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Water submeter certificates - Units in the 1s MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERI NG OF WATER AND SEWER CERTIFICATION FORM *In accordance with M.G.L.a 196.§22 and 105 CMR 410.000.A+fintmum Standards of Fitness for Human Habitation (State Sanitary Code Chapter In,the following dwelling unit is eligible far the imposition on the tenants of a charge for watw and/orsewcr .—.= PROPERTY INFORMATION Address: 206 Highland Ave V08 AQUIDIMiD24 iI Town: Salem MA Zip Code-01970 EQUIPbmn INSTALLATION INFORMATION 105 CMA 410.000 requires the installation of water conservation devices prier to a dwelling unit becoming eligible for the imposition on tenants ofa charge for water and/or sewer.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2 x gallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 zng gallons per minute(2.2 gpm) Ultra-low flush water closets(toilets)not to exceed 1"'0 gallons per flash(1.6 gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common area must mat 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: Master Meter Flexible Ards M...turer Model# Licensed Plumber Certiflcadon Jweph Bellefeuille 9793 12-16-2019 Print Name of Fl ua►ber License# Dam I certify that(check all that apply): IMI 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 cityAown,if required,is attached. I ❑Dwelling unit is connected directly to a meter installed by a water company and,in accordance with i M.G.L.a 186,§22(p),does not require the installation of a submetcr. 1 Signed under the pains and penalties of perjury, h ' - - — S' f Licensed Ifuinber lilt Property Owner Certitteation 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 subnuter measures tic water usage exclusive to this unit;(S)I will provide to the tenants of this dwelling unit,prior to occupancy,a written rental agreement that clearly provides roc 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 perjuty, } c2/�c t Print Name of Owner Sienattue of Owner - D Date The property has been transferred to owner above and the unit Received terrains in cc liana with the reauirerrments of M G.L, lg6 22 Date: b aoH:FEB 21 2M 'THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITiAANG SUBMETERIIt1GG CITY OF SALEM MDPH-CSPSubmeteriug Form,Rev 11-4-16 BOARD OF HEALTH MASSACHUSET S DEPARTM NT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM *In accordance with M.G.L.c.196,§22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation (State Sanitary Cade Chapter II),the fallowing dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer service. PROPERTY INFORMATION Address: 205 H hlartd Ave Wt a 1307 a nf Units in h1d924 Ci own: Salem MA zi Code:01970 EQ1QMM4T INSTALLATION INFORMATION 105 CMR 410.000 requires the installation of water conservation devices prior to a dwelling unit becoming eligible far the imposition on tenants of a charge for water and/or sewer.The devices must meet the following specifications; Showerizcads with maximum flow rate not to exceed 2 is gallons per minute(2.5 gpm) Faucets with maximum now rate not to exceed 22n gallons per minute(2.2 gpm) Ultra-low flush water closets(toilets)not to exceed 1 6"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 similaraccredited association. A licensed plumber must install the water closets and submetering equipment. S»bmetering equipment information: V Master Meter Flexible Axis Manufacturer Model# Licensed Plumber'Certiflcsition Joseph Bellefouilie 9793 12-16-2019 Print Name of Plumber - License# Date I cardfy that(check all that apply): 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. Q Dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186,§22(p).does not require the installation ofa submeter. Signed under the pains and penalties of perjury, --4 { (4 Si titre ht Licensed Phm1ber I certifythat: 1 This dwelling unit is eligibleerr��� r Gentle teioa ( } gimposition 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 showcrhteds,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.186,122; (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 oecupattcy,a written rental agreement that clearly provides for the separate charging ofwater and/or sewer service,,and a copy of this certification fotm;(6)That all information included on this certification is true and accurate to the best of my knowledge. Signed under the palms and penalties of perjury, �. ,,. +� Print Name of Owner Signature of Owner L— Date O The property has been transferred to owner above and the unit Receiv«�EB 21 202U rrnta ns in con liance with the mirements of M.G.L.c. 18§ 22 Date: b BOH: "THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING;,UTALEM MDPH-05P Snbtnctering Form,Rev[1-4-16 BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM "I;accordance with M.G.L.c.186,§22 and 105 CMR 410.000:l4inimum Standards of Fitness for Human Habitation (Slate Sanitary Code Chapter II),the following dwelling unit is eligible for the imposition on the tenants of a charge for water and/or server service. PROPERTY INFORMATION Y Address: 205 H hlend Ave 130§ ik Of units in h1dir24 G5 down: Salem MA Zip Code:01970 EQ1NT 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:&� Ions per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 gallons per minute(22 gpm) Ultra-10w flush water closets(toilets)not to exceed 1 s'ua gallons per flush(1.6 gpt) The suibmetering 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 Wodrs Association or similaraccredited association. A licensed plumber must install the water closets and submeteiing equipment. i Submetering equipment infou ation: Master Meter _ _ Flexible Axis �_. Manufacturers - Model I.iceased Phumber Certification Joseph Bellefeuille _9799 12-'16-2019 Print Name of Plumber License# Date I certify that(check all that apply): I have installed the submetering equipment listed above in accordance with accepted plumbing standards. I have installed one or more water closets not exceeding 1.6 gallons per flush. Determined that existing water closets do not exceed 1.6 gallons per flush. The plumbing permit issued by the city/town,if required,is attached. ❑Dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c.186,§22(p),does not require the installation of submeter. Signed under the pains and penalties of perjury, J.1 i -[� Si store Licensed er Property Owner Certlf ee"Oa I certify gut:(1)This dwelling unit is eligible for the imposition on the tenants ofa charge for water and/or sewer usage in accordance with the water submetering law(MGL c.186,§22);(2)All showerbeads,faucets,and water closets in this dwelling unit are water conservation devices that meet the standards specified above;(3)71re 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 an this certification is true and accurate to the best of my knowledge. Signed under the pains and penalties of perjuuy, Print Name of Owner Signature of Owner Date The property has been transferred to owner above and the unit Rtxei reins!;;in liance with the uireamnts of M.G.L.c. 186 22 Date: b BOHF EB 21 2020 'THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBMETERING CITY OF SALEM MDPH.CSPSubmcteringFom4Rev 11-4-16 BOARD OF HEALTH MASSACIQUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORK *In accordance with M.G.L.a 186,§22 and 105 CMR 410.000.Minimum Standards of Fitness for Human habitation (State Sanitary Code Chapter In,the fallowing dwelling unit is eligible for the imposition on the tenants of a,charge for water end/or sewer service. PROPERTY INFORMATION Address. 