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HomeMy WebLinkAbout0015 FIELD STONE ROAD - Health 15 Field Stone Road W. Barnstable P A = 111 047 i I Y�F NAB CERTIFICATE OF ANALYSIS Page: 1 Barnstable County Health Laboratory Ss�cin}s Report Prepared For: Report Dated: 12/28/2007 E.F. Winslow Plumbing&;Heating Order No.: G0744592 8 Reardon Circle South Yarmouth, MA 02664 LaboratM ID#: 0744592-01 Description: Water-Drinking Water Sample#: Sampling Location: 15 Field Stone Rd.West Barnstable,MA Collected: 12/20/2007 Collected by: J.Clark Received: 12/20/2007 Test Parameters ITEM RESULT UNITS RL MCL Method# Tested Manganese 0.056 mg/L 0.0010 EPA 200.8 12/20/2007 Water sample meets the recommended limits for drinking water of all the above tested parameters. i- Approved By- �—� (La irector) s.- C7 •• co a ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 CERTIFICATE OF ANALYSIS r•. Page: 1 Barnstable County Health Laboratory `yCrt� Report Prepared For: Report Dated: 12/28/2007 E.F.Winslow Plumbing&Heating Order No.: G0744592 8 Reardon Circle South Yarmouth, MA 02664 Laboratory ID#: 0744592-01 Description: Water-Drinking Water Sample#: Sampling Location: 15 Field Stone Rd.West Barnstable,MA Collected: 12/20/2007 Collected by: I Clark Received: 12/20/2007 Test Parameters ITEM RESULT UNITS RL MCL Method# Analyst Tested Note Tannin&Lignin ND mg/L 0.10 SM 5550B yn 12/24/2007 Water sample meets the recommended limits for drinking water of all the above tested parameters. / Approved B (Lab rector)i / ND=None Detected RL = Reporting Limit MCL=Maximum Contaminant Level Superior Court House, PO.Box 427, Barnstable, MA 02630 Ph: 508-375-6605 COMMONWEALTH OF MASSACHUSETTS EXECUTIVE OFFICE OF ENVIRONMENTAL AFFAIRS DEPARTMENT OF ENVIRONMENTAL PROTECTION MAP . ' PARCEL. LOT TITLE 5 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM FORM PART A CERTIFICATION N Property Address: 15 Fieldstone Road West Barnstable, MA 02668 "`- ai Owner's Name: Louise Merrow C) Owner's Address: .;� a at3 D Date of Inspection: March 29, 2004 -a Name of Inspector: (Please Print) James M. Ford Company Name: James M. Ford r' r Mailing Address: P.O. Box 49 Cri . rn Osterville,MA 02655-0049 Telephone Number: (508)862-9400 CERTIFICATION STATEMENT I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true,accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ✓ Passes Conditionally Passes Needs F her Evaluation by the Local Approving Authority Fails Inspector's Signature: Date: April 4, 2004 The system inspector shall submi a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable,and the approving authority. Notes and Comments ****This report only describes conditions at the time of inspection and under the conditions of use at that time. This inspection does not address how the system will perform in the future under the same or different conditions of use. Title 5 Inspection Form 6/15/2000 page 1 Page 2 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 15 Fieldstone Road West Barnstable, AM Owner: Louise Merrow Date of Inspection: March 29, 2004 Inspection Summary: Check A,B,C,D or E/ALWAYS complete all of Section D A. -System Passes: ✓ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: B. System Conditionally Passes: One or more system components as described in the"Conditional Pass"section need to be replaced or repaired. The system,upon completion of the replacement or repair,as approved by the Board of Health, will pass. Answer yes,no or not determined(Y,N,ND)in the for the following statements. If"not determined", please explain. The septic tank is metal and over 20 years old* or the septic tank(whether metal or not) is structurally unsound,exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved by the Board of Health. *A metal septic tank will pass inspection if it is structurally sound,not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ND explain: Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if (with approval of Board of Health): broken pipe(s)are replaced obstruction is removed distribution box is leveled or replaced ND explain: The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): broken pipe(s)are replaced obstruction is removed ND explain: 2 i Page 3 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 15 Fieldstone Road West Barnstable, MA Owner: Louise Merrow Date of Inspection: March 29, 2004 C. Further Evaluation is Required by the Board of Health: Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health,safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health,safety and the environment: Cesspool or privy is within 50 feet of a surface water Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh 2. System will fail unless the Board of Health(and Public Water Supplier,if any)determines that the system is functioning in a manner that protects the public health,safety and environment: The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance "This system passes if the well water analysis,performed at a DEP certified laboratory, for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm,provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form. 3. Other: 3 i Page 4 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART A CERTIFICATION (continued) Property Address: 15 Fieldstone Road _West Barnstable, MA Owner: Louise Merrow Date of Inspection: March 29, 2004 D. System Failure Criteria applicable to all systems: You must indicate either"yes"or"no"to each of the following for all inspections: Yes No ✓ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ✓ Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool ✓ Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ✓ Liquid depth in cesspool is less than 6"below invert or available volume is less than '/s day flow ✓ Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped_. ✓ Any portion of the SAS,cesspool or privy is below high ground water elevation. ✓ Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ✓ Any portion of a cesspool or privy is within a Zone I of a public well. ✓ Any portion of a cesspool or privy is within 50 feet of a private water supply well. ✓ Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for coliform bacteria and volatile organic compounds indicates that the well is free from pollution from that facility and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered. A copy of the analysis must be attached to this form.] No (Yes/No)The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303,therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E. Large System: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. You must indicate either"yes"or"no"to each of the following: (The following criteria apply to large systems in addition to the criteria above) Yes No the system is within 400 feet of a surface drinking water supply the system is within 200 feet of a tributary to a surface drinking water supply the system is located in a nitrogen sensitive area(Interim Wellhead Protection Area- 1WPA)or a mapped Zone 11 of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat,or answered "yes"in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. 4 Page 5 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART B CHECKLIST Property Address: 15 Fieldstone Road West Barnstable, MA Owner: Louise Merrow Date of Inspection: March 29, 2004 Check if the following have been done: You must indicate`yes"or"no"as to each of the following: Yes No ✓ _ Pumping information was provided by the owner, occupant,or Board of Health ✓ Were any of the system components pumped out in the previous two weeks? ✓ Has the system received normal flows in the previous two week period? ✓ Have large volumes of water been introduced to the system recently or as part of this inspection ? ✓ Were as built plans of the system obtained and examined?(If they were not available note as N/A) ✓ Was the facility or dwelling inspected for signs of sewage back up? ✓ Was the site inspected for signs of break out? ✓ _ Were all system components, excluding the SAS, located on site? ✓ Were the septic tank manholes uncovered, opened,and the interior of the tank inspected for the condition of the baffles or tees, material of construction,dimensions,depth of liquid, depth of sludge and depth of scum ? ✓ Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption System(SAS)on the site has been determined based on: Yes No ✓ Existing information. For example,a plan at the Board of Health. ✓ _ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable) [310 CMR 15.302(3)(b)J. 5 Page 6 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGEAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION Property Address: 15 Fieldstone Road West Barnstable, MA Owner: Louise Merrow Date of Inspection: March 29, 2004 FLOW CONDITIONS RESIDENTIAL Number of bedrooms(design): 3 Number of bedrooms(actual): 3 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 330 Number of current residents: 1 Does residence have a garbage grinder(yes or no): No Is laundry on a separate sewage system (yes or no): n/a [if yes separate inspection required] Laundry system inspected(yes or no_): No Seasonal use(yes or no): No Water meter readings, if available(last 2 years usage(gpd)): Private well Sump Pump(yes or no): No Last date of occupancy: Currently occupied COMMERCIAIANDUSTRIAL Type of establishment: Design flow(based on 310 CMR 15.203): gpd Basis of design flow(seats/persons/sgft,etc.): Grease trap present(yes or no): Industrial waste holding tank present(yes or no) Non-sanitary waste discharged to the Title 5 system (yes or no): Water meter readings, if available: Last date of occupancy/use: OTHER(describe): GENERAL INFORMATION Pumping Records Source of information: Pumped in 2002-per owner Was system pumped as part