64 GROVE STREET, BUILDING #3, SUBMETERING OF WATER AND SEWER CERTIFICATES MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH
SUBMETERING OF WATER AND SEWER CERTIFICATION FORM
In accordance with M.G.L. c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State
Sanitary Code, Chapter 1I the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer.
PROPERTY INFORMATION
Address: 64 Grove Street Building #3 Unit# 101 #Of units in bldg.38
City/Town: Salem MA Zip Code: 01970
EQUIPMENT INSTALLATION INFORMATION
105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for
submetering for water and/or sewer services. The devices must meet the following specifications: RECEIVED
Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm)
Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) MAR 17 2025
Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf)
CITY OF SALEM
The submetering equipment used to measure the quantity of water used for each dwelling unit and con n9Q?#PAEtffiALTH
meet the standards of accuracy and testing of the American Water Works Association or similar accredited association.
A Massachusetts licensed plumber must install the toilets and submetering equipment.
Submetering equipment information: MTW SUbmeter Solutions MTW MJ20-075C
Manufacturer Model#
LICENSED PLUMBER CERTIFICATION
I certify that(check all that apply):
❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards.
❑✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards.
The plumbing permit issued by the city/town,if required,is attached.
This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186, §22(p),does
not require the installation of a submeter.
Keith Rhodes &--tk kk,o-& 11433 02/21/2025
Licensed Plumber's Name Plumber' Signature License# Date
OWNER CERTIFICATION
I certify that:
(1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law
(MGL c. 186, §22).
(2)All showerheads, faucets and toilets in this dwelling unit meet the conservation standards specified above.
(3) The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and
complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, § 22).
(4) The water meter or submeter measures the water usage exclusive to this unit.
(5) I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the
separate charging of water and/or sewer service, and a copy of this certification form.
(6) All information included on this certification is true and accurate to the best of my knowledge.
THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING
Signed under the pains and penalties of perjury,
�
Rita Roberto /66 1 1694ce—& 03/06/2025
Name of Owner Signature of Owner Date—
LiThe property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date submitted to Local Health
186§22- Department:
Prior Owner's Signature Date
410-23-Submeteriniz of Water and Sewer Certification Form 5-12-23
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH
SUBMETERING OF WATER AND SEWER CERTIFICATION FORM
In accordance with M.G.L. c. 186, § 22 and 105 CMR 410.000: Minimum Standards of Fitness for Human Habitation, State
Sanitary Code, Chapter II the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer.
PROPERTY INFORMATION
Address: 64 Grove Street Building #3 Unit# 102 #Of units in bldg.38
City/Town: Salem MA Zi Code: 01970
EQUIPMENT INSTALLATION INFORMATION
105 CMR 410.130(C) requires the installation of water conservation devices prior to a dwelling unit becoming eligible for
submetering for water and/or sewer services. The devices must meet the following specifications: RECEIVED
Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm)
Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpin) MAR 17 2025
Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf)
CITY OF SALEM
The submetering equipment used to measure the quantity of water used for each dwelling unit and comm�q RqE#u ALTH
meet the standards of accuracy and testing of the American Water Works Association or similar accredited association.
A Massachusetts licensed plumber must install the toilets and submetering equipment.
Submetering equipment information: MTW S u b m ete r Solutions MTW MJ20-075C
Manufacturer Model#
LICENSED PLUMBER CERTIFICATION
I certify that(check all that apply):
❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards.
❑✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards.
The plumbing permit issued by the city/town,if required,is attached.
This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L. c. 186, §22(p),does
not require the installation of a submeter.
Keith Rhodes kk.a-& 11433 02/21/2025
Licensed Plumber's Name Plumber' Signature License# Date
OWNER CERTIFICATION
I certify that:
(1) This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law
(MGL c. 186, §22).
(2) All showerheads, faucets and toilets in this dwelling unit meet the conservation standards specified above.
(3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and
complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, § 22).
(4)The water meter or submeter measures the water usage exclusive to this unit.
(5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the
separate charging of water and/or sewer service, and a copy of this certification form.
(6) All information included on this certification is true and accurate to the best of my knowledge.
THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING
Signed under the pains and penalties of perjury, ��c--��- L ��..��cc�
Rita Roberto /66c 1 1646 & 03/06/2025
Name of Owner Signature of Owner Date
LiThe property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health
186§22- Department:
Prior Owner's Signature Date
410-23-Submetering of Water and Sewer Certification Form 5-12-23
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH
SUBMETERING OF WATER AND SEWER CERTIFICATION FORM
In accordance with M.G.L. c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State
Sanitary Code, Chapter II(the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer.
PROPERTY INFORMATION
Address: 64 Grove Street Building #3 Unit# 104 #Of units in bldg.38
City/Town: Salem MA Zip Code: 01970
EQUIPMENT INSTALLATION INFORMATION
105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for
submetering for water and/or sewer services. The devices must meet the following specifications: RECEIVE
Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm)
Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) MAR 17 2025
Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf)
CITY OF SALEM
The submetering equipment used to measure the quantity of water used for each dwelling unit and cP9ffR9Fe!J5AhTV
meet the standards of accuracy and testing of the American Water Works Association or similar accredited association.
A Massachusetts licensed plumber must install the toilets and submetering equipment.
Submetering equipment information: MTW Submeter Solutions MTW MJ20-075C
Manufacturer Model#
LICENSED PLUMBER CERTIFICATION
I certify that(check all that apply):
❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards.
✓❑ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards.
WIThe plumbing permit issued by the city/town,if required, is attached.
This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186, § 22(p),does
not require the installation of a submeter.
Keith Rhodes &--tk zko-& 11433 02/21/2025
Licensed Plumber's Name Plumber' Signature License# Date
OWNER CERTIFICATION
I certify that:
(1) This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law
(MGL c. 186, §22).
(2) All showerheads, faucets and toilets in this dwelling unit meet the conservation standards specified above.
(3) The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and
complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, § 22).
(4) The water meter or submeter measures the water usage exclusive to this unit.
(5)1 will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the
separate charging of water and/or sewer service, and a copy of this certification form.
(6) All information included on this certification is true and accurate to the best of my knowledge.
THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING
Signed under the pains and penalties of perjury,Rita Roberto A�c� A949& 03/06/2025
Name of Owner Signature of Owner Date
The property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health
lab§22- Department:
Prior Owner's Signature Date
410-23-Submetering of Water and Sewer Certification Form 5-12-23
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH
SUBMETERING OF WATER AND SEWER CERTIFICATION FORM
In accordance with M.G.L. c. 186, § 22 and 105 CMR 410.000: Minimum Standards of Fitness for Human Habitation, State
Sanitary Code, Chapter II the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer.
PROPERTY INFORMATION
Address: 64 Grove Street Building #3 Unit# 105 #Of units in bldg. 38
City/Town: Salem MA Zip Code: 01970
EQUIPMENT INSTALLATION INFORMATION
105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for
submetering for water and/or sewer services. The devices must meet the following specifications: RECEIVED
Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) MAR 17 2025
Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm)
Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) CITY OF SALEM
The submetering equipment used to measure the quantity of water used for each dwelling unit and common arreeaOmus�ALTH
meet the standards of accuracy and testing of the American Water Works Association or similar accredited association.
A Massachusetts licensed plumber must install the toilets and submetering equipment.
Submetering equipment information: MTW Submeter Solutions MTW MJ20-075C
Manufacturer Model#
LICENSED PLUMBER CERTIFICATION
I certify that(check all that apply):
✓❑ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards.
✓❑ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards.
WIThe plumbing permit issued by the city/town,if required,is attached.
This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L .c. 186, §22(p),does
not require the installation of a submeter.
Keith Rhodes kkpat" ' 11433 02/21/2025
Licensed Plumber's Name Plumber' Signature License# Date
OWNER CERTIFICATION
I certify that:
(1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law
(MGL c. 186, §22).
(2)All showerheads, faucets and toilets in this dwelling unit meet the conservation standards specified above.
(3) The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and
complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, § 22).
(4) The water meter or submeter measures the water usage exclusive to this unit.
(5) I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the
separate charging of water and/or sewer service, and a copy of this certification form.
(6) All information included on this certification is true and accurate to the best of my knowledge.
THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING
Signed under the pains and penalties of perjury,
Rita Roberto Ae�_ 146&& 03/06/2025
Name of Owner Signature of Owner Date
The property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health
186§22- Department:
Prior Owner's Signature Date
410-23-Submetering of Water and Sewer Certification Form 5-12-23
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH
SUBMETERING OF WATER AND SEWER CERTIFICATION FORM
In accordance with M.G.L. c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State
Sanitary Code, Chapter II the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer.
PROPERTY INFORMATION
Address: 64 Grove Street Building #3 Unit# 106 #Of units in bldg.38
City/Town: Salem MA Zip Code: 01970
EQUIPMENT INSTALLATION INFORMATION
105 CMR 410.130(C) requires the installation of water conservation devices prior to a dwelling unit bec e or
submetering for water and/or sewer services. The devices must meet the following specifications: ED
Showerheads with maximum flow rate not to exceed 2.5 gallons per minute (gpm) MAR 17 2025
Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm)
Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) CITY OF SALEM
60ARD OF HEALTH
The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must
meet the standards of accuracy and testing of the American Water Works Association or similar accredited association.
A Massachusetts licensed plumber must install the toilets and submetering equipment.
Submetering equipment information: MTW SUbmeter Solutions MTW MJ20-075C
Manufacturer Model#
LICENSED PLUMBER CERTIFICATION
I certify that(check all that apply):
❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards.
�✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards.
P/lThe plumbing permit issued by the city/town,if required,is attached.
This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L . c. 186, §22(p),does
not require the installation of a submeter.
Keith Rhodes &--d, kR.o& 11433 02/21/2025
Licensed Plumber's Name Plumber' Signature License# Date
OWNER CERTIFICATION
I certify that:
(1) This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law
(MGL c. 186, §22).
(2) All showerheads, faucets and toilets in this dwelling unit meet the conservation standards specified above.
(3) The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and
complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, § 22).
(4)The water meter or submeter measures the water usage exclusive to this unit.
(5)1 will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the
separate charging of water and/or sewer service, and a copy of this certification form.
(6) All information included on this certification is true and accurate to the best of my knowledge.
THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING
Signed under the pains and penalties of perjury, /} [
Rita Roberto 03/06/2025
Name of Owner Signature of Owner Date
LiThe property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health
186§22- Department:
Prior Owner's Signature Date
410-23-Submetering of Water and Sewer Certification Form 5-12-23
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH
SUBMETERING OF WATER AND SEWER CERTIFICATION FORM
In accordance with M.G.L. c. 186, § 22 and 105 CMR 410.000: Minimum Standards of Fitness for Human Habitation, State
Sanitary Code, Chapter II(the"Housing Code"),the following dwelling unit is eligible for submetering water and sewer.
PROPERTY INFORMATION
Address: 64 Grove Street Building #3 Unit# 107 #Of units in bldg.38
City/Town: Salem MA Zi Code: 01970
EQUIPMENT INSTALLATION INFORMATION
105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit bee AtCEI1
ED
submetering for water and/or sewer services. The devices must meet the following specifications:
Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) MAR 17 2025
Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm)
Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) CITY OF SALEM
BOARD OF HEALTH
The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must
meet the standards of accuracy and testing of the American Water Works Association or similar accredited association.
A Massachusetts licensed plumber must install the toilets and submetering equipment.
Submetering equipment information: M TW S u b m ete r Solutions MTW MJ20-075C
Manufacturer Model#
LICENSED PLUMBER CERTIFICATION
I certify that(check all that apply):
❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards.
✓❑ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards.
The plumbing permit issued by the city/town,if required,is attached.
This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L. C. 186, § 22(p),does
not require the installation of a submeter.
Keith Rhodes Uz-& 11433 02/21/2025
Licensed Plumber's Name Plumber' Signature License# Date
OWNER CERTIFICATION
I certify that:
(1) This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law
(MGL c. 186, §22).
(2)All showerheads, faucets and toilets in this dwelling unit meet the conservation standards specified above.
(3) The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and
complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, § 22).
(4) The water meter or submeter measures the water usage exclusive to this unit.
(5) I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the
separate charging of water and/or sewer service, and a copy of this certification form.
(6) All information included on this certification is true and accurate to the best of my knowledge.
THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING
Signed under the pains and penalties of perjury,
Rita Roberto /&&�& 1694d&_ 03/06/2025
Name of Owner Signature of Owner Date
LiThe property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L C. Date Submitted to Local Health
186§22- Department:
Prior Owner's Signature Date
410-23-Submetering of Water and Sewer Certification Form 5-12-23
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH
SUBMETERING OF WATER AND SEWER CERTIFICATION FORM
In accordance with M.G.L. c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State
Sanitary Code, Chapter II(the"Housing Code" , the following dwelling unit is eligible for subractering water and sewer.
PROPERTY INFORMATION
Address: 64 Grove Street Building #3 Unit# 108 #Of units in bldg.38
City/Town: Salem MA Zi Code: 01970
EQUIPMENT INSTALLATION INFORMATION
105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for
submetering for water and/or sewer services. The devices must meet the following specifications: RECEIVED
Showerheads with maximum flow rate not to exceed 2.5 gallons per minute (gpm)
Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm) MAR 17 2025
Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf)
CITY OF SALEM
The submetering equipment used to measure the quantity of water used for each dwelling unit and commol AR01CHHEALTH
meet the standards of accuracy and testing of the American Water Works Association or similar accredited association.
A Massachusetts licensed plumber must install the toilets and submetering equipment.
Submetering equipment information: MTW SUbmeter Solutions MTW MJ20-075C
Manufacturer Model#
LICENSED PLUMBER CERTIFICATION
I certify that(check all that apply):
✓❑ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards.
✓❑ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards.
WIThe plumbing permit issued by the city/town,if required,is attached.
This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L. c. 186, § 22(p),does
not require the installation of a submeter.
Keith Rhodes 11433 02/21/2025
Licensed Plumber's Name Plumber' Signature License# Date
OWNER CERTIFICATION
I certify that:
(1) This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law
(MGL c. 186, §22).
(2)All showerheads, faucets and toilets in this dwelling unit meet the conservation standards specified above.
(3) The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and
complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, § 22).
(4) The water meter or submeter measures the water usage exclusive to this unit.
(5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the
separate charging of water and/or sewer service, and a copy of this certification form.
(6) All information included on this certification is true and accurate to the best of my knowledge.
THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING
Signed under the pains and penalties of perjury,
Rita Roberto /&� �C� 03/06/2025
Name of Owner Signature of Owner Date
LiThe property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health
186§22- Department:
Prior Owner's Signature Date
410-23-Submetering of Water and Sewer Certification Form 5-12-23
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH
SUBMETERING OF WATER AND SEWER CERTIFICATION FORM
In accordance with M.G.L. c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State
Sanitary Code, Chapter II the"Housing Code"),the following dwelling unit is eligible for submetering water and sewer.
PROPERTY INFORMATION
Address: 64 Grove Street Building #3 Unit# 109 #Of units in bldu. 38
City/Town: Salem MA zip Code: 01970
EQUIPMENT INSTALLATION INFORMATION
105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit beeQ 1
submetering for water and/or sewer services. The devices must meet the following specifications: It b
Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) MAR 17 2025
Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm)
Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) CITY OF SALEM
BOARD OF HEALTH
The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must
meet the standards of accuracy and testing of the American Water Works Association or similar accredited association.
A Massachusetts licensed plumber must install the toilets and submetering equipment.
Submetering equipment information: MTW Submeter Solutions MTW MJ20-075C
Manufacturer Model#
LICENSED PLUMBER CERTIFICATION
I certify that(check all that apply):
✓❑ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards.
❑✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards.
WIThe plumbing permit issued by the city/town,if required,is attached.
This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L. c. 186,§22(p),does
not require the installation of a submeter.
Keith Rhodes &tk viff& 11433 02/21/2025
Licensed Plumber's Name Plumber' Signature License# Date
OWNER CERTIFICATION
I certify that:
(1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law
(MGL c. 186, §22).
(2)All showerheads, faucets and toilets in this dwelling unit meet the conservation standards specified above.
(3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and
complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, § 22).
(4) The water meter or submeter measures the water usage exclusive to this unit.
(5) 1 will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the
separate charging of water and/or sewer service, and a copy of this certification form.
(6) All information included on this certification is true and accurate to the best of my knowledge.
THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING
Signed under the pains and penalties of perjury,Rita Roberto Ae�_ A949& 03/06/2025
Name of Owner Signature of Owner Date
The property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local Health
186§22- Department:
Prior Owner's Signature Date
410-23-Submetering of Water and Sewer Certification Form 5-12-23
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH
SUBMETERING OF WATER AND SEWER CERTIFICATION FORM
In accordance with M.G.L. c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State
Sanitary Code, Chapter II the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer.
PROPERTY INFORMATION
Address: 64 Grove Street Building #3 Unit# 110 # Of units in bldg.38
City/Town: Salem MA Zip Code: 01970
EQUIPMENT INSTALLATION INFORMATION
105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becgln�g,�ji2iV
6
submetering for water and/or sewer services. The devices must meet the following specifications: '-j�(�t �/
Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm) MAR 17 2025
Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm)
Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf) CITY OF SALEM
BOARD OF HEALTH
The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must
meet the standards of accuracy and testing of the American Water Works Association or similar accredited association.
A Massachusetts licensed plumber must install the toilets and submetering equipment.
Submetering equipment information: MTW Submeter Solutions MTW MJ20-075C
Manufacturer Model#
LICENSED PLUMBER CERTIFICATION
I certify that(check all that apply):
❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards.
�✓ 1 have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards.
The plumbing permit issued by the city/town, if required,is attached.
This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186, §22(p),does
not require the installation of a submeter.
Keith Rhodes cka Tlo-& 11433 02/21/2025
Licensed Plumber's Name Plumber' Signature License# Date
OWNER CERTIFICATION
I certify that:
(1) This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law
(MGL c. 186, §22).
(2)All showerheads, faucets and toilets in this dwelling unit meet the conservation standards specified above.
(3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and
complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, § 22).
(4) The water meter or submeter measures the water usage exclusive to this unit.
(5) I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the
separate charging of water and/or sewer service, and a copy of this certification form.
(6) All information included on this certification is true and accurate to the best of my knowledge.
THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING
Signed under the pains and penalties of perjury,
Rita Roberto A� 149;&& 03/06/2025
Name of Owner Signature of Owner Date J
The property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G. c. Date Submitted to Local Health
185§zz- Department:
Prior Owner's Signature Date
410-23-Submetering of Water and Sewer Certification Form 5-12-23
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH
SUBMETERING OF WATER AND SEWER CERTIFICATION FORM
In accordance with M.G.L. c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State
Sanitary Code, Chapter II(the "Housing Code"),the following dwelling unit is eligible for submetering water and sewer.
