565 Septic Inspection 1997 assn F.WId
geese.
Arise Paul CYked
aeewww
Commonwealth of Massachusetts
Executive Office of Environmental Affairs
Department of
Environmental Protection
!6LLi
MAY 51997
ON F.OAR;OF HEAL'F.
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION
Property Addis CDLES ME.4eta+ £e&O, M0Cf440.4 P yt:>✓
Data of Immediate MARC-9 Et,/99 7
Name of Inspevtae R4YMaJl MI Et34gaa+WI
Company Name,Address and Telephone Number. w Er.wS
CERTIFICATION STATEMENT
I certify that I bave pusonaly inspected the sewage disposal system at this addraa and that the information reported below is true accurate
and complete as of the time of inspection. The inspection was performed based on my training and npenence• the proper frmcticm and
maintenance of umu•swan disposal rystema. The system
Passes
_
Conditionally Pasty
_
Needs Further Evaluation By the Iced Appro,tg Authority
Inspector's slg aturt; // /'/I�l Data Il 'EU it/97
The System Inspector shall submit a copy of this inspection report to the Approving Authority within thirty(30)days of=pitting this
inspection. It the system is•shared system or his a design flow of 10,000 gpd or greater,the inspector and the system owner shall submit the
report to the sppmprian regional a ce of the Department of Environmental Protection.
The original should be cent to the system owner and copies sent to the buyer, if pplicable and the approving authority.
Address of Owner.
(If different/
. Bo4&'1 ( 4R�5-19-GV/i
Hno�.MA , olfi
Trudy Cam
aesvew
David O.Sines
Camises
INSPECTION SUMMARY:
Check A B,C,or D:
Al 9Y8' 1 PABSM5:
I have not frond any iMormation which indicates that the system violates any of the failure criteria es defined in 310 CMR 15301
Any failure criteria not evaluated an indicatd below.
BI SYSTEM CONDITIONALLY PASSES:
Om or mom system components need to be replaced or repaired. The system upon completion of the rapla cant or npae,perms
Indicate yin,u,or not datermm.d(Y,N,u ND). Describe basis of determination in all instavrr flat determined*,aplam why not)
The septic tank is metal,cracked structurally unsound,shoo substantial infiltration or adiration,.o tank lirTur•is
inninent. The system will pass inspection if the misting septic tank is replaced with a conforming septic tank as approved
by the Board of Health.
(revised 11/03/95) 1
One Winter Stet • Boston,Maaandwady 02109 • FAX(517)551.1049 • T•tephce•(917)212.9909
0 Ponied en Rarnse our
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(amtineed)
Property Addtaac
Owner
Dm of Impeetioa
B1 SYSTEM CONDITIONALLY PASSES (continued)
- Sewage backup or breakout or high ask water level demand in the distribution been doe to Bohan or obstructed pfp(s)
or don to a benbn,settled or at distribution boa The system MU pawl impend=if(with approval of tin Bard of
Health):
beano pipets)In replaced
charmed=is.®ond
distribution bon is Imaged er replaced
- me system nquved pumping moo than facer tfmes a year don to broken or obtnsced pipes). The tycoon will pass .
inspection if(with approval of the Hoard of Health):
_ broken pipes)an replaced
obtnmtioa is removed
CI 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 the
public health,safety and the environment.
1) SYSTEM WILL PASS UNLESS BOARD OF HEALTH DETERMINES THAT TEE SYSTEM IS NOT FUNCTIONING IN A
MANNER WHICH WILL PROTECT THE PUBLIC HEALTH AND SAFETY AND THE ENVIRONMENT.
Cesspool or privy is within 50 feet of a surface warm
Cesspool or privy L within 50 feet of a bordering vegetated wetland or a salt mush.
2) SYSTEM WILL FAIL UNLESS THE BOARD OF HEALTH(AND PUBLIC WATER SUPPLIER.IF APPROPRIATE)
DETERMINES THAT THE SYSTEM IS FUNCTIONING IN A MANNER THAT PROTECT THE PUBLIC HEALTH AND
SAFETY AND THE ENVIRONMENT
The system has ptic tank and soil absorption system and L within 100 feet to a surface water supply or=binary to•
ark=water supply.
