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72 Flint St. Water & Sewer Submeter Certificates Units 1101-1120 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 St. Unit#— #Of units in bldg. 80 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 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 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 Michael Muise 11058 Master 2/10/21 Print Name of Plumber License# Date I certify that(check all that apply): X❑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 compatk,nd, 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, S ure of Lice6stfil Plum 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 certificatio n; (6)That all information included on this certification is true and accurate to the best of m4knowledd Signed under the pains and penalties of perjury, DSF Salem Flint LLC 2/10/21 Print Name of Owner Signature of Owner e D Date The property has been transferred to owner above and the unit Received FEB 2 3 202 remains in compliance with the requirements of M.G.L. c. 186, §22 Date: bN BOH: _ *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBhff"R#rSALEM 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 St. Unit# #Of units in bldg. 80 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 M201C Manufacturer Model# Licensed Plumber Certification Michael Muise 11058 Master 2/10/21 Print Name of Plumber License# Date I certify that(check all that apply): X❑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 a rdance w' i 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, 4Z DSF Salem Flint LLC 2/10/21 Print Name of Owner Si nature of Owner Pa Date R9s 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: FF9 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 St. Unit# 116 #Of units in bldg. 80 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 Michael Muise 11058 Master 2/10/21 Print Name of Plumber License# Date I certify that(check all that apply): P 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 d, 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, Signature of Licen d PJumber 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 LLC7�42/10/21 Print Name of Owner �unatur of O vner = 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: F . 9 9 ;,r,7' *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 St. Unit# #Of units in bldLn 80 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 M201C Manufacturer Model# Licensed Plumber Certification Michael Muise 11058 Master 2/10/21 Print Name of Plumber License# Date I certify that(check all that apply): X❑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 y and, 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, L i nature orGcens d 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 fort • (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 2/10121 Print Name of Owner Sinatur of Owner FbB El The property has been transferred to owner above and the unit d FEB 2 3 20. 1 remains in compliance with the requirements of M.G.L. c. 186, §22 Date: : *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBIVt�E{TY'16ftALEM 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 St. Unit# #Of units in bldg. 80 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 '/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 Michael Muise 11058 Master 2/10/21 Print Name of Plumber License# Date I certify that(check all that apply): X❑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 Od, 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 nature 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 f ;(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 2/10/21 Print Name of Owner Signature of Owner a / Date The property has been transferred to owner above and the unit Received remains in com liance with the req uirements of M.G.L. c. l 86, §22 Date: _ b sox: FEB 2 3 20::1 *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUB1ItffYt�'%PLEM 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 St. Unit# q00 #Of units in bldg. 80 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 M201C Manufacturer Model# Licensed Plumber Certification Michael Muise 11058 Master 2/10/21 Print Name of Plumber License# Date I certify that(check all that apply): X❑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 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, A. L_� 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 knowle ge. Signed under the pains and penalties of perjury, DSF Salem Flint LLC 2/10/21 Print Name of Owner Sionat 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: b\ BOH: FEB 2 3 20 1 *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBMETERING CITY OF SALFM 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 If),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 St. Unit# 1[0] #Of units in bldg. 80 City/Town: Salem MA Zi i 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 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 Michael Muise 11058 Master 2/10/21 Print Name of Plumber License# Date I certify that(check all that apply): X❑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 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, 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 certific . n 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 2/10/21 Print Name of Owner Sin ure of OwnerEl Date The property has been transferred to owner above and the it/ Received remains in compliance with the requirements of M.G.L. c. 186, §22 Date: b� BOH: FEB 2 3 2011 *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBMbWOv GSPLGEM 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 St. Unit# 1.6 75 Of units in bldg. 80 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 Michael Muise 11058 Master 2/10/21 Print Name of Plumber License# Date I certify that(check all that apply): X❑1 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 nd, in accorda ce 7th 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 Licenst imber 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 knowledg Signed under the pains and penalties of perjury, DSF Salem Flint LLC 2/10/21 Print Name of Owner Sh-matu e of OwnerEl 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: FEB 2 3 20 1 *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBMETERING CITY OF 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 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 St. Unit 4 #Of units in bldg. 80 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 Michael Muise 11058 Master 2/10/21 Print Name of Plumber License# Date I certify that(check all that apply): X❑l 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 compgn d in accord /c . th 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 2/10/21 Print Name of Owner Signatur .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: FEB *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 St. Unit# W o #Of units in bldg. 80 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 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 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 Michael Muise 11058 Master 2/10/21 Print Name of Plumber License# Date I certify that(check all that apply): X❑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 compantn ,inaccordance Y I i 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 knowle Signed under the pains and penalties of perjury, DSF Salem Flint LLC 2/10/21 Print Name of Owner SlgVature of Owner Date Date u d ❑ 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: J b� BOH: 1 *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBM R 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 St. Unit# It [ ( #Of units in bld 80 Citv/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 Michael Muise 11058 Master 2/10/21 Print Name of Plumber License# Date I certify that(check all that apply): FX_1I have installed the submetering equipment listed above in accordance with accepted plumbing standards. 