PROPERTY INFORMATION
Address: 64 Grove Street Building #3 Unit# 201 #Of units in bldg.38
City/Town: Salem MA Zi Code: 01970
EQUIPMENT INSTALLATION INFORMATION
105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for
submetering for water and/or sewer services. The devices must meet the following specifications:
Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm)
Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm)
Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf)
The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must
meet the standards of accuracy and testing of the American Water Works Association or similar accredited association.
A Massachusetts licensed plumber must install the toilets and submetering equipment.
Submetering equipment information: MTW SUbmeter Solutions MTW MJ20-075C
Manufacturer Model#
LICENSED PLUMBER CERTIFICATION
I certify that(check all that apply):
❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards.
�✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards.
The plumbing permit issued by the city/town,if required,is attached.
This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186, §22(p),does
not require the installation of a submeter.
Keith Rhodes kkcd, 11433 02/21/2025
Licensed Plumber's Name Plumber' Signature License# Date
OWNER CERTIFICATION
I certify that:
(1) This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law
(MGL c. 186, §22).
(2)All showerheads, faucets and toilets in this dwelling unit meet the conservation standards specified above.
(3) The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and
complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, § 22).
(4) The water meter or submeter measures the water usage exclusive to this unit.
(5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the
separate charging of water and/or sewer service, and a copy of this certification form.
(6) All information included on this certification is true and accurate to the best of my knowledge.
THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING
Signed under the pains and penalties of perjury,
Rita Roberto + 03/06/2025
Name of Owner Signature of Owner Date
The property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Subnf ikd
186§22- Department:
Prior Owner's Signature Date
CITY OF SALEM
BOARD OF HEALTH
410-23-Submeteriniz of Water and Sewer Certification Form 5-12-23
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH
SUBMETERING OF WATER AND SEWER CERTIFICATION FORM
In accordance with M.G.L. c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State
Sanitary Code, Cha ter II the"Housin Code" ),the followin dwellin unit is eli ible for submeterin water and sewer.
PROPERTY INFORMATION
Address: 64 Grove Street Building #3 Unit# 202 #Of units in bldg.38
City/Town: Salem MA Zip Code: 01970
EQUIPMENT INSTALLATION INFORMATION
105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for
submetering for water and/or sewer services. The devices must meet the following specifications:
Showerheads with maximum flow rate not to exceed 2.5 gallons per minute (gpm)
Faucets with maximum flow rate not to exceed 2.2 gallons per minute (gpm)
Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf)
The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must
meet the standards of accuracy and testing of the American Water Works Association or similar accredited association.
A Massachusetts licensed plumber must install the toilets and submetering equipment.
Submetering equipment information: MTW S U b m ete r Solutions MTW MJ20-075C
Manufacturer Model#
LICENSED PLUMBER CERTIFICATION
I certify that(check all that apply):
❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards.
�✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards.
WIThe plumbing permit issued by the city/town,if required,is attached.
This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L L. c. 186, §22(p),does
not require the installation of a submeter.
Keith Rhodes kko-& 11433 02/21/2025
Licensed Plumber's Name Plumber' Signature License# Date
OWNER CERTIFICATION
I certify that:
(1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law
(MGL c. 186, §22).
(2)All Showerheads, faucets and toilets in this dwelling unit meet the conservation standards specified above.
(3) The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and
complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, § 22).
(4) The water meter or submeter measures the water usage exclusive to this unit.
(5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the
separate charging of water and/or sewer service, and a copy of this certification form.
(6) All information included on this certification is true and accurate to the best of my knowledge.
THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING
Signed under the pains and penalties of perjury,
Rita Roberto A� A49;&& 03/06/2025
Name of Owner Signature of Owner Date
The property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Subm"L30t9Vl p4h
186§22- Department: V L..
Prior Owner's Signature Date
CITY OF SALEM
410-23-Submetering of Water and Sewer Certification Form 5-12-23 BOARD OF HEALTH
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH
SUBMETERING OF WATER AND SEWER CERTIFICATION FORM
In accordance with M.G.L. c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State
Sanitary Code, Chapter II the"Housing Code"),the following dwelling unit is eligible for submetering water and sewer.
PROPERTY INFORMATION
Address: 64 Grove Street Building #3 unit# 203 #Of units in bldg.38
City/Town: Salem MA Zip Code: 01970
EQUIPMENT INSTALLATION INFORMATION
105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for
submetering for water and/or sewer services. The devices must meet the following specifications:
Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm)
Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm)
Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf)
The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must
meet the standards of accuracy and testing of the American Water Works Association or similar accredited association.
A Massachusetts licensed plumber must install the toilets and submetering equipment.
Submetering equipment information: MTW Submeter Solutions MTW MJ20-075C
Manufacturer Model#
LICENSED PLUMBER CERTIFICATION
I certify that(check all that apply):
❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards.
�✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards.
WIThe plumbing permit issued by the city/town,if required,is attached.
This dwelling unit is connected directly to a meter installed by a water company and, in accordance with M.G.L .c. 186, §22(p),does
not require the installation of a submeter.
Keith Rhodes dC�a Tlo-& 11433 02/21/2025
Licensed Plumber's Name Plumber' Signature License# Date
OWNER CERTIFICATION
I certify that:
(1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law
(MGL c. 186, §22).
(2)All showerheads, faucets and toilets in this dwelling unit meet the conservation standards specified above.
(3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and
complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, § 22).
(4) The water meter or submeter measures the water usage exclusive to this unit.
(5)1 will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the
separate charging of water and/or sewer service, and a copy of this certification form.
(6) All information included on this certification is true and accurate to the best of my knowledge.
THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING
Signed under the pains and penalties of perjury, AWC&
Rita Roberto /&� 03/06/2025
Name of Owner Signature of Owner SubmQ�fDattee j
The property has been transferred to the owner above and the unit remains in compliance with the requirements of AGI c. Date rtmentY[3-ill/lt.af 11
186§22- Department:
Prior Owner's Signature Date
CITY OF SALEM
BOARD OF HEALTH
410-23-Submetering of Water and Sewer Certification Form 5-12-23
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH
SUBMETERING OF WATER AND SEWER CERTIFICATION FORM
In accordance with M.G.L. c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State
Sanitam- Code, Chai?ter II(the "Housing Code" ),the following dwelling unit is eligible for submetering water and sewer.
PROPERTY INFORMATION
Address: 64 Grove Street Building #3 Unit# 204 #Of units in bldg.38
City/Town: Salem MA Zip Code: 01970
EQUIPMENT INSTALLATION INFORMATION
105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for
submetering for water and/or sewer services. The devices must meet the following specifications:
Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm)
Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm)
Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf)
The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must
meet the standards of accuracy and testing of the American Water Works Association or similar accredited association.
A Massachusetts licensed plumber must install the toilets and submetering equipment.
Submetering equipment information: MTW Submeter Solutions MTW MJ20-075C
Manufacturer Model#
LICENSED PLUMBER CERTIFICATION
I certify that(check all that apply):
✓❑ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards.
✓❑ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards.
WIThe plumbing permit issued by the city/town,if required,is attached.
This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L. c. 186, §22(p),does
not require the installation of a submeter.
Keith Rhodes kP,o LU, 11433 02/21/2025
Licensed Plumber's Name Plumber' Signature License# Date
OWNER CERTIFICATION
I certify that:
(1) This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law
(MGL c. 186, §22).
(2)All showerheads, faucets and toilets in this dwelling unit meet the conservation standards specified above.
(3) The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and
complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, § 22).
(4) The water meter or submeter measures the water usage exclusive to this unit.
(5) I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the
separate charging of water and/or sewer service, and a copy of this certification form.
(6) All information included on this certification is true and accurate to the best of my knowledge.
THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING
Signed under the pains and penalties of perjury,
Rita Roberto 03/06/2025
Name of Owner Signature of Owner e
The property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Sub,VT11FAjAtL&MtzkA1th
186§22- Department:Prior Owner's Signature Date A?�n�5
CITY OF SALEM
BOARD OF HEALTH
410-23-Submetering of Water and Sewer Certification Form 5-12-23
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH
SUBMETERING OF WATER AND SEWER CERTIFICATION FORM
In accordance with M.G.L. c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State
Sanitary Code, Chapter II(the"Housing Code"),the following dwelling unit is eligible for submetering water and sewer.
PROPERTY INFORMATION
Address: 64 Grove Street Building #3 Unit# 205 #Of units in bldg. 38
City/Town: Salem MA Zip Code: 01970
EQUIPMENT INSTALLATION INFORMATION
105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for
submetering for water and/or sewer services. The devices must meet the following specifications:
Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm)
Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm)
Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf)
The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must
meet the standards of accuracy and testing of the American Water Works Association or similar accredited association.
A Massachusetts licensed plumber must install the toilets and submetering equipment.
Submetering equipment information: MTW SUbmeter Solutions MTW MJ20-075C
Manufacturer Model#
LICENSED PLUMBER CERTIFICATION
I certify that(check all that apply):
❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards.
❑✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards.
FV] The plumbing permit issued by the city/town,if required,is attached.
This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L . c. 186, §22(p),does
not require the installation of a submeter.
Keith Rhodes kko-dL ' 11433 02/21/2025
Licensed Plumber's Name Plumber' Signature License# Date
OWNER CERTIFICATION
I certify that:
(1) This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law
(MGL c. 186, §22).
(2) All showerheads, faucets and toilets in this dwelling unit meet the conservation standards specified above.
(3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and
complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, § 22).
(4)The water meter or submeter measures the water usage exclusive to this unit.
