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72 Flint St. Water & Sewer Submeter Certificates Units 1401-1420 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# 1401 #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 comps nraccordan1cwit 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 w . ental gree ent that clearly provides for the separate charging of water and/or sewer service,and a copy of this c ificatio f ;(6) 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 Si nature of Owner Pates 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 C ate: by BOH: I F:; , 2 Ll *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBMETERING CITY OF Say,"1 i'1 MDPH-CSP Submetering Form,Rev 11-4-16 BOARID CF HEALT 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# ` 4o l- #Of units in bldg. 80 Citv/Town: Salem MA Zip Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.000 requires the installation of water conservation devices prior to a dwelling unit becoming eligible for the imposition on tenants of a charge for water and/or sewer.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2 ''/'gallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 2/10 gallons per minute(2.2 gpm) Ultra-low flush water closets(toilets)not to exceed 1 6/10 gallons per flush(1.6 gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A licensed plumber must install the water closets and submetering equipment. Submetering equipment information: Next Century M201 C Manufacturer Model# Licensed Plumber Certification Michael Muise 11058 Master 2/10/21 Print Name of Plumber License# Date I certify that(check all that apply): X❑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 anrncco ance 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 ofVe'. ; (6)That all information included on this certification is true and accurate to the best of my know d Signed under the pains and penalties of perjury, DSF Salem Flint LLC 2/10/21 Print Name of Owner Siunatu e of Owner - El 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 20r 1 *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBME�E�i1111GSALEM 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 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 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 an , i cco dance 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 2/10/21 Print Name of Owner 5i6attife of Owner Ida n 7 Date The property has been transferred to owner above and the unit Received FEB B 20 1 remains in compliance with the requirements of M.G.L. c. 186, §22 Date: b BOH: *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUB i 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# I A04 #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❑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 wit M.G.L . c. 186, §22(p), does not require the installation of a submeter. Signed under the pains and penalties of perjury, Signature of Licens d Plumber Property Owner Certification I certify that: (1)This dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer usage in accordance with the water submetering law(MGL c. 186, §22); (2)All showerheads, faucets,and water closets in this dwelling unit are water conservation devices that meet the standards specified above; (3)The water submeter measuring the use of water in the dwelling unit was installed by a licensed plumber and is in compliance with the standards specified above,or the water meter measuring the use of water in this dwelling unit was installed by a"water company" as defined in M.G.L. c. 186, § 22; (4)The water meter or submeter measures the water usage exclusive to this unit; (5)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, l- DSF Salem Flint LLC 2/10/21 F a Print Name of Owner Signature!t Owner 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 SUBN�I P 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 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 T/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 and, in a cordance w' M.G.L . c. 186, §22(p), does not require the installation of a submeter. Signed under the pains and penalties of perjury, nature 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)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 Si nature of O nerEl `Dat Date LL The property has been transferred to owner above and the unit Received FEB 20 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 SUBN�IT� 4 E, . Or I-P=ALFH 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 k o #Of units in bldg. 80 Citti/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,^i accordance witl M.G.L . c. 186, §22(p),does not require the installation of a submeter. ' Signed under the pains and penalties of perjury, S na ure 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,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 o Owner Date The property has been transferred to owner above and the unit Received FEB B 20 i remains in com liance 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 SUBNtF�Tfsl�If�if ,." _'•.1 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# [4ol # 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 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 2/10/21 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 an , n accordance 7 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; 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 Sipinature of Owner '__=5a_te7El Date v J 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 SUBN61T1gvR8NGSA E1i,1 BOARD Or HEA 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# I