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72 Flint St. Water & Sewer Submeter Certificates Units 1301-1320 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# 76 p #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 con any and, in accordan h M.G.L . c. 186, §22(p),does not require the installation of a submet r. 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 wnature o ner R7; 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 2021 *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBMETERING CITY OFSAJDDA MDPH-CSP Submetering Form,Rev 11-4-16 BOARD Oi=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# V 2j `., #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"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 compan afid, in ance th M.G.L .c. 186, §22(p),does not require the installation of a submeter. Signed under the pains and penalties of perjury, �31i mature 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 knowledg Signed under the pains and penalties of perjury, DSF Salem Flint LLC 2/10/21 Print Name of Owner Slgpit4 of Owner —.Dzte,,, Date ri The property has been transferred to owner above and the unit Received remains in compliance with the requirements of M.G.L. c. 186, §22 Date: by BOH: *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBMETERING CITY OF SI?LEM MDPH-CSP Submetering Form,Rev 11-4-16 BOPi D 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 SOS #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❑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 n , 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, 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 rentalperempent that clearly provides for the separate charging of water and/or sewer service,and a copy of this certification fKn;(6) 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 _,Wt�f�a Date ° i ❑ 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 9 *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBM EJERING I Y OF SALEM 30A'--!D OF FIEAL T" J 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# o 44 #Of units in bldg. 80 City/Town: Salem MA Zi2 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. 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 4d, 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, Im Si lture 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 cement that clearly provides for the separate charging of water and/or sewer service,and a copy of this certification rm; ( )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 13 Date The property has been transferred to owner above and the unit Received remains in com liance with the requirements of M.G.L. c. 186, §22 Date: b\ BOH: FEB 2 W 20.1 *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBMEIII�LC�, BOARD CF . 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# ?jQ� #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 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 , 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, Sign 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 Signature )f Owner 21 Date The property has been transferred to owner above and the unit Received FEB Z� remains in compliance with the requirements of M.G.L. c. 186, §22 Date: b� BOH: W *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBN& is S^LEM r.. CF- 1-1EALTH 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# (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 ''/'gallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 2110 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 com al y and, in accordan with M.G.L . c. 186, §22(p),does not require the installation of a submeter Signed under the pains and penalties of perjury, i mature of icensed 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, 1 DSF Salem Flint LLC Print Name of Owner Sinatur of Owner D El 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: by BOH: *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBKOTIfRDWEALEM 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 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 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 /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-M 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 , m accordance w' h M.G.L . c. 186, §22(p),does not require the installation of a submeter. Signed under the pains and penalties of perjury, Sig ture of Licensed Plumber Property Owner Certification I certify that: (1)This dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer usage in accordance with the water submetering law(MGL c. 186, §22);(2)All showerheads,faucets,and water closets in this dwelling unit are water conservation devices that meet the standards specified above;(3)The water submeter measuring the use of water in the dwelling unit was installed by a licensed plumber and is in compliance with the standards specified above, or the water meter measuring the use of water in this dwelling unit was installed by a"water company" as defined in M.G.L. c. 186, § 22; (4)The water meter or submeter measures the water usage exclusive to this unit;(5) I will provide to the tenants of this dwelling unit,prior to occupancy,a written rental agreement that clearly provides for the separate charging of water and/or sewer service,and a copy of this certificatio orm (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 Si gnat e of Owner =I�te'o 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 sox: FEB 2 3 2011 *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUB N'll71 i�LGG`3T L0.1 MDPH-CSP Submetering Form,Rev It-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 , 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 nature icensed 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 ,t )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 31".lial ure:.f 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: F'=2 2 2 J *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBMETERING CITE'OF SALcM MDPH-CSP Submetering Form,Rev 11-4-16 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# �j #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, 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, Sin ire 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 of Ow r Date The property has been transferred to owner above and the unit Received remains in compliance with the requirements of M.G.L. c. 186, §22 Date: b� BOLL FEB 2 3 ZQ] *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBM TERINNG MiTY OF SALEM MDPH-CSP Submetering Form,Rev 11-4-16 BOAFFID OF FIEAU H MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM *In accordance with M.G.L. c. 186, §22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation (State Sanitary Code Chapter I1),the following dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer service. PROPERTY INFORMATION 72 Flint St. Address: iJnit# '(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 compd,in accor e with M.G.L . c. 186, §22(p), does