- The imam has•septic tank and soil absorption system and is within•Zone I of•public water supply well.
- Tin"stem hen septic tank and soil absorption amino and is within 50 fat of•private water supply well.
The system her a septic tank and soil absorption spasm and is Les than 100 feet but 50 bet or more from•private water
apply well,unless a wall water analysis for oliform bacteria and volatile^Moist compounds indicates that the well is free
from pollution from that facility and the presence of mamma ninegen and nitrate=roam le goal to ce lair than 5 lark
3) OTHER
(revised 11/0365)
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART A
CERTIFICATION(continued)
Property Address
Owner.
Date of Inepeetles
DI SYSTEM FAIL&
I have determined that the sync violate.one or more of the following failure atria as defined in 310 CMR 15303. The basis for
this determination is identified blow. The Board of Health should be contacted to determine what will be me.ary to corns the
_ Backup of sewage into hclity or system component due to an overloaded or clogged SAS or oespepcoL
Discharge or pouding of effluent to the surface of the ground surface waters due to an overloaded or dogged SAS or
owe pool
Static liquid level in the distribution bar above outlet invert due to an overloaded or coned SAS or cesspool.
- Liquid depth in cesspool is less than r below invert or available volume is le.than 1/2 day flow.
Required pumping more than 4 times in th last veer NOT due to clogged or obstructed pipers).
Number of times pumped
Any portion of the Soil Absorption System.cesspool or privy is below the high groundwater elevation.
- Any portion of a 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•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. If the well has been analysed to be acceptable,attach copy of well water analysis for
colitis=bacteria,volatile organic compounds, ammonia nitugen and nitrate nitrogen.
El LARGE SYSTEM FAILS:
Tha fallowing atria apply to large systems in addition to the criteria above:
The system serves•nudity with design now of 10,000 gpd or greater(Large Sync)and the sync is•sign:reent threat to public
be.lth and safety and the environment bemuse one or more of the following conditions net
- the sync is within 400 feet of•surface drinking ester supply
_ the enfant L within 200 feet of a tributary to a surface drinking eater supply
_ the system is)mead in a nitrogen sensitive area(Interim Wellhead Protection Area(IWPA)or•mapped Zona D of a public
eater supply well)
The°moor or ablator of ay such system shall bring the system and facility into hill compliance with the gtamdwnc treatment program
requirement of 314 MR 5.00 and 6.00. Please consult the local regional office of the Department far hneher information..
frevised 11/03/95)
3
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART B
CHECKLIST
Pm/mete Addreaa 5"tS Oo LFMBMO». RoAO, Do£fla -a PIV,J
DW tm�IS PZIe1GE
of lv.p l
3-27-'77
Clack if the fallowing have been done:
YPrunping information was requested of the owner,occupant,and Sow of NWth.
1 None of the system components have been pumped for at least two weeks and the oyster=has been receiving normal flow rates
'1I during that period. Large volumes of water have not been inn oe as
adnd into the system recently ar part of this inspection.
•'L Ayboilt plane have been obtained and examined Note if they an not available with N/A.
�T e reality dwelling was inspected for signs of sewage back-up.
'
T!y system does not receive nonwemWy or industrial waste flow
_Ti/eAta was inspected for signs of breakout.
/
✓All rym®mmponmm,excluding the Soil Absorption System,have been located on the site.
The septic tank manholes were uncovered,opened.and the interior of the septic tank was inspected for condition of baffles or
s},material of construction.dimensions,depth of liquid,depth of sludge,depth of scum.
_✓
The
S.and location of the Soil Absorption System on the site has been determined bast'on aiming information or
yappv�atd by non-intNave methods.
The facility owner and occupants, of different from owner)were provided with information on the proper maintenance of Sub-
Surface Disposal System.
(revised 11/03/95) 4
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION
Pt party Address j r C'o C E N E„o ow ,'?gyp ,Jp(C7)44mpro,J
°In
D I�.p.147U/5 P�ew6 L
3 Z7-t7
FLOW CONDITIONS
RESIDENTIAL:
Design flow) ;TO pike.