205 Highland Ave 1305 24 cityrroww Salem MA Zs Code:01970 EQUIPIt+II M INSTALLATION INFORMATION 105 CMR 410.000 requires the installation of water conservation devices prim to a dwelling unit becoming eligible far the imposition on tenants of a charge for water and/or semen The devices must meet the fallowing specification: i Showerheads with maximum flow rate not to exceed 2"gallons per minute(15 Spin) Faucets with maximum flow rate not to exceed 2 2A0 gallons per minute(2.2 gpm) Ultra-low&A water closets(toilets)not to exceed 1 d10 gallons per flush(1.6 gpf) The submetering equipment used to measure the quantity of water used for each dwelling unit and common am must meet the standards of accuracy and testing of the American Water Works Association or similar accredited association. A licensed plumbs must install the water closets and submetaing equipment. Submetering equipment information: _ Maslen'Meter Flexible Axis Manufacturer Model# Licensed Plumber Certification C Joseph Bellefeuille 9793 12-18 2019 Print Name of Plumber License# Date I certify that(check all that apply): have installed the submete&g equipment listed above in accordance with accepted plumbing standards. I have installed one or more water closets not exceeding 1.6 gallons per flush. Detetmined that existing water closets do not exceed 1.6 gallons per flush. The plumbing pem it issued by the cityAown,if required,is attached ❑Dwelling unit is connected directly m a inter installed by a water company and,in accordance with M.G.L.c.186,§22(p),does not require the installation of a submeter. Signed under the pains and penalties of perjury, �- S' aturc icered er Properly Owner Certification l 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 submcteriag law(MGL c.186,§22);(2)All sbowenccads,faucets,and wow 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 far the separate charging of water and/or sewer service,and a copy of this certification farm;(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, Print Name of Owner Si atom of Owner e^ Date The property has been transferred to owner above and the unit Received FEB 21 20 rerusaios is con liana with the requirements of M.G.L.c 186._§22 Date: b $OH: *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO IN MATING SU�>�F MALEM MDPH-CSP Submeteriag Form,Rev 114-16 BOARD OF HEALTH MASSACRUSETTS DEPARTMENT OF PUBLIC HEALTH SUBNWMRING 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 hollowing dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer service. --- PROPERTY INFORMATION Address: 205 HIghland Ave i w,A 1304 g Of tinift in birig 24 Ci gowL 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 temnls of a charge for water and/or sewer.The devices Waist meet the fallowing specifications: Sbowerheads with maximum flow rate not to exceed 2�Ilons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 gallons per minute(2.2 gpm) Ultra-low flush water closets(toilets)not to exceed I s"a 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 Wodrs Association or simrilaraccredited association. A licensed plumber must install the water closets and submetering equipment. Submatering equipment information: hAasteP Meter Flexible Axis _ Manufacturer Model if Licensed Plumber Certification Joseph Beliefeuillo 9793 12-16-2019 Print Name of Plumber f License# Date I certify+that(deck all that apply): I have installed the submetering equipment listed above in accordance with accepted plumbing standards. I have installed one or more water closets not exceeding 1.6 gallons per flush Determined that existing water closets do not exceed 1.6 gallons per flush. The plumbing permit issued by the cityhowu,if required,is attached. ❑Dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c.116,122(p),does not require the installation of a submeter. Signed under the p ilas and penalties of perjury, �' U __ v S' lure Licensed her 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 showerfhcads,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 metcr measuring the use of water in this dwelling unit was installed by a"watcr 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, Q s 6:. D Print Name of Owner Si attire of Owner Date The property has been transferred to owner above and the unit RecavFEB 21 202 retrains is compliance with the rmuirements of M.G.L c.186,422 Date: BOH: *THIS FORM MUST BE Fillip WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING S9WEKALEM MDPH-CSP Submetecing Form,Rev 114-16 130ARD Or HEALTH MASSACRUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERKNG 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 Humm Habitation (State sanitary Code Chapter I),the following dwelling unit is eligible for the imposition on the tenants of a charge for wa and/or sewer service. PROPERTY 1WFORMA7ION Address: 205 Highland Ave nit1303 unift in MA& 24 Cityrroww Salem MA ;jp Code:01970 EQUIPM$NT INSTALLATION INFORMATION J" 105 CMR 410.000 requires the installation of water conservation devices prier 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: Sbowaheads wM maximum flow rate not to exceed 2:*tons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 gallons per minute(2.2 gpm) Ultra-tow flush water closets(toilets)not to exceed I sot*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 Wodm Association or similar accredited association. A licensed plumber must install the water closets and submetering equipment. Submetering equipment information: Master Meter Flexible Axis Manufacturer Model# Licensed Plumber Certification Joseph Bellefeuille 9793 12-16-2019 Print Name of Plumber License# Date I certify that(chock all that apply): Rh 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 