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BP-69181 ' rmit No. BP-69181 Project Location: 42 SUNDANCE RD Commonwealth of Massachusetts 4270.00 TOWN OF DARTMOUTH M p#� 0079 400 Slocum Road,Dartmouth,MA 02747 Lot: 0048 Phone: (508)910-1820 •• Fax: (508)910-1838 Sublot: 0033 BVILDING PF,R.MIT Category: AGP/RE-ROOF/ wows, ALTER' FIELD INSPECTION Project# '; JS 2013=001855 Est'`Cost $15000.00 Contractor: License: Phone#. Fee' $150.00 Const.class: Engineer: License: Phone#: Use Group R3 Lot;Size(sq ft.) ..�= .. 268615�� Zoning: SRB Applicant: Phone#: Aquifer Zone: N/A STEVEN S DAMS (508)996-8186 OWNER: Flood Zone. ZONE X. DAVIS STEVEN S&GAYLE E DAMS New Const ::. N/A Alt.Gonst.: N/A . . DATE ISSUED: /3 TO PERFORM_ THE FOLLOWING WORK: r,,,- Insta1127 foot aove ground swimming pool witiilproper:^barrier./replace one window(SAME SIZE, SAME OPENING)/strip and re-roof/construct stairs to existing deck DATE TIME TYPE OF INSPECTION&REMARKS IN DATEJ 0 iL--- l it v °_ Vi* -in II l I 1 _,....,j____ o .. : ae•weatre.**.f.aerafbr...s .=... ... ..-, ,.... C1,77-1 MU ' €2,0 wiCt) st< = >s c-) 7 1 •C-‘% ; , , • L., i \ i, ,, v 3 . ,,..\ --.- , -*# , '• pi . ## . .. 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Boston,MA 02114-2017 www.mass.gov/dia Wo- ers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Ap. scant Information Please Print Legibly 4 ame (Business/Organization/Individual): S761/�N .0 V14 V/S Address: 4Z s UN'011'AA i O. City/State/Zip: 1U. - ovTI Phone #: SO8 qq .0 6 W Are you an employer? Check the appropriate box: Type of project(required): 1.11 I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑ New construction listed on the attached sheet. 7. ❑ Remodeling 2.[ I am a sole proprietor or partner- ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition o workers' comp. insurance comp. insurance.1 equired.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. *Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: r i 3 7 VtPolicy#or Self-ins.Lic."#: 1J L - Expiration Date: iAb Site Address 4Z s l/n/DN CLE R D- City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do ereby certify under the •ains and penalties of perjury that the information provided above is true and correct. gnature: ^ Date:.. Phone#: 50V - 996 9 f$ Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association, corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s)name(s), address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or • town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 7-2010 www.mass.gov/dia 7jc3U ,_. };, .