(5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the
separate charging of water and/or sewer service, and a copy of this certification form.
(6) All information included on this certification is true and accurate to the best of my knowledge.
THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING
Signed under the pains and penalties of perjury, �wRita Roberto Ae�_ AW9& 03/06/2025
Name of Owner Si nature of Owner t
The property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L C. Date I 1 alth
186§22- Deparrtt ment:
Prior Owner's Signature Date MAR 17 2 0 2�
CITY OF SALEM
BOARD OF HEALTH
410-23-Submetering of Water and Sewer Certification Form 5-12-23
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH
SUBMETERING OF WATER AND SEWER CERTIFICATION FORM
In accordance with M.G.L. c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State
Sanitary Code, Cha Ater II(the "Housing Code" ,the following dwelling unit is eligible for submetering water and sewer.
PROPERTY INFORMATION
Address: 64 Grove Street Building #3 Unit# 206 #Of units in bldg.38
City/Town: Salem MA Zi Code: 01970
EQUIPMENT INSTALLATION INFORMATION
105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for
submetering for water and/or sewer services. The devices must meet the following specifications:
Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm)
Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm)
Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf)
The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must
meet the standards of accuracy and testing of the American Water Works Association or similar accredited association.
A Massachusetts licensed plumber must install the toilets and submetering equipment.
Submetering equipment information: MTW Submeter Solutions MTW MJ20-075C
Manufacturer Model#
LICENSED PLUMBER CERTIFICATION
I certify that(check all that apply):
❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards.
�✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards.
W] The plumbing permit issued by the city/town,if required, is attached.
This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186, §22(p),does
not require the installation of a submeter.
Keith Rhodes kko-& 11433 02/21/2025
Licensed Plumber's Name Plumber' Signature License# Date
OWNER CERTIFICATION
I certify that:
(1) This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law
(MGL c. 186, §22).
(2)All showerheads, faucets and toilets in this dwelling unit meet the conservation standards specified above.
(3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and
complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, § 22).
(4)The water meter or submeter measures the water usage exclusive to this unit.
(5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the
separate charging of water and/or sewer service, and a copy of this certification form.
(6) All information included on this certification is true and accurate to the best of my knowledge.
THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING
Signed under the pains and penalties of perjury, ll ""��
Rita Roberto �(7�.(.� 03/06/2025
Name of Owner Signature of Owner
The property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Sub n alth
186§22- Department:
Prior Owner's Signature Date
CITY OF SALEM
BOARD OF HEALTH
410-23-Submetering of Water and Sewer Certification Form 5-12-23
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH
SUBMETERING OF WATER AND SEWER CERTIFICATION FORM
In accordance with M.G.L. c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State
Sanitary Code, Chapter II the"Housing Code" ),the following dwelling unit is eligible for submetering water and sewer.
PROPERTY INFORMATION
Address: 64 Grove Street Building #3 unit# 207 #Of units in bide.38
City/Town: Salem MA Zip Code: 01970
EQUIPMENT INSTALLATION INFORMATION
105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for
submetering for water and/or sewer services. The devices must meet the following specifications:
Showerheads with maximum flow rate not to exceed 2.5 gallons per minute (gpm)
Faucets with maximum flow rate not to exceed 2.2 gallons per minute (gpm)
Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf)
The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must
meet the standards of accuracy and testing of the American Water Works Association or similar accredited association.
A Massachusetts licensed plumber must install the toilets and submetering equipment.
Submetering equipment information: MTW SUbmeter Solutions MTW MJ20-075C
Manufacturer Model#
LICENSED PLUMBER CERTIFICATION
I certify that(check all that apply):
❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards.
❑✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards.
WIThe plumbing permit issued by the city/town,if required,is attached.
This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L. c. 186, §22(p),does
not require the installation of a submeter.
Keith Rhodes &--tk aka 11433 02/21/2025
Licensed Plumber's Name Plumber' Signature License# Date
OWNER CERTIFICATION
I certify that:
(1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law
(MGL c. 186, §22).
(2)All showerheads, faucets and toilets in this dwelling unit meet the conservation standards specified above.
(3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and
complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, § 22).
(4)The water meter or submeter measures the water usage exclusive to this unit.
(5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the
separate charging of water and/or sewer service, and a copy of this certification form.
(6) All information included on this certification is true and accurate to the best of my knowledge.
THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING
Signed under the pains and penalties of perjury,
Rita Roberto 1&_ /64_9&& 03/06/2025
Name of Owner Signature of Owner Date
The property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date SubHECAE4VE&Ith
186§22- Department:
Prior Owner's Signature Date
CITY OF SALEM
BOARD OF HEALTH
410-23-Submetering of Water and Sewer Certification Form 5-12-23
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH
SUBMETERING OF WATER AND SEWER CERTIFICATION FORM
In accordance with M.G.L. c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for.Human Habitation, State
Sanitary Code, Chapter II(the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer.
PROPERTY INFORMATION
Address: 64 Grove Street Building #3 Unit# 208 #Of units in bldg.38
City/Town: Salem MA Zip Code: 01970
EQUIPMENT INSTALLATION INFORMATION
105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for
submetering for water and/or sewer services. The devices must meet the following specifications:
Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm)
Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm)
Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf)
The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must
meet the standards of accuracy and testing of the American Water Works Association or similar accredited association.
A Massachusetts licensed plumber must install the toilets and submetering equipment.
Submetering equipment information: MTW SUbmeter Solutions MTW MJ20-075C
Manufacturer Model#
LICENSED PLUMBER CERTIFICATION
I certify that(check all that apply):
❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards.
❑✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards.
7 The plumbing permit issued by the city/town,if required, is attached.
This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L c. 186, §22(p),does
not require the installation of a submeter.
Keith Rhodes ckia z 11433 02/21/2025
Licensed Plumber's Name Plumber' Signature License# Date
OWNER CERTIFICATION
I certify that:
(1) This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law
(MGL c. 186, §22).
(2)All showerheads, faucets and toilets in this dwelling unit meet the conservation standards specified above.
(3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and
complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, § 22).
(4) The water meter or submeter measures the water usage exclusive to this unit.
(5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the
separate charging of water and/or sewer service, and a copy of this certification form.
(6) All information included on this certification is true and accurate to the best of my knowledge.
THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING
Signed under the pains and penalties of perjury, ____,,cc.�
Rita Roberto C�B(�f!.(. 03/06/2025
Name of Owner Signature of Owner
�a j '^ _
The property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Su ml lW iiYlW CM LLiDth
lab§22- Department:
Prior Owner's Signature Date —1Y1fi� 7 25
CITY OF SALEM
BOARD OF HEALTH
410-23-Submetering of Water and Sewer Certification Form 5-12-23
• MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH
SUBMETERING OF WATER AND SEWER CERTIFICATION FORM
In accordance with M.G.L. c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State
Sanitary Code, Chapter II(the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer.
PROPERTY INFORMATION
Address: 64 Grove Street Building #3 Unit# 209 #Of units in bldyT.38
City/Town: Salem MA Zip Code: 01970
EQUIPMENT INSTALLATION INFORMATION
105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for
submetering for water and/or sewer services. The devices must meet the following specifications:
Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm)
Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm)
Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf)
The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must
meet the standards of accuracy and testing of the American Water Works Association or similar accredited association.
A Massachusetts licensed plumber must install the toilets and submetering equipment.
Submetering equipment information: M T W S U b m et e r Solutions MTW MJ 20-075 C
Manufacturer Model#
LICENSED PLUMBER CERTIFICATION
I certify that(check all that apply):
❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards.
�✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards.
The plumbing permit issued by the city/town,if required,is attached.
This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186, §22(p),does
not require the installation of a submeter.
Keith Rhodes R64a 11433 02/21/2025
Licensed Plumber's Name Plumber' Signature License# Date
OWNER CERTIFICATION
I certify that:
(1) This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law
(MGL c. 186, §22).
(2)All showerheads, faucets and toilets in this dwelling unit meet the conservation standards specified above.
(3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and
complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, § 22).
(4)The water meter or submeter measures the water usage exclusive to this unit.
(5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the
separate charging of water and/or sewer service, and a copy of this certification form.
(6) All information included on this certification is true and accurate to the best of my knowledge.
THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING
Signed under the pains and penalties of perjury,
Rita Roberto /6e�_ 1649; & 03/06/2025
Name of Owner Signature of Owner _
The property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date SubnIiAe O OC I Ith
:
Department
186§z2- Prior Owner's Signature Date MAR 17 2025_ J
CITY OF SALEM
BOARD OF HEALTH
410-23-Submetering of Water and Sewer Certification Form 5-12-23
` MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH
SUBMETERING OF WATER AND SEWER CERTIFICATION FORM
In accordance with M.G.L. c. 186, § 22 and 105 CMR 410.000: Minimum Standards of Fitness for Human Habitation, State
Sanitary Code, Chapter II the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer.
PROPERTY INFORMATION
Address: 64 Grove Street Building #3 Unit# 210 #Of units in bldg.38
City/Town: Salem MA Zip Code: 01970
EQUIPMENT INSTALLATION INFORMATION
105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for
submetering for water and/or sewer services. The devices must meet the following specifications:
Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm)
Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm)
Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf)
The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must
meet the standards of accuracy and testing of the American Water Works Association or similar accredited association.
A Massachusetts licensed plumber must install the toilets and submetering equipment.
Submetering equipment information: MTW S u b m ete r Solutions MTW MJ20-075C
Manufacturer Model#
LICENSED PLUMBER CERTIFICATION
I certify that(check all that apply):
❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards.
�✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards.
FV] The plumbing permit issued by the city/town,if required,is attached.
This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186, § 22(p),does
not require the installation of a submeter.
Keith Rhodes &--d1, kkv-& 11433 02/21/2025
Licensed Plumber's Name Plumber' Signature License# Date
OWNER CERTIFICATION
I certify that:
(1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law
(MGL c. 186, §22).
(2)All showerheads, faucets and toilets in this dwelling unit meet the conservation standards specified above.
(3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and
complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, § 22).
(4)The water meter or submeter measures the water usage exclusive to this unit.
(5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the
separate charging of water and/or sewer service, and a copy of this certification form.
(6) All information included on this certification is true and accurate to the best of my knowledge.
THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING
Signed under the pains and penalties of perjury,
Rita Roberto Ae�— 1649& 03/06/2025
Name of Owner Signature of Owner Date
The property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Sub EC Ith
186§22- Department:Prior Owner's Signature Date ri
CITY OF SALEM
BOARD OF HEALTH
410-23-Submetering of Water and Sewer Certification Form 5-12-23
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH
SUBMETERING OF WATER AND SEWER CERTIFICATION FORM
In accordance with M.G.L. c. 186, § 22 and 105 CMR 410.000:Minimum Standards of'Fitness for Human Habitation, State
Sanitary Code, Chapter II(the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer.
PROPERTY INFORMATION
Address: 64 Grove Street Building #3 Unit# 301 #Of units in bldg.38
City/Town: Salem MA Zip Code: 01970
EQUIPMENT INSTALLATION INFORMATION
105 CMR 410.130(C) requires the installation of water conservation devices prior to a dwelling unit becoming eligible for
submetering for water and/or sewer services. The devices must meet the following specifications:
Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm)
Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm)
Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf)
The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must
meet the standards of accuracy and testing of the American Water Works Association or similar accredited association.
A Massachusetts licensed plumber must install the toilets and submetering equipment.
Submetering equipment information: M TW S u b m ete r Solutions MTW MJ20-075C
Manufacturer Model#
LICENSED PLUMBER CERTIFICATION
I certify that(check all that apply):
✓❑ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards.
❑✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards.
WIThe plumbing permit issued by the city/town,if required,is attached.
This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L. c. 186, § 22(p),does
not require the installation of a submeter.
Keith Rhodes &-di, ao-& 11433 02/21/2025
Licensed Plumber's Name Plumber' Signature License# Date
OWNER CERTIFICATION
I certify that:
(1) This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law
(MGL c. 186, §22).
(2)All showerheads, faucets and toilets in this dwelling unit meet the conservation standards specified above.
(3) The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and
complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, § 22).
(4) The water meter or submeter measures the water usage exclusive to this unit.
(5) 1 will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the
separate charging of water and/or sewer service, and a copy of this certification form.
(6) All information included on this certification is true and accurate to the best of my knowledge.
THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING
Signed under the pains and penalties of perjury, _,c [
Rita Roberto /6621 �C�9;e—& 03/06/2025
Name of Owner Signature of Owner
LiThe property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date SubnH MtMth
186§Zz- Department:
Prior Owner's Signature Date MAR 1. 7 2025
CITY OF SALEM
BOARD OF HEALTH
410-23-Submeterin2 of Water and Sewer Certification Form 5-12-23
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH
SUBMETERING OF WATER AND SEWER CERTIFICATION FORM
In accordance with M.G.L. c. 186, § 22 and 105 CMR 410.000: Minimum Standards of Fitness for Human Habitation, State
Sanitary Code, Chapter II the"Housing Code" ),the following dwelling unit is eligible for submetering water and sewer.
PROPERTY INFORMATION
Address: 64 Grove Street Building #3 Unit# 302 #Of units in bldg.38
City/Town: Salem MA Zip Code: 01970
EQUIPMENT INSTALLATION INFORMATION
105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for
submetering for water and/or sewer services. The devices must meet the following specifications:
Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm)
Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm)
Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf)
The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must
meet the standards of accuracy and testing of the American Water Works Association or similar accredited association.
A Massachusetts licensed plumber must install the toilets and submetering equipment.
Submetering equipment information: M T W S u b m ete r Solutions MTW MJ20-075C
Manufacturer Model#
LICENSED PLUMBER CERTIFICATION
I certify that(check all that apply):
❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards.
✓❑ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards.
WIThe plumbing permit issued by the city/town,if required,is attached.
This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L. c. 186, §22(p),does
not require the installation of a submeter.
Keith Rhodes kka& 11433 02/21/2025
Licensed Plumber's Name Plumber' Signature License# Date
OWNER CERTIFICATION
I certify that:
(1) This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law
(MGL c. 186, §22).
(2)All showerheads, faucets and toilets in this dwelling unit meet the conservation standards specified above.
(3) The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and
complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, § 22).
(4)The water meter or submeter measures the water usage exclusive to this unit.
(5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the
separate charging of water and/or sewer service, and a copy of this certification form.
(6) All information included on this certification is true and accurate to the best of my knowledge.
THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING
Signed under the pains and penalties of perjury,
Rita Roberto ! 03/06/2025
Name of Owner Signature of Owner RFIGFIVFn
The property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submitted to Local health
186§22- Department: MAR 17 2025
Prior Owner's Signature Date
CITY OF SALEM
BOARD OF HEALTH
410-23-Submetering of Water and Sewer Certification Form 5-12-23
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH
SUBMETERING OF WATER AND SEWER CERTIFICATION FORM
In accordance with M.G.L. c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State
Sanitary Code, Chapter II the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer.
PROPERTY INFORMATION
Address: 64 Grove Street Building #3 Unit# 303 #Of units in bldg.38
City/Town: Salem MA Zi Code: 01970
EQUIPMENT INSTALLATION INFORMATION
105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for
submetering for water and/or sewer services. The devices must meet the following specifications:
Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm)
Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm)
Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf)
The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must
meet the standards of accuracy and testing of the American Water Works Association or similar accredited association.
A Massachusetts licensed plumber must install the toilets and submetering equipment.
Submetering equipment information: MTW Submeter Solutions MTW MJ20-075C
Manufacturer Model#
LICENSED PLUMBER CERTIFICATION
I certify that(check all that apply):
❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards.
�✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards.
The plumbing permit issued by the city/town,if required,is attached.
This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186, §22(p),does
not require the installation of a submeter.
Keith Rhode ,- , kko-& 11433 02/21/2025
s
Licensed Plumber's Name Plumber' Si,nature License# Date
OWNER CERTIFICATION
I certify that:
(1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law
(MGL c. 186, §22).
(2)All showerheads, faucets and toilets in this dwelling unit meet the conservation standards specified above.
(3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and
complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, § 22).
(4)The water meter or submeter measures the water usage exclusive to this unit.
(5)1 will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the
separate charging of water and/or sewer service, and a copy of this certification form.
(6) All information included on this certification is true and accurate to the best of my knowledge.
THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING
Signed under the pains and penalties of perjury, [[ ""�
Rita Roberto crB(7 rt.[.� 03/06/2025
Name of Owner Signature of Owner — �
LiThe property bas been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submlt& Oil fi
lab§22- Department: �A
Prior owner's Signature Date MAR 17
2025
CITY OF SALEM
BOARD OF HEALTH
410-23-Submetering of Water and Sewer Certification Form 5-12-23
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH
SUBMETERING OF WATER AND SEWER CERTIFICATION FORM
In accordance with M.G.L. c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State
Sanitaiy Code, Chapter II(the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer.
PROPERTY INFORMATION
Address: 64 Grove Street Building #3 Unit# 304 #Of units in bldg.38
City/Town: Salem MA Zin Code: 01970
EQUIPMENT INSTALLATION INFORMATION
105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for
submetering for water and/or sewer services. The devices must meet the following specifications:
Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm)
Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm)
Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf)
The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must
meet the standards of accuracy and testing of the American Water Works Association or similar accredited association.
A Massachusetts licensed plumber must install the toilets and submetering equipment.
Submetering equipment information: MTW S u b m ete r Solutions MTW MJ20-075C
Manufacturer Model#
LICENSED PLUMBER CERTIFICATION
I certify that(check all that apply):
✓❑ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards.
❑✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards.
WIThe plumbing permit issued by the city/town,if required,is attached.
This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L .c. 186, §22(p),does
not require the installation of a submeter.
Keith Rhodes zkI.o-d , 11433 02/21/2025
Licensed Plumber's Name Plumber' Signature License# Date
OWNER CERTIFICATION
I certify that:
(1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law
(MGL c. 186, §22).
(2)All showerheads, faucets and toilets in this dwelling unit meet the conservation standards specified above.
(3) The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and
complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, § 22).
(4) The water meter or submeter measures the water usage exclusive to this unit.
(5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the
separate charging of water and/or sewer service, and a copy of this certification form.
(6) All information included on this certification is true and accurate to the best of my knowledge.
THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING
Signed under the pains and penalties of perjury, nn-- [
Rita Roberto /Gt9C� 03/06/2025
Name of Owner Signature of Owner
The property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date e
ls6§22- Deparrtmeime nt:
Prior Owner's Signature Date
CITY OF SALEM
BOARD OF HEALTH
410-23-Submetering of Water and Sewer Certification Form 5-12-23
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH
SUBMETERING OF WATER AND SEWER CERTIFICATION FORM
In accordance with M.G.L. c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State
Sanitai , Code, Chapter II the "Housing Code" ,the following dwelling unit is eligible for submetering water and sewer.