cityhown,if required,is attached. Q Dwelling unit is connected directly to a meter installed by a water company and.in accordance with M.G.L.e. 186,§22(p).does not require the installation of a submeter. Signed under the pains and penalties of perjury, �. A . I G� Sjeature6f Licensed Phnnber Property Owner Certification t 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,§22k(2)All showenccads,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.186,122; (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 farm;(6)That all information included on this certification is hue and accurate to the best of my knowledge. signed under the pains and penalties of perjury, Pc3� C. f - 0, 0 INzC_ (z- t6 A Print Name of Owner Si attire ofOwner � + Date L L '— O The property has been ttamsfetsed to owner above and the unit Received remains in E2RIiaace with the reauiraments of M.G.L.c. 186 22 Date: lbyBOM "THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUB ETERING CITY OF SALEM MDE'H-CSP Submeteriug Form,lieu 1 i-4-16 BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC WEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM "In accordance with M.G.L.c.196,§22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation (State Sanitary Code Chapter U),the following dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer service. . PROPERTY INFORMATION Address: 205 Highland Ave 0 24 Ci !Town: Salem MA Za Codc:01970 EQU PA+17DNT INSTALLATION IlYFORMATION 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* llons per minute(L5 gpm) Faucets with maximum flow rate not to exceed 2 gallons per minute(2.2 gpm) Ultra-low flush water closets(toilets)not to exceed 1 site gallons per flush(1.6 gpi) The submetering equipment used to measure the quantity ofwater used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Wades Association or similar accredited association. A licensed plumber must install the water closets and submetering equipment, Submetering equipment information: Idaaster Meter Flexible Axis Manufacturer Model# Licessed PlusaberGertiflcadon Joseph Bellefeuille _ 9793 12-16-2019 Print Name of Plumber License# Date I certify that(check all that apply). 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 cityhown,if required,is attached. ❑Dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 196,§22(p),does not require the installation of a submetee. Signed under the pains and penalties of perjury, V Sigs+atute oT Licensed Plumber Property Owner Cer dflcatioF 1 certify that:(1)This dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer usage in accordance with the water submctering law(MGL c. 186,§22);(2)All showed=&,faucets,and water closets in this dwelling unit are water conservation devices that meet the standards specified above;(3)7 be 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.e.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 ofpedury, r, Print Name of Owner Sfgmawm of Owner Date C3 The property has been transferred to owner above and the unit Received remains in ianee with the uiremenu of M.G.L.c. IB6.,22 Dates 130H: FEB 2120 0 'THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING wlu P ALEM MDPH-CSP Subnutering Faun,Rev 114-16 BOARD OF HEALTH �t — � _ i �` MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM "In accordance with M.G.L.a 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 an the tenants of a charge for water and/or sewer sr*vkc PROPERTY INFORMATION Address: 206 H hland Ave tm@t a 1301 24 6Town: Salem MA zip code..01970 EQUIPMENT INSTALLATION DWORMATION 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 sews The devices must meet the following specifications: Sbowerheads with maximum flow rate not to exceed 2"r1lons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 ai gallons per minute(2.2 gpm) Ultra-tow flush water closets(toilets)not to exceed 1&!°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 Worts Association or similar accredited association. A licensed plumber trust install the water closets and submetering equipment. Submetcriug equipment information: Master Meter Flexible Axis Manufacturer Model# Liceaved Plumber Certification -- Joseph Bellefeuille _ 9793 12-16-2019 Nam - Print Na of Plumber License# _ Y_ Date I certify that(chart all that apply): 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 cityhown,if required,is attached ❑Dwelling unit is connected directly to a meter installed by a water company and,in accordance with XG.L.c.186,§22(p),does not require the installation of a submeter. Signed under the pains and penalties of perjury, � a sknature of Licensed Plumber Property Owner Certification " 1 ccn*that:(1)This dwelling unit is eligible far the imposition on the tenants of a charge for water and/or sewer usage in accordance with the water submett ring law(MGL c.186,§22);(2)All showenccads,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 watery meter measuring the use of water in this dwelling unit was installed by a'tivater 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 farm;(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, Print Name of Owner _ Sienature of Owner ► . TD4atc � I3 The property has been transferred to owner above and the unit eived remains in cam liance with the ohnicnas of M.G.L.c. 186 22 Data BOH:! - °THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUbMETENING CITY OF SALEM MDPH-CSP Subntetering Form,Rev 11-4-16 BOARD OF HEALTH MASSACEWSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM *In accordance with M.G.L.c.186.122 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation (State Sanitary Code Chapter M the 6nllowing dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer service. PROPERTY INFORMATION Addr=: 205 fthland Ave y_ _ • 124 24 [ CitvrLbwu: Salem - MA zipCCode•01970 �� 4 EQ1[>IPMIM INSTALLATION INFORMATION 105 CMR 410.000 requires the installation of waterconservation devices prior to a dwelling unit becoming eligible for the imposition on tenants of a charge for water and/or sewer.The devices oust meet the following specifications: Showerheads with maximum flow rate not to exceed 2 s gallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 2" gallons per minute(22 Win) Ultra-tow flush water closets(toilets)not to exceed 16r10 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. Snbmetering equipment information: Master Meter Flexible Axis -- �^ Manufacturer - Model# Licensed Plumber Certification Jweph Bellefeuille 9793 12-16 2019 Print Name of Plumber License# Date I certify that(check all that apply): have installed the submetering equipment listed above in accords=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 cityitown,if required,is attached. ❑Dwelling unit is connected directly to a meter installed by a water company and in accordance with M.G.L.c.186.