% R.J. Margetta Adjustment En F PROF SIGNAL ADJUSTERS AND PROPERTY APPRAISERS - 82 Granite Street • ® n Fall River,MA 02720 x` , j (508)675-5330 (508)675-5326 3 : personal Fax(508)675-4660 commercial inland marine • FORM OF NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASS. GENERAL LAWS, CHAPTER 139, SECTION 3B 2/19/13 Attn: Building Inspector . Dartmouth Building Department 400 Slocum Road , N. Dartmouth, MA 02747 RE : INSURED: Steven & Gayle Davis MAIL LOCA: 42 Sundance Road, North Dartmouth, MA 02747 LOSS LOCA: 42 Sundance Road, North Dartmouth, MA 02747 POLICY NO: 22607400004 CLAIM NO: 033320420 DATE/LOSS : 2/8/13 TYPE/LOSS : blizzard FILE NO: M13-24919-B/Z Claim has been made involving loss, damage, or destruction of the above captioned property, which may either exceed $1, 000 . 00 or cause Mass . General Laws, Chapter 143 , Section 6 to he applicable . If any notice under Mass . General Laws, Chapter 139, Section 3B is appropriate please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss, type of loss, and file number. Sincerely, Robert J. 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KNOCKOUTS INLET PLAN VIEW �6- • 9" COVER -18DIA COVER 10' ■ 14" COVER r 4' CROSS SECTION VIEW SEPTIC TANK NOT TO SCALE 8'_ O•- LEGEND 100 EXISTING CONTOUR PROPOSED CONTOUR —i' PIPE INVERT ELEVATION -� TEST PIT a � SEPTIC TANK C� DISTRIBUTION BOX W PROPOSED WATER SERVICE LINE iZ OBSERVED GROUNDWATER TABLE ELEVATION RESERVE AREA I / T LAUX DWELLING PRECAST LEACHING CHAMBER TOP OF F D 4 X 8— D FOUNDATION FLOWDIrFUSORC EL '6" PRECAST LEACHING CHAMBER FD4X8—L FLOWDIFFUSORI,�) ' t990 ROTONDO S SC!L �. \1 I -Ty ZorJG� Lot 1;2a9A s PLo'T PLAA� �LALe; i •, J �o I FINISH GRADE SOT INFORMATION Subdivision Name: 1'05( 00N Date: AV& C71 iq Sgj Lot: Owner: PA I0,-(IAO0"(�i Assessors Plat: 1q Lot Zoning District: Aquifer District: ?7 Other Overlay Districts: FIRM Zone: fi Special Permits Or Variances, I/x $ Of Lot Coverage: ��b DESIGN DATA , Vc;'�2 l Q C� �L0 VJ eO2tJl� x 110 G PD O � - = 4� 0 GPO O '� /� E4::Z)V11zeD SI Ds Vl1D.-LL : LOQG x .11 o' C)r-'E�P x 2 Sl oas x `.00 &PD/s.F. 1 &0-T tvk W 1 p X D. r_;" "j Gtpp/s F G FD eM06 12 r WIVE, �x . 01C0 ' DEEP K Z e:Q0S k PC) � 69 U P D �Avqe GoVG'o "Co to O� �iNiSN Ca�AD� FINISH GRADE ELEY r SEPTIC TANK l t 6, 10 KI • ' • : ;.:.:�• •..:;: �_ �--- LEVEL STABLE BASE SEA I.bTr-, a` t1 SYSTEM PROFILE - -- 8.0-14- At�usT�p NOT TO SCALE r_ 0 ►LA■ V1tw (0 I= !�3 Q C3 o s r- a ►r on wI•ao■ L_ r J r11Ot■T Vt[W .J r `.. _J. LI. --.00anuTs too No I-.stat t a r.ow Goof VIEW SICnON A -A SECTION... PRECAST LEACHING CHAMBER FD 4 X 8 — L FLOWDI--FUSOR'- Ir sioT. I I A 1 1 I • . ; ( 1 1 •' • r♦---•-- - --- ---- -- -- - - - - - - - - - A r- - - - - • - -�- I I• C►lAw OUT .N0190010 COVI■ rAr - 'LAN V"%v . 1 �7 C3 C] CJ 07 - 0 tm T ■ .\ - On •�••O■ r J • a r r a w r • . nw •....n...,. r . ° ° . r la•Ia ►nowt VIM Eto■ V41w �r• ram --- - �--� N • . J I "-CCPLMn 00A NO "TyLat'am y r L J L �♦ • _ 1/CT104I1 A.A •�C f10M S • , PRECAST LEACHING CHAMBER FD 4 X 8 — D FLOWD'-,FFUSOR1' Ab NAa, tJ cVf:-�TU P_-r--D 2H PCrroK! pc OP, AFP 12DVE5D GENERAL NOTES 1. THIS SYSTEM SHALL BE INSPECTED WHEN LEACHING AREA IS FULLY EXCAVATED � AND WHEN ALL COMPONENTS ARE IN PLACE. WHEN THE SYST=M IS READY FOR INSPECTION, THE CONTRACTOR SHALL NOTIFY THE LOCAL BARD OF HEALTH. 