HomeMy WebLinkAboutLegal Document - 285 REA STREET 10/17/2013 i" u
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office o Alternative Selvage Disposal System
1Vf.Cx.L. c. 21A, § 13 and.310 CMR 15.028"/(1.0)
�1'"his Notice to be recorded and/or Bled for registration in the chain of title of the Property serve 1) .. �& t C ✓f 11&��)VER
e wage Disposal system("Alternative system ),I iftyt
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NAME,(S) OF OWNER OF PROPY SERVED BY AT_,TERNA IV
E S TEIViI:
ADD RE SS OF PROPERTY SETI;V TD ALTS 1NAT VE SY 1VX:
2RJ TIJ
TITLE REFERENCE FOR PROPERTY SERVED BY ALTERNATIVE SYSTEM Ielieck and
complete each that appliesl:
Deed recorded with the Registry of Deeds in Book ML Page
_Certificate of Title No. issued by the Land Registration Office of the _Registry District
—source of title other than by deed
Irf Alternative System Owner(s)is other than Property Owner(s),complete the following:)
Alternative System Owner Name:
Alternative System Owner Address:
' WHEREAS, Section 15.280 of Title 5 of the State Environmental Code ("Approval of
Alternative Systems"), provides for the Massachusetts Department of Environmental Protection(the
"Department") to approve or certify., as appropriate, all proposals to construct,upgrade or replace on-site
sewage disposal systems using alternative systems;
WHEREAS, owners and/or operators of approved or certified alternative systems are subject to
general conditions, as specified in Section 15.287 of Title 5 of the State Environmental Code, 310 CMR
15.287, and may be subject to special conditions, as specified in the Department's approvals or
certifications; such general and special conditions potentially including, without hinitation, requirements
relating to the use of trained operators, periodic inspections, maintenance, sailiplirig;reporting aid/or
recordkeeping;
WHEREAS, Section 15.287(10) of Title 5 of the State Env ironmentat,Code,,,3 10 CMR�
15.287(10),requires that"prior to obtaining a Certificate of Compliance for
upgraded system, the system owner shall record in the chain of title for the property served by the
alternative system in the Registry of Deeds and/or Land Registration Office, as applicable, a Notice
disclosing both the existence of the alternative on-site system and the Department's approval of the
system. The system owner shall.also provide evidence of such recording to the local Approving
Authority[J"and
WHEREAS, the Property is served by an alternative sewage disposal system.
NOW, THEREFORE,Notice of an alternative sewage disposal system is hereby given for the
above-referenced Property, as follows:
1. Existence. An alternative system has been installed as a new or upgraded alternative sewage disposal
system, on or adjacent to the Property, and serves the Property. The trade name and model number(s) of
the alternative system are as follows: fi
Trade /fi e mane of technology: ;1*-1/ ll, � ✓
X
Manufacturer Name:
Model number(s):
,W
Page I ot'2
2. Approval/Certification. On ��/" j� ''! [datel, the Department, pursuant to its authority
under the section of Title 5 as specified below, approved or certified the technol used in the above-
referenced alternative system, under NlassDEP Transmittal Number� ��!; ,� [�z a��smittal "lumber
of approval or certification].
[Check one of the following,as applicable:]
—Approved for remedial use under 310 CNLR 15.284
Approved for piloting under 310 CNIR 15.285
Provisionally approved tinder 310 CNIR 1.5.286
Certified for general use under 310 CMR 15.288
A copy of the Department's Approval/Certification is available from the Department in person or on-
line at the Department's website: ih p: ',,v r lass.�ac,��?�iep .
WITNESS the execution hereof under seal this day of *l _, 20/_? , made by
the above-named Alternative System Owner(s).
(Alternative System Owner(s)l
Print Name(s): Am4udr, 1&44W
ss CONINIONWEALTH OF NLASSACHUSETTS
On this_t`day of (fi e/ 20 , before me, the undersigned notary public, personally
appeared A gAeA ,4 M My S (name of document signer), proved to me through satisfactory
evidence o(identification, which were MA4)41 t W LIGC 4� , to be the person whose name is
signed on the preceding or attached document, knotiv dged to me that (he) (she) signed it
voluntarily for its stated purpose. �.�
(offici signature and seal of
------------------------- --------------- ------------------- ---- ---------------------- ---- - - -
[Complete the following Property Owner(s)Consent if Alternative System Owner(s, s than t
Owner(s):l
CONSENTED TO:
[Property Owner(s)1 —
Print Name(s):
Date:
CO?VF IONWEALTH OF N \SSACHUSETTS
ss
On this day of 20_, before me, the undersigned notary public, personally
appeared (name of document signer), proved to me through satisfactory
evidence of identification, which were , to be the person w'lose name is
signed on the preceding or attached document, and acknowledged to me that(he) (she) Signed it
voluntarily for its stated purpose.
(official signature and seal of notary) --
Upon recording, return to:
[Name and address of Propem Owner(s)]
Pa 2 ge ? of
,q,f4-Al 114MoS
225 1<C1q- ST-1
/v�2 04 +V46 P-o/ Mk
Sullivan Engineering- Group, LLC
Civil Lngineeis& Land Development Consultants
October 15, 2013
RECEIVED
Town of North. Andover
Board of Health 00' Z 2 013
Re: 285 Rea Street, North Andover �� � ��r��:: a �r� .
Certification for Alternative Soil Absorption System
Quick Plus Standard LP (Infiltrator)
Board of Health;
Joseph & Amanda Ramos, owner of 285 Rea Street, provides the following certification in accordance with
Section 11(l 8) of"Standard Conditions for Alternative Soil Absorption. Systems with General Use
Certification and/or Approved for Remedial Use':
1) The owner has been provided a copy of the Title 5 I/A technology approval, the Owners Manual, and
the Operation and Maintenance Manual, and the Owner agrees to comply with all terms and
conditions.
2) The owner agrees to provide a Deed Notice for the "Alternative Sewage Disposal System". Proof of
the recorded deed notice will be submitted to the Board of Health.
3) The owner agrees to fulfill his responsibilities to provide written notification of the Approval to an new
Owner, as required by 310 CMR 15.287(5).
4) The design does not provide for the use of garbage grinders and the owner understands this.
5) Whether or not covered by warranty, the System Owner understands the requirement to repair, replace,
modify or take any other action as required by the Department or the Local Approving Authority
(LAA), if the Department or the LAA determines the System to be failing to protect public health and
safety and the environment, as defined in 310 CMR 15.303.
Print Owners Name:
Date:
Owners Signature:
22 Mount Vernon Road Boxford, Massachusetts 01.921 (978) 352-7871-Phone 978 352-7871 - Fax