BP-5479SOIL DATA
DATE= c,�-� 6�,ov!
PERFORMED BY: ��
WITNESSED
BY: (tee= t ►-�
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WT— viol
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01�
5. 5' DIA. OUTLET
II
L_—�
�svr
TOP VIEW
GRO55 5ECTION VIEW
DISTRIBUTION BOX
NOT TO SCALE
ID-(�
— — — — — — — — —
I
4•-10• I ® / � � r � l
5•dla. LJ
I
outlet
------------
PLAN VIEW
i!RL KM
+
_J
END VIEW
3.5 •dia.
knockouts
inlet
6•x9' 18'dia. cover 10•x14•
1• cover
taper I— cover �4.
3'
Ir-
-7.5
'
4'--G'
7' 4•-O•
liquid
level
3•walls 1
3'
CR055 SECTION VIEW
SEPTIG TANK
NOT TO 5GALE
LEGEND
100
EXISTING CONTOUR
0o
PROPOSED CONTOUR
PIPE INVERT ELEVATION
TEST PIT
SEPTIC TANK
❑ .
DISTRIBUTION BOX
W
PROPOSED WATER SERVICE LINE
OBSERVED GROUNDWATER
®
TABLE ELEVATION
%
�C111L1J
RESERVE AREA
PLOT PLAN-
5CALE, 1•= 190
(00'
01 pw
MODEL:
75'1
12-5
180 *
'3305
DIMENSIONS L
85"
85"
90"
90" .
W
27"
28"
36"
52" 1
H
12"
18"
20.5"
30.5" j
h
6"
11.5"
14"
24"
_CAPACITY (gallons)
75
112
170
.400
"ALLOWANCE WITH 3" OF STONE COVER OVER CHAMBERS
N GENERAL NOTES
API ----- -- --
u a .
4,
�,•. FULLY EXCAVATED
1) THI5 SYSTEM SHALL BE INSPECTED WHEN 'LEACHING AREA IS
-M IS READY FOR INSPECTION.
A AND WHEN ALL COMPONENTS ARE IN PLACE. WHEN THE 5Y5T�-
""b`BDII
r" ` THE CONTRACTOR SHALL NOTIFY THE LOCAL BOARD OF HEALTH.
2) WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT. DUST AND FINES.
/W A& o� - /(o OY W D01%
3) ALL ELEVATIONS ARE BASED ON gcwME9 ELEVATION DATUM.
-
4 i•®4
R THE LIMITS OF THE
�p 4) HEAVY EQUIPMENT SHALL NOT BE ALLOWED TO OPERATE OVER
DE5IGN DATA Loc.c.� MA-F "' OF THE SEWAGE DISPOSAL SYSTEM DURING THE COURSE OF CONSTRUCTION OF THE
1 ' _.
24 ,� SYSTEMS.
c
--5
� ti DESIGN PERG RATE: 1" IN Gi
'DlZopnll \�5) NO FIELD MODIFIGATION5 TO THE SEWAGE DISPOSAL SY5TEh SHALL BE MADE WITHOUT
DP51GN FLOW= 2� BEDROOMS x 110 GPD/BDM GPD REQUIRED PRIOR WRITTEN APPROVAL OF THE ENGINEER AND THE LOCAL BOARD OF HEALTH.
SYSTEM DESIGN: USE CULTEG CONTACTOR MODEL # �i0 G) UNLESS OTHERWISE NOTED ALL SYSTEM COMPONENTS SHALIL BE INSTALLED IN
i
'+'s7 ACCORDANCE WITH TITLE 'V OF THE STATE ENVIRONMENTAL CODE AND ANY
ALL UNITS WITH l% OF CRUSHED STONE
, APPLICABLE LOCAL REGULATIONS.
DEEP X 51DE5 X G/5GPI) xSIDEWALL
7) 5EPTIG TANK. DISTRIBUTION BOX. ETC. SHALL BE MANUFACTURED BY A. ROTONDO + 5GN5 '
BOTTOM- 1 a LONG x 12 WIDE x A,70 G/SF C-2(o GPD OR APPROVED EQUAL.
t� J�
STRUCTURES N ORDER TOLPROVIDE SA WATERTIGHT SEAL.
OR LEAVE ALL CONCRETE
GPD PRaVIDED
- Z �-sQ��.�� v� 9� ALL SHIPLAP JOINTS IN THE SEPTIC TANK SHALL BE SEALED WITH NEOPRENE GASKETS
\ i OR ASPHALT CEMENT.
