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Commonwealth of Massachusetts <br /> Cityffown of Mashpee <br /> Soil Suitability AssessmentOn-Site Sewage Disposal <br /> F. " icati <br /> 1 certify that 1 am currently approved by the Department of Environmental Protection pursuant to 310 CMR 15.017 to conduct soil <br /> evaluations and that the above analysis has been performed by me consistent with the required training, expertise and experience <br /> described in 310 CMR 15.017. 1 further certify that the results of my soil evaluation, as indicated in the attached Soil Evaluation Form, <br /> are accurate and in accordance with 310 CMR 15.100 through 15.107. <br /> Sigh&#e oil Evaluator Date <br /> Typed or Printed Name of Soil Evaluator/License# Date of Soil Evaluator Exam <br /> NP, <br /> Name of Board of Health Witness Board of Health <br /> Note: In accordance with 310 CMR 15.018(2)this form must be submitted to the approving authority within 60 days of the date of field testing, and <br /> to the designer and the property owner with Percolationrest Form 12. <br /> t5forml 1 j1 jMashpee041211 •rev.1/10 Form 11—Soil Suitability Assessment for On-Site Sewage Disposal •Page 7 of 7 <br />