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72 Flint St. Water & Sewer Submeter Certificates Units 2101-2314 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 H),the following dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer service. PROPERTY INFORMATION Address: 72 Flint Street Unit# 2101 #Of units in bldg. 42 city/Town: Salem MA Zi Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.000 requires the installation of water conservation devices prior to a dwelling unit becoming eligible for the imposition on tenants of a charge for water and/or sewer.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2 /2 gallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 2/10 gallons per minute(2.2 gpm) Ultra-low flush water closets(toilets)not to exceed 1 6J10 gallons per flush(1.6 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 licensed plumber must install the water closets and submetering equipment. Submetering equipment information: Next Century M201 C Manufacturer Model# Licensed Plumber Certification �h. �� �r�� � l� z 20 Print Name of Plumber License# bate I certify that(check all that apply): ®I have installed the submetering equipment listed above in accordance with accepted plumbing standards. I have installed one or more water closets not exceeding 1.6 gallons per flush. Determined that existing water closets do not exceed 1.6 gallons per flush. The plumbing permit issued by the city/town,if required,is attached. ❑ Dwelling unit is connected directly to a meter installed by a water comp an�,in accor with M.G.L.c. 186, §22(p),does not require the installation of a submeter. z a. Signed under the pains and penalties of perjury, Signature of Li nsed Plumber Property Owner Certification I certify.that: (1)This dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer usage in accordance with the water submetering law(MGL c. 186,§22);.(2)All showerheads,faucets,and water closets in this dwelling unit are water conservation devices that meet the standards specified above; (3)The water submeter measuring the use of water in the dwelling unit was.installed by a licensed plumber and is in compliance with the standards specified above;or the water metermeasuring the use of water in this dwelling unit was installed by a"water company" as defined in 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)That all information included on this certification is true and accurate to the best of my knowle . Signed under the pains and penalties of perjury, DSF Salem Flint LLC Print Name of Owner Signafurt of Owner Date The property has been transferred to owner above and the unit Received remains in compliance with the requirements of M.G.L.c. 186, s22 Date: by BOH: N O V 12 2029 *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBMETERING CITY OF SALEM MDPH-CSP submetering Form,Rev 11-4-16 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 U),the following dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer service. PROPERTY INFORMATION Address: 72 Flint Street unit# 2102 #of units in bldg. 42 Ci /Town: Salem MA Zip Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.000 requires the installation of water conservation devices prior to a dwelling unit becoming eligible for the imposition on tenants of a charge for water and/or sewer.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2 Ys fallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 2/1 gallons per minute(2.2 gpm) Ultra-low flush water closets(toilets)not to exceed 1 6/10 gallons per flush(1.6 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 licensed plumber must install the water closets and submetering equipment. Submetering equipment information: Next Century M201 C Manufacturer Model# Licensed Plumber Certification Print Name of Plumber License date I certify that(check all that apply): ®I have installed the submetering equipment listed above in accordance with accepted plumbing standards. X I have installed one or more water closets not exceeding 1.6 gallons per flush. Determined that existing water closets do not exceed 1.6 gallons per flush. The plumbing permit issued by the city/town,if required,is attached. ❑Dwelling unit is connected directly to a meter installed by a water comp nd,i ac dance i M.G.L.c. 186, §22(p),does not require the installation of a submeter. Signed under the pains and penalties of perjury, P 4 , Signature of Licens 166er Property Owner Certification I certify that: (1)This dwelling unit is eligible for the imposition on the tenants of a charge for water an or sewer usage in accordance with the water submetering law(MGL c. 186, §22);(2)All showerheads,faucets, and water closets in this dwelling unit are water conservation devices that meet the standards specified above; (3)The water submeter measuring the use of water in the dwelling unit was installed by a licensed plumber and is in compliance with the standards specified above, or the water meter measuring the use of water in this dwelling unit was installed by a"water company" as defined in 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)That all information included on this certification is true and accurate to the best of my knowle e. Signed under the pains and penalties of perjury, DSF Salem Flint LLC Print Name of Owner Sigh'atfire of Owner -RIEUEVED _ Date The property has been transferred to owner above and the unit Received 0 V 12 2020 remains in compliance with the requirements of M.G.L. c. 186, 22 Date: b BO *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SMQ;"6T_E§M@M BOARD OF HEALTH MDPH-CSP Submetering Form,Rev 11-4-16 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 following dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer service. PROPERTY INFORMATION Address: 72 Flint Street unit# 2103 #Of units in bldg. 42 city/Town: Salem MA zi Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.000 requires the installation of water conservation devices prior to a dwelling unit becoming eligible for the imposition on tenants of a charge for water and/or sewer. The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2�'gallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 2/10 gallons per minute(2.2 gpm) Ultra-low flush water closets(toilets)not to exceed 1 6/10 gallons per flush(1.6 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 licensed plumber must install the water closets and submetering equipment. Submetering equipment information: Next Century M201 C Manufacturer Model# Licensed Plumber Certification q .6 Print Name of Plumber License# Dat I certify that(check all that apply): ®I have installed the submetering equipment listed above in accordance with accepted plumbing standards. I have installed one or more water closets not exceeding 1.6 gallons per flush. Determined that existing water closets do not exceed 1.6 gallons per flush. The plumbing permit issued by the city/town,if required,is attached. ❑ Dwelling unit is connected directly to a meter installed by a water comp n d, ' a ordan with M.G.L.c. 186, §22(p),does not require the installation of a submeter. Signed under the pains and penalties of perjury, r Signature of Licensed Plumber Property Owner Certification I certify that: (1)This dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer usage in accordance with the water submetering law(MGL c. 186, §22);(2)All showerheads,faucets, and water closets in this dwelling unit are water conservation devices that meet the standards specified above; (3)The water submeter measuring the use of water in the dwelling unit was installed by a licensed plumber and is in compliance with the standards specified above,or the water meter measuring the use of water in this dwelling unit was installed by a"water company" as defined in 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)That all information included on this certification is true and accurate to the best of my knowled Signed under the pains and penalties of perjury, DSF Salem Flint LLC o Print Name of Owner —Signaj4k9f6wner Date The property has been transferred to owner above and the unit Receiveo V 12 Z02D remains in compliance with the requirements of M.G.L. c. 186, 22 Date: b BOH.1V *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING S�PMFCTFTMI�M BOARD OF HEALTH' MDPH-CSP Submetering Form,Rev 11-4-16 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 In,the following dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer service. PROPERTY INFORMATION Address: 72 Flint Street Unit it 2104 #Of units in bldg. 42 city/Town: Salem MA Zi f Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.000 requires the installation of water conservation devices prior to a dwelling unit becoming eligible for the imposition on tenants of a charge for water and/or sewer. The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2 Yz&allons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 2/1 gallons per minute(2.2 gpm) Ultra-low flush water closets(toilets)not to exceed 1 6110 gallons per flush(1.6 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 licensed plumber must install the water closets and submetering equipment. Submetering equipment information: Next Century M201 C Manufacturer Model# Licensed Plumber Certification Print Name of Plumber License# Date I certify that(check all that apply): ®I have installed the submetering equipment listed above in accordance with accepted plumbing standards. I have installed one or more water closets not exceeding 1.6 gallons per flush. Determined that existing water closets do not exceed 1.6 gallons per flush. The plumbing permit issued by the city/town,if required,is attached. ❑Dwelling unit is connected directly to a meter installed by a wateel any and,in accord a with M.G.L . c. 186, §22(p),does not require the installation of a sub Signed under the pains and penalties of perjury, f! Si ature of Lic nsed Number Property Owner Certification I certify that: (1)This dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer usage in accordance with the water submetering law(MGL c. 186, §22); (2)All showerheads,faucets, and water closets in this dwelling unit are water conservation devices that meet the standards specified above; (3)The water submeter measuring the use of water in the dwelling unit was installed by a licensed plumber and is in compliance with the standards specified above,or the water meter measuring the use of water in this dwelling unit was installed by a"water company" as defined in 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)That all information included on this certification is true and accurate to the best of my knowledge. Signed under the pains and penalties of perjury, DSF Salem Flint LLC v Print Name of Owner Signaturd of Owner Date The property has been transferred to owner above and the unit Received'0 V 1 2 2020 remains in compliance with the requirements of M.G.L.c. 186, ,22 Date: b BOH. _ *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING 5�11 1 IFTF§INOF_ G.M BOARD OF HEALTH MDPH-CSP Submetering Form,Rev 11-4-16 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 following dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer service. PROPERTY INFORMATION Address: 72 Flint Street unit# 2105 #Of units in bld . 42 ci /Town: Salem MA Zip Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.000 requires the installation of water conservation devices prior to a dwelling unit becoming eligible for the imposition on tenants of a charge for water and/or sewer. The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2'l gallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 2/10 gallons per minute(2.2 gpm) Ultra-low flush water closets(toilets)not to exceed 1 6/10 gallons per flush(1.6 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 licensed plumber must install the water closets and submetering equipment. Submetering equipment information: Next Century M201 C Manufacturer Model# Licensed Plumber Certification AI �4L & qW-:70 Print Name of Plumber License# Date I certify that(check all that apply): ®I have installed the submetering equipment listed above in accordance with accepted plumbing standards. I have installed one or more water closets not exceeding 1.6 gallons per flush. Determined that existing water closets do not exceed 1.6 gallons per flush. The plumbing permit issued by the city/town,if required,is attached. ❑Dwelling unit is connected directly to a meter installed by a water com ny and,.in or with M.G.L.c. 186, §22(p),does not require the installation of a submeter. Signed under the pains and penalties of perjury, -signature of Licen ed Pl er 7__ Property Owner Certifica 'on I certify that: (1)This dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer usage in accordance with the water submetering law(MGL c. 186, §22); (2)All showerheads,faucets,and water closets in this dwelling unit are water conservation devices that meet the standards specified above; (3)The water submeter measuring the use of water in the dwelling unit was installed by a licensed plumber and is in compliance with the standards specified above,or the water meter measuring the use of water in this dwelling unit was installed by a"water company" as defined in 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)That all information included on this certification is true and accurate to the best of my knowledge. Signed under the pains and penalties of perjury, DSF Salem Flint LLC AO Print Name of Owner -signaturqof Owner Date The property has been transferred to owner above and the unit Receivef0 V 12 2020 remains in compliance with the requirements of M.G.L. c. 186, §22 Date: by BOH: *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUAVUEBR fEM BOARD OF HEALTH MDPH-CSP Submetering Form,Rev 11-4-16 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 H),the following dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer service. PROPERTY INFORMATION Address: 72 Flint Street unit it 2106 #Of units in bldg. 42 City/Town: Salem MA zi code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.000 requires the installation of water conservation devices prior to a dwelling unit becoming eligible for the imposition on tenants of a charge for water and/or sewer. The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2''gallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 