Number of bedrooms: 'Z
Member of carat coda: /
Garbage pander(yes or non Wb
Iamdry v.e d to system(yes or ion ✓aS
Seasonal use(yea or ml:e)
Water mere reeding,if available. Oil War tr weld-
IAA data f oeeupanny: / .veeENTLY Ctzv 4s j
COMMERCIAL/INDUSTRIAL)
Tyne of establishment
Design Dow, plans/day
Grass tram prawn=Vs or no)_
Industrial Waste Holding Tank present (yes or no)__
Non-sanitary waste discharged to the Title 5 system:(yes or nod_
Water meter reading,if available:
Let date of occupancy)_
OTHER:(Derain
last data of occupancy:
GENERAL INFORMATION
PUMPING RECORDS and eon of in formation:
System pumped as part of inspection) (yes or no t"--.$
If ys..odnma pumped: 91n tLnilon.
Reason for pimping aide-hoc Tit N/e ,Mrm.L TY'
TYPE}IP SYSTEM
✓ Septic tankidisimbamn bat/soil abmrptio)system
- S_orpml
Overflow l
- prier
.�Shared natant(yes or no) (Lys,attach previous inspection records,if any)
Other(explain)
APPROXIMATE AGE of W components,date installed(if known)and ewn of vrfsmaton: LANK AMU 1602 t-'
Sewage odes detected when arriving at the mite:(pa or no)
(revised I)/03/95) 5
LtauH Flat) - /`%89
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION POEM
PART C
SYSTEM INFORMATION(o®tlewd)
Property Addres GtE /14 67 icw0 Vt719v/ ?
✓Pen
r3/)vs P,e,✓6cE
Date of Inspeetiom
3-Z7-97
SEPI7C TANK: ✓
(loure on site plan)
Depth below ped.:Z3lr
Material of COES1711 edam J n=eta metal FBP_mhane:Plam)
7.5-X 3,
Sbrdg dept! Y"
Distance from top of sludge to bottom of outlet ter or baffle Z/c�r
Sam thielm.s: 7" _
Distance from top of scam to top of outlet to or baffle:
Distance from bottom of scum to bottom f alert. bete. / 7
Comments:
(recommendation for pumping,condition of inlet and outlet ten or bates depth of liquid lewd in relation to outlet invert,structural integrity,
evidence of leakage,etc.) rAdk W e) c tLe,VT caiJOmat/ —RAF's AP,t3I,t 7V AF W04Kmlc
62i2R47tY - um✓fo I£U:+t. /s eV 49.-1 All RI Y"ell/2-I Cr//iE — Fi/ng1/7)lrn/6 IA;Tit twit
Cw—Frl J4 A 90owC to BC ;IN tRoaltIG pceFat y — No S/c✓S or RgC/c t/P
GREASE TRAP. 1 -
(loate on site plan)
Depth below grade__
Material of mvscomon_onmete metal_FRP_othererplan
Dimensions:
Sum thicaneer_
Distance from top of sawn to top of outlet tee or baffle:_
Disano from bottom of sum to bottom of outlet tee or bate
(recommendation for pumping.®ditim of inlet and outlet ten or barn,depth of liquid level in relation to outlet aeon,.summaff integrity,
evidence of leakage,etc.)
•
(revised 11/03/95) g
SUBSURFACE SEWAGE DISPOSAL BYBTEI(INSPECTIONFORM
PART C
SYSTEM INFORMATION(oontbaud)
Property Amts 5-6C COLE mei-004 Roe VotniAk
Omer. Psfra S ,if/NCLC %Oj/
D.S.of Inspeoriam
3-27-57
TIGHT OR BOLDING TANE:4(
Ocoee on site plm)
Depth below made:_
Materiel at mnstrosbo: comet metal FRP orbnlnpLin)
Di nsosionc
Cepaciey- gallons
D.oi.So.r_p,masiday
Alarm level:
Comments:
(candition of inlet w,condition of alarm end Got.witches,etc.)
DISTRIBUTION BOR ✓
(lout on sit plan)
Depth of liquid level above outlet invert:
Comments:
lame if level and distribution s equal,evidence of solids carryover,evidence of leakage into or out of boc etc.)
