LOT 30 PERC DEPTH 124" EL. 160.17 ANDICAP @ 124" EL. 161.67 14. ANY LEACHING AREA (OR PUMP CHAMBER) VENTS shall be constructed of 4" solvent wield SCH
ADD I' HANDICAP PERC DF PTH 102' EL. 163.5 40 PVC, The twin 90 degree elbows comprising the "U" shE'l not be glued. Any D-box vent pipe shall
utilize an inlet knockout. Vent to extend 24" min. above pr�Posed grade.
SOIL EVALUATIONS:
- 15. --RESERVE
- ' - AREAS that are shown within _s may r ,
�. v._•-.--:--..:--------•'� a ,�---_ 25 of grope IiM y equine impervious barnt'.rs to be
rnsta-fled (to conform to ,rde lope requirements) during the installation of the future reserve, �g6 PERFOR"►1EDfrBY99Kenneth E. Fortier
/ IWITNESSED BY: Susan Griffin 16. For RESERVE AREAS that may be required to be installed of a higher elevation than the prirrary area
n
10 LOT 30
PROP 40;,
S.4.S T 30
,SITE PLAN
SCALE- I" = 30'
6
DEEP OBSERVATION HOLE LCiG
TP # 431A (Elevation = 173.41 )
Depth from Soil
Soil Texture Soil Color Soil
Other: Structure, Stones,
Surface Horizon
(USDA) (Munselo Mottling
Boulders, Consistency, . Gravel
(Inches)
0-5" O
5 - 11" A
Sandy 1OYR3/4
Friable
Loam
11 - 24" B
Sandy IOYR5/6
Firm
Loam
24 - 66" C,
Silt 2.5Y5/6 @ 33"
Firm, Sandy Loam
Loam 7.5YR518
deposits
& 2.5Y7/2
66 - 120" C2
Sandy 10YR5/4
F--irm, Sand deposits,
Loam
gobbles, Stones, and
Rocks
BEDROCK DEPTH
= > 120"
ELEVATION = 163.41
SEEPAGE DEPTH
= None
ELEVATION = 163.41
ESTIMATED SEASONAL HIGH GROUNDWATER DEPTH = 33"
ELEVATION = 170.66 Lj
DEEP OBSERVATION HOLE LO -
TP # 431E (Elevation = 172.51
)
Depth from Soil
Soil Texture Soil Color Soil
iOther. Structure, Stones,
Surface Horizon
(USDA) (Munselq Mottling
Boulders, Consistency, % Gravel
(Inches)
0-3"
O
Friable
3 - 10"
A
Sandy
1OYR3/4
Loam
Firm
10 - 28"
B
Sandy
1OYR5/6
Loam
28- 60"
C,
Silt
1 OYR6/4
@ 46"
;Firm, Sandy Loam
Loam
IOYR5/8&
deposits
2.5Y7/2
60 - 92" C2
Sandy 1 OYR5/4
Firm, Loamy Sand
Loam
deptosits, Cobbles and Few
Stones
BEDROCK DEPTH
= > 120"
ELEVATION = 162.51
SEEPAGE DEPTH = None
ESTIMATED SEASONAL HIGH GROUNDWATER DEPTH = 46"
ELEVATION = 162.51
ELEVATION = 168.68
EXISTING
LEGEND PROPOSED
100----
CQNTOURS I003
91" 9
�-
SPOT ELEVATION 9-
PROF ERTY LINE
EP --EDGE (OF PAVEMENT E.=.
lam'
STONE WALL
WELL
DEEFP TEST HOLE -
�_____�
LEACHING TRENCH
PLUNBiNG PIPE
(due to any naturally occurring slopes in the topography)., either a pump system or elevating the
building sewer & tank may be necessary.
17. ANY CLEAN -OUTS shown shall extend to within 3 inches Zf finished grade and capped with a SCH
40 threaded clean out fitting.
t
18. ANY VENTS shown shall be constructed of 4" Sch. 40 PVC. The twin 90 degree elbows on tc3p of the
vent shall NOT be glued, allowing future inspection access. Sheet metal screws are recommerided to
prevent unauthorized entry. Horizontal lengths of vent pipin shall be sloped up toward the vent. Any
vents shown connected to the Distribution Box are to utilizE an unused D-BOX INLET opening.