2/10 gallons per minute(2.2 gpm) Ultra-low flush water closets(toilets)not to exceed 1 6/10 gallons per flush(1.6 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 licensed plumber must install the water closets and submetering equipment. Submetering equipment information: Next Century M201 C Manufacturer Model# Licensed Plumber Certification Print Nam of Plumber License ate I certify that(check all that apply): ®I have installed the submetering equipment listed above in accordance with accepted plumbing standards. I have installed one or more water closets not exceeding 1.6 gallons per flush. Determined that existing water closets do not exceed 1.6 gallons per flush. The plumbing permit issued by the city/town,if required,is attached. ❑ Dwelling unit is connected directly to a meter installed by a water com 'my and;in acc rdanc M.G.L.c. 186, §22(p),does not require the installation of a submeter. Signed under the pains and penalties of perjury, jjnature of Licens-e-d-Flainber Property Owner Certificatio I certify that: (1)This dwelling unit is eligible for the imposition on the tenan s of a charge for water and/or sewer usage in accordance with the water submetering law(MGL c. 186, §22);(2)All showerheads,faucets,and water closets in this dwelling unit are water conservation devices that meet the standards specified above; (3)The water submeter measuring the use of water in the dwelling unit was installed by a licensed plumber and is in compliance with the standards specified above,or the water meter measuring the use of water in this dwelling unit was installed by a"water company" as defined in 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)That all information included on this certification is true and accurate to the best of my knowled, . Signed under the pains and penalties of perjury, DSF Salem Flint LLC , Print Name of Owner 77v�SigniturhJbf Owner Date The property has been transferred to owner above and the unit Received NO V 12 2020 remains in compliance with the requirements of M.G.L.c. 186, §22 Date: by BOH: *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SU§W'jRWtEM BOARD OF HEALTH MDPH-CSP Submetering Form,Rev 11-4-16 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 following dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer service. PROPERTY INFORMATION Address: 72 Flint Street unit it 2107 #Of units in bid . 42 city/Town: Salem MA Zip Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.000 requires the installation of water conservation devices prior to a dwelling unit becoming eligible for the imposition on tenants of a charge for water and/or sewer.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2 v2gallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 2/10 gallons per minute(2.2 gpm) Ultra-low flush water closets(toilets)not to exceed 1 6/10 gallons per flush(1.6 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 licensed plumber must install the water closets and submetering equipment. Submetering equipment information: Next Century M201 C Manufacturer Model# Licensed Plumber Certification Print Name of Plumber License# Date I certify that(check all that apply): ®I have installed the submetering equipment listed above in accordance with accepted plumbing standards. I have installed one or more water closets not exceeding 1.6 gallons per flush. Determined that existing water closets do not exceed 1.6 gallons per flush. The plumbing permit issued by the city/town,if required,is attached. ❑Dwelling unit is connected directly to a meter installed by a water c any and,in ccordanc ith M.G.L. c. 186, §22(p),does not require the installation of a subm Signed under the pains and penalties of perjury, Signatute of Licens Anber Property Owner Certification I certify that: (1)This dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer usage in accordance with the water submetering law(MGL c. 186, §22);(2)All showerheads,faucets,and water closets in this dwelling unit are water conservation devices that meet the standards specified above; (3)The water submeter measuring the use of water in the dwelling unit was installed by a licensed plumber and is in compliance with the standards specified above,or the water meter measuring the use of water in this dwelling unit was installed by a"water company" as defined in 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)That all information included on this certification is true and accurate to the best of my knowledge. Signed under the pains and penalties of perjury, DSF Salem Flint LLC Print Name of Owner Si a e of Owner Date The property has been transferred to owner above and the unit Received remains in compliance with the re uirements of M.G.L. c. 186, §22 Date: by BOH: NOV 12 *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBMETERING CITY OF SALEM MDPH-CSP Submetering Form,Rev 11-4-16 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 following dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer service. PROPERTY INFORMATION Address: 72 Flint Street unit# 2108 #Of units in blqg. 42 ci /Town: Salem MA zi Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.000 requires the installation of water conservation devices prior to a dwelling unit becoming eligible for the imposition on tenants of a charge for water and/or sewer.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2 /2§allons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 2/1 gallons per minute(2.2 gpm) Ultra-low flush water closets(toilets)not to exceed 1 6110 gallons per flush(1.6 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 licensed plumber must install the water closets and submetering equipment. Submeteririg equipment information: Next Century M201 C Manufacturer Model# Licensed Plumber Certification CU Alrl fir _ Iqly-4 A& Print Name of Plumber License# ate I certify that(check all that apply): ®I have installed the submetering equipment listed above in accordance with accepted plumbing standards. I have installed one or more water closets not exceeding 1.6 gallons per flush. Determined that existing water closets do not exceed 1.6 gallons per flush. The plumbing permit issued by the city/town,if required,is attached. ❑Dwelling unit is connected directly to a meter installed by a water company and,lfn accordance th M.G.L. c. 186, §22(p),does not require the installation of a submeter. Signed under the pains and penalties of perjury, I�A .4 S a re of cens d Pliiniber Property Owner Certification I certify that:(1)This dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer usage in accordance with the water submetering law(MGL c. 186,§22);(2)All showerheads,faucets, and water closets in this dwelling unit are water conservation devices that meet the standards specified above; (3)The water submeter measuring the use of water in the dwelling unit was installed by a licensed plumber and is in compliance with the standards specified above,or the water meter measuring the use of water in this dwelling unit was installed by a"water company" as defined in 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 thi,Certification form;(6)That all information included on this certification is true and accurate to the best of my knowled Signed under the pains and penalties of perjury, DSF Salem Flint LLC Print Name of Owner i a e of Owner Date The property has been transferred to owner above and the unit Received N O V 12 2020 remains in compliance with the requirements of M.G.L.c. 186, §22 Date: by BOH: *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBNIIURIEKLEM BOARD OF HEALTH MDPH-CSP Submetering Form,Rev 11-4-16 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 IT),the following dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer service. PROPERTY INFORMATION Address: 72 Flint Street unit# 2109 #Of units in bldg. 42 City/Town: Salem MA zi Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.000 requires the installation of water conservation devices prior to a dwelling unit becoming eligible for the imposition on tenants of a charge for water and/or sewer.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2 v2 gallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 2/10 gallons per minute(2.2 gpm) Ultra-low flush water closets(toilets)not to exceed 1 6/10 gallons per flush(1.6 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 licensed plumber must install the water closets and submetering equipment. Submetering equipment information: Next Century M201 C Manufacturer Model# Licensed Plumber Certification ` Print Name of Plumber License# bate I certify that(check all that apply): ®I have installed the submetering equipment listed above in accordance with accepted plumbing standards. I have installed one or more water closets not exceeding 1.6 gallons per flush. Determined that existing water closets do not exceed 1.6 gallons per flush. The plumbing permit issued by the city/town,if required,is attached. <, ❑Dwelling unit is connected directly to a meter installed by a water company and,M accordan e i M.G.L. c. 186,§22(p),does not require the installation of a submeter. Signed under the pains and penalties of perjury, I Aignature of Licensed Plumber Property Owner Certification I certify that: (1)This dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer usage in accordance with the water submetering law(MGL c. 186,§22); (2)All showerheads,faucets,and water closets in this + dwelling unit are water conservation devices that meet the standards specified above; (3)The water submeter measuring the use of water in the dwelling unit was installed by a licensed plumber and is in compliance with the standards specified above,or the water meter measuring the use of water in this dwelling unit was installed by a"water company" as defined in 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 ,Crtification form; (6)That all information included on this certification is true and accurate to the best of my knowledg . Signed under the pains and penalties of perjury, DSF Salem Flint LLC Print Name of Owner Si ture of Owner Date The property has been transferred to owner above and the unit ` Received No1/ 1 2i ZOZO remains in compliance with the requirements of M.G.L. c. 186, §22 Date: 1 by BOH: V *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SI WBM, EM BOARD OF HEALTH MDPH-CSP Submetering Form,Rev 11-4-16 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 following dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer service. PROPERTY INFORMATION Address: 72 Flint Street _ _ unit# 2110 #Of units in bldg., 42 Ci /Town: Salem MA zip Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.000 requires the installation of water conservation devices prior to a dwelling unit becoming eligible for the imposition on tenants of a charge for water and/or sewer.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2'/�gallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 2/10 gallons per minute(2.2 gpm) Ultra-low flush water closets(toilets)not to exceed 1 6/10 gallons per flush(1.6 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 licensed plumber must install the water closets and submetering equipment. Submetering equipment information: Next Century M201 C Manufacturer Model# Licensed Plumber Certification 0. AA()I - L Print Name of Plumber License# Date I certify that(check all that apply): ®I have installed the submetering equipment listed above in accordance with accepted plumbing standards. I have installed one or more water closets not exceeding 1.6 gallons per flush. Determined that existing water closets do not exceed 1.6 gallons per flush. The plumbing permit issued by the city/town,if required,is attached. ❑Dwelling unit is connected directly to a meter installed by a water comp nd,in actor a th M.G.L.c. 186, §22(p),does not require the installation of a submeter., Signed under the pains and penalties of perjury, ha re of Licens umber Property Owner Certification I certify that:(1)This dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer usage in accordance with the water submetering law(MGL c. 186, §22); (2)All showerheads, faucets,and water closets in this dwelling unit are water conservation devices that meet the standards specified above; (3)The water submeter measuring the use of water in the dwelling unit was installed by a licensed plumber and is in compliance with the standards specified above,or the water meter measuring the use of water in this dwelling unit was installed by a"water company" as defined in 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 thi-- certification form; (6)That all information included on this certification is true and accurate to the best of my knowled Signed under the pains and penalties of perjury, DSF Salem Flint LLC ItIIAP Print Name of Owner Signafure of Owner Date The property has been transferred to owner above and the unit Received.0V 12 2020 remains in compliance with the requirements of M.G.L. c. 186,§22 Date: by BOH: *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING S KNRt-M BOARD OF HEALTH MDPH-CSP Submetering Form,Rev 11-4-16 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 11),the following dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer service. PROPERTY INFORMATION Address: 72 Flint Street unit# 2111 #of units in bl . 