of the inspection (yes or no): No If yes, volume pumped: gallons-- How was quantity pumped determined? Reason for pumping: TYPE OF SYSTEM ✓ Septic tank,distribution box, soil absorption system Single cesspool Overflow cesspool Privy Shared system (yes or no) (if yes,attach previous inspection records, if any) Innovative/Alternative technology. Attach a copy of the current operation and maintenance contract(to be obtained from system owner) Tight Tank Attach a copy of the DEP approval Other(describe): Approximate age of all components,date installed(if known)and source of information: Installed 1124195-per as built card Were sewage odors detected when arriving at the site(yes or no): No 6 Page 7 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 15 Fieldstone Road West Barnstable, MA Owner: Louise Merrow Date of Inspection: March 29, 2004 BUILDING SEWER(locate on site plan) Depth below grade: Materials of construction: _cast iron _40 PVC other(explain): Distance from private water supply well or suction line: Comments(on condition of joints,venting,evidence of leakage,etc.): SEPTIC TANK: ✓ (locate on site plan) Depth below grade: 10" Material of construction: ✓ concrete _metal _fiberglass _polyethylene _other(explain) If tank is metal list age: Is age confirmed by a Certificate of Compliance(yes or no): (attach a copy of certificate) Dimensions: 1000 gal. Sludge depth: 2" Distance from top of sludge to bottom of outlet tee or baffle: 30" Scum thickness: 3" Distance from top of scum to top of outlet tee or baffle: 6" Distance from bottom of scum to bottom of outlet tee or baffle: 12" How were dimensions determined: Measuring stick Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert,evidence of leakage, etc.): Tees were present. The liquid level was even with the outlet invert. There did not appear to be any signs of leakage. GREASE TRAP: None (locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other (explain): Dimensions: Scum thickness: Distance from top of scum to top of outlet tee or baffle: Distance from bottom of scum to bottom of outlet tee or baffle: Date of last pumping: Comments(on pumping recommendations, inlet and outlet tee or baffle condition,structural integrity, liquid levels as related to outlet invert, evidence of leakage,etc.): 7 Page 8 of 1 I OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 15 Fieldstone Road West Barnstable, MA Owner: Louise Merrow Date of Inspection: March 29, 2004 TIGHT or HOLDING TANK: None (tank must be pumped at time of inspection)(locate on site plan) Depth below grade: Material of construction: _concrete _metal _fiberglass _polyethylene _other(explain): Dimensions: Capacity: izallons Design Flow: allons/day Alarm present(yes or no): Alarm level: Alarm in working order(yes or no): Date of last pumping: Comments(condition of alarm and float switches, etc.): DISTRIBUTION BOX: ✓ (if present must be opened)(locate on site plan) Depth of liquid level above outlet invert: Even Comments(note if box is level and distribution to outlets equal,any evidence of solids carryover, any evidence of leakage into or out of box,etc.): The D-box was clean. No solids were present. The cover was 16"below grade. PUMP CHAMBER: None (locate on site plan) Pumps in working order(yes or no): Alarms in working order(yes or no) Comments(note condition of pump chamber,condition of pumps and appurtenances,etc.): 8 Page 9 of 1 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 15 Fieldstone Road West Barnstable, MA Owner: Louise Merrow Date of Inspection: March 29, 2004 SOIL ABSORPTION SYSTEM(SAS): ✓ (locate on site plan,excavation not required) If SAS not located explain why: Type ✓ leaching pits,number: I -4'x 6'(600 gal.)w/3'stone(per as built card) leaching chambers,number: leaching galleries, number: leaching trenches, number, length: leaching fields,number,dimensions: overflow cesspool,number: Innovative/alternative system Type/name of technology: Comments(note condition of soil,signs of hydraulic failure, level of ponding,damp soil, condition of vegetation, etc.): There did not appear to be any signs of failure. The bottom to grade was approximately 8. CESSPOOLS: None (cesspool must be pumped as part of inspection)(locate on site plan) Number and configuration: Depth-top of liquid to inlet invert: Depth of solids layer: Depth of scum layer: Dimensions of cesspool: Materials of construction: Indication of groundwater inflow(yes or no): Comments (note condition of soil, signs of hydraulic failure, level of ponding,condition of vegetation, etc.): PRIVY: None (locate on site plan) Materials of construction: Dimensions: Depth of solids: Comments(note condition of soil,signs of hydraulic failure, level of ponding,condition of vegetation,etc.): 9 Page 10 of I 1 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 15 Fieldstone Road West Barnstable, MA Owner: Louise Merrow Date of Inspection: March 29, 2004 SKETCH OF SEWAGE DISPOSAL SYSTEM Provide a sketch of the sewage disposal system including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. p w o 1,\ 3AtV 3 i as 3y II 0 0 a as 3q �I Y as ys 3 y 3► s� 10 I F. Page 11 of 11 OFFICIAL INSPECTION FORM - NOT FOR VOLUNTARY ASSESSMENTS SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM PART C SYSTEM INFORMATION (continued) Property Address: 15 Fieldstone Road West Barnstable, MA Owner: Louise Merrow Date of Inspection: March 29, 2004 SITE EXAM Slope Surface water Check cellar Shallow wells Estimated depth to ground water 40 +/- feet Please indicate (check) all methods used to determine the high ground water elevation: Obtained from system design plans on record- If checked, date of design plan reviewed: Observed site(abutting property/observation hole within 150 feet of SAS) ✓ Checked with local Board of Health-explain: topographic and water contours maps Checked with local excavators, installers-(attach documentation) Accessed USGS database-explain: You must describe how you established the high ground water elevation: Using a Barnstable topographic map and a water contours map, the maps were showing approximately 40'+/-to ground water at this site. This report has been prepared and the system inspected and passed as of the date of inspection. This report is not a warranty or guarantee that the system will function properly in the future. There have been no warranties or guarantees, either expressed, written or implied, relating to the system, the inspection and/or this report. 11 TOWN OF BARNSTABLE ✓ LOCATION ' `L S�� �-�• SEWAGE # VI LLILAGE W� ��'��S � - ASSESSOR'S MAP & LOT / — Of7 INSTALLER'S NAME&PHONE NO. SEPTIC TANK CAPACITY LAUD LEACHING FACILITY: (type) P-?' (size) NO.OF BEDROOMS 3 BUILDER OR OWNER �00 re, ✓VI C rr0 W PERMITDATE: COMPLIANCE DATE: Separation Distance Between the: Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility Feet Private Water Supply Well and Leaching Facility (If any wells exist on site or within 200 feet of leaching facility) Feet Edge of Wetland and Leaching Facility(If any wetlands exist within 300 feet of leaching/facility) Feet Furnished by �T. FO C p we.11 I^ a as 3q y as ys 3 No.-------------- -- Fee--------------------- BOARD OF HEALTH TOWN OF BARNSTABLE application,forlVe[C Con5tructioni9ermit A pli ation is ereby m de for a permit to Construct 0<), Alter ( ), or Repair ( )an individual Well at: Location — Address Assessors Map and Parcel r Owner Address J- � — --------------------— ------------ X ✓ 1d/ -------- Installer — Driller ddress Type of Building ��� Dwelling — - -�f----------------------------- Other - Type of Building---------------------------------- No. of Persons--------------------------- — --- Type of Well-— -- - ---- -- Capacity--- � G - - - -- - j - Purpose of Well - 1., C o /'-'� �od Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation - The undersigned further agrees not to place the well in operation u > a er 'ficat pliayda has been issued by the Board of Health. Signed date — Application Approved By-- ---- �--- /� date � Application Disapproved for the following reasons:---------------/----------------—------ ----------------------- --------------------------- - ---------------------------------------------------------------------------------------- G� — date Permit No. -- �=�`- `I= -------- Issued--- `� ------------- date BOARD OF HEALTH TOWN OF BARNSTABLE (Certificate ®f (Compliance THIS ISJO CERTIF)( That the Individual Well Constructed V ), Altered ( ), or Repaired ( ) Installer at � / ram- - - ——-- -- ----has been installed in accordance with the provisions of the Town of Barnstable Board ofof Health Private Well Protection Regulation as described in the application for Well Construction Permit Ni /GDated THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE-------------------- —-- -- --- -- Inspector------------------------------------------—- - ------------ .., "'"'F .y -+f � ...�, -a` ,y}.�•....;n5�',.,tiA,,.n..i':Lfarl�.•is-. .r^�i�..r'f.-t'-I':'';' �rtwk 'y.d� -t.-.�.,._ni,�,....'•-rfi'v t',;-a� .. ..rwC'�•...•g• . ,I_,3� I 0. //J/ �! Fee------------ - BO'ARD.OF HEALTH TOWN` OF BARNSTABLE J. y2(pplicat ion forlVell CongtructionPermit A ph ation is'l ereliy m de for^/aQ� Loc Addres� it to Construct Q<), Alter ( ); or Repair ( ' )an individual Well at: � -/ /C � - ` -— - --- -- Assessors Ma d Parcel'-- ------- P an r- n` Owner Address � '=a� - -- ---- - �--- - -, -------- Installer - Driller ddress Type of Building Dwelling------ -, ------------------------------ Other - Type of Building ----------- No. of Persons------------------------------------------------ Type of Well—— C�2� - ---- - - Capacity--- ��----- —— - --— Purpose of Well/ er -C I Agreement: The undersigned agrees to install the aforedescribed individual well in accordance with the provisions of The Town of Barnstable Board of Health Private Well Protection Regulation — The undersigned further agrees not to place the well in operation uZZ 'ficat o pli a has been issued by the Board of Health. Signed --- - ---- ------ - l�_®/__� -- date Application Approved By-- date Application Disapproved for the following reas( ------=---=---------=-- ------------- —— - - i, _ i ---- -----— -- ------- — --=—— - --- -----------—-----------------—----------------------------------- d ate Permit No. �- -— ---------- Issued-------� - ------------------- --��s�--- `_'-" date yaw e.