72 Flint St. Water & Sewer Submeter Certificates Units 1201-1220 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 bl . 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 compa and, i 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 ficoised 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) iat 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 of wrier iat
Fbi
The property has been transferred to owner above and the unit eived FEB 2 3 20..1
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 SUBr0fi 1 CSALEM
BOARD OF HEALTH
NVIDPH-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# t Q #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 2/10 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 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 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,
11 &qnp6re of Licensed Plumber
Property Owner Certification
1 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 2/10/21
Print Name of Owner Si Tn ture of caner .Datt: -
Date o ':�
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: 1TFR q 3 L' 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# Of units in bldLi. 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):
FX_1I 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 with
M.G.L . c. 186, §22(p), does not require the installation of a submeter.
Signed under the pains and penalties of perjury,
Jignature 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 of Owner f.7;t�
El
Date
The property has been transferred to owner above and the unit Received FEB 2 20 1
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 SUB'9ff %ALi_M
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 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.
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 com 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,
LS ignati e 6f LikerLwd 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 tl 's certific o form; (6)That all information included on
this certification is true and accurate to the best of my know ge.
Signed under the pains and penalties of perjury,
DSF Salem Flint LLC 2/10/21
Print Name of Owner Sigfiature of Owner Data
T�b
ate r
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: sox: FEBR�2 G3 20"1
*THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUB CITY O 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# 20 c; #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):
R 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 accordanc 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 Tnature f 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,and4ofificatio orm; (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 2110/21
Print Name of Owner SiLIT atu e of Owner r I °h - a
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 SUBIFV ALE{l4
BOARD OF HEALTH
N41DP1i-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 4,1 1100 #Of units in bldg. $0
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):
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 Licens 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)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 )That all information included on
this certification is true and accurate to the best of my know]e e.
Signed under the pains and penalties of perjury,
DSF Salem Flint LLC10r21 D
Print Name of Owner Signature A caner L)ati
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, ti22 Date: bN BOH:
*THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBM9VePI3FGSALE v.7
BOARD OF H EIAE:i 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 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# K01 # 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 i2 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�n 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,
Si ature of V&jefnsed Kumber
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; hat 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 Si natur of Owner ' 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 Date: b Box: FEB 2 3 20 i
*THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUB NWITY VE'S DEEP
BOARD OF HEALTH
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 St. Unit# t,2 #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 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
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,
Si nature of L censed 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 2/10/21
Print Name of Owner Si gnatt Owner mote•-,r- —
Date a t L__'.. L_I G'
❑ 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 2 20H
*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 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 2 6 t #Of units in bldp. 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
1 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 and, 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, // — /�14
SiLKnakire of Lker6eklumber
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 )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 of Owner I I0—t 11 ;
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 20 1
*THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBII�IMALEM
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# Z Q #Of units in bid . 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):
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 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,
_,Signature o 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 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 2/10/21
Print Name of Owner Si nature ot 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 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
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 bld�,. 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 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,
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) 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 knowledge.
Signed under the pains and penalties of perjury,
DSF Salem Flint LLC 2/10/21
Print Name of Owner Siena urekf Owner
Date
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 Box: FEB 2 3 20 1
*THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBM E
BOARD OF HEATH
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 St. Unit# t 2 M #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 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 compan , 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,
Sin 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 2/10/21
Print Name of Owner Si nature f..Owner f <+te, 1;
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 29. i
*THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBMETERING
CITY OF Sr'!LEN-1
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 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 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 v�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):
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 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,
Si_natt 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 knowled
Signed under the pains and penalties of perjury,
DSF Salem Flint LLC 2/10121
Print Name of Owner Si(')natuug ot Owner -.lea
El L 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: bN Box: FEB 2 3 20211
*THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUB 11�FI P6W%A 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 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 '/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 compan 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,
..
Si ture of Li 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 certification fo • (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 Signature o ner -- al re
Date
The property has been transferred to owner above and the unit Received FEB 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 SUB'19M&%ALEM
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 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 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
Si nature f Licensed Plur b pr
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 Si gnatur, of Owner Date
Date ,�
The property has been transferred to owner above and the unit Received R E C E I U _l
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 SUBMERKRll$(Pj 2021
MDPH-CSP Submetering Form,Rev 11-4-16 CITY OF SALEM
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# 2 t #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 d,An 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, _
Si Ina ire of Lice sed 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 knowledge.
Signed under the pains and penalties of perjury,
DSF Salem Flint LLC 2/10/21
Print Name of Owner Si rnatu e o Owner
Date
The property has been transferred to owner above and the unit Received FEB 2 2�
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 SUBN Y4TV%LEKi
BOARD 0-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 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❑l 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 i 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,
SijnatLZ 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 2/10/21
Print Name of Owner Si natur of w er I?at�Gm p
Date � "—
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: FEB 2 3 20 1
*THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBMETERING
CITY OF SALE,`1
MDPH-CSP Submetering Form,Rev 11-4-16 BOARD OF! E,-r%LTH
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# 'L 119 #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.
XM 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 d, i accor rice with
M.G.L . c. 186, §22(p), does not require the installation of a submeter.
v__�
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,
DSF Salem Flint LLC 2/10/21
Print Name of Owner Signature 4 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% sox: FEB 2 3 20 1
*THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUB'SWA91SALEM
NOPH-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# z L 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❑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 company , ' 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• hat 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 igAature'o`rMner Deter -P
Date ®N
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: bN BOH: FEB :. 20 1
*THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBMETERING
CITY OF Sr,l.E
MDPN-CSP Submetering Form,Rev 11-4-16
BOARD OF
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 St. Unit# ; a #Of units in bldgw. 80
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 '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• , 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 knowledge.
Signed under the pains and penalties of perjury,
DSF Salem Flint LLC 2/10121
Print Name of Owner Sh nati e of Owner a%�
El Date --
The property has been transferred to owner above and the unit Received FEB 2 2��
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 SUBIff_TI RN& EM
BOARD OF HEALTH
MDPH-CSP Submetering Form,Rev 11-4-16