HomeMy WebLinkAboutLegal Document - 303 BERRY STREET 1/4/2016 ".3
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Notice of Alternative Sewage Disposal System
M.G.L. c. 21A, § 13 and 310 CMR 15.0287(10)
This Notice to be recorded and/or filed for registration in the chain of title of the Property served by an.Alternative
This Disposal System("Alternative System ),I
NAME(S)
OF OWNER OF PROPERTY SERVED BY ANTYRNTIVE SYSTEM:
:[P pnu r
ADDRESS OF PROPERTY SERVED BY ALTERNATIVE SYSTEM: 30�
—.4/74
TITLE REFERENCE FOR PROPERIFY SERVED BY ALTERNATIVE SYSTEM[check and
complete each that applies].
Registry of Deeds In Book
�fr� Z�4
A Deed recorded with the 7page
—Certificate of Title No. issued by the Land Registration office of tits
I-- ___Registry District
—Source of title other than by deed
[If Alternative System Owner(s)is other than Property owner(s),complete the folloNving:1
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(tile
"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
r6cordkeephig;
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 now 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 ihelalternatiyo 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,Noti6e of an alternative sewage disposal system is hereby given for the
.4bove-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. &04y( t7-4Jnh2/0,
Manufacturer Name: JLW
Y
Model number(s):
Page I of 2 UE" 0 2013
3
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roflTl'
2. Approval/Certification, on AV(7' 222013 . [date], the Department,pursuant to its authority
under the section of Title 5 as specified below, approved or certified the technology used in the above-
referenced alternative system,under MassDEP Transmittal Number XZZ 50 L 2- _ [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
XCertified for general use under 310 C-MR 15.288
A copy of the Department's Approval/Certification is available from the Department in person or on-
line at the Departtrient's website: littP://www..inassgoAl/I gep .
WITNESS the execution hereof under seal this Z day Of 4*PM klt- 201
the above-named Alternative System Owner(s). made by
'7
[Alternative System Owner(s)l
Print Name(s):
COMMONWEALTH OF MASSACHUSETTS
ss
On this 12- day of 10 t*.4 t3 0 / before me,the undersigned.notary public,personally <CF
appeared 7Hv"4--:S pr;jP-r.,-L V
(name of document signer),proved to me through satisfactory
evidence of identification, whiff were >p-I
to be the person vihose name IS a M
signed on the preceding or attached document, and acknowledged to me that(h ) (she)signed it z;2!
voluntarily for its stated purpose. J 04 a >
4.0
0 ^
(official signature and seal of notary) ,10
tr
-------------------------------- ------------------------------------------------------- ---------
[Complete the following Property Owner(s)Consent-if Alternative System Owner(s)is o------------------------------
ther than the Property
Owner(s):]
Z
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 me that(L) (she) signed it
voluntarily for its stated purpose.
Upon recording,return to: (official signature and seal of notary)
[Name and address of Property Owner(s)]
Page 2 of 2
i
RECEIPT
Printed: December 30, 2013 @ 11:59:5
Essex North Registry
M. Paul Iannuccillo
Register
Trans#: 29527 Oper:LRRECKM
THOMAS PERRY
Book: 13743 Page: 221 Inst#: 36365
Ctl#: 88 Rec:12-30-2013 @ 11:59:54a
NAND 303 BERRY ST
DOC DESCRIPTION TRANS AMT
---------
NOTICE
Surcharge CPA $20.00 20.00
50.00 recording fee 50.00
5.00 TECH FEE 5.00
Total flees: 75.00
Total charges: 75.00
CASH PMT PAYMENT -CASH 75.00