\� 10) EXCAVATE ALL UNSUITABLE MATERIAL IN LEACHING AREA AND I5AGKFILL WITH CLEAN
L,4
GRAVEL AND COARSE SAND.
FINISH GRADE
OVER TANK 11) THI5 SYSTEM 15 NOT DESIGNED FOR A GARBAGE DISPOSAL 'UNIT.
ARROWS PED ON UNITS
FINISH GRADE I CiZ.p� MUST POI TAITOWARD D—BOX.
ELEV.
I�
DWELLING
TOP OF
FOUNDATION ,
EL 2.10
\C-700 GALLON IaD.D�I
REINFORCED CONCRETE
5EPTIG TANK
\ �D:bs DISTRIBUTION I la0
FINISH GRADE 1 a 1 ,0,
rr
., 0.
B. 0. H. STAMP
.�
P. E. _ _ P
CLIENT:
i
,
t�
2' OF 3/8• PEA5TONE
V+ OF 3K.
D'
V N . C �► t �%'� A
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ty
_
(
CIVIL
\(bCI PiD
15UE5UREAGE
1 No.32165
5EWAGE
2' OF 3/4' - 1 1/2•
CRUSHED WASHED STONE
�' c
`�� � �J
Dl5P05AL SY5TEM
� D
CSEE NOTE #2)"
I
SEE NOTE #11
14��i
LIMIT OF ExcAVATION-�J
ALL AROUND
B.O.H.. NOTES
P.L.S. AMP
CONTACT. �A0
— — — -
— — — — — — —
— — —Aw���CL•
.�ii_ —
—
.
-
a{pr
��G�GiO�.I AL 1-lt(�h\
C�+Z�y1,1DWA'C1;LGL�1.L�lJ : 147�J-tom
13 Waby Read
Hw Redford. MA 02745
[/��
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•
C506J 9984113
0
-M-7554
. PAX C506)
O I LEZONING REVIEWED, Lan and Environmental Engineering
Land Use Planning
SYSTEM PRr Any Chang ost
NOT TO 5CALE Be Resubmi DATE: 10-\O-ar7 DWC, NO.
BY
0-1a'A SAr2Y LOAM
oo
PROPOSED CONTOUR
C IoY� 3l3)
PIPE INVERT ELEVATION
Owner: GA.tjyc ;i4A
-.A t-y (oAM
( IoY
TEST PIT
STARTING UNIT
Assessors Plat: Lot,:
12p
SEPTIC TANK
Zoning District:
to Y2 6%3)
VAPL-Afvo V", 30
DISTRIBUTION BOX
Aquifer District: t�1 ��.: L2
=
(toYf-,
too WATEQ�
W
PROP05ED WATER SERVICE LINE
Other Overlay Districts:
183.E No Mori t,I;�
OBSERVED GROUNDWATER
FIRM Zone:
_
VATe IZ_01'g1
TABLE ELEVATION
Special Permits Or Variances: (��A
s��l✓G rl G .
RESERVE AREA
% Of Lot Coverage:
'SELECT" BACKFILL. 1' BROKEN
P�cSTONE OR SCREENED GRAVEL--,
��� Pam@ �2' wA�@ � _ _
WVr
---,
,I
L
TOP VIEW
5. 5' DIA. OUTLET
CR055 SECTION VIEW
DISTRIBUTION BOX
NOT TO SCALE
J ar OL KM
END VIEW
---------------
i
4'-10'
II 3.5'dia.
5•la. I L J I knockouts
owlet I I Inlet
---
PLAN VIEW
�-18'dla. cover 10'x14'
taper �— cover cover
4'
3'
1'-7.5. V-1'
-7 0 10" 4 -G
:7' 4'-0'
liquid
level
3'walls
:1
CRO55 SECTION VIEW
C-,F-PTIr_ T A NIK
NOT TO SCALE
DWELLING
TOP OF
FOUNDATION
EL = 1°Ik.C,-7p
t-lge--role of SLAP
00
E
4' SCREENED VL NT
(OPTIONAL)
3' MINIMUM
MODEL:
75
125
1 180 *
330�
DIMENSIONS L
85"
85"
90"
90"
W
27"
28"
36"
52"
H
12"
18"
20.5"
30.5"
h
6"
11.5"
14"
24"
_CAPACITY (gallons)
75
112
170
400
#ALLOWANCE WITH 3" OF STONE COVER OVER CHAMBERS
j j y
0
GENERAL NOTES
TQA ci_
n
A 1) THIS SYSTEM SHALL BE INSPECTED WHEN LEACHING AREA 15 FULLI EXCAVATED
\Q` AND WHEN ALL COMPONENTS ARE IN PLACE. WHEN THE SYSTEM 15 READY FOR INSPECTION.
anee THE CONTRACTOR SHALL NOTIFY THE LOCAL BOARD OF HEALTH.