41•bo1/4 E.rS77 it CWLO • 07 RE 40C471» DORWC MIS ,rr$Paflas/
Cap
PUMP CHAMBER:
moo on site plan)
Pumps in ecating°Sarlyes or m)
Comments:
(not condition of pumps dumber.condition of pimps end pp rtmays,etc)
Invited 11/03/95)
7
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM INFORMATION(oat tamed)
Ptapety Address S-6f COLk"I"1E-N-DOU Rct49, N 1-7W4mP'=r✓
Data ) MMus
AmicLe-
-L7-y7
SOIL ABSORPIYON SYSTEM(SAS).
fleee on site Pisa if=sulk;...bore not requited,bet may be approsimated by rem-baut.s methods)
If not determined to be prasmt aplsie:
Type
lambing pits,number_
teaching oheObRa number
loathing galleries,.saber_
teaching ttanebes,nombenlen the
leaching bids,numb,dimensions: /FA 20 W X VO t LONG
overflow oepool,number
S,9.K wA1 40✓0 IN S L✓4.n�S
WjT4 /JO s.-74.„.0100‘ aAPat w'Til
Comments:(note condition of ail.signs of hydraulic failure,level of pending,condition of vegetatioaett) 4/0 °Dots -A/O S/1/W(V Sots S
/ta0 5U,(j-/ICS 4TOteour - 5/TE /5 AOFGk/A7f[✓ J//® YD fNcnore r .0 cC 2)(C4(MACE
3 7-€ r pro Exc.*VA rut — .vu S/cA/C OF If✓ORAtL/C a10-(19i
S✓4 re-I Afmre-mec rz LW" Alocn•w,✓c Ploinz AY
CESSPOOLS:��Ai/
(locate on site pWt)
Number and configuration
Depth-top of liquid to inlet invert:
Depth of solids layer.
Depth of.cum layer
Dimensions of osespaol,
Materials of ommuction:
Indication of groundwater.
inflow Ineepaol must be pumped as put of inspection)
Comments:(note=edition of soil,signs of hydtettlic failure,level of poeding condition of vegetation,etc)
PRIVY:A
(locate on ate plan)
Mnuisk of omatrmtim: Dmmsims:
Depth of solids:_
Comments:(note aveditim of sail,signs of bydtnle faihve,Mel of pending.omditioe of.yetaeoa me)
(revised 11/03/95) 8
SUBSURFACE SEWAGE DISPOSAL SYSTEM INSPECTION FORM
PART C
SYSTEM"INFORMATION(mataued)
Property Addrme r(pS COLCHE,t J Raab ,A/08-7)i9MProd
On.r. PHni/j AU./6 L
Date of Impmlisrc
3-Z7-9 7
SKETCH OF SEWAGE DISPOSAL SYSTEM:
=de ties to at least two prominent references landmarks or benchmarks
locate ail well within 100'
SEE 4TMegg)
DEPTH TO GROUNDWATER
Depth to groundwater 7/ feet
method of determination or approximation
(revised 11/03/95) 9
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Iz SEPTIC SYSTEM LAYOUT
AG1 „c,
1-4g Eg OWNER: PHILLIS PRINGLE
CO 51 n ,fl ADDRESS: 565 COLES MEADOW ROAD
ro
NORTHAMPTON, MA.
DATE: MARCH 27, 1997
INSPECTOR: RAY MIECZKOWSKI
o
0
A
m
at_ a • A,
ou
LP,GIf FIELD 15 MPROMIATELY
zPO FEET WIDE BY 40 FEET LONG
SEPTIC SYSTEM LAYOUT
OWNER: PHILLIS PRINGLE
ADDRESS: 565 COLES MEADOW ROAD
NORTHAMPTON, MA.