42 Ci /Town: Salem MA Zip Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.000 requires the installation of water conservation devices prior to a dwelling unit becoming eligible for the imposition on tenants of a charge for water and/or sewer. The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2 y'gallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 2/10 gallons per minute(2.2 gpm) Ultra-low flush water closets(toilets)not to exceed 1 6110 gallons per flush(1.6 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 licensed plumber must install the water closets and submetering equipment. Submetering equipment information: Next Century M201 C Manufacturer Model# Licensed Plumber Certification Print Name of Plumber License# Date I certify that(check all that apply): ®I have installed the submetering equipment listed above in accordance with accepted plumbing standards. X I have installed one or more water closets not exceeding 1.6 gallons per flush. Determined that existing water closets do not exceed 1.6 gallons per flush. The plumbing permit issued by the city/town,if required,is attached. ❑Dwelling unit is connected directly to a meter installed by a water compal anr accordance M.G.L. c. 186, §22(p),does not require the installation of a submeter.,� Signed under the pains and penalties of perjury, Signature of Licensed Plumber Property Owner Certification I certify that: (1)This dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer usage in accordance with the water submetering law(MGL c. 186, §22); (2)All showerheads,faucets,and water closets in this dwelling unit are water conservation devices that meet the standards specified above; (3)The water submeter measuring the use of water in the dwelling unit was installed by a licensed plumber and is in compliance with the standards specified above, or the water meter measuring the use of water in this dwelling unit was installed by a"water company" as defined in 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)That all information included on this certification is true and accurate to the best of my knowledge. Signed under the pains and penalties of perjury, r DSF Salem Flint LLC lb- h Print Name of Owner Si atuo of Owner Tby ate The property has been transferred to owner above and the unit eceived remains in compliance with the requirements of M.G.L.c. 186, �22 Date: BOH: *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBMETERING CITY OF SALEM NIDPH-CSP Submetering Form,Rev 11-4-16 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 11),the following dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer service. PROPERTY INFORMATION Address: 72 Flint Street unit# 2112 #Of units in bldg. 42 Ci /Town: Salem MA 4' Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.000 requires the installation of water conservation devices prior to a dwelling unit becoming eligible for the imposition on tenants of a charge for water and/or sewer.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2 v�§allons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 2/1 gallons per minute(2.2 gpm) Ultra-low flush water closets(toilets)not to exceed 1 6/10 gallons per flush(1.6 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 licensed plumber must install the water closets and submetering equipment. Submetering equipment information: Next Century M201 C Manufacturer Model# Licensed Plumber Certification Print Name of Plumber License# Date I certify that(check all that apply): ®I have installed the submetering equipment listed above in accordance with accepted plumbing standards. I have installed one or more water closets not exceeding 1.6 gallons per flush. Determined that existing water closets do not exceed 1.6 gallons per flush. The plumbing permit issued by the city/town,if required,is attached. ❑Dwelling unit is connected directly to a meter installed by a water comp and,in accordanc ith M.G.L.c. 186, § 22(p),does not require the installation of a submeter. Signed under the pains and penalties of perjury, tore of Licens Plu er Property Owner Certification I certify that: (1)This dwelling unit is eligible for the imposition on the tenants of a charge for water an or sewer usage in accordance with the water submetering law(MGL c. 186, §22);(2)All showerheads,faucets,and water closets in this dwelling unit are water conservation devices that meet the standards specified above;(3)The water submeter measuring the use of water in the dwelling unit was installed by a licensed plumber and is in compliance with the standards specified above,or the water meter measuring the use of water in this dwelling unit was installed by a"water company" as defined in 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)That all information included on this certification is true and accurate to the best of my knowledge. Signed under the pains and penalties of perjury, DSF Salem Flint LLC Print Name of Owner Signature f Owner Date 1- The property has been transferred to owner above and the unit Received remains in compliance with the requirements of M.G.L.c. 186, s22 Date: b BOH: f *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBMETERING CITY OF SALEM MDPH-CSP Submetering Form,Rev 11-4-16 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 following dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer service. PROPERTY INFORMATION Address: 72 Flint Street unit# 2113 #Ofunits in bld . 42 Ci /Town: Salem MA Zi Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.000 requires the installation of water conservation devices prior to a dwelling unit becoming eligible for the imposition on tenants of a charge for water and/or sewer. The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2''gallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 2/10 gallons per minute(2.2 gpm) Ultra-low flush water closets(toilets)not to exceed 1 6110 gallons per flush(1.6 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 licensed plumber must install the water closets and submetering equipment. Submetering equipment information: Next Century M201 C Manufacturer Model# Licensed Plumber Certification q1P L-oo Print Name of Plumber License# LDate I certify that(check all that apply): ®I have installed the submetering equipment listed above in accordance with accepted plumbing standards. I have installed one or more water closets not exceeding 1.6 gallons per flush. ❑ Determined that existing water closets do not exceed 1.6 gallons per flush. ® The plumbing permit issued by the city/town,if required,is attached. ❑Dwelling unit is connected directly to a meter installed by a water comp y d,in accordan a 'th M.G.L .c. 186, § 22(p),does not require the installation of a submeter. Signed under the pains and penalties of perjury, �i' ature of Licensed Plumber Property Owner Certification I certify that: (1)This dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer usage in accordance with the water submetering law(MGL c. 186, §22);(2)All showerheads,faucets,and water closets in this dwelling unit are water conservation devices that meet the standards specified above; (3)The water submeter measuring the use of water in the dwelling unit was installed by a licensed plumber and is in compliance with the standards specified above, or the water meter measuring the use of water in this dwelling unit was installed by a"water company" as defined in 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 certification form; (6)That all information included on this certification is true and accurate to the best of my know dge. Signed under the pains and penalties of perjury, f DSF Salem Flint LLC 16 n-2 Print Name of Owner snignowe of Owner q Date The property has been transferred to owner above and the unit Received remains in compliance with the requirements of M.G.L. c. 186,§22 Date: by BOH: NOY 12 2020 *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBMETERING CITY OF SALEM MDPH-CSP Submetering Form,Rev 11-4-16 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 following dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer service. _ PROPERTY INFORMATION Address: 72 Flint Street unit# 2114 #Of units inbldg. 42 citvrrown: Salem MA Zip Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.000 requires the installation of water conservation devices prior to a dwelling unit becoming eligible for the imposition on tenants of a charge for water and/or sewer.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2'/�gallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 2/10 gallons per minute(2.2 gpm) Ultra-low flush water closets(toilets)not to exceed 1 6/10 gallons per flush(1.6 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 licensed plumber must install the water closets and submetering equipment. Submetering equipment information: Next Century M201 C Manufacturer Model# Licensed Plumber Certification bcAkq/ _ qL_, /-Z 6 Print Name of Plumber License# Date I certify that(check all that apply): ®I have installed the submetering equipment listed above in accordance with accepted plumbing standards. X I have installed one or more water closets not exceeding 1.6 gallons per flush. Determined that existing water closets do not exceed 1.6 gallons per flush. The plumbing permit issued by the city/town,if required,is attached. ❑Dwelling unit is connected directly to a meter installed by a water company and,in accordar/wi h M.G.L. c. 186, §22(p),does not require the installation of a submeter-' �CSigned under the pains and penalties of perjury, Si ature of ficensed tuber Property Owner Certification I certify that: (1)This dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer usage in accordance with the water submetering law(MGL c. 186, §22);(2)All showerheads,faucets,and water closets in this dwelling unit are water conservation devices that meet the standards specified above; (3)The water submeter measuring the use of water in the dwelling unit was installed by a licensed plumber and is in compliance with the standards specified above,or the water meter measuring the use of water in this dwelling unit was installed by a"water company" as defined in 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)That all information included on this certification is true and accurate to the best of my knowledge. Signed under the pains and penalties of perjury, DSF Salem Flint LLC Print Name of Owner SignatAre of Owner Date The property has been transferred to owner above and the unit Received remains in compliance with the requirements of M.G.L. c. 186, �22 Date: b BOH: NOV 12 22020 *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SU cMY OF SALEM MDPH-CSP Submetering Form,Rev 11-4-16 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 following dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer service. PROPERTY INFORMATION Address: 72 Flint Street unit# 2201 #Of units in bld . 42 City/Town: Salem MA zip Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.000 requires the installation of water conservation devices prior to a dwelling unit becoming eligible for the imposition on tenants of a charge for water and/or sewer.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2 /'§allons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 2/1 gallons per minute(2.2 gpm) Ultra-low flush water closets(toilets)not to exceed 1 6110 gallons per flush(1.6 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 licensed plumber must install the water closets and submetering equipment. Submetering equipment information: Next Century M201 C Manufacturer Model# Licensed Plumber Certification ©� /�, q Print Name of Plumber License# Date I certify that(check all that apply): ®I have installed the submetering equipment listed above in accordance with accepted plumbing standards. X I have installed one or more water closets not exceeding 1.6 gallons per flush. Determined that existing water closets do not exceed 1.6 gallons per flush. The plumbing permit issued by the city/town,if required,is attached. ❑Dwelling unit is connected directly to a meter installed by a water corn d,in accordance M.G.L.c. 186, §22(p),does not require the installation of a submeter. Signed under the pains and penalties of perjury, Si a re of Licensed Mudiber Property Owner Certification I certify that: (1)This dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer usage in accordance with the water submetering law(MGL c. 186, §22); (2)All showerheads,faucets,and water closets in this dwelling unit are water conservation devices that meet the standards specified above; (3)The water submeter measuring the use of water in the dwelling unit was installed by a licensed plumber and is in compliance with the standards specified above,or the water meter measuring the use of water in this dwelling unit was installed by a"water company" as defined in 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)That all information included on this certification is true and accurate to the best of my knowledge. Signed under the pains and penalties of perjury, DSF Salem Flint LLC Print Name of Owner Si ature of er r Date The property has been transferred to owner above and the unit Received remains in compliance with the requirements of M.G.L. c. 186, '22 Date: Jbv BOH. NOV 1R2N2020 *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUCITY OF ISALEM MDPH-CSP Submetering Form,Rev 11-4-16 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 following dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer service. PROPERTY INFORMATION Address: 72 Flint Street Unit# 2202 #Of units in bldg. 42 Ci /Town: Salem MA zi Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.000 requires the installation of water conservation devices prior to a dwelling unit becoming eligible for the imposition on tenants of a charge for water and/or sewer.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2''2 gallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 2/10 gallons per minute(2.2 gpm) Ultra-low flush water closets(toilets)not to exceed 1 6/10 gallons per flush(1.6 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 licensed plumber must install the water closets and submetering equipment. Submetering equipment information: Next Century M201 C Manufacturer Model# Licensed Plumber Certification ( _ sN Print Name of Plumber License 9 Date I certify that(check all that apply): ®I have installed the submetering equipment listed above in accordance with accepted plumbing standards. X I have installed one or more water closets not exceeding 1.6 gallons per flush. Determined that existing water closets do not exceed 1.6 gallons per flush. The plumbing permit issued by the city/town,if required,is attached. ❑Dwelling unit is connected directly to a meter installed by a water comp )and,in accor a f'th ' M.G.L.c. 186, §22(p),does not require the installation of a submeter. Signed under the pains and penalties of perjury, Si ature of Licensed Plumber Property Owner Certification I certify that: (1)This dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer usage in accordance with the water submetering law(MGL c. 186, §22); (2)All showerheads,faucets, and water closets in this dwelling unit are water conservation devices that meet the standards specified above; (3)The water submeter measuring the use of water in the dwelling unit was installed by a licensed plumber and is in compliance with the standards specified above,or the water meter measuring the use of water in this dwelling unit was installed by a`water company" as defined in 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)That all information included on this certification is true and accurate to the best of my knowledge. Signed under the pains and penalties of perjury, DSF Salem Flint LLC 16 Print Name of Owner §19Tia of Owner Date The property has been transferred to owner above and the unit Received 0 U 12 Z020 remains in compliance with the requirements of M.G.L. c. 186, §22 Date: b BOH. *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING S�ftyw§IKiriM BOARD OF HEALTH MDPH-CSP Submetering Form,Rev 11-4-16 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 following dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer service. PROPERTY INFORMATION Address: 72 Flint Street Unit# 2203 #Of units inbldg. 