TO?0 007�xcav � 2� WASHED 4 D CRUSHED STONE SHALL BE FREE OF ALL DIRT. DUST ANE FINES.
/ 0 b�-A 1�0.1 _ ��M�! 3) ALL ELEVATIONS ARE BASED ON Ao,ELEVATION DATUM.
- 4) HEAVY EQUIPMENT SHALL NOT BE ALLOWED TO OPERATE OVER TAE LIMITS OF THE
DESIGN DATA: LoGI MAP OF THE SEWAGE DISPOSAL SYSTEM DURING THE COURSE OF GORSTRUGTION OF THE
/ ZvA�A PRoPo "�°� SYSTEMS.
6�� DESIGN PERG RATE: 1' IN
I T)'A1ELLI>s(� ' 5) NO FIELD MODIFICATIONS TO THE SEWAGE DISPOSAL SYSTEM SHA'!-L BE MADE WITHOUT
O.�:Iak.�v DESIGN FLOW, 2� BEDROOMS x 110 GPD/BDM = ��v GPD REQUIRED 440''� l PRIOR WRITTEN APPROVAL OF THE ENGINEER AND THE LOCAL BOARD OF HEALTH.
14� SYSTEM DESIGN: USE GULTEG CONTACTOR MODEL G) UNLESS OTMERW15E NOTED ALL SYSTEM COMPONENTS SHALL BE N5TALLED IN u� ;
ha ALL UNITS WITH OF CRUSHED STONE ACCORDANCE WITH TITLE V OF THE STATE ENVIRONMENTAL CODE AND ANY
a Iq2 APPLICABLE LOCAL REGULATIONS.
SIDEWALL= I .a LONG x Z DEEP X 251DE5 X 0.1k G/SF = I I'I .� GPD.`.',
7) SEPTIC TANK. DISTRIBUTION BOX. ETC. SHALL BE MANUFACTURED BY A. ROTON� =SONS
OR APPROVED EQUAL.
BOTTOM: LONG x t2 WIDE x b•� G/SF = GPD
as ALL CONCRETE
a� GROUT TO BE USED AT ALL POINTS WHERE PIPES ENTER OR LEAV:-- � �- •.-" q
�E�LL STRUCTURES IN ORDER TO PROVIDE A WATERTIGHT SEAL.
4 I
•� '.
.-� GPD PROVIDED
9) ALL SHIPLAP JOINTS IN THE SEPTIC TANK SHALL BE SEALED WITH R1=0PRENE G KE75 '
\ �- \ � � � � / Z t �T�-MrC7�aT� u►.��t�, OR ASPHALT CEMENT.
10) EXCAVATE ALL UNSUITABLE MATERIAL IN LEACHING AREA AND BACKF-L WITH GLEAN
GRAVEL AND COARSE SAND.
FINISH GRADE t9�
OVER TANK
4 ..J
FINISH GRADE I - 11) THIS SYSTEM IS NOT DESIGNED FOR A GARBA E r
I HEREBY CERTIFY THAT ALL WELLS WITHIN 200' OF THE
PROPOSED LEACHING FAGILITY ARE 5HOWN
ARROWS STAMPED ON UNITS
MUST POINT TOWARD D-BOX.
r- FINISH GRADE 1.42
BOX I SEE NOTE #11
L _ 142j LIMIT OF EXCAVATION
LEVEL STABLE BASE — — — — — — — — — — — — — — — — — — -- --- --
�?t, 70 J Ai - u �
C,aCOUDwATvV_ FAJ,: 1
.SYSTEM PROFILE
NOT TO SCALE
G DISPOSAL UNIT.
V_V117 Lames wAV.1 V�-t UL7-.7 P�t�c 1I
B.O.H. STAMP P� C11ENT.