DATE: MARCH 27, 1997
INSPECTOR: RAY MIECZKOWSKI
RIORDON
ASSOCIATES
Sample No.. 7543
P.O.Box 178
176 BROOKSIDE CIRCLE
FLORENCE, MA 01060
(413)586-1060
AGREEMENT FOR WATER TESTING
CERTIFICATE OF WATER ANALYSES
Date: April 19, 1997
Client: Sample Location:
Phyllis Pringle Drilled Well &Distrib. System
565 Coles Meadow Road Pringle Residence
Northampton, MA 01060 565 Coles Meadow Road
Northampton, MA 01060
On. 3 Apr 1997 at, 9:30 a.m., John P. Riordan sampled the water at the above location. The water samples taken at that
lime were analyzed, under the direction of John P. Riordan, RIORDON ASSOCIATES Scientist, using standardized
APHA, EPA and ASTM methods.
The following agreed upon analyses were performed by Mass. Lab Cert.No. MA100.
TEST RESULT E.P.A LIMIT
Ammonia ND <0.2 mg/I.
Total Coliform 0/100 ml. 0/100 ml.
Nitrate/Nitrite .0.730 mg/1. 10 mg/I.
me/L. millizrams per liter ND =Not Detected, ml. =milliliter
COMMENTS: (at this time):The above results obtained from the analyses performed on the submitted water sample(s)
MEET E.P.A. and United States Public Health Service approved sanitary standards for drinking water. Retest Coliform
Count Annually.
Please call RIORDON ASSOCIATES at retest time and if you have questions regarding this report.
John P. Riordon, Director.
CONSULTANTS TO HOME AND BUSINESS
WATER-AIR-ENVIRONMENTAL TESTING&SERVICES
-04/14/9'7
page 2 of 6
Purchase Order Number: 980252
LIMS-BAT g: LIMS.28825
Job Number: 28825
Sample Matrix: DKG WATER
Sampled: 04/03/97
0KG WATER
7543
Date SPEC
Units 97805654 Analyzed Analyst MDL LIMIT P/F
cis-1,3-Dichloropropene ug/l ND 04/10/97 OFF 0.5
t-1,3-D)chlaropropene ug/l ND 04/10/97 OFF 0.5
Ethyl Benzene ug/l ND 04/10/97 OFF 0.5 700 P
Fluorotrichlorcmethane ug/l ND 04/10/97 MFF 0.5
Nexachlorobutadiene ug/I NO 04/10/97 MFF 0.5
Isopropylbenzene ugh ND 04/10/97 MFF 0.5
p-Isopropyltoluene ug/l ND 04/10/97 MFF 0.5
Methyl tett-Butyl Ether (MTBE) ughl ND 04/10/97 NFF 0.5
Methylene Chloride ug/l 0.11 04/10/97 MFF 0.5 5.0 P
Naphthalene ug/l ND 04/10/97 MFF 0.5
n-Propylbenzene ug/l ND 04/10/97 MFF 0.5
Styrene ug/l ND 04/10/97 NFF 0.5
1,1,1,2-Tetrachloroethane ug/l ND 04/10/97 MFF 0.5
1,1,2,2-Tetrechloroethane ug/L ND 04/10/97 MFF 0.5
Tetrachloroethylene ug/L ND 04/10/97 MFF 0.5 5.0 P
Toluene ug/L ND 04/10/97 NFF 0.5 1000 P
1,2,3-Trichlorobenzene ug/l ND 04/10/97 NFF 0.5
1,2,4-Trichlorobenzene ug/t ND 04/10/97 MFF 0.5 70.0 P
1,1,1-Trichloroethane ug/l ND 04/10/97 NFF 0.5 200 p
1,1,2-Trichlaroethane ug/I ND 04/10/97 NFF 0.5 5.0 P
Trichtoroethylene ug/I ND 04/10/97 .MFF 0.5 5.0 P
Trichlorofluorciethane ug/L ND 04/10/97 MFF 0.5
1,2,3-Trichloropropane ug/l ND 04/10/97 NFF 0.5
1,2,4-Trimethylbenzene ug/l ND 04/10/97 MFF 0.5
1,3,5-Trimethylbenzene ug/l ND 04/10/97 MFF 0.5
Vinyl Chloride ug/l ND 04/10/97 MFF 0.5 2.0 P
p&m-Xylene ug/l ND 04/10/97 MFF 1.0
o-Kylene ug/t - ND 04/10/97 MFF 0.5
MOL • Method Detection Limit
NO • Not Detected
BOL • Below Detection Limit
NM • Not Measured
SPEC LIMIT • a client specified, recoil ended, or
regulatory level for comparison with data to
determine PASS (P) or FAIL (F) condition of results.
