HomeMy WebLinkAboutNotice of Alternative Sewage Disposal System - Miscellaneous - 1761 SALEM STREET 12/2/2021 i�
Notice of Alternative Sewage Disposal System
M.G.L. c. 21A, § 13 and 310 CMR 15.0287(10)
(rThis Notice to be recorded and/or filed for re istration in the chain of title of the Property served by an
1�lternative Sewage Disposal System("Alternative System").]
NAME(S)OF OWNER OF PROPERTY SERVED BY ALTERNATIVE SYSTEM: JOSE VIERA
ADDRESS OF PROPERTY SERVED BY ALTERNATIVE SYSTEM: 1761 SALEM STREET,NORTH
ANDOVER,MA 01845.
TITLE REFERENCE FOR PROPERTY SERVED BY ALTERNATIVE SYSTEM [check and complete each
that applies]:
X_Deed recorded with the Essex North Registry of Deeds in Book 16482,Page 263
_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 may be
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 15.287(10),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:Presby Enviro-Septic Leaching System
Manufacturer Name: Infiltrator Water Technologies—Presby Environmental.
Model number(s):Presby Enviro-Septic®Leaching System
2. Annroval/Certification. On July 13,2013,revised September 26,2013,and Modified October 30,2019 [date],the
Department,pursuant to its authority under the section of Title 5 as specified below,approved or certified the
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technology used in the above-referenced alternative system,under MassDEP Transmittal Number X283867
[Transmittal Number of approval or certification].
[Check one of the following,as applicable:]
_X_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. og v/dep.
WITNESS the execution hereof under seal this day of ,20 ,made by the above-
named Alternative System Owner(s).
[Alternative System Owner(s)]
Print Name(s):
COMMONWEALTH OF MASSACHUSETTS
ss
On this day of December 20_, before me, the undersigned notary public, personally appeared Jose Viera,
proved to me through satisfactory evidence of identification,which were to
be the person whose name is signed on the preceding documents or attached document, and acknowledged to me that
he signed it voluntarily for its stated purposes,individually.
Notary Public:
My Commission Expires:
[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)]
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