A cg #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"0 gallons per minute(2.2 gpm) Ultra-low flush water closets(toilets)not to exceed 1 6/10 gallons per flush(1.6 gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A licensed plumber must install the water closets and submetering equipment. Submetering equipment information: Next Century M201 C Manufacturer Model# Licensed Plumber Certification Michael Muise 11054 Master 2/10/21 Print Name of Plumber License# Date I certify that(check all that apply): FXII have installed the submetering equipment listed above in accordance with accepted plumbing standards. M 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,i ccordance 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 2/10/21 Print Name of Owner Sienatum of Owner Date The property has been transferred to owner above and the unit Received FEB ZQ 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 SUBIV�TMM6 S 1 EM BC,4%`R,D OF HEAD-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# 14nq #Of units in bide. 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): _ DI 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 n , in accordanc w'tl 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 Swnatu e o Owner I.,.drat Date V%,,,;T_i�,�u The property has been transferred to owner above and the unit Received remains in compliance with the requirements of M.G.L. c. 186, §22 Date: by BOH: EB 2 3 �C *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBMETERING r CITY CF S�.l_L�,1 MDPH-CSP Submetering Form D Cy ,Rev 11-4-16 BOAF r I-E:A Ui Fl 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# (A-10 #Of units in bldg. 80 Cit l/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. 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 yr' , n accor ce th M.G.L . c. 186, §22(p), does not require the installation of a submet Signed under the pains and penalties of perjury, 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) 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 o9/ 7 ;(6)That all information included on this certification is true and accurate to the best of my knowle Signed under the pains and penalties of perjury, DSF Salem Flint LLC 2/10/21 Print Name of Owner Z Signature of Owner �Qate- Date The property has been transferred to owner above and the unit Received remains in compliance with the requirements of M.G.L. c. 186, §22 Date: bv BOH: FEB 2 3 20 1 *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBMETERING CITY OF SN-EPA MDPH-CSP Submetering Form,Rev 11-4-16 BOARD Or HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM *In accordance with M.G.L. c. 186, §22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation (State Sanitary Code Chapter If),the following dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer service. PROPERTY INFORMATION .Address: 72 Flint St. Unit# ( 411 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"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 com r and, ' accord c ► ith M.G.L . c. 186, §22(p), does not require the installation of a submete ' 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 ren greement that clearly provides for the separate charging of water and/or sewer service,and a copy of thi tificatio orm, (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 Si�natu e of Owner Date 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: 21 *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 RD OF HEEALTH 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# All #Of units in bldg. 80 City/Town: Salem MA Zi Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.000 requires the installation of water conservation devices prior to a dwelling unit becoming eligible for the imposition on tenants of a charge for water and/or sewer.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2 Y gallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 2/10 gallons per minute(2.2 gpm) Ultra-low flush water closets(toilets)not to exceed 1 6/10 gallons per flush(1.6 gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A licensed plumber must install the water closets and submetering equipment. Submetering equipment information: Next Century 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 acc h M.G.L . c. 186, §22(p), does not require the installation of a submeter. Signed under the pains and penalties of perjury, Signature of 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 exclusive to this unit;(5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agr emen that clearly provides for the separate charging of water and/or sewer service,and a copy of this certification form; 6)Th 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 lanature 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: by BOH: *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBML'l�ERINCf' L-"41 Cl T Y OF SALEM MDPH-CSP Submetering Form,Rev 11-4-16 BOA iD Or HEACI 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 bldg. 80 City/Town: Salem MA Zip Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.000 requires the installation of water conservation devices prior to a dwelling unit becoming eligible for the imposition on tenants of a charge for water and/or sewer.