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Home My WebLink AboutLegal Document - 730 WINTER STREET 4/9/2014 Notice of Alternative Sewage Disposal System M.G.L. c. 21A, § 13 and 310 CMR 15.0287(10) his Notice to be recorded and/or filed for registration in the chain of title of the Property served by an Alternative ewage Disposal System("Alternative System").] NAME(S) OF OWNER OF PROPERTY SERVED BY ALTERNATIVE SYSTEM: ", 'E� v't-;-,n ADDRESS OF PROPERTY SERVED BY ALTERNATIVE SYSTEM: TITLE REFERENCE FOR PROPERTY SERVED BY ALTERNATIVE SYSTEM [check and complete each that applies]: Deed recorded with the VSS.e y: Registry of Deeds in Book 1 ,Page Certificate of Title No. issued by the Land Registration Office of the Registry District Source of title other than by deed [If 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 maybe subject to special conditions, as specified in the Department's approvals or certifications; such general and special conditions potentially including,without limitation,requirements relating to the use of trained operators,periodic inspections,maintenance, sampling,reporting and/or recordkeeping; WHEREAS, Section 15.287(10) of Title 5 of the State Environmental Code, 310 CMR 15.297(l 0),requires that"prior to obtaining a Certificate of Compliance for installation of a new or 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: Trade name of technology: CA)✓f Co °t�e+DT`� Manufacturer Name: "PC K--cal y t r_o e-,-1'�i� Y va G, Model number(s): Page 1 of 2 2. Approval/Certification. On 21 l Z- [date], the Department, pursuant to its authority under the section of Title 5 as spe ified below, approved or certified the technology used in the above- referenced alternative system, under MassDEP Transmittal Number V Z 15` fe [Transmittal Number of approval or certification]. [Check one of the following,as applicable:] Approved for remedial use under 310 CMR 15.284 Approved'-for piloting under 310 CMR 15.285 Provisionally approved under 310 CMR 15.286 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: http://www.mass.gov/de . WITNESS the execution hereof under seal this day of , 20 ,made by the above-named Alternative System Owner(s). -------- [Alternative S stem ON er(s)] Print Name(s . -�I i r l�1/�✓t y1 J� COMMONWEALTH OF MASSACHUSETTS ss On this day of��JYA` 20_4before me,the undersigned notary public,personally appeared[ft(i 12N (name of document signer),proved to me through satisfactory evidence of identification,which were Q h D L_ ,to be the person whose name is r attached document, and acknowledged to me that(he) (she)signed it vohjftr Yf stated urpose. Notalic Commonweaassachusetts 4(offficisignature nd seal otary) My Commission Expires July 3,2020 - ------------------------------------------------------------------------- [Complete the following Property Owner(s)Consent if Alternative System Owner(s)is other than the Property Owner(s):] CONSENTED TO: [Property Owner(s)] Print Name(s): Date: COMMONWEALTH OF MASSACHUSETTS 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 whose 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 Property Owner(s)] Page 2 of 2 ('dyr /IF" � S - � ��vTA"v�r'.i�'fl� Mailing: 237 Merrimac St., Newburyport, Ma 01950 Phone: 978-360-9358 Fax: 978-372-9970 Email: cjablonski @yahoo.com Operation anb Alaintenance Z[greement April 9, 2014 To: North Andover Health Department Essex County Registry of Deeds Alternative System Owner for 730 Winter St., North Andover, Ma Address: 730 Winter St. North Andover, Ma 01845 This contract is an agreement between the current property owner of 730 Winter St. in North Andover, Massachusetts and the North Andover Health Department stating that the alternative septic system.to be installed shall be inspected annually. The inspector must be a licensed Massachusetts Title V Inspector and certified by Enviro-Septic (Presby) to perform the inspection. The inspection will require a full Title V inspection including the septic tank distribution box, and inspection port. The inspection is the responsibility of the home owner as written in the deed. This contract expires April 8, 2015 and must be renewed annually. &0_ i ad SI Number Lice s "'Title V Inspector Iq Current l3roperty Owner C T 66 Prope ty Owner (Print) (Sign-and-Date) Owner's Certification for 730 Winter St., North Andover, Mass. I, bn� 13yv&v,) nq O , the Owner of record of 730 Winter St.,North Andover, Mass., her by certify to the following: i. have been provided a copy of the Title 5 I/A technology Approval, the Owner's Manual, and the Operation and Maintenance Manual for the Presby Enviro-Septic Wastewater Treatment System, and I agree to comply with all terms and conditions; ii. for Systems installed under a Remedial Use Approval, I agree to fulfill my responsibilities to provide written notification of the Approval to any new Owner, as required by 310 CMR 15.287(5); iii. the design does not provide for the use of garbage grinders,the restriction is understood and accepted; and iv. whether or not covered by a warranty, I understand the requirement to repair, replace, modify or take any other action as required by the Department or the 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 53-�- y Signed Date I c+� ua Q ti rl U � C a ® CD n '4 a) J �► (f) o UJ - 4�J a. th 3� ui U C n LIJ �-- a c L E (_ c6 0 y CL cu iiiiiii o ._ 76 w uj ui Ln � to ■ � � � O ®0�1p7 l,U Wak O � ji -1— 0