�.-rw.-rr.rr,rmi.err�err.�eesv��,r�®r oAa..�icae�mr�e s.�r��..e�eee�er.r am err sr.�e.rer e...-rr..®�wiin aro rr..�e w�.�...�enr erwrwsci f BOARD OF HEALTH TOWN - OF BARNSTABLE �erfificate ®f �Com�liance . THIS IS O CERTIFY,.That the Individual Well Constructed V), Altered.,(' ) orjRepaired ( ) -------------------------------- J Installer c - - -- ---—----a t- 6. —'. J G -- ----- --_ - r�� '. - has been installed in accordance with the provisions of the Town of Barnstable Board of HealthhPPrivate Well Protection Regulation as described in the application for Well Construction Permit N�i�" �,�,�Dated �� � THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A GUARANTEE THAT THE WELL SYSTEM WILL FUNCTION SATISFACTORY. DATE- --- --—— -- —— --=—--- — Inspector---------------------------------------—=-- --------------- i BOARD OF HEALTH I, TOWN OF BARNSTABLE Vell con5truct ion Permit No. Cl!____• 7 ! Fee �iw�� ___��_�_� Permission is hereby ranted- !�� --` ---------------------------------------------------------------- to.Constr ct 0, Alter ( ), or R pair ( )'an Individual Well at: No. �--y- - 2 —---- Street as shown on the a ,llication for a W 1 Construction Permit No. ---- Dated ------------- -------a---- --- ---- Board of Health DATE--- —'-- z 7 / 'OWN OF BARNSTABLE LOCATION , ,a t�,A-„SEWAGE # - VILLAGE ��(�� � ASSESSOR'S MAP & LOT 111-w INSTALLER'S NAME & PHONE NO,j� ;"�t�—�` f�� — r� SEPTIC TANK CAPACITY LILEACHING FACILITY:(type) t> r (size) -4 NO. OF BEDROOMS PRIVATE LL OR PUBLIC WATER BUILDER OR OWNER DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED: VARIANCE GRANTED: Yes No I _ _ - qS g S'7 ^fie V{1 • , �� • � Igo...` Fxs��. ........ ?. THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ' TOWN OF BARNSTABLE Apli iratilatt for Uhripwial Morks Tott6trurttntt Vveruttt Applicati is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at f Location-i�ddress or t No. b2s fc�c� -RvLA c�t-g-g ........................................................... P.o .`�oti 'esa r.�l �v►�. s �`-1 w U-z-ca c� owner ,, ff wi�ofrj . ---° "' .... 4S. .. Installer Address r Type of Building Size Lot............................Sq. feet �., Dwelling— No. of Bedrooms............................................E xpansion Attic ( ) Garbage Grinder ( ) aOther—Type of Building ............................ No. of persons---------------------------- Showers ( ) — Cafeteria ( ) Q' Other fixtures _____________________ w Design Flow--------------------------------------------gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity------------gallons Length________________ Width---------------- Diameter................ Depth................ x Disposal Trench—No. .................... Width.................... Total Length.................... Total leaching area....................sq. ft. Seepage Pit No_____________________ Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) ~' Percolation Test Results Performed by.......................................................................... Date........................................ Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water-.___-.._____-_-__--__-. C-14 Test Pit No. 2................minutes per inch Depth of Test Pit--------------------- Depth to ground water........................ a ...•--••--••---•.._...-••----•--•--•-•••-------•-----•----------•--••-•-------------------•---------------------------------•-•----•-•---------------- ----- 0 Description of Soil--------------------------------------------•---------...------.....-----------------------------------•------------------------------------------------...........-•--- x c, ----- w U Nature of Repairs or Alterations—Answer when applicable................................................................................................ Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersi ed further agrees not to place the system in operation until a Certificate of Compliance s been issued y th d of Signed ......... . ... . . --------...... ......................- te----- Da ApplicationApproved B ..................I.................................. -------------------------.....---- -- I��-- Date Application Disapproved for the following reasons- -------------------------------------------------------------------------------------------------------------------------------- ................................................ --- ----------- --- --------------------------------------------------------------- -------------------- - --------- -- Permit No. ...::.......t�... ��.............:.... Issued --------� '''.... � Die Dace s� -r THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Appliration for DioVoottl Wnrk.6 Tonstrur#inn Famit Applicatiop is hereby made for a Permit to Construct ( ) or Repair ( ) an Individual Sewage Disposal System at a� ...Lu-i l FI C c.._t-; 5 i U KC:. ZQA : tv .�. Fn t I (� 11 I ►'fl tZ C.6-c_.- -----------------------•------•----...........----•---•--------•--•-••---.............----•- •-•-•------------------••-------•-------•----•-•--------•--------.._....-----------------...---•-- Location-Address or Lot No. ................... I�4r^ I t'4 ' � =C r�1t.�I �`-� r� — ���r^- r ti -• • --- _ . --- (� . .. , 1 a.a /� ! /....................../ 1 t... ...tic +. dd{r✓.St� J�.NI�I Installer Address UType of Building Size Lot............................Sq. feet Dwelling— No. of Bedrooms...........---------------------------------Expansion Attic ( ) Garbage Grinder ( ) `k Other—Type of Building No. of persons____________________________ Showers — Cafeteria a' Other fixtures ................................. . W Design Flow............................................gallons per person per day. Total daily flow............................................gallons. WSeptic Tank—Liquid capacity__._-_-__-_gallons Length................ Width---------------- Diameter----.._-_.__-._- Depth................ x Disposal Trench—No. .................... Width-------------------- Total Length-------------------- Total leaching area-______---.._-------sq. ft. 3 Seepage Pit No--------------------- Diameter-------------------- Depth below inlet.................... Total leaching area..................sq. ft. Z Other Distribution box ( ) Dosing tank ( ) aPercolation Test Results Performed by.------------------------------------------------------------------------- Date........................................ a Test Pit No. I................minutes per inch Depth of Test Pit.................... Depth to ground water........................ Test Pit No. 2................minutes per inch Depth of Test Pit-------------------- Depth to ground water........................ p� ...---•---•-----------------•--•-•••----••-•-----•-•----•-•.._....••------------•---.......-----.........--•---......._......----•-......--.................. 0 Description of Soil..............................------•-------------------------------------•-----------------------------------------------------.....--------------------•-----•------- x U .........•.... w -------------- ---------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------•---•--- UNature of Repairs or Alterations—Answer when applicable................................................................................................ Agreement: _ The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions of TITLE 5 of the State Environmental Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has been issued by the board of health /!J Signed ---------- 1CLt..L'r...... Dare _.... ...... . �----- Application Approved B ......... �. !>'l1,'....... �_ �?� ----------------------------- ,, `y .. ' ITare Application Disapproved for the following reasons- -----------------------------------------------j ....................................... ........................................ ...................................................... .................------------------------------------- ---------------------------................- �/ Dace Permit No. `1...`........... .................. Issued ....� <".14;7_1�......... Dare r--^---.—,—..—'.-- ---.------.-----—.----. ---------------.—_--------..—.------ THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE Gex#ifirate of C�amplian e THIS IS TO CERTIFY, That the Individual Sewage Disposal System constructed ( �) or Repaired ( ) by ----y_IL.. �. .-.--.�.-.� --------------------------------- ----------- ------------------------------------- -- Installer at ............... jr�.. .....�../ i'1. �., T"n. :... fl:c ..,-._... -�'�'�' _. :a:...............------------------------------ -------------------------- has been installed in accordance with the provisions of TI"fI.E 5 of The State Environmental Code as described in the application for Disposal Works Construction Permit No. dated �".�"". ! THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE`CONSTRUED S A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE ....; -�� .... �-------`-r'j-------------------------- Inspector '_ ........ ------------------------------------------------------ ------------------- THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH TOWN OF BARNSTABLE No.r.....:.... FEs.......................