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2 /'gallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 2/10 gallons per minute(2.2 gpm) Ultra-low flush water closets(toilets)not to exceed 1 6/10 gallons per flush(1.6 gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A licensed plumber must install the water closets and submetering equipment. Submetering equipment information: Next Century M201C Manufacturer Model# Licensed Plumber Certification Michael Muise 11058 Master 2/10/21 Print Name of Plumber License# Date I certify that(check all that apply): X❑I have installed the submetering equipment listed above in accordance with accepted plumbing standards. X❑I have installed one or more water closets not exceeding 1.6 gallons per flush. ❑ Determined that existing water closets do not exceed 1.6 gallons per flush. ®The plumbing permit issued by the city/town, if required, is attached. ❑Dwelling unit is connected directly to a meter installed by a water comp n and, in ordanc ith M.G.L . c. 186, §22(p),does not require the installation of a submete Signed under the pains and penalties of perjury, "AInature 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 writte ental agreement that clearly provides for the separate charging of water and/or sewer service,and a copy of this c ifi ation form;(6)That all information included on this certification is true and accurate to the best of my knowle Signed under the pains and penalties of perjury, DSF Salem Flint LLC 2/10/21 Print Name of Owner igri ture of Owner Date Date The property has been transferred to owner above and the unit Received s 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 SUBMFIWR40 2021 N DPH-CSP Submetering Form,Rev 11-4-16 CITY OF SALEM HOA=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# [ m A- #Of units in bldg. 80 City/Town: Salem MA Zip Code: 01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.000 requires the installation of water conservation devices prior to a dwelling unit becoming eligible for the imposition on tenants of a charge for water and/or sewer.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2 /'gallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 2/10 gallons per minute(2.2 gpm) Ultra-low flush water closets(toilets)not to exceed 1 6/10 gallons per flush(1.6 gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A licensed plumber must install the water closets and submetering equipment. Submetering equipment information: Next Century M201C Manufacturer Model# Licensed Plumber Certification Michael Muise 11058 Master 2/10/21 Print Name of Plumber License# Date I certify that(check all that apply): X❑I have installed the submetering equipment listed above in accordance with accepted plumbing standards. X❑ I have installed one or more water closets not exceeding 1.6 gallons per flush. ❑ Determined that existing water closets do not exceed 1.6 gallons per flush. ® The plumbing permit issued by the city/town, if required, is attached. ❑Dwelling unit is connected directly to a meter installed by a water company a in accordance wi 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)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental e nent that clearly provides for the separate charging of water and/or sewer service,and a copy of this certification to ;(6) at 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 ignature of caner Date Date ❑ The property has been transferred to owner above and the unit Received remains in compliance with the rec uirements of M.G.L. c. 186, §22 Date: by BOH: *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBMtTEKNI, 6 - C� CITY OF SALESA MDPH-CSP Submetering Form,Rev 11-4-16 BOAHD 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# JA(vj #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 Y2 gallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 2/10 gallons per minute(2.2 gpm) Ultra-low flush water closets(toilets)not to exceed 1 6/10 gallons per flush(1.6 gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A licensed plumber must install the water closets and submetering equipment. Submetering equipment information: Next Century M201 C Manufacturer Model# Licensed Plumber Certification Michael Muise 11058 Master 2/10/21 Print Name of Plumber License# Date I certify that(check all that apply): X❑I have installed the submetering equipment listed above in accordance with accepted plumbing standards. X❑I have installed one or more water closets not exceeding 1.6 gallons per flush. _ ❑Determined that existing water closets do not exceed 1.6 gallons per flush. ®The plumbing permit issued by the city/town, if required, is attached. ❑Dwelling unit is connected directly to a meter installed by a water comp S - and, in Tac9dance► i z M.G.L . c. 186, §22(p), does not require the installation of a submeter. Signed under the pains and penalties of perjury, S.­P'ature of Licensed Plumber Property Owner Certification I certify that: (1)This dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer usage in accordance with the water submetering law(MGL c. 186, §22);(2)All showerheads,faucets,and water closets in this dwelling unit are water conservation devices that meet the standards specified above; (3)The water submeter measuring the use of water in the dwelling unit was installed by a licensed plumber and is in compliance with the standards specified above, or the water meter measuring the use of water in this dwelling unit was installed by a"water company" as defined in M.G.L. c. 186, § 22; (4) The water meter or submeter measures the water usage exclusive to this unit;(5) I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the separate charging of water and/or sewer service,and a copy of this certification form;(6)That all information included on this certification is true and accurate to the best of my knowledge. Signed under the pains and penalties of perjury, DSF Salem