2' 01= 3/8' PEASTONE ' g•e��➢-�y�"""'� ��'°�� �. ✓ . /► A���j� ll (., L�►
_ G10i10_A
' No 32165
_ �: /' 5UBSURF AGE SEWAGE
CRUSHED WASHED STONE
-�.
C5EE NOTE #2)
,aI SPO SAL SYSTEM
ALL AROUND try
B. 0. H. NO TES P.L.S. STAMP CONTACT:
�/-�7� N" eau /a•d Mn 02745
(50e3 •.99-2M
FAX c5c a) qqa-7554
Civil and Environmental Engineering
Lang' Use Planning
�v►s�0 tz t3 a�
DATE: I 0-0-a r-7 DWC. No.
SOIL DATA LEGEND
DATE- bK PERFORMED BY= WITNESSED BY: �-p 6'rz1fl-i
- 100 .EXISTING CONTOUR
TP— wl TP— toy WT— i?ok Ick1 G1511-1
V
1"lV v v
'%per\L
to
t�q Z
y
0-I0A 5A0pYL0AM
0o
PROPOSED CONTOUR
( IDY(Z 3/3)
/�
PIPE INVERT ELEVATION
2Jr,O!�,QIJL7Y LoAM
10Y 0 &I&)
TEST PIT
1?,p LOAM`(SA�V
F-1
SEPTIC TANK
( to Yr-13)
2A`��-30
DISTRIBUTION BOX
000-, 1-(�5)
hlo WATEQ
W
PROPOSED WATER SERVICE LINE
I g� G� No MoT t ►->;�
®
OBSERVED GROUNDWATER
TABLE ELEVATION
RESERVE AREA
WAIL
►-A2A 0 nA��'.-2�-qCi
•�A�� c�-�-ate ��-�: �-�-a�
FDA" „ PLOT PLAN
5CALEs 1'= 1?0
ZGi.00
5. 5' DIA. OUTLET
-- ,
II I
L--J I J
TOP VIEW
GRO55 SECTION VIEW
DISTRIBUTION BOX
NOT TO 5GALE
--------I
I
4'-10'
n'dla.
nutlet
I I
L--------------
PLAN VIEW
3I 91LRL,.
+ I
END VIEW
3.5'dia.
knockouts
Inlet
6'xq' 18'dla. cover 10'x14'
1' cover
taper cover t-E4.
I
3'
1'-7.5'
10•.
mil- �7 4'—G•
.7- 4'_0'
liquid
level
3'walls 1
3•
CRO55 5ECTION VIEW
SEPTIC TANK
NOT TO SCALE
LON \1
110
00
/ 0
/ 011
Q
07 cP
CQ
A
,
a I gVwj C ",w. �
TnP0 W ooD
\ot01
0
— i v1D
VjAj �v
o�=lak.�v
i 5 F L
,u-.
S
z IqZ
�3
�r5 j
<Ga� 4�� '
FINISH GRADE hM
OVER TANK = / ^�
FINISH GRADE 1 q2•C{-
/ ELEV.
I �
DWELLING I I
1
TOP OF
FOUNDATION ,
EL = Iollk.tiJp t0 @ Z°Io
\SOD GALLON
REINFORCED CONCRETE
-for o f SLA g
SEPTIC TANK
G
- 'Grinder, I�irl®®I
L,
06" ta < € Ij tf� yet' .1.1e e�/ICeS.
'SELECT' BACKFILL. 1' BROKEN
STONE OR SCREENED GRAVEL
4' SGREENED VENT
(OPTIONAL)
3' MINIMUM -�
/�..� —
��� O0000000000�l�•
GULTEG • •
MODEL:
75
125
180
330ry
DIMENSIONS L
85"
85"
90"
90"
W
27"
28"
36"
52"
H
12"
18"
20.5"
30.5"
h
6"
11.5"
14"
24"
CAPACITY gallons
75
112
170
400
rNGINEERS AS -BUILT
STATEM ENT REQUIRE[i'
BOARD OF HEALTH INSPECTION,
REQUIRED WHEN EXCAVATED
—ELEVATIONS USA' t1 T ` O
CHANGED WITHOUT m`
OF HEALTH APP OV'Pi
CONSTRUCTION OF THIS SEPTIC S
UT BE COMPLETED WITH THP
YEARS OF THE DATE OF APP � 1A,
9
*ALLOWANCE WITH 3" OF STONE COVER OVER CHAMBERS
GENERAL NOTES-
1): THI5 SYSTEM SHALL BE INSPECTED WHEN LEACHING AREA 15 FULLY EXCAVATED
AND WHEN ALL COMPONENTS ARE IN PLACE. WHEN THE SYSTEM 115 READY FOR INSPECTION,
THE CONTRACTOR SHALL NOTIFY THE LOCAL BOARD OF HEALTH.
2), WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT. DUST AKV FINES.
3) ALL ELEVATIONS ARE BASED ON gc,�unn�� ELEVATION DATUM.
4) HEAVY EQUIPMENT SHALL NOT BE ALLOWED TO OPERATE OVER !,1 If LIMITS OF THE
OF THE SEWAGE DISPOSAL SYSTEM DURING THE COURSE OF CONSTRUGTION OF THE
SYSTEMS.
5) NO FIELD MODIFICATIONS TO THE SEWAGE DISPOSAL SYSTEM SH?LL BE MADE WITHOUT
PRIOR WRITTEN APPROVAL OF THE .ENGINEER AND THE LOCAL BO�n OF HEALTH.
G) UNLESS OTHERWISE NOTED ALL SYSTEM COMPONENTS SHALL BE INSTALLED IN
ACCORDANCE WITH TITLE V OF THE STATE ENVIRONMENTAL CODE AND ANY
APPLICABLE LOCAL REGULATIONS.
7) SEPTIC TANK. DISTRIBUTION BOX. ETC. SHALL BE MANUFACTURED t;Y A. ROTONDO +SONS
OR APPROVED EQUAL.
8) GROUT TO BE USED AT ALL POINTS WHERE PIPES ENTER OR LEAVE ALL GONGRETE
STRUCTURES IN ORDER TO PROVIDE A WATERTIGHT SEAL.
q�, ALL SHIPLAP JOINTS IN THE SEPTIC TANK SHALL BE SEALED WITH NEOPRENE GASKETS
OR ASPHALT CEMENT.
10) EXCAVATE ALL UNSUITABLE MATERIAL IN LEACHING AREA AND BAGh`ILL WITH GLE
GRAVEL AND COARSE SAND.'
�$t
11) THIS SYSTEM 15 NOT DESIGNED FOR A GARBAGE DISPOSAL UNIT. DEC I b I99a
D, I�111! TN
80 � PDX01 r � .EA, LTA&
p CLIENT.
�NOF
I I 2' OF 3/8' PEA5TONf •, , -AAA
sI a EN D G
Ij 'M
BY:
2' OF 3/4' - 1 v2• TOWN F DARTNI UTH
I qD. '1 DISTRIBUTION � �� V) I I Io C CRUSHED
NOTE WASHED STONE OOAR® OF HEALTH
BOX I SEE NOTE #11 I ALL AROUND
L — — — — — — — — - — — — - — — I R��j.lij— — LIMIT OF EXCAVATION — B.O.H. NOTES
LEVEL STABLE BASE
THE APPROVAL BY THIS OWN
DOES NOT GUARANTEE TIDE
EFFECTIVENESS OF ANY
PROFILE
INSTALLATION
SYSTEM DARTI�OUTH BOARD OF HEALTH
I HEREBY:.GERTIFY THAT ALL WELLS WITHIN 200' OF THE
PROPOSED LEACHING FACILITY ARE SHOWN NOT TO SCALE
a" 1' I
g
i � j. l• ranberry 1
� Bo`
c so�—
(J�
� 1 0 ^�j•
DESIGN DATA LoGtn MAP
DESIGN PERG RATE: 1' IN Gi
'
DESIGN FLOW:
j BEDROOMS x 110 GPD/BDM = ��O GPD REQUIRED
SYSTEM DE51GN:
USE CO GULTEG GONTAGTOR MODEL # ��i0
ALL UNITS WITH A- OF CRUSHED STONE
Z� SIDEWALLI
� q .� LONG x. Z, DEEP X 251DE5 X 0.1k G/5F
= 111
GPD
'Lx BOTTOM-
1 q LONG x 12 WIDE x b �� G/SF =
3y3.L�-
GPD
(AO �i�iD>
G�'II.2
GPD PROVIDEI%
2 �►�� vI��TG,
ARROWS STAMPED ON UNITS
4m MUST POINT TOWARD D—BOX.