$22(p),does not require the installation of a submeter. Signed under the pains and penalties of perjury, 4 d" G iv Si attire of Licensed Plumber Property Owner Certification I certify the.(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 am 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•,(S)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 ofperjwy, Print Name of Owner S' ature of Owner Date The property has been transferred to owner above and the unit peg 21 2020 rehtains is ro Hance whit the uirements of M.G.L,a 186 22 Date: h B *THIS FORM MUST BE FILED WiTH THE LOCAL BOARD OF HEALTH PRIOR TO 1NMATINCz'�ETMIM MDPH-CSPSubhncteringFomr,Rev 11.4-I6 BOAFID OF' HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING.OF WATER AND SEWER CERTIFICATION FORM "In accordance with M.G.L.c.186,§22 and 10S CN1R 410.000:Minimum Standards of Fitnew 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: 205 Hi hand Ave 12074 af units im hider 24 C' frown: Salem MA zip code:01970 EQUIPMZNT INSTALLATION INFORMATION 10S CMr R 410.000 requires the installation of water conservation devices prior to a dwelling unit becoming eligible for the imposition an tenants ofa charge for water and/or sewer.The devices must meet the fbilowing specifications: Showerieeads with maximum flow rate not to exceed 2%gallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 2" gallons per minute(2.2 gpm) Ultra-low flush water closets(toilets)not to exceed 1*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: __ Master Meter Flexible Ands Manufacturer Model# Licensed Plumber Cerdflcatloo Joseph ®ellefeuille 9793 12-18 2019 r- Print Name of Plumber License# Date I certify that(check all that apply): I have installed the submetering equipment listed above in accords=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 cityhown,if required,is attached. Dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c.186,§22(p),does not require the installation of a submeter. Signed under the pains and penalties of perjury, n Signahm,ofticensed Phtmber Property Owner Certification 1 certify that:(1)This dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer usage in accordance with the water subinetering law(MGL e.186,§22);(2)All showerfneads,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 submeer 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 ofwater and/or sewer service:,,and a copy of this certification fnsm;(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, Print Name of Owner Sionattire of Owner D Date O The property has been ttaasf and to owner above and the unit Received remains in 2MIiance with the rwairements of M.G.I.,c.196 ZZ. Date: by BOH• FEB 21 20 0 *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIAMNS SU 1T SALEM MDPH-CSPSubmctering 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%the following dwelling unit is eligible for the imposition an the tenants of a charge for water and/or sewer sere€cc. . PROPERTY llVFORMATIQN Address: 206 Highland-Ave tha.,g 120$ nf imits in hicis 24 /Gown Salem MA Zip Code:01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.000 requites the installation of water conservation devices prior to a dwelling unit becoming eligible for the imposition an tenants of a charge for water and/or sewer.The devices must meet the fallowing specifications: Showerheads with maximum flow rate not to exceed 2%gallons per minute(2.5 Spat) Faucets with maximum flow gate not to exceed 2' gallons per minute(22 gpm) Ultra-low flush water closets(toilets)not to exceed t 6"0 gallons per flush(1.6 gpf) The submctering 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 shmilaraccmdited association. A licensed plumber must install the water closets and submetering equipment. Submetering equipment information: Master Meter Flexible Axis Manufacturer Model# Licensed Plumber Certifleadon Joseph Sellefeuiile 9793 12-16 2019 Print Name of Plumber License# Date I certify that(check ail that apply): I have installed the submatering equipment listed above in accordance with accepted plumbing standards. I have installed one or more water closets not exceeding 1.6 gallons per Bush. Determined that existing water closets do not exceed 1.6 gallons per flush. The plumbing permit Issued by the cityRown,if required,is attached. ❑Dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c.186,§22(p),does not require the installation of a submeter. Signer/under the palm and penalties of perjury, Si tuts dt Licensed ber Property Owner Certification 1 certify that:(1)This dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer usage in acconbeec with the water submetering law(MGL c, 186,§22);(2)All showed=ds,faucets,and water closets in this dwelling unit we 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 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 farm;(6)That all information included on this certification is trim and accurate to the best of toy knowledge. Sighed under the pains and penalties of perjury, as V ( " ok Z- � Print Name of Owner 43' of Owner `= p Date Q The property has been traasf:tmd to owner above and the unit Received remains in compliance with the uirements of M.G.L.c. 186 z2 Date: b BOHTEB 2 1 202 *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SlY1l�UlET�I�`i+FM MDPH-CSl'Submcttring Form,Rev 1 i-4-16 HOARD OF HEt,%1[.T-{ MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTNICATION FORM *In accordance with M.G.L.e.196.$22 and 105 CMR 410.000.Minimum,Standards of Fitness for Human Habitation (State Sanitary Code Chapter II),the following dwelling unit is eligible far the imposition on the tenants of a charge for water and/or sewer service. PROPERTY INFORMATION Address: 205 1-119 Marx!Ave um g 1205 N QE utritm in hidgr 24 .atyrroww Salem MA Zi Code•01970 EQUIPMENT RWALLAnON 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 far water and/or sewer.The devices must meet the following specifications: Sbowerheads with maximunn flow rate not to exceed 2:jallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed Z gallons per minute(2.2 gpm) Ultra-low flush water closets(toilets)lent to exceed I et0 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 submeteriag equipment. Submetering equipment information: Master Meter _ Flexible Axis Manufbcttm Model# Licensed Plmnber CertIficadon Joseph Bellefeuille 9793 12-18 2019 J Print Name of Plumber License# Date I certify+that(check all that apply): I have installed the submetering equipment listed above in accordance with accepted plumbing standards. I have installed one or more water closets not exceeding 1.6 gallows per flush. Determined that existing water closets do not exceed 1.6 gallons per flush. The plumbing permit issued by the cityhown,if required,is attached, ❑Dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c.186,122(p).does not require the installation of a submeter. Signed under the pains and penalties of perjury, ! _ Si turn 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 submetcring law(MOL 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 MG.