JOHN CORDON
RIORDON ASSOCIATES
P.O. SOX 178
FLORENCE, MA 01060
Purchase Order Number: 880252
Project Location: COLES MEADOW RD., NORTHAMPTON, MA.
Date Received: 04/03/97
Sampled: 04/03/97
DKG WATER
7543
D4/14/97
page 1 of 6
LIMS-BAT 0: LIMS-28825
Job Muster: 28825
Sa pla Matrix: DKG WATER
Date SPEC
Units 97505654 Analyzed Analyst MDL LIMIT P/F
Benzene ug/t ND 04/10/97 MFF 0.2 5.0 P
ercmobenzene ug/t ND 04/10/97 MFF 0.5
Bromochloromethane ug/t ND 04/10/97 NFf 0.5
BrmudichLOromethane ug/t ND 04/10/97 NFF 0.5
Bromamethane ug/t ND 04/10/97 MFF 0.5
Bromofonh ug/t NO 04/10/97 NFF 0.5
n-Butytbenzene ug/i NO 04/10/97 MFF 0.5
sec-Sutylbenzene ug/t ND 04/10/97 MFF 0.5
tert-Butytbenzene ug/t PO 04/10/97 NFF 0.5
Carbon Tetrachloride ug/t NO 04/10/97 MFF 0.5 5.0 P
Chlorobenzene ug/t ND 04/10/97 MFF 0.5 100 P
ChLorodibrommethane ug/l ND 04/10/97 MFF 0.5
Chloroethane ug/L ND 04/10/97 MFF 0.5
Chloroform ug/l ND 04/10/97 MFF 0.5
Ch[oromethane ug/L ND 04/10/97 MFF 0.5
c-Chlorotoluene ug/l nap 04/10/97 MFF 0.5
p-Chtorototuene lg/L ND 04/10/97 MFF 0.5
Dibromoowthane ug/t ND 04/10/97 NFF 0.5
1,2-Dichlorobenzene ug/l ND 04/10/97 MFF 0.5 600 P
1,3-Dichlorobenzene ug/t NO 04/10/97 MFF 0.5
1,4-Di chlorobenzene ug/t ND 04/10/97 MFF 0.5 75.0 P
Dichlorodifluoramethane ug/L ND 04/10/97 MFF 0.5
1,1-DichLaroethane ug/l ND 04/10/97 MFF 0.5
1,2-DichLoroethane ug/L NO 04/10/97 MFF 0.2 5.0 P
1,1-Dichtoroethylene ug/t ND 04/10/97 MFF 0.5 7.0 P
cis-1,2-DichLoraethylene ug/t ND 04/10/97 MFF 0.5 70.0 P
t-1,2-DichloroethyLene ug/t ND 04/10/97 NFF 0.5 100 P
1,2-Dichtoropropene ug/l NO 04/10/97 NFF 0.5
1,3-Dichloropropane ug/L NO 04/10/97 NFF 0.5
2,2-Dichloropropane ug/t ND 04/10/97 Mff 0.5
1,1-Dichloropropene ug/l ND 04/10/97 MFF 0.5
1,3-Dichtoropropene ug/l ND 04/10/97 MFF 0.5
MDL = Method Detection Limit
ND = Not Detected
BDL = Below Detection Limit
NM • Not Measured
SPEC LIMIT • a client specified, recommended, or
regulatory level for cwparlson with data to
determine PASS (P) or FAIL (F) corditimn of results.
r
* 9
�� if 1/
Ntist
THE COMMONWEALTH OF MASSACHUSETTS ,
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BE IT KNOWN THAT
•
Raymond Mieczkowski
Has satisfied the Department's qualifications as required and is hereby
authorized to use the title
CERTIFIED TITLE 5 SYSTEM INSPECTOR
as provided in 310 CMR 15.340 and Section 13 of Chapter 21A of the
General Laws. Issued by The Department of Environmental Protection.
May 25, 1995 •
Acting Director of the ).4 of Water Pollution Control