2. WASHED CRUSHED STONE SHALL BE FREE OF ALL DIRT, DUST AND FINES. 3 . ALL ELEVATIONS ARE BASED ON A�ME;o ELEVATION DATUM . ' � 4. HEAVY EQUIPMENT SHALL NOT BE ALLOWED TO -OPERATE OVE? THE LIMITS OF THE SEWAGE DISPOSAL SYSTEM DURING THE COURSE OF CONSTRUCTION OF THE SYSTEMS. 5. NO FIELD MODIFICATIONS TO THE SEWAGE DISPOSAL SYSTE'' SHALL BE MADE WITHOUT PRIOR WRITTEN APPROVAL OF A ENGINEER AND TH- LOCAL BOARD OF HEALTH. - 6. UNLESS OTHERWISE NOTED ALL SYSTEM COMPONENTS SHALL ,E INSTALLED IN ACCORDANCE WITH TITLE V OF THE STATE ENVIROMENTA; CODE AND ANY g APPLICABLE LOCAL RULES. 5 7. AT ALL POINTS OF INTERSECTION OF WATER LINES AND SEER LINES, MECHANICAL JOINT CAST IRON PIPE SHALL BE INSTALLED ;OR BOTH LINES 10' EITHER SIDE OF THE INTERSECTION POINT. 8. SEPTIC TANK, DISTRIBUTION BOX, ETC. SHALL BE MANUFA(-TURED BY. A. ROTONDO & SONS OR APPROVED EQUAL. 9. GROUT TO BE USED AT ALL POINTS WHERE PIPES ENTER. OR LEAVE ALL CONCRETE i STRUCTURES IN ORDER TO PROVIDE A WATERTIGHT SEAL. 10. ALL SHIPLAP JOINTS IN SEPTIC TANK SHALL. HE SEALED VTH NEOPRENE GASKETS OR ASPHALT CEMENT. 11. EXCAVATE ALL UNSUITABLE MATERIAL IN LEACHING AREA ASD BACKFILL WITH CLEAN GRAVEL AND COARSE SAND. 12. A CERTIFICATE OF COMPLIANCE AS REQUIRED BY SECT. 2.f OF TITLE V MUST BE OBTAINED BY THE CONTRACTOR UPON COMPLETION OF 1W ABOVE WORK. IF AN "AS -BUILT" PLAN IS REQUIRED DUE TO CONTRACTOR DEQ ATI NG FROM THESE PLANS, WORK FOR SUCH "AS -BUILT" PLANS SHALL BE COMP(JNSATED FOR BY THE CONTRACTOR. 13. THIS SYSTEM IS NOT DESIGNED FOR GARBAGE DISPOSAL UN;T. q45-7277 /7 A A -tom H .. B.O.H. STAMP P.E. STAMP 07 #.' a I e .. i B.O.N. NOTES i - 1 71 ! CL IEN� ' MOU"'Of u LaQD SUBSURFACEuSEWAGE DISPOSAL SYSTEM con cl: t/Nt. at: 13 Wet ry ci; y Rond fir* E34 elrx'd, MA 02745 _ J (5W Z 8-2125 Civil arc' Environmental Engineering Land U► e Planning ,i DATE: job no, ti - - _ - -- - MAP.80 ...............-- - 1j1 49 m 13- l ,o W - 4.59 At. 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S P ( - 30o� - dm 1.18 Ac_See iMp -- • 78 ' \ p2t•62 N N O' `'N For Map 79 N 5YG�A.� a9i a 1 a 59d711 I3g3939.yr t29 533.50' c55AG Lots 6-15.Thru t� t62 @ 5-4 sa/i `' ,,�' in /5004 ♦O 313.94' �r 6-22 150 a ) 270 1 154.75 0- 2.60 Ac. n 8t 4$-17- =o '� N 166.84' 466.56' S g59 cw - 48-18 2S5 6� ,e 166:84 r 228.07' • ♦r 210' 't, ti24 i tp _ 60 - N 44r909 ` _ 4a sc Fr 43,r3e ;� 48-42 48 _41 39° 0s' �"�° 48-39 a 48 ° 50 �. 7q • v a Sq• FI, ey 4 5,462 ^ bOa Ae. ��p1. 245 Ss ♦� t_85 Ac. 49' - - 48 - 40 48 -4 44_1w 36 1 I 2T4.50 j N .p 40PT8 ,�O 48-5 - j / >a > /•30 Ac. 1; �,Ae Sary 392 ' 17Ae Iso' �,�e 1 Sq.F/ ♦ * -48-6 �� 155 at. 52 9� $ _ 2T 5.63 0 599� t24.28' OUO' iiE `!5O' ' IOS ge4.12'3`�1 v 0 /.72 Ac. 0. 