PROPERTY INFORMATION
Address: 64 Grove Street Building #3 Unit# 305 #Of units in bldg.38
City/Town: Salem MA Zip Code: 01970
EQUIPMENT INSTALLATION INFORMATION
105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for
submetering for water and/or sewer services. The devices must meet the following specifications:
Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm)
Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm)
Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf)
The submetcring equipment used to measure the quantity of water used for each dwelling unit and common area must
meet the standards of accuracy and testing of the American Water Works Association or similar accredited association.
A Massachusetts licensed plumber must install the toilets and submetering equipment.
Submetering equipment information: MTW Submeter Solutions MTW MJ20-075C
Manufacturer Model#
LICENSED PLUMBER CERTIFICATION
I certify that(check all that apply):
✓❑ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards.
✓❑ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards.
WIThe plumbing permit issued by the city/town,if required,is attached.
This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L. c. 186, §22(p),does
not require the installation of a submeter.
Keith Rhodes kR,a-da 11433 02/21/2025
Licensed Plumber's Name Plumber' Signature License# Date
OWNER CERTIFICATION
I certify that:
(1) This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law
(MGL c. 186, §22).
(2)All showerheads, faucets and toilets in this dwelling unit meet the conservation standards specified above.
(3) The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and
complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, § 22).
(4) The water meter or submeter measures the water usage exclusive to this unit.
(5) I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the
separate charging of water and/or sewer service, and a copy of this certification form.
(6) All information included on this certification is true and accurate to the best of my knowledge.
THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING
Signed under the pains and penalties of perjury, [[
Rita Roberto A� A949& 03/06/2025
Name of Owner Signature of Owner Date
LiThe property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Subm JVth
186§22- Department:
Prior Owner's Signature Date
CITY OF SALEM
BOARD OF HEALTH
410-23-Submetering of Water and Sewer Certification Form 5-12-23
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH
SUBMETERING OF WATER AND SEWER CERTIFICATION FORM
In accordance with M.G.L. c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State
Sanitary Code, Chapter II the "Housing Code" ,the following dwelling unit is eligible for submetering water and sewer.
PROPERTY INFORMATION
Address: 64 Grove Street Building #3 Unit# 306 #Of units in bldg.38
City/Town: Salem MA Zip Code: 01970
EQUIPMENT INSTALLATION INFORMATION
105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for
submetering for water and/or sewer services. The devices must meet the following specifications:
Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm)
Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm)
Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf)
The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must
meet the standards of accuracy and testing of the American Water Works Association or similar accredited association.
A Massachusetts licensed plumber must install the toilets and submetering equipment.
Submetering equipment information: MTW SUbmeter Solutions MTW MJ20-075C
Manufacturer Model#
LICENSED PLUMBER CERTIFICATION
I certify that(check all that apply):
❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards.
❑✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards.
The plumbing permit issued by the city/town,if required,is attached.
This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L. c. 186,§22(p),does
not require the installation of a submeter.
Keith Rhodes kR,oaa 11433 02/21/2025
Licensed Plumber's Name Plumber' Signature License# Date
OWNER CERTIFICATION
I certify that:
(1) This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law
(MGL c. 186, §22).
(2)All showerheads, faucets and toilets in this dwelling unit meet the conservation standards specified above.
(3) The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and
complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, § 22).
(4)The water meter or submeter measures the water usage exclusive to this unit.
(5)1 will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the
separate charging of water and/or sewer service, and a copy of this certification form.
(6) All information included on this certification is true and accurate to the best of my knowledge.
THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING
Signed under the pains and penalties of perjury,
Rita Roberto � A 4 03/06/2025
Name of Owner Signature of Owner Date
The property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Subm h
186§22- Department:
Prior Owner's Signature Date
CITY OF SALEM
BOARD OF HEALTH
410-23-Submetering of Water and Sewer Certification Form 5-12-23
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH
SUBMETERING OF WATER AND SEWER CERTIFICATION FORM
In accordance with M.G.L. c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State
Sanitary Code, Chapter II the "Housing Code" ,the following dwelling unit is eligible for submetering water and sewer.
PROPERTY INFORMATION
Address: 64 Grove Street Building #3 Unit# 307 #Of units in bldg.38
City/Town: Salem MA Zip Code: 01970
EQUIPMENT INSTALLATION INFORMATION
105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for
submetering for water and/or sewer services. The devices must meet the following specifications:
Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm)
Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm)
Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf)
The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must
meet the standards of accuracy and testing of the American Water Works Association or similar accredited association.
A Massachusetts licensed plumber must install the toilets and submetering equipment.
Submetering equipment information: MTW SUbmeter Solutions MTW MJ20-075C
Manufacturer Model#
LICENSED PLUMBER CERTIFICATION
I certify that(check all that apply):
❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards.
❑✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards.
The plumbing permit issued by the city/town,if required,is attached.
This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.C. 186, §22(p),does
not require the installation of a submeter.
Keith Rhodes &--& kk -& 11433 02/21/2025
Licensed Plumber's Name Plumber' Signature License# Date
OWNER CERTIFICATION
I certify that:
(1) This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law
(MGL c. 186, §22).
(2)All showerheads, faucets and toilets in this dwelling unit meet the conservation standards specified above.
(3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and
complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, § 22).
(4)The water meter or submeter measures the water usage exclusive to this unit.
(5)1 will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the
separate charging of water and/or sewer service, and a copy of this certification form.
(6) All information included on this certification is true and accurate to the best of my knowledge.
THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING
Signed under the pains and penalties of perjury,
Rita Roberto /66!1 164 ,egg 03/06/2025
Name of Owner Si nature of Owner Date
LiThe property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L C. Date SubminEtOEWE[Dh
186§22- Department:
Prior Owner's Signature Date
CITY OF SALEM
410-23-Submetering of Water and Sewer Certification Form 5-12-23 BOARD OF HEALTH
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH
SUBMETERING OF WATER AND SEWER CERTIFICATION FORM
In accordance with M.G.L. c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State
Sanitary Code, Chapter II the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer.
PROPERTY INFORMATION
Address: 64 Grove Street Building #3 Unit# 308 #Of units in bldg.38
City/Town: Salem MA Zip Code: 01970
EQUIPMENT INSTALLATION INFORMATION
105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for
submetering for water and/or sewer services. The devices must meet the following specifications:
Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm)
Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm)
Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf)
The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must
meet the standards of accuracy and testing of the American Water Works Association or similar accredited association.
A Massachusetts licensed plumber must install the toilets and submetering equipment.
Submetering equipment information: MTW Submeter Solutions MTW MJ20-075C
Manufacturer Model#
LICENSED PLUMBER CERTIFICATION
I certify that(check all that apply):
❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards.
❑✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards.
The plumbing permit issued by the city/town,if required,is attached.
This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186, §22(p),does
not require the installation of a submeter.
Keith Rhodes 11433 02/21/2025
Licensed Plumber's Name Plumber' Signature License# Date
OWNER CERTIFICATION
I certify that:
(1) This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law
(MGL c. 186, §22).
(2)All showerheads, faucets and toilets in this dwelling unit meet the conservation standards specified above.
(3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and
complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, § 22).
(4)The water meter or submeter measures the water usage exclusive to this unit.
(5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the
separate charging of water and/or sewer service, and a copy of this certification form.
(6) All information included on this certification is true and accurate to the best of my knowledge.
THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING
Signed under the pains and penalties of perjury, [ I
Rita Roberto 03/06/2025
Name of Owner Signature of Owner Date
T property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submi kAE1 h
ls6§22- Department:
Prior Owner's Signature Date
CITY OF SALEM
BOARD OF HEALTH.
410-23-Submetering of Water and Sewer Certification Form 5-12-23
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH
SUBMETERING OF WATER AND SEWER CERTIFICATION FORM
In accordance with M.G.L. c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State
Sanitary Code, Chapter II(the"Housing Code" ),the following dwelling unit is eligible for submetering water and sewer.
PROPERTY INFORMATION
Address: 64 Grove Street Building #3 Unit# 309 #Of units in bldg. 38
City/Town: Salem MA Zip Code: 01970
EQUIPMENT INSTALLATION INFORMATION
105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for
submetering for water and/or sewer services. The devices must meet the following specifications:
Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm)
Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm)
Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf)
The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must
meet the standards of accuracy and testing of the American Water Works Association or similar accredited association.
A Massachusetts licensed plumber must install the toilets and submetering equipment.
Submetering equipment information: MTW Submeter Solutions MTW MJ20-075C
Manufacturer Model#
LICENSED PLUMBER CERTIFICATION
I certify that(check all that apply):
❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards.
�✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards.
FThe plumbing permit issued by the city/town,if required,is attached.
This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186, §22(p),does
not require the installation of a submeter.
Keith Rhodes,- , RR,oat"l, 11433 02/21/2025
Licensed Plumber's Name Plumber' Signature License# Date
OWNER CERTIFICATION
I certify that:
(1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law
(MGL c. 186, §22).
(2)All showerheads, faucets and toilets in this dwelling unit meet the conservation standards specified above.
(3) The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and
complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, § 22).
(4) The water meter or submeter measures the water usage exclusive to this unit.
(5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the
separate charging of water and/or sewer service, and a copy of this certification form.
(6) All information included on this certification is true and accurate to the best of my knowledge.
THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING
Signed under the pains and penalties of perjury,
Rita Roberto /&� 1&149& 03/06/2025
Name of Owner Signature of Owner
LiThe property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Subl 1th
186§22- Department:
Prior Owner's Signature Date M.A R 1 7 2 A 25_
CITY OF SALEM
BOARD OF HEALTH
410-23-Submetering of Water and Sewer Certification Form 5-12-23
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH
SUBMETERING OF WATER AND SEWER CERTIFICATION FORM
In accordance with M.G.L. c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State
Sanitary Code, Chapter II the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer.