42 ci /Town: Salem MA zi Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.000 requires the installation of water conservation devices prior to a dwelling unit becoming eligible for the imposition on tenants of a charge for water and/or sewer.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2 v'gallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 2/10 gallons per minute(2.2 gpm) Ultra-low flush water closets(toilets)not to exceed 1 6110 gallons per flush(1.6 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 licensed plumber must install the water closets and submetering equipment. Submetering equipment information: Next Century M201 C Manufacturer Model# Licensed Plumber Certification Print Name of Plumber License# Date I certify that(check all that apply): ®I have installed the submetering equipment listed above in accordance with accepted plumbing standards. I have installed one or more water closets not exceeding 1.6 gallons per flush. Determined that existing water closets do not exceed 1.6 gallons per flush. The plumbing permit issued by the city/town,if required,is attached. ❑ Dwelling unit is connected directly to a meter installed by a water comp ,in accordance M.G.L. c. 186, §22(p),does not require the installation of a submeter. Signed under the pains and penalties of perjury, ature of Lic ed Plumber Property Owner Certification I certify that: (1)This dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer usage in accordance with the water submetering law(MGL c. 186, §22); (2)All showerheads,faucets,and water closets in this dwelling unit are water conservation devices that meet the standards specified above; (3)The water submeter measuring the use of water in the dwelling unit was installed by a licensed plumber and is in compliance with the standards specified above, or the water meter measuring the use of water in this dwelling unit was installed by a"water company" as defined in 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)That all information included on this certification is true and accurate to the best of my knowledge Signed under the pains and penalties of perjury, DSF Salem Flint LLC Print Name of Owner 7Si a of Owner Date nL The property has been transferred to owner above and the unit Received remains in compliance with the requirements of M.G.L.c. 186, §22 Date: by BOH:NOV 12 2020 *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBMETERING CITY OF SALEM MDPH-CSP Submetering Form,Rev 11-4-16 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 1I),the following dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer service. PROPERTY INFORMATION Address: 72 Flint Street Unit# 2204 #Of units in bldg. 42 city/Town: Salem MA zi code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.000 requires the installation of water conservation devices prior to a dwelling unit becoming eligible for the imposition on tenants of a charge for water and/or sewer.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2 /2 gallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 2J10 gallons per minute(2.2 gpm) Ultra-low flush water closets(toilets)not to exceed 1 6110 gallons per flush(1.6 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 licensed plumber must install the water closets and submetering equipment. Submetering equipment information: Next Century M201 C Manufacturer Model# Licensed Plumber Certification Print Name of Plumber License# Date I certify that(check all that apply): ®I have installed the submetering equipment listed above in accordance with accepted plumbing standards. I have installed one or more water closets not exceeding 1.6 gallons per flush. Determined that existing water closets do not exceed 1.6 gallons per flush. The plumbing permit issued by the city/town,if required,is attached. ❑Dwelling unit is connected directly to a meter installed by a water company in accordance M.G.L . c. 186,§22(p),does not require the installation of a submeter. Signed under the pains and penalties of perjury, ature of LicCPlumber Property Owner Certification I certify that:(1)This dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer usage in accordance with the water submetering law(MGL c. 186, §22); (2)All showerheads,faucets, and water closets in this dwelling unit are water conservation devices that meet the standards specified above; (3)The water submeter measuring the use of water in the dwelling unit was installed by a licensed plumber and is in compliance with the standards specified above, or the water meter measuring the use of water in this dwelling unit was installed by a"water company" as defined in 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)That all information included on this certification is true and accurate to the best of my knowledge. Signed under the pains and penalties of perjury, DSF Salem Flint LLC Print Name of Owner Si a of Owner El The property has been transferred to owner above and the unit Received remains in compliance with the requirements of M.G.L. c. 186, §22 Date: by BOH: NOV 12 2020 *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBPfYTE-RIOF SALEM BOARD OF HEALTH NIDPH-CSP Submetering Form,Rev 11-4-16 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 I1),the following dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer service. PROPERTY INFORMATION Address: 72 Flint Street Unit# 2205 #Of units in bldg. 42 ci mown: Salem MA zi, Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.000 requires the installation of water conservation devices prior to a dwelling unit becoming eligible for the imposition on tenants of a charge for water and/or sewer.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2"gallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 2/10 gallons per minute(2.2 gpm) Ultra-low flush water closets(toilets)not to exceed 16110 gallons per flush(1.6 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 licensed plumber must install the water closets and submetering equipment. Submetering equipment information: Next Century _ M201 C Manufacturer Model# Licensed Plumber Certification Print Name of Plumber License# Date I certify that(check all that apply): ®I have installed the submetering equipment listed above in accordance with accepted plumbing standards. I have installed one or more water closets not exceeding 1.6 gallons per flush. Determined that existing water closets do not exceed 1.6 gallons per flush. The plumbing permit issued by the city/town,if required,is attached. ❑Dwelling unit is connected directly to a meter installed by a water comp an�,in accor th M.G.L .c. 186, §22(p),does not require the installation of a submeter. 1 Signed under the pains and penalties of perjury, JI i ature f L cense Plumber Property Owner Certification I certify that:(1)This dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer usage in accordance with the water submetering law(MGL c. 186, §22); (2)All showerheads,faucets,and water closets in this dwelling unit are water conservation devices that meet the standards specified above; (3)The water submeter measuring the use of water in the dwelling unit was installed by a licensed plumber and is in compliance with the standards specified above, or the water meter measuring the use of water in this dwelling unit was installed by a"water company" as defined in 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)That all information included on this certification is true and accurate to the best of my knowledge. Signed under the pains and penalties of perjury, DSF Salem Flint LLC A ,�d Print Name of Owner Si a of Owner I bate _ Date The property has been transferred to owner above and the unit Received remains in compliance with the requirements of M.G.L. c. 186, §22 Date: by BOH: *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SU METERING CITY OF MDPH-CSP Submetering Form,Rev 11-4-16 BOARD 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 IT),the following dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer service. PROPERTY INFORMATION Address: 72 Flint Street Unit# 2206 #Of units in bldg. 42 City/Town: Salem MA zi Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.000 requires the installation of water conservation devices prior to a dwelling unit becoming eligible for the imposition on tenants of a charge for water and/or sewer.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2'�gallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 2/10 gallons per minute(2.2 gpm) Ultra-low flush water closets(toilets)not to exceed 1 6110 gallons per flush(1.6 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 licensed plumber must install the water closets and submetering equipment. Submetering equipment information: Next Century M201 C Manufacturer Model# Licensed Plumber Certification I Alt U A414e.- Cf13;6,, Print Name of Plumber License# Date I certify that(check all that apply): ®I have installed the submetering equipment listed above in accordance with accepted plumbing standards. I have installed one or more water closets not exceeding 1.6 gallons per flush. Determined that existing water closets do not exceed 1.6 gallons per flush. The plumbing permit issued by the city/town,if required,is attached. .c ❑Dwelling unit is connected directly to a meter installed by a water com ny and,in a cordance M.G.L.c. 186, §22(p),does not require the installation of a submete Signed under the pains and penalties of perjury, 14 't tilAr Nignature of Lice se Pl er Property Owner Certification I certify that: (1)This dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer usage in accordance with the water submetering law(MGL c. 186, §22); (2)All showerheads,faucets,and water closets in this dwelling unit are water conservation devices that meet the standards specified above; (3)The water submeter measuring the use of water in the dwelling unit was installed by a licensed plumber and is in compliance with the standards specified above, or the water meter measuring the use of water in this dwelling unit was installed by a"water company" as defined in 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)That all information included on this certification is true and accurate to the best of my knowledge. Signed under the pains and penalties of perjury, DSF Salem Flint LLC -dip IDAZZ Print Name of Owner Signakure of Owner Date tliLCEI The property has been transferred to owner above and the unit Received remains in compliance with the requirements of M.G.L. c. 186, '22 Date: by BOH: ,0 V 12 ^020 *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBMETERING CITY OF SALEM MDPH-CSP Submetering Form,Rev 11-4-16 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 Il),the following dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer service. PROPERTY INFORMATION Address: 72 Flint Street Unit# 2207 #Of units in bldg. 42 City/Town: Salem MA Zip Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.000 requires the installation of water conservation devices prior to a dwelling unit becoming eligible for the imposition on tenants of a charge for water and/or sewer.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2 iz gallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 2/10 gallons per minute(2.2 gpm) Ultra-low flush water closets(toilets)not to exceed 16110 gallons per flush(1.6 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 licensed plumber must install the water closets and submetering equipment. Submetering equipment information: Next Century M201 C Manufacturer Model# Licensed Plumber Certification LU Print Name of Plumber License# Date I certify that(check all that apply): ®I have installed the submetering equipment listed above in accordance with accepted plumbing standards. I have installed one or more water closets not exceeding 1.6 gallons per flush. Determined that existing water closets do not exceed 1.6 gallons per flush. The plumbing permit issued by the city/town,if required,is attached. ❑ Dwelling unit is connected directly to a meter installed by a water 4 any d,in accordan/V{ith rq M.G.L . c. 186, §22(p),does not require the installation of a subme Signed under the pains and penalties of perjury, 'Signature of L cens Plu -ber Property Owner Certification I certify that: (1)This dwelling unit is eligible for the imposition on the tenants of a charge for water an r sewer usage in accordance with the water submetering law(MGL c. 186, §22); (2)All showerheads,faucets,and water closets in this dwelling unit are water conservation devices that meet the standards specified above; (3)The water submeter measuring the use of water in the dwelling unit was installed by a licensed plumber and is in compliance with the standards specified above,or the water meter measuring the use of water in this dwelling unit was installed by a"water company" as defined in 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)That all information included on this certification is true and accurate to the best of my knowled Signed under the pains and penalties of perjury, DSF Salem Flint LLCX11/W Print Name of Owner SignatUre of4pkner Date The property has been transferred to owner above and the unit Received remains in compliance with the re uirements of M.G.L. c. 186, §22 Date: by BOH: NOV 12 