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 far the separate charging of water and/or sewer service,and a copy of this certification Rx n;(6)That all inrotmation included on this certification is true and accurate to the best of my knowledge. Signed under the pains and penalties of perjury, Print Name orOwner Stmature of Owner t . D Date ©The property has been transfeused to owner above and the unit Received Fig 21 202 remains in compliance a with the uitements of M.G.L.c. 186 22 Date: b HOH: *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SFISALEM MDPH-CSP Subou:teriag Form,Rev 11-4-16 BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBBCMRING 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 Humoa 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!vice. PROPERTY INFORMATION Address: 205 Highland Ave 1204 JI.Qf unift in b1fily 24 Ci rrown: Salem MA z' Code:01970 EQUIPMENT INSTALLATION INFORMATION ` 3' 105 CMR 410.000 requites the installation of water conservation devices prior to a dwelling unit becoming eligible far 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%jalloas per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 in gallons per minute(22 Spin) flush water closets(toilets)not to exceed 1 m0 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 similaraccredited association. A licensed plumber must install the water closets and submetering equipment Submetering equipment information: _ Master Meter Flexible Axis _ Mant acaurer Model Licensed Plumber Califlention Joseph Bellefeuilie 9793 12-16 2019 Print Name ofPlumber — -~ License# Date I certify am(check all that apply): I have installed the submetering equipment listed above in accordance with accepted plumbing standards. 1 have installed one or more water closets not exceeding 1.6 gallons per flush. Detumined that existing water closets do not exceed 1.6 gallons per flush. The plumbing permit Issued by the cityhown,if required,is attached. ❑Dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c.186,§22(p),does not require the installation of a submoter. Signed under the pains and penalties of perjury, Monti&of Licensed er Property Owner Certification I certify that:(1)This dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer usage in accordance with the water submetering law(MGL c.186,§22);(2)All showethcads,faucets,and watcrclosels in this dwelling unit are water conservation devices that meet the standards specified above;(3) Me 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 3 will provide to the tenants of this dwelling unit,prior to occupancy,a written rental agreement that clearly provides for the separate charging ofwater and/or sewer service,and a copy of this certification form;(6)That all information included on this certification is be and accurate to the best of my knowledge. Signed under the pains and penalties of pm jwy, Print Name of Owner Si afore of Owner t L: t= Date 13 The property has been transferred to owner above and the unit ReceivEB 21 2020 remains in compliance with the requirements of M.G.L.c.186 22 Date: b BOH *THIS FORM MUST BE FILED W1TH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SURMUTY93FTEEM MDPH-CSP SubrtctetingForm,Rev 11.4-16 BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM *In accordance with M.G.L.c.186,§22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation (State Sanitary Code Chapter 11),the following dwelling unit is eligible for the imposition an the tenants of a charge for water and/or sewer service. PROPERTY INFORMATION Address: 205 Hi hland Ave ilait# 120 24 ci rrown: 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 fallowing specificatioas: Showerhends with maximum flow rate not to exceed 2*gallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 vla gallons per minute(2.2 gpm) Ultra-tow flush water closets(toilets)not to exceed 1 61D 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 Woda Association or similar accredited association. A licensed plumber must install the water closets and submetering equipment. Submetering equipment information: Master Meter Flexible Axis ---- - — m1an u farrurf Model 1 Z.Icensed dumber Certification Joseph i3ellefeuille- 9793 12-16-2019 Nam - Print Na of Plumber - —` License# Date l I certify that(check all that apply): I have installed the submetming 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 cityhowa,if required,is attached. ❑Dwelling unit is connected directly to a meter installed by a water company and in accordance with M.G.L.c.186,§22(p).does not require the installation of a submeter. Signed under the pains and penalties ofperjury, �� � T Si attire of Licensed I Property Owner Certification I cerft 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 submetcring law(MOL c. 186,§22);(2)All showenccads,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 1 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 farm;(6)That all information included on this certification is true and accurate to the best of my knowledge. Signed under the pass and/penalties of p«]my, '-Ye- , tr.�.