PROPERTY INFORMATION
Address: 64 Grove Street Building #3 Unit# 310 #Of units in bldg.38
City/Town: Salem MA zi code: 01970
EQUIPMENT INSTALLATION INFORMATION
105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for
submetering for water and/or sewer services. The devices must meet the following specifications:
Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm)
Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm)
Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf)
The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must
meet the standards of accuracy and testing of the American Water Works Association or similar accredited association.
A Massachusetts licensed plumber must install the toilets and submetering equipment.
Submetering equipment information: MTW Submeter Solutions MTW MJ20-075C
Manufacturer Model#
LICENSED PLUMBER CERTIFICATION
I certify that(check all that apply):
❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards.
�✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards.
The plumbing permit issued by the city/town,if required, is attached.
This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186, §22(p),does
not require the installation of a submeter.
Keith Rhodes &tk ao-dr'sa. 11433 02/21/2025
Licensed Plumber's Name Plumber' Signature License# Date
OWNER CERTIFICATION
I certify that:
(1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law
(MGL c. 186, §22).
(2)All showerheads, faucets and toilets in this dwelling unit meet the conservation standards specified above.
(3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and
complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, § 22).
(4)The water meter or submeter measures the water usage exclusive to this unit.
(5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the
separate charging of water and/or sewer service, and a copy of this certification form.
(6) All information included on this certification is true and accurate to the best of my knowledge.
THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING
Signed under the pains and penalties of perjury,
Rita Roberto �1� 03/06/2025
Name of Owner Signature of Owner Date
The property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Subnt 'EYV Ith
186§22- Department:
Prior Owner's Signature Date n
MAR 7
CITY OF SALEM
410-23-Submetering of Water and Sewer Certification Form 5-12-23 BOARD OF HEALTH
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH
SUBMETERING OF WATER AND SEWER CERTIFICATION FORM
In accordance with M.G.L. c. 186, § 22 and 105 CMR 410.000: Minimum Standards of Fitness for Human Habitation, State
Sanitary Code, Chapter II(the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer.
PROPERTY INFORMATION
Address: 64 Grove Street Building #3 Unit# 401 #Of units in bldg. 38
City/Town: Salem MA Zi Code: 01970
EQUIPMENT INSTALLATION INFORMATION
105 CMR 410.130(C) requires the installation of water conservation devices prior to a dwelling unit becoming eligible for
submetering for water and/or sewer services. The devices must meet the following specifications:
Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm)
Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm)
Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf)
The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must
meet the standards of accuracy and testing of the American Water Works Association or similar accredited association.
A Massachusetts licensed plumber must install the toilets and submetering equipment.
Submetering equipment information: MTW S U b m ete r Solutions MTW MJ20-075C
Manufacturer Model#
LICENSED PLUMBER CERTIFICATION
I certify that(check all that apply):
❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards.
❑✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards.
FV] The plumbing permit issued by the city/town,if required,is attached.
This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186, §22(p),does
not require the installation of a submeter.
Keith Rhodes �'ea,-tk kko-& 11433 02/21/2025
Licensed Plumber's Name Plumber' Signature License# Date
OWNER CERTIFICATION
I certify that:
(1) This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law
(MGL c. 186, §22).
(2) All showerheads, faucets and toilets in this dwelling unit meet the conservation standards specified above.
(3) The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and
complies with the standards of accuracy and testing required by the water submetering law (M.G.L. c. 186, § 22).
(4)The water meter or submeter measures the water usage exclusive to this unit.
(5)1 will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the
separate charging of water and/or sewer service, and a copy of this certification form.
(6) All information included on this certification is true and accurate to the best of my knowledge.
THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING
Signed under the pains and penalties of perjury, [[
Rita Roberto /&� 149& 03/06/2025
Name of Owner Signature of Owner Date
LiThe property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submltl!tL� C�� B
186§22- Departmen t���V tt
Prior Owner's Signature Date
MAR 17 2025
CITY OF SALEM
410 23-Submetering of Water and Sewer Certification Form 5-12-23 BOARD OF HEALTH
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH
SUBMETERING OF WATER AND SEWER CERTIFICATION FORM
In accordance with M.G.L. c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State
Sanitary Code, Chapter II the"Housing Code" ),the following dwelling unit is eligible for submetering water and sewer.
PROPERTY INFORMATION
Address: 64 Grove Street Building #3 Unit# 402 #Of units in bldg.38
City/Town- Salem MA Zi Code: 01970
EQUIPMENT INSTALLATION INFORMATION
105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for
submetering for water and/or sewer services. The devices must meet the following specifications:
Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm)
Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm)
Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf)
The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must
meet the standards of accuracy and testing of the American Water Works Association or similar accredited association.
A Massachusetts licensed plumber must install the toilets and submetering equipment.
Submetering equipment information: MTW Submeter Solutions MTW MJ20-075C
Manufacturer Model#
LICENSED PLUMBER CERTIFICATION
I certify that(check all that apply):
❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards.
�✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards.
Fv] The plumbing permit issued by the city/town,if required,is attached.
This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L .c. 186, §22(p),does
not require the installation of a submeter.
Keith Rhodes &-tk zked. 11433 02/21/2025
Licensed Plumber's Name Plumber' Signature License# Date
OWNER CERTIFICATION
I certify that:
(1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law
(MGL c. 186, §22).
(2)All showerheads, faucets and toilets in this dwelling unit meet the conservation standards specified above.
(3) The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and
complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, § 22).
(4)The water meter or submeter measures the water usage exclusive to this unit.
(5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the
separate charging of water and/or sewer service, and a copy of this certification form.
(6) All information included on this certification is true and accurate to the best of my knowledge.
THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING
Signed under the pains and penalties of perjury, w�Rita Roberto A&I � L� 03/06/2025
Name of Owner Signature of Owner
LiThe property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Subml
tas§22- Department:
Prior Owner's Signature Date MAR 17 2025
CITY OF SALEM
BOARD OF HEALTH
410-23-Submetering of Water and Sewer Certification Form 5-12-23
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH
SUBMETERING OF WATER AND SEWER CERTIFICATION FORM
In accordance with M.G.L. c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State
Sanitary Code, Chapter II the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer.
PROPERTY INFORMATION
Address: 64 Grove Street Building #3 Unit# 403 #Of units in bldg.38
City/Town: Salem MA Zip Code: 01970
EQUIPMENT INSTALLATION INFORMATION
105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for
submetering for water and/or sewer services. The devices must meet the following specifications:
Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm)
Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm)
Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf)
The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must
meet the standards of accuracy and testing of the American Water Works Association or similar accredited association.
A Massachusetts licensed plumber must install the toilets and submetering equipment.
Submetering equipment information: MTW S U b m ete r Solutions MTW MJ20-075C
Manufacturer Model#
LICENSED PLUMBER CERTIFICATION
I certify that(check all that apply):
❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards.
❑✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards.
WIThe plumbing permit issued by the city/town,if required,is attached.
This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L .c. 186, §22(p),does
not require the installation of a submeter.
Keith Rhodes dC --tk, aeALa, 11433 02/21/2025
Licensed Plumber's Name Plumber' Signature License# Date
OWNER CERTIFICATION
I certify that:
(1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law
(MGL c. 186, §22).
(2)All showerheads, faucets and toilets in this dwelling unit meet the conservation standards specified above.
(3) The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and
complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, § 22).
(4)The water meter or submeter measures the water usage exclusive to this unit.
(5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the
separate charging of water and/or sewer service, and a copy of this certification form.
(6) All information included on this certification is true and accurate to the best of my knowledge.
THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING
Signed under the pains and penalties of perjury,
Rita Roberto /&;&4 l A&49& 03/06/2025
Name of Owner Signature of Owner
The property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Submit
186§22- Department:
Prior Owner's Signature Date MAR 17 2025
CITY OF SALEM
BOARD OF HEALTH
410-23-Submetering of Water and Sewer Certification Form 5-12-23
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH
SUBMETERING OF WATER AND SEWER CERTIFICATION FORM
In accordance with M.G.L. c. 186, § 22 and 105 CMR 410.000: Minimum Standards of Fitness for Human Habitation, State
Sanitary Code, Chapter II(the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer.
PROPERTY INFORMATION
Address: 64 Grove Street Building #3 Unit# 404 #Of units in bldg.38
City/Town: Salem MA zi Code: 01970
EQUIPMENT INSTALLATION INFORMATION
105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for
submetering for water and/or sewer services. The devices must meet the following specifications:
Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm)
Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm)
Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf)
The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must
meet the standards of accuracy and testing of the American Water Works Association or similar accredited association.
A Massachusetts licensed plumber must install the toilets and submetering equipment.
Submetering equipment information: MTW S u b m ete r Solutions MTW MJ20-075C
Manufacturer Model#
LICENSED PLUMBER CERTIFICATION
I certify that(check all that apply):
✓❑ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards.
✓❑ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards.
The plumbing permit issued by the city/town,if required,is attached.
This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L. C. 186, §22(p),does
not require the installation of a submeter.
Keith Rhodes &tk, kke-& 11433 02/21/2025
Licensed Plumber's Name Plumber' Signature License# Date
OWNER CERTIFICATION
I certify that:
(1) This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law
(MGL c. 186, §22).
(2) All showerheads, faucets and toilets in this dwelling unit meet the conservation standards specified above.