2020 *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBMETERING CITY OF SALEM MDPH-CSP submetering Form,Rev 11-4-16 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 following dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer service. PROPERTY INFORMATION Address: 72 Flint Street Unit# 2208 #Of units in bldg. 42 city/Town: Salem MA zi code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.000 requires the installation of water conservation devices prior to a dwelling unit becoming eligible for the imposition on tenants of a charge for water and/or sewer. The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2��gallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 2/10 gallons per minute(2.2 gpm) Ultra-low flush water closets(toilets)not to exceed 1 6/10 gallons per flush(1.6 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 licensed plumber must install the water closets and submetering equipment. Submetering equipment information: Next Century M201 C _ Manufacturer Model# Licensed Plumber Certification lit �26 Print Name of Plumber License# Date I certify that(check all that apply): ®I have installed the submetering equipment listed above in accordance with accepted plumbing standards. I have installed one or more water closets not exceeding 1.6 gallons per flush. ❑Determined that existing water closets do not exceed 1.6 gallons per flush. ® The plumbing permit issued by the city/town,if required,is attached. L ❑ Dwelling unit is connected directly to a meter installed by a water compan d,in ccordance M.G.L. c. 186, §22(p),does not require the installation of a submeter. Signed under the pains and penalties of perjury, i ature of Licensed Plumber Property Owner Certification I certify that: (1)This dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer usage in accordance with the water submetering law(MGL c. 186, §22); (2)All showerheads,faucets,and water closets in this dwelling unit are water conservation devices that meet the standards specified above; (3)The water submeter measuring the use of water in the dwelling unit was installed by a licensed plumber and is in compliance with the standards specified above,or the water meter measuring the use of water in this dwelling unit was installed by a"water company" as defined in 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)That all information included on this certification is true and accurate to the best of my knowledii. Signed under the pains and penalties of perjury, DSF Salem Flint LLC 3 �p Print Name of Owner Si ature of Owner Date The property has been transferred to owner above and the unit Received remains in compliance with the requirements of M.G.L. c. 186, §22 Date: by BOIE *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBMETERING CITY OF SALEM MDPH-CSP Submetering Form,Rev 11-4-16 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 I1),the following dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer service. PROPERTY INFORMATION Address: 72 Flint Street Unit# 2209 #Of units in bldg. 42 city/Town: Salem MA Zip Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.000 requires the installation of water conservation devices prior to a dwelling unit becoming eligible for the imposition on tenants of a charge for water and/or sewer.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2'/'gallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 2/10 gallons per minute(2.2 gpm) Ultra-low flush water closets(toilets)not to exceed 1 6/10 gallons per flush(1.6 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 licensed plumber must install the water closets and submetering equipment. Submetering equipment information: Next Century M201 C Manufacturer Model# Licensed Plumber Certification A416AKL, Ai�tsr- T&�t_zec Print Name of Plumber License# Dale I certify that(check all that apply): ®I have installed the submetering equipment listed above in accordance with accepted plumbing standards. X I have installed one or more water closets not exceeding 1.6 gallons per flush. Determined that existing water closets do not exceed 1.6 gallons per flush. The plumbing permit issued by the city/town,if required,is attached. ❑Dwelling unit is connected directly to a meter installed by a water compan d,in accordan M.G.L. c. 186, §22(p),does not require the installation of a submeter. Signed under the pains and penalties of perjury, S16kture of Licensed Plumber Property Owner Certification I certify that: (1)This dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer usage in accordance with the water submetering law(MGL c. 186, §22); (2)All showerheads,faucets,and water closets in this dwelling unit are water conservation devices that meet the standards specified above; (3)The water submeter measuring the use of water in the dwelling unit was installed by a licensed plumber and is in compliance with the standards specified above,or the water meter measuring the use of water in this dwelling unit was installed by a"water company" as defined in 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)That all information included on this certification is true and accurate to the best of my knowledge Signed under the pains and penalties of perjury, DSF Salem Flint LLC �• Print Name of Owner Sign re of Owner Date The property has been transferred to owner above and the unit Received remains in compliance with the requirements of M.G.L. c. 186, §22 Date: by BOH: NOV 12 2020 *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBMETERING CITY OF SALEM MDPH-CSP submetering Form,Rev 11-4-16 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 following dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer service. PROPERTY INFORMATION Address: 72 Flint Street Unit# 2210 #Of units inbldg. 42 ci /Town: Salem MA zi Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.000 requires the installation of water conservation devices prior to a dwelling unit becoming eligible for the imposition on tenants of a charge for water and/or sewer. The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2 Yz gallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 2/10 gallons per minute(2.2 gpm) Ultra-low flush water closets(toilets)not to exceed 1 6/10 gallons per flush(1.6 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 licensed plumber must install the water closets and submetering equipment. Submetering equipment information: Next Century _ M201 C Manufacturer Model# Licensed Plumber Certification QQ Print Name of Plumber License# Date I certify that(check all that apply): [XI have installed the submetering equipment listed above in accordance with accepted plumbing standards. X I have installed one or more water closets not exceeding 1.6 gallons per flush. Determined that existing water closets do not exceed 1.6 gallons per flush. The plumbing permit issued by the city/town,if required,is attached. + ❑Dwelling unit is connected directly to a meter installed by a water compan din accordance�1 M.G.L . c. 186, §22(p),does not require the installation of a submeter. / , , Signed under the pains and penalties of perjury, 4 rT re of LiceAsed Pl mb r Property Owner Certificatio I certify that:(1)This dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer usage in accordance with the water submetering law(MGL c. 186, §22);(2)All showerheads,faucets, and water closets in this dwelling unit are water conservation devices that meet the standards specified above; (3)The water submeter measuring the use of water in the dwelling unit was installed by a licensed plumber and is in compliance with the standards specified above, or the water meter measuring the use of water in this dwelling unit was installed by a"water company" as defined in 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)That all information included on this certification is true and accurate to the best of my knowled:�e. Signed under the pains and penalties of perjury, DSF Salem Flint LLC Print Name of Owner Si re of Owner �7 Date L The property has been transferred to owner above and the unit Received remains in compliance with the requirements of M.G.L. c. 186, '22 Date: by BOH: N 0 V 12 2020 *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBMETERING CITY OF SALEM MDPH-CSP Submetering Form,Rev 11-4-16 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 I1),the following dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer service. _ PROPERTY INFORMATION Address: 72 Flint Street Unit# 2211 #Of units in bldg. 42 Cit /Town: Salem MA zip code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.000 requires the installation of water conservation devices prior to a dwelling unit becoming eligible for the imposition on tenants of a charge for water and/or sewer.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2 iz gallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 2/10 gallons per minute(2.2 gpm) Ultra-low flush water closets(toilets)not to exceed 1 6/10 gallons per flush(1.6 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 licensed plumber must install the water closets and submetering equipment. Submetering equipment information: Next Century M201 C Manufacturer Model# Licensed Plumber Certification Print Name of Plumber License# Date I certify that(check all that apply): ®I have installed the submetering equipment listed above in accordance with accepted plumbing standards. I have installed one or more water closets not exceeding 1.6 gallons per flush. Determined that existing water closets do not exceed 1.6 gallons per flush. The plumbing permit issued by the city/town,if required,is attached. ❑Dwelling unit is connected directly to a meter installed by a water comp ' and,in accor e M.G.L. c. 186, § 22(p),does not require the installation of a submeter. r Signed under the pains and penalties of perjury, t 1 , iWTiature of Licensed Plumber Property Owner Certification I certify that: (1)This dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer usage in accordance with the water submetering law(MGL c. 186, §22); (2)All showerheads,faucets, and water closets in this dwelling unit are water conservation devices that meet the standards specified above; (3)The water submeter measuring the use of water in the dwelling unit was installed by a licensed plumber and is in compliance with the standards specified above, or the water meter measuring the use of water in this dwelling unit was installed by a"water company" as defined in 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)That all information included on this certification is true and accurate to the best of my knowledge. Signed under the pains and penalties of perjury, , DSF Salem Flint LLC D - Print Name of Owner Signature f Owner ps Date The property has been transferred to owner above and the unit Received remains in compliance with the requirements of M.G.L. c. 186, �22 Date: by BOH: NOV 12 2020 *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUiCITY ELMET MDPH-CSP Submetering Form,Rev 11-4-16 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 In,the following dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer service. PROPERTY INFORMATION Address: 72 Flint Street Unit# 2212 #Of units in bldg. 42 ci /Town: Salem MA zi Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.000 requires the installation of water conservation devices prior to a dwelling unit becoming eligible for the imposition on tenants of a charge for water and/or sewer.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2''gallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 2/10 gallons per minute(2.2 gpm) Ultra-low flush water closets(toilets)not to exceed 1 6/10 gallons per flush(1.6 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 licensed plumber must install the water closets and submetering equipment. Submetering equipment information: Next Century M201 C Manufacturer _ Model# Licensed Plumber Certification <S ` -0 Print Name of Plumber License# Date I certify that(check all that apply): ®I have installed the submetering equipment listed above in accordance with accepted plumbing standards. X I have installed one or more water closets not exceeding 1.6 gallons per flush. Determined that existing water closets do not exceed 1.6 gallons per flush. The plumbing permit issued by the city/town,if required,is attached. El Dwelling unit is connected directly to a meter installed by a water company lie dance M.G.L. c. 186, § 22(p),does not require the installation of a submeter. Signed under the pains and penalties of perjury, of Licensed k1pinber Property Owner Certification I certify that: (1)This dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer usage in accordance with the water submetering law(MGL c. 186, §22); (2)All showerheads,faucets, and water closets in this dwelling unit are water conservation devices that meet the standards specified above; (3)The water submeter measuring the use of water in the dwelling unit was installed by a licensed plumber and is in compliance with the standards specified above,or the water meter measuring the use of water in this dwelling unit was installed by a"water company" as defined in 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 tbill c rtification form; (6)That all information included on this certification is true and accurate to the best of my knowle ge. Signed under the pains and penalties of perjury, tl DSF Salem Flint LLC Print Name of Owner Si ature of Owner Date The property has been transferred to owner above and the unit Received remains in compliance with the requirements of M.G.L. c. 186, §22 Date: by BOH: Noy 1 2 7nn *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBMETERING CITY OF SALEM MDPH-CSP Submetering Form,Rev 11-4-16 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 following dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer service. PROPERTY INFORMATION Address: 72 Flint Street Unit# 2213 #Of units in bldg. 42 City/Town: Salem MA zip Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.000 requires the installation of water conservation devices prior to a dwelling unit becoming eligible for the imposition on tenants of a charge for water and/or sewer.