� Disposal Workii Tonotrution "rrntit Permissionis hereby granted..................................... ---------------•---•----...........----------...--•--..............---..... to Construct ( V) or Repair ( ),an Individual Sewage Disposal System at No......- 'Y .c fl_ 1..............................................w vt.. ...------------•-----.............. --:•------------ .......... Str6 tt r� /f as shown on the application for Disposal Works Construction Pte m x N _ -c. Date4l__/.!_._.._........................... Board of Health DATE............................... . -•---------- --- FORM 36508 HOBBS&WARREN.INC..PUBLISHERS ENVIROTECH LABORATORIES, INC. MA Cert. No.: M-MA 063 449 Rte. 130 • Sandwich,MA 02563 (508) 888-6460 • 1-800-339-6460 FAX(508)888-6446 CLIENT: Reef Realty LOCATION: Lot 1 Fieldstone ADDRESS: School St. W. Barnstable, MA Dennis, MA SAMPLE DATE: 9-6-94 COLLECTED BY: F. Clifford/Clifford Well DATE RECEIVED: 9-6-94 TIME: 12:30PM SAMPLE I.D.: 1F JOB TYPE: New well WELL DEPTH: 65 RESULTS OF ANALYSIS: Parameters Units Recommended Limit Result ` Coliform bacteria/100ml (MF Method) 0 0 pH pH units 6.0-8.5 5.85 Conductance umhos/cm 500 127 Sodium mg/L 28.0 11.1 Nitrate-N mg/L 10.0 0.12 Iron mg/L 0.3 4.09 Manganese mg/L 0.05 0.134 Volatile organic compounds EPA 601/602 See report attached. None detected COMMENTS: Low pH indicates high corrosive characteristics. Iron and manganese are not a health hazard, but can cause taste, staining and odor problems. Filtering system is recommended. 'Yes No WATER IS SUITABLE FOR DRINKING URPOSES R PARAMETERS TESTED. XXX Date o ald J. S ri Laboratory irector LT = Less Than y GROUNDWATER ANALYTICAL EPA METHODS 601 and 602 Volatile Organics (GC/PID/ELCD) Field ID: 1F Lab ID: 8631-01 Project: Reef Realty/Field Stone Batch ID: VG2-04524 Client: Envirotech Sampled: 09-06-94 Cont/Prsv: 40mL VOA Vial/HCl Cool Received: 09-07-94 Matrix: Aqueous Analyzed: 09-09-94 PARAMETER CONCENTRATION REPORTING LIMIT (ug/L) (ug/L) Dichlorodifluoromethane BRL 5 Chloromethane BRL 5 Vinyl Chloride BRL 5 Bromomethane BRL 5 Chloroethane BRL 5 Trichlorofluoromethane BRL 1 1,1-Dichloroethene BRL 1 Methylene Chloride BRL 1 trans-1,2-Dichloroethene BRL 1 1,1-Dichloroethane BRL 1 cis-1,2-Dichloroethene * BRL 1 Chloroform BRL 1 1,1,1-Trichloroethane BRL 1 Carbon Tetrachloride BRL 1 Benzene BRL 1 1,2-Dichloroethane BRL 1 Trichloroethene BRL 1 1,2-Dichloropropane BRL 1 Bromodichloromethane BRL 1 2-Chloroethyl Vinyl. Ether BRL 5 cis-1,37Dichloropropene BRL 1 Toluene BRL 1 trans-1,3-Dichloropropene BRL 1 1,1,2-Trichloroethane BRL 1 Tetrachloroethene BRL 1 Dibromochloromethane BRL 1 Chlorobenzene BRL 1 M Ethylbenzene BRL 1 meta-and para-Xylene * BRL 1 ortho-Xylene * BRL 1 Bromoform BRL 1 1, 1,2,2-Tetrachloroethane BRL 1 1,3-Dichlorobenzene BRL 1 1,4-Dichlorobenzene BRL 1 1,2-Dichlorobenzene BRL 1 QC SURROGATE COMPOUND SPIKED MEASURED RECOVERY QC LIMITS a,a,a-Trifluorotoluene 30 30 99 % 87 - 113 1,2-Dichloroethane-d4 30 32 108 % 83 - 117 BRL = Below Reporting Limit. * Non-target compound. Method References: Method 601 - Purgeable Halocarbons and Method 602 - Purgeable Aromatics, 40 C.F.R. 136, Appendix A (1986). N ASSESSORS MAP: 111_ ,r-., _ T E ST HOLE LOGS NOTES. q , PARCEL: 47 � V ASSUMED AD NGVD v} 1. VERTICAL DATUM FROM QUA ( ��--- ENGINEER: G ac CURRENT ZONING. RF DDYLE ENGINEERING 2, MUNICAPAL WATER S ►� .AVAILABLE.. BUILDING SETBACKS: WITNESS: THOMAS McKEAN, R.S. 3. SCHEDULE 40 4" PVC PIPE TO BE USED THROUGHOUT SEPTIC SYSTEM. 9 F: 30' S: 15' R* 15' DATE:_9-30-94 4. ALL PRECAST UNITS TO CONFORM WITH AASHTO - H--10 &• H-20 PERCOLATION RATE: < 2 MINI IN S.� LOADING SPECIFICATION i q FLOOD ZONE: C TH-1 TH-2 5. PIPE PITCH = 114" PER FOOT. 462 5 6. FIRST 2' OF PIPE OUT, OF D--BOX TO BE LAID LEVEL. er LOCUS TOP ELF' 7. THE SEPTIC SYSTEM HAS NOT BEEN DESIGNED TO ACCOMODATE THE SUBSOIL 24" 442 USE OF A GARBAGE DISPOSAL. Flx 8. ALL CONSTRUCTION DETAILS ARE TO BE IN CONFORMANCE WITH THE SAND > STATE OF MASS. ENVIRONMENTAL CODE (TITLE FIVE) AND LOCAL LOCATION MAP 84' BOULDER) s92 HEALTH REGULATIONS. LOT 1 FINE 9. CONTRACTOR TO VERIFY LOCATIONS OF ALL UTILITIES PRIOR 31788 S.F. SILTY TO CONSTRUCTION. 0.73 AC. 12 SAND 362 10. DESIGN ENGINEER TO INSPECT AND CERTIFY SUITABLE SOIL CONDITIONS f TO A DEPTH OF 4.0' BELOW LEACH PIT PRIOR TO CONSTRUCTION. FINE— MEDIUm 168" SAND 322 NO GROUNDWATER ENCOUNTERED yL SEPTIC SYSTEM DESIGN 56 54— — — _ _ �1 PROPOSED WELL FLOW,ESTIMATE: ` - 3 BEDROOMS AT 110 GAL/DAY/BEDROOM 330 CAL/DAY 52— DEC 4r 54 SEPTIC TANK: SIB SEPTIC * 5 GAL so_ _ _ _ _ _ _ _ _ _ _. -- _ _.. ` \ 5s 33 _GAL/DAY 1.5 DAYS 49 PRoposEn �o. \ z \ 1 so USE Yo00 GALLON SEPTIC TANK 2& 3 BEDROOM 24' drf�, L•P RES J \ �8,SZ. \, ING 6? BENCHMARK AT — _ 1 CATCH BASIN GAR. _ — — _ \ \ 1 ELEV- 63.6 LEAC�YING AREA: f4' TH-f 2�ICI- �' '.- \ \ \ � / 28' -y \ \ 1 64 LTSE ONE LEACH PIT (6 x 49 WITH 30' OF STONE \ 1 / l / l ,.