�— FINISH GRADE Lq2
a s1 my
GIOJOSA
SUBSURFACE SEWAGE
9F�15'CE�' �a`4
DISPOSAL SYSTEM
P.L.S. STAMP CONTACT: �a►� Acw�ACl-
AT:
• 13 'Yaby Road
Nor Bedford. MA 02745
(5C 5) 998-2125
FAX (506) 996-7554
&I and Environmental Engineering
Land Use Planning
Vt�",/isr0 12 t3 a�
DATE: 10-0-1te DWG. No.
E �
I
21-0t j
• of �
I
,
f
r � X
X
C)o
I . j
1�7 GMT
771.
/a -_ ------ — - -�
- �-0 G s
.
• COS " h
� lea :ts EndOr
Plan lust 'Be Ps t On Site �
$e_
Qurin Con struntion
-
Date -
I } j
� t 1
I+1 I ti = .1 , � � I 1 !+. ? t, �i ,• � 1 tr i ! r
C-
V)
C105
0
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4:
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La
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huj
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T- -
T,�; �` F� YT1, f"\TPT,, C"V l''1T_T`T'.`!Ta'0 T1 T 71 i
800 MECHAMCALS & PRJ[MARY 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)
III
None of the above to be provided
Hot Water Gas __ Electric Fuel OilOther
900 SPRINKLERS - FOR STRICTURES OVER 7500 SQUARE FEET and certain multifamily residential
Required, --plans; provided, _plans not provided, why?
_ Not required. not to be installed. Why?
ArchitecoEngineer 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 amd not
reproductions.
General Contractor- (if Homeowner, state homeowner here then complete section 1300)
"6mpany name. _te40me ou) nt '
1000 REQUIRED OFF-STREET PARE NG `- for ZONING & Architectural Access
I
A'ddress
i
_ NO'T .-�PPLIC.-ABLE
Phone number
construction Supervisors license number
e Parking Plan submitted To = Building Department = Planning Board Date submitted
L"
Number of spaces -indoors outside total
NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals crud not
provided
reproductions.
Handicap spaces - required ves ' no. 1
_- If }es, how man} as a part of th- total required number.
*:***__ �***_**_#***::ssss:s:sss ssssssss:s::: ssssssssss:assssss:sssssssssssssss:ss:s::ssss:s.s:ssss::s*::
`
is Route 6 (State Road) Entrance permit required? ves _ no =. If ves has it been issued ves = no =.
I
1200 FOR RESIDENTIAL REMODEL WORK ONLY
Submit copy of application and/or permit as soon as available.
Are you a Home Improvement Contractor subject to (780CMR - 6) ? Yes _No _ If no go to) -next section! -,
1100 IDENTIFICATION (print or type except as noted)
_
//
Current owner`- "
Are you claiming exemption from the requirement? Yes "_No _If yes, submit the requiredi affidavit!
nameIle
Ren--)del contractor name (please print)
ress
Address
poae rr`
Registration number (it none state "none')
If corporation, officer in charge
Phone number
A -chit_ ct/_ ngineer _ for overall design
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCZSS TO THE
Company name
���
Gt A JUkNTEE FUND! QUESTIONS OR COMPLAINTS call or write:
{
Home Improvement Contractors Registration
Address am r y/�
U
One Ashburton Place - Room 1301
/ 7
Boston, MA 02108
Phone number
(617) 727-8598
Certified by State of Massachusetts as
Owners name (print)
Certification number
Signature
NOTE Signatures and seals on all plans, affidavits and other documents SHALL BE originals and
Date
reproductions. not
i
I
In
I, the undersigned, am the owner of record or authorized lessee
the application herein submitted. I state that to the best of my knowledge and belief that the tn{otznnt2tion) and I have reviewed
application is true:and correct and that the permit requested be issued. Provided in this
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 anticipated if I request such an extension in writing. I understand than the permit may be fxtended onlor six Moy r e work y
PP e required,includin
written request. I understand that once the permit expires a new application may bf three tunes by
other requirements (including Zoning). g fees and current
s
'Name
ignature
The aborsignature isMYvoluntary signed u perjury.