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2 Yz gallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 Z/10 gallons per minute(2.2 gpm) Ultra-low flush water closets(toilets)not to exceed 1 6110 gallons per flush(1.6 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 licensed plumber must install the water closets and submetering equipment. Submetering equipment information: Next Century M201 C Manufacturer Model# Licensed Plumber Certification Print game of Plumber License# Date I certify that(check all that apply): ®I have installed the submetering equipment listed above in accordance with accepted plumbing standards. I have installed one or more water closets not exceeding 1.6 gallons per flush. Determined that existing water closets do not exceed 1.6 gallons per flush. The plumbing permit issued by the city/town,if required,is attached. ❑ Dwelling unit is connected directly to a meter installed by a water comp and,in accordancCPlber M.G.L. c. 186, §22(p),does not require the installation of a submeter. Signed under the pains and penalties of e ' gn p P P rJ�Y, ature of Li Property Owner Certification I certify that: (1)This dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer usage in accordance with the water submetering law(MGL c. 186, §22);(2)All showerheads,faucets,and water closets in this dwelling unit are water conservation devices that meet the standards specified above; (3)The water submeter measuring the use of water in the dwelling unit was installed by a licensed plumber and is in compliance with the standards specified above,or the water meter measuring the use of water in this dwelling unit was installed by a"water company" as defined in 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)That all information included on this certification is true and accurate to the best of my;knowl4edgq�. Signed under the pains and penalties of perjury, DSF Salem Flint LLC ^� Print Name of Owner Signawye of Owner Fbv The property has been transferred to owner above and the unit ived remains in compliance with the requirements of M.G.L. c. 186, 22 Date: OH: *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBMETERING CITY OF SALEM MDPH-CSP Submetering Form,Rev 11-4-16 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 following dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer service. PROPERTY INFORMATION Address: 72 Flint Street unit# 2214 #Of units in bldg. 42 Ci /Town: Salem MA Zip Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.000 requires the installation of water conservation devices prior to a dwelling unit becoming eligible for the imposition on tenants of a charge for water and/or sewer. The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2 'gallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 2/10 gallons per minute(2.2 gpm) Ultra-low flush water closets(toilets)not to exceed 1 6/10 gallons per flush(1.6 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 licensed plumber must install the water closets and submetering equipment. Submetering equipment information: Next Century M201 C Manufacturer Model# Licensed Plumber Certification Print Name of Plumber License# Date I certify that(check all that apply): ®I have installed the submetering equipment listed above in accordance with accepted plumbing standards. I have installed one or more water closets not exceeding 1.6 gallons per flush. Determined that existing water closets do not exceed 1.6 gallons per flush. The plumbing permit issued by the city/town,if required,is attached. ❑Dwelling unit is connected directly to a meter installed by a water compan in accor wi M.G.L . c. 186, § 22(p),does not require the installation of a submeter. r Signed under the pains and penalties of perjury, i ature of Licens mber Property Owner Certification FIcertify that: (1)This dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer usage in accordance with the water submetering law(MGL c. 186, §22); (2)All showerheads,faucets, and water closets in this dwelling unit are water conservation devices that meet the standards specified above; (3)The water submeter measuring the use of water in the dwelling unit was installed by a licensed plumber and is in compliance with the standards specified above,or the water meter measuring the use of water in this dwelling unit was installed by a"water company" as defined in 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)That all information included on this certification is true and accurate to the best of my knowled Signed under the pains and penalties of perjury, DSF Salem Flint LLC J Print Name of Owner Signatbre of Owner Lr Date The property has been transferred to owner above and the unit ReceivedN O 1 2 2�2� remains in compliance with the requirements of M.G.L. c. 186, §22 Date: b BOH: *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING S""EUFWgEM BOARD OF HEALTH MDPH-CSP Submetering Form,Rev 11-4-16 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 following dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer service. PROPERTY INFORMATION Address: 72 Flint Street Unit# 2301 #Of units in bldg. 42 City/Town: Salem MA ziia Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.000 requires the installation of water conservation devices prior to a dwelling unit becoming eligible for the imposition on tenants of a charge for water and/or sewer.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2 h gallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 2/10 gallons per minute(2.2 gpm) Ultra-low flush water closets(toilets)not to exceed 1 6110 gallons per flush(1.6 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 licensed plumber must install the water closets and submetering equipment. Submetering equipment information: Next Century M201 C Manufacturer Model# Licensed Plumber Certification AA t 4:U., o tc� �'��� 'I/71.-11 h�, Print Name of Plumber License# Date I certify that(check all that apply): ®I have installed the submetering equipment listed above in accordance with accepted plumbing standards. X I have installed one or more water closets not exceeding 1.6 gallons per flush. Determined that existing water closets do not exceed 1.6 gallons per flush. The plumbing permit issued by the city/town,if required,is attached. ❑Dwelling unit is connected directly to a meter installed by a water company in cordanc 7th M.G.L. c. 186, § 22(p),does not require the installation of a submeter. Signed under the pains and penalties of perjury, A . A Sijnfture of LiJensM Plu ber Property Owner Certification I certify that: (1)This dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer usage in accordance with the water submetering law(MGL c. 186, §22); (2)All showerheads,faucets,and water closets in this dwelling unit are water conservation devices that meet the standards specified above; (3)The water submeter measuring the use of water in the dwelling unit was installed by a licensed plumber and is in compliance with the standards specified above,or the water meter measuring the use of water in this dwelling unit was installed by a"water company" as defined in 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)That all information included on this certification is true and accurate to the best of my knowled Signed under the pains and penalties of perjury, DSF Salem Flint LLC Print Name of Owner S!9!!aturi of Owner Date The property has been transferred to owner above and the unit Received remains in compliance with the requirements of M.G.L. c. 186, §22 Date: bv BOH: N O V 12 2020 *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBMTyTLEIVI MDPH-CSP Submetering Form,Rev 11-4-16 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 following dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer service. PROPERTY INFORMATION Address: 72 Flint Street Unit# 2302 #Of units in bldg. 42 city/Town: Salem MA zip code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.000 requires the installation of water conservation devices prior to a dwelling unit becoming eligible for the imposition on tenants of a charge for water and/or sewer.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2�'gallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 2/10 gallons per minute(2.2 gpm) Ultra-low flush water closets(toilets)not to exceed 1 6/10 gallons per flush(1.6 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 licensed plumber must install the water closets and submetering equipment. Submetering equipment information: Next Century _ M201 C Manufacturer Model# Licensed Plumber Certification 09(a(AEL., 44 6�<c 11 o5% ft (zy Print Name of Plumber License# Date I certify that(check all that apply): ®I have installed the submetering equipment listed above in accordance with accepted plumbing standards. I have installed one or more water closets not exceeding 1.6 gallons per flush. Determined that existing water closets do not exceed 1.6 gallons per flush. The plumbing permit issued by the city/town,if required,is attached. ❑ Dwelling unit is connected directly to a meter installed by a water comp d,in ccor c i M.G.L.c. 186, §22(p),does not require the installation of a submeter. ` Signed under the pains and penalties of perjury, ture of Licensed Plumber Property Owner Certification I certify that: (1)This dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer usage in accordance with the water submetering law(MGL c. 186,§22);(2)All showerheads,faucets, and water closets in this dwelling unit are water conservation devices that meet the standards specified above; (3)The water submeter measuring the use of water in the dwelling unit was installed by a licensed plumber and is in compliance with the standards specified above, or the water meter measuring the use of water in this dwelling unit was installed by a"water company" as defined in 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 , rtification form; (6)That all information included on this certification is true and accurate to the best of my knowl e. Signed under the pains and penalties of perjury, DSF Salem Flint LLC -1 /0/1 Print Name of Owner Sil elof Owner Date L The property has been transferred to owner above and the unit Received remains in compliance with the requirements of M.G.L. c. 186, �22 Date: by BOH: NOV 1220201 *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBMETERING CITY OF SALEM MDPH-CSP Submetering Form,Rev 11-4-16 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 following dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer service. PROPERTY INFORMATION Address: 72 Flint Street Unit# 2303 #Of units in bldg. 42 ci /Town: Salem MA zi code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.000 requires the installation of water conservation devices prior to a dwelling unit becoming eligible for the imposition on tenants of a charge for water and/or sewer.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2 Ys gallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 2/1 gallons per minute(2.2 gpm) Ultra-low flush water closets(toilets)not to exceed 1 6110 gallons per flush(1.6 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 licensed plumber must install the water closets and submetering equipment. Submetering equipment information: Next Century M201 C Manufacturer Model# Licensed Plumber Certification ( �� 1� � Print Name of Plumber License# Date I certify that(check all that apply): ®I have installed the submetering equipment listed above in accordance with accepted plumbing standards. I have installed one or more water closets not exceeding 1.6 gallons per flush. Determined that existing water closets do not exceed 1.6 gallons per flush. The plumbing permit issued by the city/town,if required,is attached. ❑Dwelling unit is connected directly to a meter installed by a water coti nd,in accord th M.G.L . c. 186, §22(p),does not require the installation of a submeter Signed under the pains and penalties of perjury, USignature of Licens lumber Property Owner Certification I certify that: (1)This dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer usage in accordance with the water submetering law(MGL c. 186, §22); (2)All showerheads,faucets,and water closets in this dwelling unit are water conservation devices that meet the standards specified above; (3)The water submeter measuring the use of water in the dwelling unit was installed by a licensed plumber and is in compliance with the standards specified above,or the water meter measuring the use of water in this dwelling unit was installed by a"water company" as defined in 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 fo )That all information included on this certification is true and accurate to the best of my knowledv�--.. Signed under the pains and penalties of perjury, DSF Salem Flint LLC Print Name of Owner Sigi&ture of ner r) Date The property has been transferred to owner above and the unit Received remains in compliance with the requirements of M.G.L. c. 186, '22 Date: by BOH: NOV 12 2020 *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBWTFiALEM BOARD OF HEAL1 H MDPH-CSP Submetering Form,Rev 11-4-16 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 11),the following dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer service. PROPERTY INFORMATION Address: 72 Flint Street Unit# 2304 #ofunits in bide. 42 Ci!y/Town: Salem MA Zip Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.000 requires the installation of water conservation devices prior to a dwelling unit becoming eligible for the imposition on tenants of a charge for water and/or sewer.