(3) The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and
complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, § 22).
(4) The water meter or submeter measures the water usage exclusive to this unit.
(5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the
separate charging of water and/or sewer service, and a copy of this certification form.
(6) All information included on this certification is true and accurate to the best of my knowledge.
THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING
Signed under the pains and penalties of perjury,
Rita Roberto /&� 03/06/2025
Name of Owner Signature of Owner Date
LiThe property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date SubnRE tGl E`er, Ith
186§22-
Department:
Prior Owner's Signature Date
CITY OF SALEM
BOARD OF HEALTH
410-23-Submetering of Water and Sewer Certification Form 5-12-23
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH
SUBMETERING OF WATER AND SEWER CERTIFICATION FORM
In accordance with M.G.L. c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State
Sanitary Code, Chapter II the "Housing Code" , the following dwelling unit is eligible for submetering water and sewer.
PROPERTY INFORMATION
Address: 64 Grove Street Building #3 Unit# 406 #Of units in bldg.38
City/Town: Salem MA Zip Code: 01970
EQUIPMENT INSTALLATION INFORMATION
105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for
submetering for water and/or sewer services. The devices must meet the following specifications:
Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm)
Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm)
Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf)
The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must
meet the standards of accuracy and testing of the American Water Works Association or similar accredited association.
A Massachusetts licensed plumber must install the toilets and submetering equipment.
Submetering equipment information: MTW S U b m ete r Solutions MTW MJ20-075C
Manufacturer Model#
LICENSED PLUMBER CERTIFICATION
I certify that(check all that apply):
❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards.
�✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards.
WIThe plumbing permit issued by the city/town,if required,is attached.
This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186, §22(p),does
not require the installation of a submeter.
Keith Rhodes &-tk zkz,& 11433 02/21/2025
Licensed Plumber's Name Plumber' Si�u-nature License# Date
OWNER CERTIFICATION
I certify that:
(1) This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law
(MGL c. 186, §22).
(2)All showerheads, faucets and toilets in this dwelling unit meet the conservation standards specified above.
(3) The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and
complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, § 22).
(4)The water meter or submeter measures the water usage exclusive to this unit.
(5)1 will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the
separate charging of water and/or sewer service, and a copy of this certification form.
(6) All information included on this certification is true and accurate to the best of my knowledge.
THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING
Signed under the pains and penalties of perjury, ""�
Rita Roberto �(��.(.� 03/06/2025
Name of Owner Signature of Owner
The property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Subml to O OCa I h
186§22- Department:
Prior Owner's Signature Date MAR 17 2025
CITY OFSALEM
BOARD OF HEALTH
410-23-Submetering of Water and Sewer Certification Form 5-12-23
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH
SUBMETERING OF WATER AND SEWER CERTIFICATION FORM
In accordance with M.G.L. c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State
Sanitary Code, Chapter II the "Housing Code"),the following dwelling unit is eligible for submetering water and sewer.
PROPERTY INFORMATION
Address: 64 Grove Street Building #3 Unit# 407 #Of units in bldg.38
City/Town: Salem MA Zip Code: 01970
EQUIPMENT INSTALLATION INFORMATION
105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for
submetering for water and/or sewer services. The devices must meet the following specifications:
Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm)
Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gp►n)
Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf)
The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must
meet the standards of accuracy and testing of the American Water Works Association or similar accredited association.
A Massachusetts licensed plumber must install the toilets and submetering equipment.
Submetering equipment information: MTW SUbmeter Solutions MTW MJ20-075C
Manufacturer Model#
LICENSED PLUMBER CERTIFICATION
I certify that(check all that apply):
❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards.
�✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards.
WIThe plumbing permit issued by the city/town,if required,is attached.
This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186, §22(p),does
not require the installation of a submeter.
Keith Rhodes d(ia no-& 11433 02/21/2025
Licensed Plumber's Name Plumber' Signature License# Date
OWNER CERTIFICATION
I certify that:
(1) This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law
(MGL c. 186, §22).
(2) All showerheads, faucets and toilets in this dwelling unit meet the conservation standards specified above.
(3)The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and
complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, § 22).
(4)The water meter or submeter measures the water usage exclusive to this unit.
(5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the
separate charging of water and/or sewer service, and a copy of this certification form.
(6) All information included on this certification is true and accurate to the best of my knowledge.
THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING
Signed under the pains and penalties of perjury,
Rita Roberto /&� Ae4d;&& 03/06/2025
Name of Owner Signature of Owner M
LJThe property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L a Date Subm1t&Jttv1&M WMth
186§22- Department: 1l
Prior Owner's Signature Date MAR 17 2025 _
CITY OF SALEM
BOARD OF HEALTH
410-23-Submetering of Water and Sewer Certification Form 5-12-23
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH
SUBMETERING OF WATER AND SEWER CERTIFICATION FORM
In accordance with M.G.L. c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation, State
Sanitary Code, Chapter II(the"Housing Code" ),the following dwelling unit is eligible for submetering water and sewer.
PROPERTY INFORMATION
Address: 64 Grove Street Building #3 Unit# 409 #Of units in bld,,.38
City/Town: Salem MA Zi Code: 01970
EQUIPMENT INSTALLATION INFORMATION
105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for
submetering for water and/or sewer services. The devices must meet the following specifications:
Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm)
Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm)
Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf)
The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must
meet the standards of accuracy and testing of the American Water Works Association or similar accredited association.
A Massachusetts licensed plumber must install the toilets and submetering equipment.
Submetering equipment information: MTW SUbmeter Solutions MTW MJ20-075C
Manufacturer Model#
LICENSED PLUMBER CERTIFICATION
I certify that(check all that apply):
❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards.
�✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards.
WIThe plumbing permit issued by the city/town,if required,is attached.
This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186, §22(p),does
not require the installation of a submeter.
Keith Rhodes zR,a& 11433 02/21/2025
Licensed Plumber's Name Plumber' Signature License# Date
OWNER CERTIFICATION
I certify that:
(1)This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law
(MGL c. 186, §22).
(2)All showerheads, faucets and toilets in this dwelling unit meet the conservation standards specified above.
(3) The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and
complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, § 22).
(4) The water meter or submeter measures the water usage exclusive to this unit.
(5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the
separate charging of water and/or sewer service, and a copy of this certification form.
(6) All information included on this certification is true and accurate to the best of my knowledge.
THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING
Signed under the pains and penalties of perjury,
Rita Roberto Ait/v_ 03/06/2025
Name of Owner Signature of Owner Date
The property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date SubiRbUL4VEGIth
186§22- Department:
Prior Owner's Signature Date
CITY OF SALEM
BOARD OF HEALTH
410-23-Submetering of Water and Sewer Certification Form 5-12-23
MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH
SUBMETERING OF WATER AND SEWER CERTIFICATION FORM
In accordance with M.G.L. c. 186, § 22 and 105 CMR 410.000:Minimum Standards of fitness for Human Habitation, State
Sanitaiy Code, Chapter II the"Housing Code" ,the following dwelling unit is eligible for submetering water and sewer.
PROPERTY INFORMATION
Address: 64 Grove Street Building #3 Unit# 410 #Of units in bldg.38
City/Town: Salem MA Zi Code: 01970
EQUIPMENT INSTALLATION INFORMATION
105 CMR 410.130(C)requires the installation of water conservation devices prior to a dwelling unit becoming eligible for
submetering for water and/or sewer services. The devices must meet the following specifications:
Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm)
Faucets with maximum flow rate not to exceed 2.2 gallons per minute(gpm)
Ultra-low flush toilets not to exceed 1.6 gallons per flush(gpf)
The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must
meet the standards of accuracy and testing of the American Water Works Association or similar accredited association.
A Massachusetts licensed plumber must install the toilets and submetering equipment.
Submetering equipment information: MTW Submeter Solutions MTW MJ20-075C
Manufacturer Model#
LICENSED PLUMBER CERTIFICATION
I certify that(check all that apply):
❑✓ I have installed or inspected the submetering equipment listed above and have determined that they meet accepted plumbing standards.
❑✓ I have installed or inspected all the toilets in this unit and have determined that they meet accepted plumbing standards.
WIThe plumbing permit issued by the city/town,if required, is attached.
This dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186, § 22(p),does
not require the installation of a submeter.
Keith Rhodes kkc-& 11433 02/21/2025
Licensed Plumber's Name Plumber' Signature License# Date
OWNER CERTIFICATION
I certify that:
(1) This dwelling unit is eligible for submetering of water and/or sewer usage in accordance with the water submetering law
(MGL c. 186, §22).
(2)All showerheads, faucets and toilets in this dwelling unit meet the conservation standards specified above.
(3) The water submeter(if present)measuring the use of water in this dwelling unit was installed by a licensed plumber and
complies with the standards of accuracy and testing required by the water submetering law(M.G.L. c. 186, § 22).
(4) The water meter or submeter measures the water usage exclusive to this unit.
(5) 1 will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the
separate charging of water and/or sewer service, and a copy of this certification form.
(6) All information included on this certification is true and accurate to the best of my knowledge.
THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING
Signed under the pains and penalties of perjury,
Rita Roberto /&&� 16949;&& 03/06/2025
Name of Owner Signature of Owner
The property has been transferred to the owner above and the unit remains in compliance with the requirements of M.G.L c. Date Sub] 1 C I th
186§22- Department:
Prior Owner's Signature Date MAR 17 2025
CITY OF SALEM
BOARD OF HEALTH
410-23-Submetering of Water and Sewer Certification Form 5-12-23