-4,- Q-5 4 4- C cL, Print Name of Owner Signature of Owner t C �= Date C 1 The property has been transferred to owner above and the unit Receiv EB 212020 remains in liance with the marts of M.G.L.c. 1 22 Date: b SOH *THIS FORM MUST BE FILED VATH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING L`YMMENI MDPH-CSP SubmctermgForm,tint 11-4-16 BOARD OF HEALTH MASSACRUSETTS DEPARTMENT OF PUBLIC HEALTH SUBM ITJMG OF WATER AND SEWER CERTIFICATION FORM *In accordance with M.G.L.a 196,§22 and 105 CMR 410.0ft Minimum Standards of Fitness forIluman 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: 205 Highland Ave 1202 or„ri9rs in h& 24 citymowX Salem MA zip Code:01970 EQUIPMlfNT INSTALLATION INFORMATION 105 CMR 410.000 requires the instidlation of water conservation devices prior to a dwelling unit becoming eligible for the imposition on tenants of a charge forwater and/or sewer.The devices must meet the fbllowing specifications: Sbowetheads with maximum flow rate not to exceed gallons per minute(2.3 gpm) Faucets with maximum flow rate not to exceed 2 gallons per minute(2.2 gpm) [11tra-low flush water closets(toilets)not to exceed I a'ro gallons per flush(1.6 gpt) The submetering equipment used to measure the quantity of water used for each dwelling unit and comma 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 submateriug equipment. Submetering equipment iaformation: Master Meter Flexible Axis _ Manufacturer Model# Licensed Plumber Certification .3oseph Bellefeuille 9793 12-16-2019 Ptint Name of Plumber Licease# Date I certify that(check all that apply): have installed the submetering equipment listed above in accordance with accepted plumbing standards. I have installed one or mom 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 cityltown,if required,is attached Dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c.186,§22(p),does not require the installation of a submeter. Signed under the pains and penalties of pmjury, S' f Licensed Miariber 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)T'he 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 ofwater and/or scorer 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, Print Name of Owns Sienature of Owner t— Date O The property has been transferred to owner above and the unit Recei'!�EB 21 2020 remains in earn liance with the 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 S8R4h7ffl- lgPLEM BOARD OF HEALTH trIDPH-05P Subraetering Form.Rev 11-4-16 MASSACHUSE77S DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM *In accordance with M.G.L.c.196,§22 and 105 CMR 410.000:Minimum Standards of Fitness far Human Habitation (State Sanitary Code Chapter II).the fallowing dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer service. PROPERTY INFORMATION Address: 205 Highland Ave un-it# 1201 24 Citvrrown: Salem MA Zi Code:01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.000 requires the installation of water conservation devices prim 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: Showetheads with maximum flow rate not to exceed 2%gallons per minute(2.5 Spin) Faucets with maximum flow rate not to exceed 2 m gallons per minute(22 gpm) Ultra-low flush water closds(toilets)not to exceed 1 Leo gallons per flush(1.6 gpt) 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 similaraccredited association. A licensed plumber must install the water closets and submetering equipment. Submetering equipment inR matioa: Master Rueter Flexible Axis Manufacturer Model# Ucensed Plumber Certification Joseph Bellefeuille 9793 12-16 2019 Print Name ofPhrmber License# Date I certify that(check all that apply): MI 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 cityltown,if required,is attached. ❑Dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c.186.§22(p).does not require the installation of a submeter. n Signed under the pains and penalties of perjury, S' ature of Licensed Plumber Property Owner Certification 1 cer*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 arc 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 speearred 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.186.122; (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 orwater and/or sewer service,and a copy of this certification fomt;(6)That all information included on this certification is true and accurate to the beeg of my knowledge. Signed under the pains and penalties of perjury, Print Name of Owner �Siltatur a of Owner 1 Date D The property has been transferred to owner above and the unit Received FEB 21 202 reaudys.in compliance with the Mquirements of M.G.L.c. 186 §22 Date: by BOH: *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING S"f Pff K&LEM MDPH-CSP Submetwing 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.I B6.§22 and 105 CMR 410.000.Minimum Standards of Painless for Human Habitation (State Sanitary Code Chapter In.the fallowing dwelling unit is eligible for the imposition an the tenants of a charge for water and/or wwer em:tee. PROPERTY INFORMATION Address: 205 H hland Ave tj.ij A 11 24 Ci Rbwn: Salem MA Z' 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 fallowing specifications: Showedmcis with maximum flow rate not to exceed 2'c&alloas per minute(2.5 Spin) Faucets with maximum flow rate not to exceed 2 gallons per minute(2.2 gpm) Ultra low flush water closets(toilets)not to exceed I�t°gallons per flush(f.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 equipmenL Suubmetering equipment information: Master Meter Flexible Axis Manufacturer Model# Licensed Plumber Certttientlon Joseph 1391lef9ulite 9793 12-16-2019 Print Name of Plumber License# Date I certify that(check all that apply). 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 cityAown,if required,is attached ❑Dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c.196.§22(p),does not require the installation of a submeter.. Signed under the pains and penalties of perjury, n Si of LicemseW Plumber Prop"Owner Corti icatfon 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 submeteting law(MGL c.186,§22r(2)All showerhauh,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 subme(er 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 j ft k ag �-#. rQ O tZ Print Name of Owner Kenstare of Owner Date The property has been ttansfetred to owner above and the unit �°ivy FEB 2 1202 ransins in compliance with the requirements of M.G.L.a 186 22 Date: by BOII: *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING S1I�,TIIyCtLE BOARD OF HEALTH MD ev PH-CSP Submctrring Form,R i 1 4-15 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 Fftess for Human Habitation (State Sanitary Code Chapter ED,the hollowing dwelling unit is eligible for the imposition on the tem mts of a charge for water and/or sewer=.4=. PROPERTY INFORMATION �. Address: 205 HI hland Ave unit 4 1107 A Orionift in hidir 24 cityawwo. Salem MA Zip Code:01970 EQUIPIK 4T INSTALLATION INFORMATION 105 CMR 410.000 requites the installation of water conservation devices prim'to a dwelling unit becoming eligible for the imposition on tenants of a charge for water and/or sewer.The devices must meet the fallowing specifications: Showetheada with maximum flaw rate not to exceed 2:Vlons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 gallons per minute(2.2 gpm) Ultra-tow flush water closets(toilets)not to exceed t�Eo gallons per flush(1.6 gpQ 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 infomtation: Master Meter Flexible Axis Manufacturer Model# Licensed Plumber Certification Joseph Belleteuille 9793 12-_16 2019 Print Name of Plumber License# Date I certify that(check all that apply): [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 galIons per flush. The plumbing permit issued by the cityAown,if required,is attached ❑Dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c.186,§22(p),does not require the installation ofa submeter. Signed under the pains and penalties of perjury, r ' —Su mature of Lic=wurftunber Property Owner Certification l 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 showenccad%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 meta or submeter measures the water usage exclusive to this unit;(S)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, sue.