BOARD OF HEALT SS AMPS
5 'CTI N OF THIS SEPTIC 7Pvrf
BUST E COMPLETED WITH THR � T �ti�
YEA OF THE DATE OF AFPn
his System Is Not Designed �
Fo
r Gc;p grind r, Whin NOT ALE TIaNS UST �T RE
r to h,&A iliioh /ater Use Dev000 . CHANGED WITHOUT BOARD
OF HEALTH APPROVAL
I'
BOARD OF HEALTH
13MPM OF HEALTH INSPECTION ® D 0 -
EQUI.tvD � . ,.� ._ .:AV�,TED � �_
THE APPROVAL BY THIS OFFICEp ,
DOES NOT GUARANTEE THE APR 28 I999
It"IG!N ERS AS -BUILT EFFECTIVENESS OF ANY `
I -''A . CERTIFICATIOM' � INSTALLATION
n I 1 r VARTMOUTH BOARD OF HEALTH r3Y TOW
! Si. +TEMENT REQUIRED N 0 D SOUTH
BQAki`) OF HEALTH
P.E. STAMP SEPTIC SYSTEM DESIGN PLAN
r
taWwa OWNER: ROBERT KFOURY
rK ASSESSORS MAP CMILLERS
u rC Vlt. &LOT. M A1� 70, LOT 13 31
No.3' �a STREET LOCATION: MILLERS D t:E E I
' GINEERING FIRM: f
enneth R. FerreirQ Engireering In . 181�`t'
P.L.S. STAMP 46 Foster Street, New Bedford, MI. ..r.
Tel. (508) 992-0020 rox' (5 ° ' � 4
fCENRETH m DATE: 3-3-99 Scale: 1" 30'
8 FERREIRA ;
No. 2876 CONTACT PERSON: KEVIN SILVA
FGiSTER�ADDRESS:
Same Qs above
TEL:
SE 65I4.31
Residential
1999 Residential 1999
2.2 Authorized Agent:
-
Contact Address
2,✓� �--'
Name (..'nt),
Telephone
..:.::::.:.......
::::.::::::::::::.....................:..................................::::::::::a?iGxC±OS:,::::Ql�aRt�C'Ci(7i.�i:.::+i.:::............................:............:.::::.::::.::::::::.:::.::::::::::::.::.:::.
..::.... ..... ..:..
3.1 Licensed Construction Supervisor;
Not Applicable ❑
Licensed Construction Supervisor/
License Number
Address 7�-�) �i�
F
Expiration Date
��—��
Signature �f—
TelephoneAI
3.2 R ,,istered H We Improvement Contractor:
Not Applicable ❑
Are you a Home Improvement Contractor subject to (780 CMR-6)? ❑ yes ❑ no
If no, go to the next section!
Are you claiming exemption from the requirement? ❑ yes ❑ no
If yes, submit the required
affidavit!
Company Name
Registration Number (if none, state "none')
Address
Signature Telephone
Expiration Date
3.3 For Residential Remodel Work Only
>. PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY
FUND: QUESTIONS OR COMPLAINTS call or write: '
1 1'Iome Improvement Contractors Registration, One Ashburton Place - Room 1301, Boston, MA 02108, (617) 727-8598
i
Owner's Name (print)
Signature
by signing the above, the home owner acknowledges that there will be no eligibilty to the Guaranty Fund
Date
13.4 Homeowner Exemption - One & Two Family Only
,i
FOR HOMEOWNERS 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 116.0,
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 Rules and Regulations for Licensing Construction Supervisors.
Exception: Any Homeowner performing work for which a Building Permit is required shall be exempt from the provisions of this
section-, provides that if a Homeowner engages a person(s) for hire to do such work, that such Homeowner shall act as supervisor.
For the purposes of this section only, a "Homeowner" 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 intended to be, a one or two familydwelling, attached or detached structures
accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered
a Homeowner.
If you are applying under this section sign below:
Signatuxe:
Your signature carries certain responsibilities, including but not necessarily limited to, general liability
c:\wpwin\fforms\bldgapp.res Page 2 January 20, 1999
Residential
1999
Residential
❑ FOUNDATION ONLY
1999
1.
Date plan reviewed: �"" of - .'" ,
2. -
30 days to review period expires:
3.
OK to issue date:
4.
OK to issue subject to requested submittals(see project review worksheet):
Date:
5.
DENIED (see project review worksheet):
Date:
6.
HOLD reason:
Date'
7.
HOLD subject to Zoning Board of Appeals action:
8.
Comments:
9.
Inspector's Signature:
Date:
Applicant informed of above Date- Time: Clerk -
Comments:
Total Permit Fee: $ 37Q - ,aI Less Application Fee: $ 25.00 I Remaining Balance: $
TOTAL FEE: Gross Area - New Construction total sq. ft.
Gross Area -Alteration total sq. ft.
``�
Permit Issued To_
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