0 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 ' 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 knowle Lignaty�e Signed under the pains and penalties of perjury, DSF Salem Flint LLC 2110/21 Print Name of Ownerner Date The property has been transferred to owner above and the unit Received FEB 23 2021 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 SUBPaMRI GALEM 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 St. Unit Of units in bldg. 80 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 M201C Manufacturer Model# Licensed Plumber Certification Michael Muise 11058 Master 2/10/21 Print Name of Plumber License# Date I certify that(check all that apply): X❑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 d, in accordance i rh 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 Properly 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 2/10/21 Print Name of Owner Si nature wner M Qa r* 11 Date MIL'V c 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: F 1� n 7 *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBMETERING CITY OF SALFM 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 St. Unit# #Of units in bldg. 80 Citv/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 i�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 Michael Muise 11058 Master 2/10/21 Print Name of Plumber License# Date I certify that(check all that apply): X❑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 an 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, Signature of L ensed 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 certificatio orm; (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 2/10/21 Print Name of Owner Si= at.re of Owner BF El Date The property has been transferred to owner above and the unit Received FEB 2 3 ZO 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 SUBM,§ffI %ALEM BOARD OF HEALTH VIDPH-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 St. Unit Of units in bldg. 80 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 Michael Muise 11058 Master 2/10/21 Print Name of Plumber License# Date I certify that(check all that apply): X❑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 ' ccordance wi M.G.L . c. 186, §22(p),does not require the installation of a submeter. Signed under the pains and penalties of perjury, ig ure of icensed Plumber Property Owner Certification I certify that: (1) This dwelling unit is eligible for the imposition on the tenants Ja 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,andNT rm;(6)That all information included on this certification is true and accurate to the best of m Signed under the pains and penalties of perjury, DSF Salem Flint LLC Ni Print Name of Owner natre of Owner D Date The property has been transferred to owner above and the unit Received FEB 2 3 20 1 remains in compliance with the requirements of M.G.L. c. 186, §22 Date: bv BOH: *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBl\49TMWRBALEM 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 St. Unit# Of units in bldg. 80 Citv/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 Michael Muise 11058 Master 2/10/21 Print Name of Plumber License# Date I certify that(check all that apply): X❑1 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 a , in accordance ith 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 c cation 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 2/10/21 Print Name of Owner Si nature o Owner pate', ' Date The property has been transferred to owner above and the unit Received FEB 2 3 202 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 SUBMffPJN@ALFM 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 lI),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 St. Unit# #Of units in bld,. 80 Citv/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 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 Michael Muise 11058 Master 2/10/21 Print Name of Plumber License# Date I certify that(check all that apply): X❑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 d, 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, 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 knowle +e. Signed under the pains and penalties of perjury, DSF Salem Flint LLC 2/10/21 Print Name of Owner Sign• ire of OwnerEl 1]ate Date d- The property has been transferred to owner above and the unit r Received remains in compliance with the requirements of M.G.L. c. 186, §22 Date: by BOH: FEB 2 3 ZO'1 *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 St. Unit# t l #Of units in blda. 80 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"0 gallons per minute(2.2 gpm) Ultra-low flush water closets(toilets)not to exceed 1 6"0 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 Michael Muise 11058 Master 2/10/21 Print Name of Plumber License# Date I certify that(check all that apply): 01 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, n accordance w' M.G.L . c. 186, §22(p), does not require the installation of a submeter. Signed under the pains and penalties of perjury, SignatuW 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 f (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 2/10/21 Print Name of Owner Signature f Owner r- Date * , 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 CDate: by BOH: FEB 2 3 202. *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBMETERING CITY OF SALEM MDPH-CSP Submetering Form,Rev I1-4-16 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 lI),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 St. Unit# 11 Jg Of units in bldpg. 80 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 1/1 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 M201C Manufacturer Model# Licensed Plumber Certification Michael Muise 11058 Master 2/10/21 Print Name of Plumber License# Date I certify that(check all that apply): x❑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 wit 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 ' n ;(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 2/10/21 Print Name of Owner Signature of Owner r9: t I-- Date I L u 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: FEB 2 3 20"1 *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBMETERING CITY OF SALF_M 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 St. Unit #Of units in bldg. 80 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 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 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 M201C Manufacturer Model # Licensed Plumber Certification Michael Muise 11058 Master 2/10/21 Print Name of Plumber License# Date I certify that(check all that apply): X❑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 d, 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, /PM ZL:��_ S nature 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 fo ; (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 2/10/21 Print Name of Owner Si nature f-owner at 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: FEB 2 3 20 9 *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUB*F M%ALEM BOARD OF HEALTH NMPH-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 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 St. Unit# Q #Of units in bldg. 80 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 /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 Michael Muise 11058 Master 2/10/21 Print Name of Plumber License# Date I certify that(check all that apply): X❑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 rid, 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, S!gbature of Licen•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)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 fo ; (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 2/10/21 Print Name of Owner S1 mature of Owner bale p— 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: FEB 2 3 2021 *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBMETERING CITY OF SALEM MDPH-CSP Submetering Form,Rev l 1-4-16 BOARD OF HEALTH