- . ewe- es�•F �-�+� 24 � L (�. Print Name of Owner Signature of Owner Date U The property has been tramsfemed to owner above and the unit Received remains in compliance with the requirements of M.G.L.c. 186 FEB 21 202 22 Date: BOH: *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBMETERING . CITY OF Sr�.1.ELL MDPH-CSP Submetering Form,Rcv 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 Hunan Habitation (State Sanitary Code Chapter U),the following dwelling unit is eligible for the imposition an the tenants of a charge for water and/or sewer - PROPERTY INFORMATION Address: 205 Highland Ave T ut g 1106 it QF trnifn in h1eig 24 City/Town: Salem MA Zip Code;01970 EQUU MENT 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 fallowing specifications: Sbowerheads with maximum flow rate not to exceed 2 n�allona per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 gallons per minute(2.2 gpm) Ultra-low flush water closets(toilets)not to exceed 1 a'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. Submeteri g equipment information: Master Meter Flexible Axis — Manufacturer Model# Licensed Plumber Cerdfkxftn Joseph Bellefeuille 9793 12-16-2019 Print Name of Plumber License# Date I ceriyfy that(check all that apply): I have installed the submetaing equipment listed above in accordance with accepted plumbing standards. I have installed one or mote water closets not exceeding 1.6 gallons per Bush. Determined that existing water closets do not exceed 1.6 gallons per flush. The plumbing permit issued by the city/town,if required,is attached ❑Dwelling unit is connected directly to a meter installed by a water company and.in accordance with M.G.L.c.186,§22(p).does not require the installation of a submeter. Signed under the pains and penalties of perjury, �� lY✓� � V Signature orLicensed Plumber Property Owner Certification 1 certify that:(1)This dwelling unit is eligible for the imposition on the tenants of a charge ter water and/or sewer usage in accordance:with the water submetering law(MGL c. 186,§22),(2)All showaheads,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 ibis certification form;(6)That all information included on this certification is tnic and accurate to the best of my knowledge. Signed under the pains and penalties of perjury, Print Name of[owner sionatum of Owner - D Date O The property has been transfened to owner above and the unit Received remains in compliance with the r uirements of M.G.L.c. 186 22 Date: by BOHTEB 21 202 *THIS FORM MUST BE FILED 1MITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING S�JJJTEFI SALEM Mt3PH-CSP Su6uuctarirsgForm,Rev 11-4-t6 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 CMit 410.000:Minimum Standards of Fitness far Human Habitation (State Sanitary Code Chapter U),the following dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer service. PROPERTY INFORMATION Address: 205 Highland Ave Unit 9 1105 &Qf tonia in bldg-24 City/Town: Salem MA Zip Code:01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.000 requires the installation of water conservation devices prier to a dwelling unit becoming eligible for the imposition on tenants of n charge for water and/or sewer.The devices must meet the following specifications: Sbowerheads with maximum flow rate not to exceed 2:4alIons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 gallons per minute(21 gpm) Lgtm-low flush water closets(toilets)not to exceed 1°�to PRODS 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 Icensed plumber must install the water closets and submetering equipment. Submetering equipment inforauttion: Master Meter Flexible Axis Manufacturer Model# --— Licensed Plumber Certification Joseph Beilefeunle 9793 12-16-2019 ! Print Name of Plumber License# Date I certify that(check all that apply): 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 cityhown,if req*4 is attached. ❑Dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c.196,1 22(p),does not require the installation of a submater. Signed under the pains and penalties of perjury, n _ V Si cure Licensed P er _- Property Owner Certification I certify that;(1)This dwelling unit is eligible for the imposition on the tenants of it charge for water and/or sewer usage in aecotdaaoe with the water submetering law(MGL e.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 watersubmeter 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 twants 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 am and accurate to the best of my knowledgm Signed under the pains and penalties of pedury, 1� Print Name of Owner Sit=.naturc of Owner ate Date The property has been trans&m ed to owner above and the unit RecaivedFEB 2 1202 remains in compliance with the:mquirements of M.G.L.e.186 22 Date: by BOH: *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBME7,8R1 MLEM BOARD OF HEALTH MDPH-CSP Submetering Form,Rav 11-4-16 MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMIMRING OF WATER AND SEWER CERTIFICATION FORM "In accordance with M.G.L.c.196,§22 and 105 CMR 410.000:Minimum Standards of Fitness far Human Habitation (State Sanitary Code Chapter 11),the following dwelling unit is eligible far the imposition an the tenants of a charger for water and/or sewer semee. PROPERTY INFORMATION Address: 205 Highland Ave > • 110 24 Ci /rows Salem MA Zi Code:01970 EQIUIPMBNT INSTALLATION INFORMATION 105 CMR 410.000 requites the installation of water conservation devices prier to a dwelling unit becoming eligible for the imposition on tenants of a charge for water and/or sewer.The devices must meet the fallowing specifications: Showerheads with maximum flow rate not to exceed 2:lions per minute(2.5 Spin) Faucets with maximum flow rate not to exceed 2 gall as per minute(2.2 gpm) Ultra-low flush water closets(toilets)not to exceed t dE4 gallons per flush(t.6 gpt) 