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2'/2 gallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 2J10 gallons per minute(2.2 gpm) Ultra-low flush water closets(toilets)not to exceed 1 6110 gallons per flush(1.6 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 licensed plumber must install the water closets and submetering equipment. Submetering equipment information: Next Century M201 C Manufacturer Model# Licensed Plumber Certification 11 Print Name of Plumber License# Date I certify that(check all that apply): [XI have installed the submetering equipment listed above in accordance with accepted plumbing standards. I have installed one or more water closets not exceeding 1.6 gallons per flush. Determined that existing water closets do not exceed 1.6 gallons per flush. The plumbing permit issued by the city/town,if required,is attached. ❑Dwelling unit is connected directly to a meter installed by a water compiin and, accordance h M.G.L.c. 186, §22(p), does not require the installation of a submeter., c Signed under the pains and penalties of perjury, _ a re of Lice Ser Property Owner Certification I certify that: (1)This dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer usage in accordance with the water submetering law(N4GL c. 186, §22); (2)All showerheads,faucets, and water closets in this dwelling unit are water conservation devices that meet the standards specified above; (3)The water submeter measuring the use of water in the dwelling unit was installed by a licensed plumber and is in compliance with the standards specified above,or the water meter measuring the use of water in this dwelling unit was installed by a"water company" as defined in 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)That all information included on this certification is true and accurate to the best of my knowledge. Signed under the pains and penalties of perjury, DSF Salem Flint LLC / I Print Name of Owner Si a e of Owner Date The property has been transferred to owner above and the unit Received N 0 V 12 2020 remains in com liance with the requirements of M.G.L. c. 186, §22 Date: b BOH: *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SU WEVNLEM BOARD OF HEALTH MDPH-CSP Submetering Form,Rev 11-4-16 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 In,the following dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer service. PROPERTY INFORMATION Address: 72 Flint Street unit# 2305 #Of units in bldg. 42 City/Town: Salem MA Ziz Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.000 requires the installation of water conservation devices prior to a dwelling unit becoming eligible for the imposition on tenants of a charge for water and/or sewer.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2''A gallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 2/10 gallons per minute(2.2 gpm) Ultra-low flush water closets(toilets)not to exceed 1 6/10 gallons per flush(1.6 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 licensed plumber must install the water closets and submetering equipment. Submetering equipment information: Next Century M201 C Manufacturer Model# Licensed Plumber Certification Al l t� 4,,;*� toC-oo Print Name of Plumber License# Date I certify that(check all that apply): ®I have installed the submetering equipment listed above in accordance with accepted plumbing standards. I have installed one or more water closets not exceeding 1.6 gallons per flush. Determined that existing water closets do not exceed 1.6 gallons per flushKjn The plumbing permit issued by the city/town,if required,is attached. ❑Dwelling unit is connected directly to a meter installed by a water comparerdant M.G.L.c. 186, §22(p),does not require the installation of a submeter. Signed under the pains and penalties of perjury, Si re of Licensed Plumber Property Owner Certification I certify that: (1)This dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer usage in accordance with the water submetering law(MGL c. 186, §22);(2)All Showerheads,faucets,and water closets in this dwelling unit are water conservation devices that meet the standards specified above;(3)The water submeter measuring the use of water in the dwelling unit was installed by a licensed plumber and is in compliance with the standards specified above,or the water meter measuring the use of water in this dwelling unit was installed by a"water company" as defined in 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)That all information included on this certification is true and accurate to the best of my knowledge. Signed under the pains and penalties of perjury, DSF Salem Flint LLC Print Name of Owner Sign4ure of Owner y Tb ate The property has been transferred to owner above and the unit eceived NOV 12 2020 remains in compliance with the requrem ients of M.G.L. c. 186, y22 Date: BOH: *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SU"WWWEM BOARD OF HEALTH MDPH-CSP Submetering Form,Rev 11-4-16 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 H),the following dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer service. PROPERTY INFORMATION Address: 72 Flint Street unit# 2306 #Ofunits inwqg. 42 city/Town: Salem MA Zi Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.000 requires the installation of water conservation devices prior to a dwelling unit becoming eligible for the imposition on tenants of a charge for water and/or sewer.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2''/'gallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 2/1 gallons per minute(2.2 gpm) Ultra-low flush water closets(toilets)not to exceed 1 6/10 gallons per flush(1.6 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 licensed plumber must install the water closets and submetering equipment. Submetering equipment information: Next Century M201 C Manufacturer Model# Licensed Plumber Certification bq Print Name of Plumber License# Date I certify that(check all that apply): ®I have installed the submetering equipment listed above in accordance with accepted plumbing standards. X I have installed one or more water closets not exceeding 1.6 gallons per flush. Determined that existing water closets do not exceed 1.6 gallons per flush. The plumbing permit issued by the city/town,if required,is attached. ` ❑Dwelling unit is connected directly to a meter installed by a water co any end,in accor th M.G.L. c. 186, §22(p),does not require the installation of a subme Signed under the pains and penalties of perjury, Signature of Licensed Plumber Property Owner Certification I certify that: (1)This dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer usage in accordance with the water submetering law(MGL c. 186, §22); (2)All showerheads,faucets,and water closets in this dwelling unit are water conservation devices that meet the standards specified above; (3)The water submeter measuring the use of water in the dwelling unit was installed by a licensed plumber and is in compliance with the standards specified above,or the water meter measuring the use of water in this dwelling unit was installed by a"water company" as defined in 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)That all information included on this certification is true and accurate to the best of my knowle Signed under the pains and penalties of perjury, DSF Salem Flint LLC Print Name of Owner Si ture of Owner Oft Date The property has been transferred to owner above and the unit Received remains in compliance with the requirements of M.G.L. c. 186, §22 Date: by BOH: NOV 12 2020 *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBMETERING CITY OF SALEM MDPH-CSP submetering Form,Rev 11-4-16 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 following dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer service. PROPERTY INFORMATION Address: 72 Flint Street unit# 2307 #Of units in bldg. 42 Ci /Town: Salem MA zi Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.000 requires the installation of water conservation devices prior to a dwelling unit becoming eligible for the imposition on tenants of a charge for water and/or sewer.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2!4 gallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 2"0 gallons per minute(2.2 gpm) Ultra-low flush water closets(toilets)not to exceed 1 6/10 gallons per flush(1.6 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 licensed plumber must install the water closets and submetering equipment. Submetering equipment information: Next Century M201 C Manufacturer Model# Licensed Plumber Certification Print Name of Plumber License# Date I certify that(check all that apply): ®I have installed the submetering equipment listed above in accordance with accepted plumbing standards. I have installed one or more water closets not exceeding 1.6 gallons per flush. Determined that existing water closets do not exceed 1.6 gallons per flush. The plumbing permit issued by the city/town,if required,is attached. ❑ Dwelling unit is connected directly to a meter installed by a water cot ny and,in accordance ' M.G.L. c. 186, §22(p),does not require the installation of a submet Signed under the pains and penalties of perjury, v Signature of Licens Plumber Property Owner Certification I certify that: (1)This dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer usage in accordance with the water submetering law(MGL c. 186, §22);(2)All showerheads,faucets,and water closets in this dwelling unit are water conservation devices that meet the standards specified above;(3)The water submeter measuring the use of water in the dwelling unit was installed by a licensed plumber and is in compliance with the standards specified above,or the water meter measuring the use of water in this dwelling unit was installed by a"water company" as defined in 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)That all information included on this certification is true and accurate to the best of my knowle Signed under the pains and penalties of perjury, DSF Salem Flint LLC Print Name of Owner Si ature of Owner a Date The property has been transferred to owner above and the unt Received N O U 1 2 �02� remains in compliance with the requirements of M.G.L. c. 186, 22 Date: by BOH: *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SU ,TWWEM BOARD OF HEALTH MDPH-CSP Submetering Form,Rev 11-4-16 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 following dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer service. PROPERTY INFORMATION Address: 72 Flint Street Unit# 2308 #Of units in bid . 42 city/Town: Salem MA Zip Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.000 requires the installation of water conservation devices prior to a dwelling unit becoming eligible for the imposition on tenants of a charge for water and/or sewer.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2 A gallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 2/10 gallons per minute(2.2 gpm) Ultra-low flush water closets(toilets)not to exceed 1 6/10 gallons per flush(1.6 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 licensed plumber must install the water closets and submetering equipment. Submetering equipment information: Next Century M201 C Manufacturer Model# Licensed Plumber Certification Print Name of Plumber License# Date I certify that(check all that apply): ®I have installed the submetering equipment listed above in accordance with accepted plumbing standards. X I have installed one or more water closets not exceeding 1.6 gallons per flush. Determined that existing water closets do not exceed 1.6 gallons per flush. The plumbing permit issued by the city/town,if required,is attached. ❑Dwelling unit is connected directly to a meter installed by a water co n a n accordance M.G.L. c. 186, §22(p),does not require the installation of a submeter. Signed under the pains and penalties of perjury, Signature of Licensed Plumber Property Owner Certification I certify that: (1)This dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer usage in accordance with the water submetering law(MGL c. 186, §22); (2)All showerheads,faucets,and water closets in this dwelling unit are water conservation devices that meet the standards specified above; (3)The water submeter measuring the use of water in the dwelling unit was installed by a licensed plumber and is in compliance with the standards specified above,or the water meter measuring the use of water in this dwelling unit was installed by a"water company" as defined in 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)That all information included on this certification is true and accurate to the best of my knowl g . Signed under the pains and penalties of perjury, DSF Salem Flint LLC C Print Name of Owner S' ature of OwnerR00aElVED Date The property has been transferred to owner above and the unit Received NOV �o2d remains in compliance with the requirements of M.G.L.c. 186, 22 Date: _ b. BOH: *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUff TRTAV EM BOARD OF HEALTH MDPH-CSP submetering Form,Rev 11-4-16 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 following dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer service. PROPERTY INFORMATION Address: 72 Flint Street Unit# 2309 #Of units in bldg. 42 city/Town: Salem MA zi Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.000 requires the installation of water conservation devices prior to a dwelling unit becoming eligible for the imposition on tenants of a charge for water and/or sewer.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2 i4 gallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 2/10 gallons per minute(2.2 gpm) Ultra-low flush water closets(toilets)not to exceed 1 6/10 gallons per flush(1.6 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 licensed plumber must install the water closets and submetering equipment. Submetering equipment information: Next Century M201 C Manufacturer Model# Licensed Plumber Certification Ck4�& qL 0 Print Name of Plumber License# Date I certify that(check all that apply): ®I have installed the submetering equipment listed above in accordance with accepted plumbing standards. X I have installed one or more water closets not exceeding 1.6 gallons per flush. Determined that existing water closets do not exceed 1.6 gallons per flush. The plumbing permit issued by the city/town,if required,is attached. ❑Dwelling unit is connected directly to a meter installed by a water company arld,is accordanc h M.G.L. c. 186, §22(p),does not require the installation of a submeter. Signed under the pains and penalties of perjury, Signature of Licensed Plumber Property Owner Certification I certify that: (1)This dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer usage in accordance with the water submetering law(MGL c. 186, §22);(2)All showerheads,faucets,and water closets in this dwelling unit are water conservation devices that meet the standards specified above; (3)The water submeter measuring the use of water in the dwelling unit was installed by a licensed plumber and is in compliance with the standards specified above,or the water meter measuring the use of water in this dwelling unit was installed by a"water company" as defined in 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 ds rtification form; (6)That all information included on this certification is true and accurate to the best of my IQ ge. Signed under the pains and penalties of perjury, DSF Salem Flint LLC Print Name of Owner Si a of Owner a 11 Date The property has been transferred to owner above and the unit Received N O V 1 ���� remains in compliance with the requirements of M.G.L. c. 186, '22 Date: b BOH: *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SU FTP'WEM BOARD OF HEALTH MDPH-CSP Submetering Form,Rev 11-4-16 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 following dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer service. PROPERTY INFORMATION Address: 72 Flint Street Unit# 2310 #Of units in bldg. 42 ci /Town: Salem MA zi Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.000 requires the installation of water conservation devices prior to a dwelling unit becoming eligible for the imposition on tenants of a charge for water and/or sewer.