• �l2 EFFECTIVE DIAMETER x '4 DEEP) PROPOSED DWELLING S CAR l l l l 63. 9 AGE D Rlv ! I � SIDE AREA: 12 x 4 x PI — 151 SF (2.5) = GAL/DAY d 7--�� 44 D / BOTTOM AREA: 6 x 6 x PI = 113 SF (1.0) = 113 GAL/DAY TOTAL CAPACITY PR I --�_ 1 - _ ---- - . 1 ,p BE OSED / ' • / T , I I v 490 CAL/L+AY ROOd! =T I ( 4 `-� 0g SELLING \ .• /�--'• .j T F. 46.0 64. 0 / SEPTIC SYSTEM SECT ION 2" PEASTONE ¢s ...... ....• / / i / / / / / of 3 4" 1 1 2" 46.0 WASHED STONE 65. 5 TOP OF FOUNDATION 6 166 le // \,42.45 o 68 �' 42 � 42.7 1000 GAL ELEV. ,84ELEV. 42.0JID—BOX 32.0 43.0 SEPTIC TANK ELEV *---.ELEV. _ f 9, •i / / / / / ELEV. '3' / / ELEV. f / sy / / / / / _ • TEE SIZES: 36.0 � 3 / JA ,ol ! / / / INLET:`6" UP, 10" DOWN ELEV. .--- 12 44 / OUTLET: 6" UP 19" DOWN ONE LEACH PIT (6' x 4') WITH / i / / / / 1170. 3 BENCHMARK AT ' � 12' EFF. DIAM. x 4' DEEP� 3 OF STONE ( ) ! / / CONC. BOUND ELEV.- 66.3 (H-20) 48 / 56 ! / 46 6 0 2/ 6 64 68 70 r 44 50 52 54 58 UTILITY SITE AND SEWAGE PLAN CLUSTER LOT 2 4 LOCATION: KEY. EXISTING CONTOUR. . ................. LOT 1 FIELDSTONE ROAD PROPOSED CONTOUR. ........ ( ;3r THOMASjE EXISTING SPOT ELEVATION. 25.5 WEST BARNSTABLE MA civil- PROPOSED. SPOT ELEVATION: 25 PREPARED FOR- TEST HOLE. UTILITY P -O- EEF REALTY FENCE LINE: QW-1 ' — DEMAREST—McLELLAN'ENGINEERING , ,yvy 'SCALE.• 1" = 30 DATE 7 ,Z2 94 HYDRANT. STREET P.O. BOX 463 24 scsooL , WEST DENNIS, 'MASSACHUSETT s 02670 REFERENCE: PLAN BOOK 413 PAGE 99 _ THOMAS McLELLAN, P.E. JOHN Z. DEMAREST JR.,P.L.S. DM # 94-039 1 r ti N i ASSESSORS MAP. 111 �; ST. . _ 0 LOGS NOTES. PARCEL: 47 T� H L L' . Y - -. - 1 VERTICAL DATUM. ASSUMED FROM QUAD NGVD +,� CURRENT ZONING: ENGINEER: DOYLE ENGINEERING Nc �� 2. �lUNICAPAL WATER IS . .AVAILABLE. 4► S. THOMAS McKEAN, R.S. ll BUILDING SETBACKS: WITNE. . SCHEDULE 40 - 4 PVC PIPE TO BE USED THROUGHOUT SEPTIC SYSTEM. F: 0' S: R. DATE.-9 30 94 4. ALL PRECAST UNITS TO CONFORM W S fc� �-, �_ 1s M IT H AA HT 0 H 10 & H-20 s*r PERCOLATION RATE < 2 MIN IN 8 •�--- LOADING SPECIFICATIONS. , q FL60D ZONE: C TH-1 TH-2 5. PIPE PITCH = PER FOOT. 1 462 g 6. FIRST 2' OF PIPE OUT OF D-BOX. TO BE LAID LEVEL. TOP `& ELEV LOCUS SUB.>OIL 7. THE SEPTIC SYSTEM HAS NOT BEEN DESIGNED TO ACCOMODATE THE • `- , 24" 442. USE OF A GARBAGE DISPOSAL. FINE 8. ALL CONSTRUCTION DETAILS ARE TO BE IN CONFORMANCE WITH THE SANWITH' STATE OF MASS. ENVIRONMENTAL CODE (TITLE FIVE) AND LOCAL LOCATION MAP BOUL6ER 84" 392 HEALTH REGULATIONS. LOT 1 FINL 9. CONTRACTOR TO VERIFY LOCATIONS OF ALL UTILITIES PRIOR SILT ' - . 31,788 S.F. TO CONSTRUCTION. SANII 0.73 f AC. 12 362 10. DESIGN ENGINEER TO INSPECT AND CERTIFY SUITABLE SOIL CONDITIONS TO A DEPTH OF 4.0' BELOW LEACH PIT PRIOR TO CONSTRUCTION. FINE MEDIUM ...w 16e SANII 322 _NO GROUNDWATER ENCOUNTERED 56- - 0 , a SETT I C SYSTEM DESIGN iF 4 F 56 - _ d PROPOSED WELL 54" r. FLOW .ESTIMATE. � FEDROOMS AT 110 GAL/DAY/BEDROOM 330 GAL/DAY 52 DIP :.. 54 58 SEPTIC TANK. _cKI El \ 56 330 GALIDAY 1.5 DAYS - 495 GAL PROPOSED \ \ 1 60 USI' GALLON SEPTIC TANK 28' ; 3 BEDROOM 24' 1p. RES _ 2�B 1 - �- DWELLING , .�f P - \ �52. 1 1 6 F BENCHMARK AT CATCH BASIN L. 48- - - -- - - - \ 1 1 1 ELEV= G 63.6 LEACEING AREA: AR \ \ 14' TH-1 ,. 28' \ \ 1 64 SSE ONE LEACH PIT (6 1 x 4, WITH 3.0' OF STONE ... ........... I ) ) ) DWELLING 4s- i \ \ ) l _(12' EFFECTIVE DIAMETER x 4' DEEP) PROPOSED ' 63. 9 , GAR,gGE .DRIyE ••--• � .••.•I � i / / .,IDE AREA:, 12 x 4 x PI = 151 SF (2.5) GAL/DAY . . , / \ 46 ~�` 1. �• l l l / j30TTOM AREA 6 x 6 x PI = 113 SF (1.0) 113 GAL/DAY PROPOSED 1 •z,- , 11 _, .T? A ? ..flAtl n .a s �.. Tr - _..... :-. w.,...4--_..,.-.. e,..-- -• .m - _ _ , _. .. 8 BIPD ¢ _ ____ . ._.,:._•_ ,... . _.�',>?'�3-�'� -,.may__.,,: ,:� _._ T F _ 46.0 , 64. 0 S E I C SYSTEM SECTION 2" PEASTONE Q ..... / / / / / •'•• / p� ' OF314" - 1 V2" 44 ....... / / / / 46.0 WASHED STONE Q� TOP OF FOUNDATION / 65. 5 166 \42.45 68 49 42.7 ELEV. D-BOX ' _� 1000 GAL - 4 . ✓ / / 4Y ELEV. SEPTIC TANK 42.01 ELEV. 32.0 Z43.0G, _ ELEV. s. 67•/ / / / / / / / ELEV. / �� 3' ELEV. 36.0 . TEE SIZES: INLET. 6" UP, 10" DOWN ELEV. .- 12' 44 f / / / OUTLET: 6" UP '19" DOWN ONE LEACH PIT (6' x 4') WITH 1 / /7o. s BENCHMARK AT 3' OF STONE 12' EFF. DIAM. x 4' DEEP CONIC BOUND ( ) 46 48 / _/ 56 58 60 62 64 / 68 70 44 50 52 54 UTILITY SITE AND SEWAGE PLAN CLUSTER LOT 2 KEY. ., LOCATION. G 'CONTOUR: EXISTING LOT 1 FIELDSTONE ROAD PROPOSED CONTOUR:. .............................. 71 ;. . EXISTING SPOT ELEVATION: 25.5 sc._t a' - �.: WEST ARNSTABLE, MA PROPOSED SPOTELEVATION: 25 A• �v PROP Q . : n rc.as? 1 / ., PREPARED FOR - TEST HOLE. . UTILITY POLE. --� F- . , , �r,t..-: �� 'Z h_ '" REEF REALTY FENCE :LINE:. •• -• � - �' SCALE: 1" 30' DATE: HYDRANT: -�- DEYAREST-YcLELLAN ENGINEERING �; � �. � -' � 7-,Z,2-94 24 SCHOOL STREET P.O. BOX 463 USETTS ozs7o ': "REFERENCE: :PLAN BOOK 413 PAGE. 99 HEST DBNNIS, �IASSACH THOMAS McLELLAN, P.E. JOHN Z. DEMAREST P.L.S.I. DAL! # 94-039-1