act and is s' g under the pains and penalties of
1 ate
Who is authorized 'ckup the permit at the Building De art7L222-
1400;��e onnn
Address Phone 110,N EOWNER EXEMPTION - ONE & TWO FAMIQ.Y ONLY z
FOR HOME OWNERS WHO LNTEND TO PERFORb1.'D BE RESPONSIBLE FOR THEIR
I'R OWN
PROJECT
109.1.1 Licensing of Construction Supervisors: Except for those structures governed by Constructio
in Section. 1_,.0, effective July 1, 1982. no individual shall be engaged in directly sue n Control
construction, reconstruction. alteration, repair, removal or demolition involvingthe structuralP rststng persons engaged in
structures, unless he or she is licensed in accordance with the rules and re ulat ons mu elements B buildings or
Riles and Regulations for Licensing Co-Structica S a�:rrvisors, g promulgated by the BBRS entitled
ExaPtion: •may Home Owner performing work for which a _
the provisions of this section: provides that if a Home Owner engages a person(s) hire to do such wequired shall beorke�P from
Home Owner shall act as supervisor. ,chat such
For the purposes of this sectiot: „ah•, 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 intended to be, a one or two family dwellin
or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in
two -rear period shall not be considered a Home Owner.
If you are apphin under this secri n sign below:
Signature C4
Your signature ca es certain resp ibil-ties, including but not necessarily limited
_________::::::::___� sg::=t'a=liabili
NOTICE TO LICENSED CONTRACTORS: The Building Code provides in the Rules and Regulations section that
Licensed Construction Super<isor, whether or not they have taken the ermi are res any
2.15.2 of seclon :a P responsible for code compliance. (see
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1500 COST
Cost of Improvement
------------
Items to be installed but not included in the above cost: Electrical 5
Plumbing
HS AC
I;
Other
TOTAL S `)`✓ //
Afternoon of existing, :no increase in gross square feet. A separate Refuse Disposal Deciarath n required -
Demolition - describe structure
Number of dwelling units Number of bedrooms A separate Refuse IDissposal
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
Number of lavers when complete
A separate disposal declaration REQUIRED
= Replacement doors and windows - (for existing only) (only where doors and windows exist an(will not be
enlarged) EGRESS dimensions must be maintained. Enlarged or new windows in an existing dwe?!ling will be
considered as an Alteration, otherwise will be included in new construction. (see Code section 34101.10 for
residential and Article 8 for cnm, iercial)
— Temporary structure- includes when allowed, trailers, tents and the like and only for limited pe"ods of time.
Describe
500 CONSTRUCTION PLANS
None submitted. Whv?
Y/Submitted, usually three sets required. Four sets for food serviceluses. Number of sets submitted 3
600 SITE PLAN
ep 13 Not required, , why.
Submitted When? Previously, date _ _ With this application
700 UIUX171 ES
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 suppply, when
required, is available. See Code 780 CIMR 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.
_ Woodstove ' - used (will require inspection prior to installation), new
(provide manufacturers
instructions). Location(s) (list)
' .tFireplace(s) - (includes flue) List location(s) MOO
Game Court - describe (include overall dimensions)
Tent, Trailer (Mobile Home) or Other - describe
300 COMI1 ItCIAI,'_ PROPOSED PROJECIyUSE - INCLUDING THREE FAMILY OR MORE
'I /THIS
RE AND EXEMPT USES
THIS SECTION NOT APPLICABLE
(The following descriptions are based on the Massachusetts State Building Code Article 3, AS NOTED) (See e
Code)
= Assembly - restaurant, Iounge, theater, school, etc. (see Code Section 302.0) Describe
Business - office, assembly with less than 50 occupants - indicate Medical or other Professio
nal (see Co
de 303.0)
= Educational - structure for training including child day care for those over 2 vears 9 months (see Code Section
304.0)
it
— Factory ; Industrial - (see Code Section 305.0)
— High Fizard- - (see Code Section 306.0)
_ Institutional - hospital, nursing home, infant day care (see Code Section 307.0)
I 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)
A Utility & Miscellaneous Structures - includes tents and agricultural structures (see Code Section 311.0
_� flew tenant for any of the above, indicate above (see Code Section 119.0 and Zoning By-law section 3
" = Tent or Trailer - temporary purpose?
Other
Describe the proposal briefly, INCLUDE - under of dweTmg Units and bedrooms or Occupant
also existing condition panttuadasappficabl
400 TYFE OF CONSTRUCTION OR WORK TO BE PERFORMED
i ,New Construction r
and/or Addition. _ total gross square feet
(For commercial only total gross cubic feet) - indicate
It will be considered new construction if there an increase in square footage in addition to anv
alterations).