85 PD 39• ; �° ' -- 34 g�,C5 - j 0 2T_ v f2S.1M0 Ac Z4g r.s4 ae t o � o e}g`l5 . 5•40 a! ` o .tom '0a. m \e• 48-38 t`'° O`�R � 44MO �.. 48-43 0 48 _ 7 t5o 5 �y h san' n N sa.Fr. N c 48-t4"T. a lq . ` 48-19 3.eT 7 5o N r 45 y. 41,400 Q F ,n 41,104 ,p t G. N' 18s6 Ac. b♦ Sp. Fl. 41 721 `° O °' a 794 . Sq.FI. a+ n 2.40 a63 e3 t6p14 N sv.f� n 48-20 4sv f 1w 'Qo' � I.s� a `�'° `Q� 46 �o dG `�y� 40,�0- i a S.D/3g f4747, 41,242 0. 0 202!� 510' •7) p 4 41T�Sa1X S ems' �- SalL - 1 5 -2 1 9.95 14 }� N Sq, F1. 1 ^� 747' a ( 1.84 AC. t H 63 a • 48-44 - �0 48-37 n o 47 ! Ze Ae -J 40,001 = 2.07 Ac. M cd °e 42 r' 4fi e3 \ : Sp. Ft. < s 23.90' 4$ - $ 385.os $ 40500 / M 3. f1SPR.�NG BROOK11 S z cy o 48 21322g 32 .� �' N 1.80 Ac. a� - - - se • 48 _ I -- p F o 300, 6�•/0' n 42,337 "v1 q`' ry +a - o aid- 0 5 -) ev i n 64 Sq. Ff. o e 48 - M 415' 0.83 s� .�► J�� � N N 41 �°. Cl) 'far AG - 3�.10 �: 28 W) '~ 2 /8 Ac 4T.83' 39 48.-2 1.84 ac. a 924I10 ,t* s15{ 40,284 Sq. f 4a700 48-2r. •� 52 O o7 0 206' N ' 40000 b FL 451.36 7' I _ - _ - .9N 065 .44i / .: Ff. It 3T.37 48 - 9 s° • �� 'so 48 - 3 r A5 4 40 G 309. 4- N 5.0 Ac. 40,749 SO• c p1 I ItiS00 I n 195. 2 . 48-35 a 267.5fi' 94' tBaot 1 9A 3i011. n S¢/l. i a� 48-{2 m 23.5� 113.9s a g�\, i•►. 298 Ac. 'n T f 170.-9' tq6 23 980 1 m 43,333 i * 5 b '1 \ v sJ ' 48 -52 SQOF - tt$ 91 i 321.96, Srq.FL 2T0 h 66 Ff. F,.48-23- ,\ t . +t s', O - , L + LD.i Ac ' ` 180. a `'-40,09T. ~48�L4 a . 130.0� o �' 211.ct'1 39 i r 2-2 O!' % Sq.FI. ry`y 40,000 s�o, • 403.66 1.49 Ae. v 450. ..27 t 30.0 "' 48" 11 °/ p so Fl. 48-46 48 -10 a`��� �- t ,� IB o sa,324 1_67 AZ SOX �iVl1► "�F.�1R4� 3.eo Ac. 8 5 • l.59 AC. 246 , 67 Sq-Ft.�N Q�P�SF- "i +'�- a 40,000 �`' 38 94 104 Ae ?99,T0 S !w e ti,,e 48-34 ° ,A Sq. pA �H t ti f31q. 3p2.93' ° MAP 76 LOT 'n� G ti 594 at. T. �?� \e� u a 3 b s0,eee 22"7 - zo'48-25" 00� a cr, Z-4 Q' o. Z r• �184 Ac. ,� 68 7 Sq.-Ft. ho'. Q�.� 4g87.? ��. s\5 xw 37 I Las AG 3r4:is' EV ° ti • sq•Fr' 4osao O 9�93 I o N .� 0' 259 , 48 Ac. 306 =' M MAP 7B LOT s7 $ >•ss, e _ CL �i M0 d 20s.n. '3 4s,29e 22-6 ;� MAP 76 UJT N '� tea' I ►; 69 r ss e2, 4 n 41,ses 22-t3 LOe At 4q : 2ss' tv sv F1. 48-47 P/0 7`- _ ?6_1 all aP x zes•7!• , 1.17 Ac.. .p J �. O TAX MAP UTH -33 TOWN OF. DARTIVio ' 28.96 6. t7 Ac- 13RSSTOL COUNTY , MASSACHUSETTS 21.ra' DATE OF AERIAL PHOTOGRAPHY 3 - 29 - see MAP 76 For LOTS PREPARED 8Y DATE OF COMPLETION I - 186 _ I-I-O? _ MAlNE _ - I - 95 - `}g-2g :.Thfu 48 -32 a . - - 1 -48 Thru 48-50 JAMES W. SEWALL COMPANY OLD TOWN, ' REVISIOtaS 6_I5-89_ - - 48 SCALE. 1 INCH = 200 FEET I DATE OF � I_I-91 - LEGEND z - - 2-g�99 - . �1 _I - 92 For Assessment Purposes PARCEL NUMBERS .......... 2 c I -I.93 ._--1-1-g to be used for Conveyances 1- 1_02 Not ueTCH LINE. �� j-1- 94 _ I - I _ 06 P/0 80 1- 81 • MAP NUMBER 78 79 so 76 W