not require the installation of a submeter. an an Signed under the pains and penalties of perjury, J 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 agreemA that clearly provides for the separate charging of water and/or sewer service,and a copy of this certification form;(6 ha 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 ner -D'afe, F� IB3 El The property has been transferred to owner above and the unit d FEB `� 2� 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 SUBMtTW(NPSALEM 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 iz gallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 2/10 gallons per minute(2.2 gpm) Ultra-low flush water closets(toilets)not to exceed 1 6/10 gallons per flush(1.6 gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A licensed plumber must install the water closets and submetering equipment. Submetering equipment information: Next Century M201 C Manufacturer Model# Licensed Plumber Certification 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 compan nd, in accordant with M.G.L . c. 186, §22(p), does not require the installation of a submeter. Signed under the pains and penalties of perjury, /I i mature 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 m ; (6)That all with 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 natt e of Owner Dat Date 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 Box: FEB n l *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 BOA SD 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 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 compan nd, in accordance w'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) 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 V rm; (6)That all information included on this certification is true and accurate to the best of my knowl Signed under the pains and penalties of perjury, DSF Salem Flint LLC 2/10/21 Print Name of Owner Si nat re of Ownerate 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: by BOH: *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBWiTERN&GQ,LrE-M OF HEALTH MDPH-CSP Submetering Form,Rev 1.1-4-16 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 compan nd, Kaordance 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 ;(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 Sign ire of OwnerL I V1D Fby e The property has been transferred to owner above and the unit eived FEB 2 7021 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 SUB111�TVFW%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# ts 14 #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 2/10 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 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, inature 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 knowledg Signed under the pains and penalties of perjury, DSF Salem Flint LLC 2 2/10/21 Print Name of Owner Si mature f Owner Date-, n Date ri L_ The property has been transferred to owner above and the unit Received remains in compliance with the requirements of M.G.L. c. 186, §22 Date: by BOH: F== 0 2 *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBMETERING CITY V OF SALDIA MDPH-CSP Submetering Form,Rev 11-4-16 6` ArRD CF' - - 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# �j(r #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 /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 compan d, in accordant 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 icensed 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 2/10/21 Print Name of Owner Signature Owner 1' D Date The property has been transferred to owner above and the unit Received FEB 2 3 20` 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 SUBNILE��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 I Sib 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. 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. ` V Signed under the pains and penalties of perjury, V�ig ature of Licensed Plumber Property Owner Certification I certify that: (1)This dwelling unit is eligible for the imposition on the tenants of a ch ge 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 P 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: by Box: FEB 3 20 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 - OF HEAI-fH 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 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) 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 Signature f Owner -; -Dates 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 BOH: FEB 2 3 20 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 OF HEAD H 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#- IS155 #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"0 gallons per minute(2.2 gpm) Ultra-low flush water closets (toilets)not to exceed 1 6110 gallons per flush(1.6 gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A licensed plumber must install the water closets and submetering equipment. Submetering equipment information: Next Century M201 C Manufacturer Model# Licensed Plumber Certification Michael Muise 11058 Master 2110/21 Print Name of Plumber License# Date I certify that(check all that apply): XII 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, olgiiature 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,anAg rceArtificat' €' rm;(6)That all information included on this certification is true and accurate to the best of Signed under the pains and penalties of perjury, DSF Salem Flint LLC 2/10/21 Print Name of Owner SIgnat re of Owner r—DatesEl �- 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: FF B 2, 2 *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBMETERING C!TY OF SALFM MDPH-CSP Submetering Form,Rev 11-4-16 0F �­lE_7'L H 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 Cite/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 , 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) I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the separate charging of water and/or sewer service,and a copy of this certification fo ) That all information included on this certification is true and accurate to the best of my knowledge. Signed under the pains and penalties of perjury, DSF Salem Flint LLC 2/10/21 Print Name of Owner Signature o Owner FbvBOH: ` The property has been transferred to owner above and the unit ed FEB `� ;� ZQ� 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 SUBII�EFIJILCL��� OF HEALTH 1VIDPH-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# [�jID #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 compa.4 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, Si nature o i 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 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 �*o 2/10/21 Print Name of Owner Si nature o owner Date Date 1 LZ , 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: G, n �_� *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBMETERIN C F _..] ,NMPH-CSP Submetering Form,Rev 11-4-16 — 2 1j.— ;-; - {-f