If project is an addition to existing structure - Total gross square feet of existing
— FOR COMMERCIAL ONLY
i
Will this project be subject to CONSTRUCTION CONTROL (over 35,000 cu.ft.) Yes
see Code section 127.0) Designer to submit Code Synopsis. NO• (If yes
Will this project require Peer review (over 400,000 cu.ft.) Yes No (see Code Appendix
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 Dante Nov 4 3 1997
Applicant informed of above - Date time - staff (fax, phtone, in person)
= Over six months since approved for issue - DEEMED abandoned!
Advise applicant. Hold 90 days for return then dispose if not picked up.
Inspector Late
Advised applicant Date Time staff (by phone, fax or in pecs;an)
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OFFICEUNSPECTORS NOTES
C�
TOTAL FEED
Gross area - new constructions --_ Total Sq. Ft.
Total S
alteration 9• Ft.
Permit is issued to
Commentsinotes on permit
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Date of Application subnussion _ '
Flat Lo LZ
Street L�f its% f /mil ' Q' Aquifer Zone
Owner
Owner mail address
Owner phone # r , rD (-Ira.. %
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OTHER INVOLVED AGENCIES - The following agencies require separate jurisdictional permits or approval for your
Proposed project. CONTACT Tmw FOR WONS
b
.AY COLLECTOR — Approved HOLD By J''LJ
Date
12 Board of Appeals PP Approved By Date
❑ Conservation Commission C Approved By
Date
a D.P.W. Water _ Approved By ❑ D.P.W. Sewer = Approved By Date
TOWN. OF DAR OUTH -B DING-PEF.AMI -
TELEPHONE 508-999-0720 AX> 508=999-0`738.'
APPLICATION FOR ZONING AND BUILDING PERMIT
Instructions
The applicant shall complete this application to the best of their ability prior to submission. leaving no item unanswered. Tie
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. Weft FEWC (Tea not
(for oti5oe me only)
Total Cost $ Received By _
Less Application Fee $
Total Permit Fee s Permit #
D Mu nAITON CINLY
Date Rteed/i 7'- /
Inued Dates
❑ D.T.W. Cross Connection [Z Approved By 100 LOCATION OF PROJECTTOTAL LAND AREA SQUARE FEET Alle
P
Date
Q ,Treasurer (Bond) ❑ Approved By
Date CU N,_C7 /rl U 11 rt g /� GJ LOT _' ZONING DISTRICT
ACCESSORS PLAT
❑ D.P.W. Engineering .
g g .� Approved Ry Date
--- rk OTHER ZONING G`zER=.AY DISTRICTS, if applicable
()Board of Health (well) Approved By
leI Date t/NUMBER & STREET i ,/�('rPlr
P) Board of Health (septic) Approved By
Date
NEAREST CROSS STREET
❑ Board of Health (food service) _ Approves By _
Date SUBDIVISION NAME & LOT # 1 -
❑ Planning Board (parking) ,_ Approved By /
Date or BUSINESS NAME
1TEE DISTRICT (1 - II Approved By
Date �n�SS�
s::as:as:a:::: BUILDING DEPARTMENT APPROVAL: PREVIOUS TENANT / OWNER -
200 RFSIDENTIAI, -PROPOSED PROJECT -one &two family residence only _
❑ ZONING
- THIS SECTION NOT APPLICABLE -N+
❑ BUILDING INSPECTOR/BUILDING COMMISSIONER
��
_ic' Single family - number bedrooms number baths t
❑ CONTROL CONSTRUCTION AFFIDAVIT ,
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PROJECT SIJMTARY: number bedrooms unit 2 number baths unit 2 a ^.r.
t
new cotsstructi i alteration/demo sewage disposal - publiciprivate Accessory apartment Total gross sq. ft.
Accessory structure:
[Alter;add interior walls) [add roomsl [add foo riot
tP ] water supply - public/private well
[pool] [garage;shed/dickGarage -detached attached to dwelling cimensions L -� W �
) [game court] [food service]
Describe.` ' = Carport detached - attached to dwelling, dimensions L
W
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ass sssssssssssssssssssas ssssssssssssssssssssssssssssssssss To the various departments: Shed - dimensions L W
Deck -dimensions. L W
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 Gazebo - dimensions L W
cooperation is appreciated.
Swimming pool above ground in -ground Size _
The Building Department -Date sent for review / ``7
By __ i Chimnev - number of flues