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2 '/'gallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 Z/10 gallons per minute(2.2 gpm) Ultra-low flush water closets(toilets)not to exceed 1 6/10 gallons per flush(1.6 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 licensed plumber must install the water closets and submetering equipment. Submetering equipment information: Next Century M201 C Manufacturer Model# Licensed Plumber Certification l L 00�7 -� Print Name of Plumber License# Date I certify that(check all that apply): ®I have installed the submetering equipment listed above in accordance with accepted plumbing standards. X I have installed one or more water closets not exceeding 1.6 gallons per flush. Determined that existing water closets do not exceed 1.6 gallons per flush. The plumbing permit issued by the city/town,if required,is attached. ❑Dwelling unit is connected directly to a meter installed by a water company ,in accordance with M.G.L. c. 186, §22(p),does not require the installation of a submeter. Signed under the pains and penalties of perjury, ,.+ SLAnature of LicenseiVPlunih6r Property Owner Certification I certify that: (1)This dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer usage in accordance with the water submetering law(MGL c. 186,§22);(2)All showerheads,faucets,and water closets in this dwelling unit are water conservation devices that meet the standards specified above; (3)The water submeter measuring the use of water in the dwelling unit was installed by a licensed plumber and is in compliance with the standards specified above,or the water meter measuring the use of water in this dwelling unit was installed by a"water company" as defined in 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 's certification form; (6)That all information included on this certification is true and accurate to the best of my knowl ge. Signed under the pains and penalties of perjury, DSF Salem Flint LLCIL Print Name of Owner L.4�r -Aiknature of Owner R EARF Fby The property has been transferred to owner above and the un t eived N O U 12 ZOZQ remains in compliance with the requirements of M.G.L. c. 186, 22 Date: OH: *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SU *TWNJ@LEM BOARD OF HEALTH MDPH-CSP Submetering Form,Rev 11-4-16 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 I1),the following dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer service. PROPERTY INFORMATION Address: 72 Flint Street Unit# 2311 #Of units in bid . 42 Ci /Town: Salem MA Zil, Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.000 requires the installation of water conservation devices prior to a dwelling unit becoming eligible for the imposition on tenants of a charge for water and/or sewer.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2 �'gallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 2/10 gallons per minute(2.2 gpm) Ultra-low flush water closets(toilets)not to exceed 1 6110 gallons per flush(1.6 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 licensed plumber must install the water closets and submetering equipment. Submetering equipment information: Next Century M201 C Manufacturer Model# Licensed Plumber Certification L:�-T A5- �A Azz Print Name of Plumber License# Date I certify that(check all that apply): ®I have installed the submetering equipment listed above in accordance with accepted plumbing standards. I have installed one or more water closets not exceeding 1.6 gallons per flush. Determined that existing water closets do not exceed 1.6 gallons per flush. The plumbing permit issued by the city/town,if required,is attached. ❑Dwelling unit is connected directly to a meter installed by a water companfthd,in 6ccordance i M.G.L. c. 186, §22(p),does not require the installation of a submeter. Signed under the pains and penalties of perjury, i afore of Licensed Plumber Property Owner Certification I certify that: (1)This dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer usage in accordance with the water submetering law(MGL c. 186, §22); (2)All showerheads,faucets,and water closets in this dwelling unit are water conservation devices that meet the standards specified above; (3)The water submeter measuring the use of water in the dwelling unit was installed by a licensed plumber and is in compliance with the standards specified above,or the water meter measuring the use of water in this dwelling unit was installed by a"water company" as defined in 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)That all information included on this certification is true and accurate to the best of my knowledge. Signed under the pains and penalties of perjury, DSF Salem Flint LLC 4 Print Name of Owner a re of Owner Date L — The property has been transferred to owner above and the unit / Received remains in compliance with the requirements of M.G.L. c. 186, §22 Date: N O V 12 2020 *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBMETERING CITY OF SALEM MDPH-CSP Submetering Form,Rev 11-4-16 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 Il),the following dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer service. PROPERTY INFORMATION Address: 72 Flint Street Unit# 2312 #Of units inbldg. 42 City/Town: Salem MA zi;, code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.000 requires the installation of water conservation devices prior to a dwelling unit becoming eligible for the imposition on tenants of a charge for water and/or sewer. The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2''gallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 2/1 gallons per minute(2.2 gpm) Ultra-low flush water closets(toilets)not to exceed 1 6/10 gallons per flush(1.6 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 licensed plumber must install the water closets and submetering equipment. Submetering equipment information: Next Century M201 C Manufacturer Model# Licensed Plumber Certification Print Name of Plumber License# Date I certify that(check all that apply): [XI have installed the submetering equipment listed above in accordance with accepted plumbing standards. I have installed one or more water closets not exceeding 1.6 gallons per flush. Determined that existing water closets do not exceed 1.6 gallons per flush. The plumbing permit issued by the city/town,if required,is attached. ❑Dwelling unit is connected directly to a meter installed by a water compan di accordanc wit M.G.L.c. 186, §22(p),does not require the installation of a submeter. Signed under the pains and penalties of perjury, (_ 60 Signature of LiceAsed Plumber Property Owner Certification I certify that: (1)This dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer usage in accordance with the water submetering law(MGL c. 186, §22);(2)All showerheads,faucets,and water closets in this dwelling unit are water conservation devices that meet the standards specified above; (3)The water submeter measuring the use of water in the dwelling unit was installed by a licensed plumber and is in compliance with the standards specified above,or the water meter measuring the use of water in this dwelling unit was installed by a"water company" as defined in 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 th' i fication form; (6)That all information included on this certification is true and accurate to the best of my knowle e. Signed under the pains and penalties of perjury, DSF Salem Flint LLC lb Print Name of Owner SO mature of Owner r E-- Date The property has been transferred to owner above and the nit Received remains in compliance with the requirements of M.G.L. c. 186, §22 Date: by BOH: NOV 12 2020 *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUB OF SALEM BOARD OF HEALTH MDPH-CSP Submetering Form,Rev 11-4-16 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 11),the following dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer service. PROPERTY INFORMATION Address: 72 Flint Street unit# 2313 #Of units in bldg. 42 City/Town: Salem MA Zii? Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.000 requires the installation of water conservation devices prior to a dwelling unit becoming eligible for the imposition on tenants of a charge for water and/or sewer.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2''gallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 2/10 gallons per minute(2.2 gpm) Ultra-low flush water closets(toilets)not to exceed 1 6/10 gallons per flush(1.6 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 licensed plumber must install the water closets and submetering equipment. Submetering equipment information: Next Century M201 C Manufacturer Model# Licensed Plumber Certification Print Name of Plumber License# to I certify that(check all that apply): ®I have installed the submetering equipment listed above in accordance with accepted plumbing standards. I have installed one or more water closets not exceeding 1.6 gallons per flush. Determined that existing water closets do not exceed 1.6 gallons per flush. The plumbing permit issued by the city/town,if required,is attached. / ❑Dwelling unit is connected directly to a meter installed by a water compTT7 � th M.G.L .c. 186, § 22(p),does not require the installation of a submeter. Signed under the pains and penalties of perjury, 11 Signature of Licensed Plkg6r Property Owner Certification I certify that: (1)This dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer usage in accordance with the water submetering law(MGL c. 186, §22); (2)All showerheads,faucets,and water closets in this dwelling unit are water conservation devices that meet the standards specified above;(3)The water submeter measuring the use of water in the dwelling unit was installed by a licensed plumber and is in compliance with the standards specified above,or the water meter measuring the use of water in this dwelling unit was installed by a"water company" as defined in 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 1; (6)That all information included on this certification is true and accurate to the best of my knowledge. Signed under the pains and penalties of perjury, DSF Salem Flint LLC l Print Name of Owner i ature o Owner a Date The property has been transferred to owner above and the unit Received NOV 1 2 2OZO remains in compliance with the requirements of M.G.L.c. 186, §22 Date: b BOH: *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SU8"I, PTkEM BOARD OF HEALTH MDPH-CSP Submetering Form,Rev 11-4-16 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 Il),the following dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer service. PROPERTY INFORMATION Address: 72 Flint Street unit# 2314 #Of units in bldg. 42 City/Town: Salem MA zip code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.000 requires the installation of water conservation devices prior to a dwelling unit becoming eligible for the imposition on tenants of a charge for water and/or sewer. The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2''/'fallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 2/1 gallons per minute(2.2 gpm) Ultra-low flush water closets(toilets)not to exceed 1 6110 gallons per flush(1.6 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 licensed plumber must install the water closets and submetering equipment. Submetering equipment information: Next Century M201 C Manufacturer Model# _ Licensed Plumber Certification U ► R Print Name of Plumber License# Date I certify that(check all that apply): ®I have installed the submetering equipment listed above in accordance with accepted plumbing standards. X I have installed one or more water closets not exceeding 1.6 gallons per flush. Determined that existing water closets do not exceed 1.6 gallons per flush. The plumbing permit issued by the city/town,if required,is attached. ❑Dwelling unit is connected directly to a meter installed by a water compan ,in ccordanc i h M.G.L.c. 186, §22(p),does not require the installation of a submeter. Signed under the pains and penalties of perjury, _ Signature of Licensed Plumber Property Owner Certification I certify that:(1)This dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer usage in accordance with the water submetering law(MGL c. 186, §22);(2)All showerheads,faucets, and water closets in this dwelling unit are water conservation devices that meet the standards specified above; (3)The water submeter measuring the use of water in the dwelling unit was installed by a licensed plumber and is in compliance with the standards specified above,or the water meter measuring the use of water in this dwelling unit was installed by a"water company" as defined in 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)That all information included on this certification is true and accurate to the best of my knowledge. Signed under the pains and penalties of perjury, DSF Salem Flint LLC 411- a-11, Print Name of Owner gignarwner a Tby ate The property has been transferred to owner above and the unit eceived N O V 12 2020 remains in compliance with the requirements of M.G.L. c. 186, '22 Date: BOH: *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUMVW&RINALEM BOARD OF HEALTH MDPH-CSP Submetering Form,Rev 11-4-16