Flint LLC 2/10/21 Print Name of Owner Signature o Owner Date Date w. ❑ 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: _ *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBM IPQ6 9 U I Y OF SALEM MDPH-CSP Submetering Form,Rev 11-4-16 BOARD OF HEAL-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# 1410 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 i�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 co ny and, in accordan ith M.G.L . c. 186, §22(p),does not require the installation of a submet L 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 L,1 Sikmn ture of O -ner D 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 2 3 20� 1 *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUB WIALEM BOARD OF HEALTH MDPH-CSP Submetering Form,Rev 11-4-16 MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM *In accordance with M.G.L.c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation (State Sanitary Code Chapter I1),the following dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer service. PROPERTY INFORMATION Address: 72 Flint St. Unit# 14( #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"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): Ol 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 accIncrth M.G.L . c. 186, §22(p),does not require the installation of a submeter: Signed under the pains and penalties of perjury, §ig6aturc 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 J�� 2/10/21 Print Name of Owner Sig fure Owner .,,,Date,--, A Date i '— m V 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: - 9, 3 ' *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBMETERING CITY OF SALEM MDPH-CSP Submetering Form,Rev 11-4-16 BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM *In accordance with M.G.L. c. 186, § 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation (State Sanitary Code Chapter 1I),the following dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer service. PROPERTY INFORMATION Address: 72 Flint St. Unit# 41 #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❑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 a y nd,in accordance,1/1 M.G.L .c. 186, §22(p), does not require the installation of a submcte . Signed under the pains and penalties of perjury, i nature of Licensed Plumber Property Owner Certification I certify that: (1)This dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer usage in accordance with the water submetering law(MGL c. 186, §22); (2)All showerheads,faucets,and water closets in this dwelling unit are water conservation devices that meet the standards specified above;(3)The water submeter measuring the use of water in the dwelling unit was installed by a licensed plumber and is in compliance with the standards specified above, or the water meter measuring the use of water in this dwelling unit was installed by a"water company" as defined in M.G.L. c. 186, § 22; (4)The water meter or submeter measures the water usage exclusive to this unit; (5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the separate charging of water and/or sewer service,and a copy of this certification fo • 6)That all information included on this certification is true and accurate to the best of my knowledge. Signed under the pains and penalties of perjury, DSF Salem Flint LLC 2/10/21 Print Name of Owner i nature or Owner `=Dated Date The property has been transferred to owner above and the unit Received FEB 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 SUBMEFR-SAI-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 #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. 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 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 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 §Ignratiife of Owner r—Date ; r Date a t:_`a 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 20c1 *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 1330ARID 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# LASO #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 comp y ai ,in accor ce w' i M.G.L . c. 186, §22(p), does not require the installation of a submeter. , Signed under the pains and penalties of perjury, Signature of Licensed Plumber Property Owner Certification I certify that: (1)This dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer usage in accordance with the water submetering law(MGL c. 186, §22); (2)All showerheads,faucets,and water closets in this dwelling unit are water conservation devices that meet the standards specified above; (3)The water submeter measuring the use of water in the dwelling unit was installed by a licensed plumber and is in compliance with the standards specified above,or the water meter measuring the use of water in this dwelling unit was installed by a"water company" as defined in M.G.L. c. 186, § 22; (4)The water meter or submeter measures the water usage exclusive to this unit; (5)I will provide to the tenants of this dwelling unit,prior to occupancy, a written rental agreement that clearly provides for the separate charging of water and/or sewer service,and a copy of this certification form; (6)That all information included on this certification is true and accurate to the best of my knowledge. Signed under the pains and penalties of perjury, I— )4111, DSF Salem Flint LLC f 2/10/21 Print Name of Owner S gnature of Owner I-Rate 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 9 *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBMETERING CITY OF SAL F�4 MDPH-CSP Submetering Form,Rev 11-4-16 B0AF-D