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 Wodcs Association or similar accredited association. A licensed plumber must install the water closets and submetering equipment. Stbmetering equipment infomcation: Master Meter Flexible Axis _ Manufacturer Model# 1 Licensed Plumber Cestillcaden Joseph 9ellefeuille 9793 12-16-2019 Print Nairn of Plumber License# Date I ceztify that(check all that apply): I have installed the submetering equipment listed above in accordance with accepted plumbing standards. I have installed one or move water closets not exceeding 1.6 gallons per Bush. Determined that existing water closets do not exceed 1.6 gallons per flush. The plumbing permit issued by the cityhown,if required,is attached. Dwelling unit is connected directly to a meta installed by a water company and,in accordance with M.G.L..c.186,§22(p),does not require the installation of a submeter. Signed under the pains and penalties of perjury, ! S' aturc of Licensed Plumber Property Owner Certification 1 certify that:(1)This dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer usage in accordance with the water submetering law(MGL c. 186,§22);(2)Alt 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 watcr 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 orwater 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 informai'con included on this certification is tux and accurate to the best of my knowledge. Signed under the pains and penalties ofperjuty, Qs Print Name of Owner Signawre of Owner _ i LZ tz I ' lz Date O The property has been transferred to owner above and the unit ReextvEg 2 12020 remains in compliance with the requirements of M.G.L.c.186 22 Date: bj Boll "THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING t:Il Y UfFEM BOARD OF HEALTH MDPH-CSP SubmderingForm,Rev 11-4-16 MASSACHIJSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM *In accordance with M.G.L.c.196,§22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation (State Sanitary Code Chapter II),the following dwelling unit is eligible far the imposition on the tenants of a charge for water and/or sewer service. - -- - - - PROPERTY INFORMATION Address: 206 HI bland Ave W1 u 110 24 Ci rrown: Salem MA_ zi code:01970 EQUEPK 4T INSTALLATION HWORMATION 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 fallowing specifications: Sbowerbeeds with maximum flow rate not to exceed 2�allons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed Z gallons per minute(22 gpm) Ultra-tow,flush water closets(toilets)not to exceed 1 eta gallons per Bob(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 Iicensed plumber must install the water closets and submetering equipment. Submetering equipment information: Master Meter Flexible AXIS Manufacturer Model# I.dcenseti Plumber Certification ----Joseph Beliefeullie 9793 12-16-2019 Print Name of Plumber License# Date I certify tint(check all that apply): have installed the submete:ring equipment listed above in accordance with accepted plumbing standards I have installed one or more water closets not exceeding 1.6 gallons per Lush. Determined that existing water closets do not exceed 1.6 gallons per flush. The plumbing permit issued by the cityRowm,if required,is attached. ❑Dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c.186.§22(p),does not require the installation of a submeter. Signed under the pains and penalties of perjury, IV signatureorLiemised er Property Owner Certification t cer*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 showalicads,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.186,122; (4)'Tbe water meter or submeter measures the water usage exclusive to this unit',(5)I will provide to the tenant of this dwelling unit,prior to occupancy,a written rental agreement that clearly provides for the separate charging of water and/or sewer savic-,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, Print Name of Owner Sienaturz of Owner Date The property has bean transferred to owner above and the unit Received retrains in rota liance with the reouireme nts of M.G.L.c.186 22 Date: b Bolt FEB 21 202 *THIS FORM MUST BE FILED VdM THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBMETERING CITY OF SALEM MDPH-CSP SubrwtcringFo n,Rcv 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.1116,§22 and 105 CMR 410.000.Minimum Standards of Fitness for Human Habitation (State Sanitary Code Chapter II),the fallowing dwelling writ is eligible far the imposition an the tenants of a charge for water and/or sewer Service. PROPERTY INFORMATION — � - Addma: 205 Highland Ave i in;t# 1102 - 24 a Frown: Salem MA Zip Code:01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.000 requites the installation of water conservation devices prior to a dwelling unit becoming eligible for the imposition on tenants of a charge far water and/or sews The devices must meet the fallowing specifications: Showerbeads with maximum flow rate not to exceed 2% Ions per minute(L5 gpm) Faucets with maximum dow rate not to exceed 2 gallons per minute(22 gpm) Elitra-law flush water closets(toilets)not to exceed 1 010 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 similaraecredited association. A licensed plumber must install the water closets and submetering equipment. Submeteting equipment information: Master Meter Flexible Axis Manufacturer Model# W :.icensed Plumber Certification Joseph Bellefe_ulile 9793 12-16-2019 Print Name of Plumber License# Date I certify that(chick all that apply). I have installed the submetering equipment listed above in accordance with accepted plumbing standards. I have installed one or more water closets not exceeding 1.6 gallons per flush. Determined that existing water closets do not exceed 1.6 gallons per bush. The plumbing permit issued by the cityhown,if required,is attached ❑Dwelling unit is connected directly to a meter installed by a water company Sad,in accordance with M.G.L.c.186,§22(p),does not require the installation of a submeter. Signed under the pains and penalties of perjury, �*- � A Si tune of Licensed Plumber Property Owner CertiBeatlon l 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(MOL c.196,§22);(2)All showerhmds,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 specifed above,or the water meter measuring the use of water in this dwelling unit was irWalled by a"water company" as defined in M.G.L.c.186,§22; (4)The water motor 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 farm;(6)That all information included on this certification is true and accurate to the best of my knowledge. Signed under the pains and penalties ofperjury, Print Name of Owner ladrrc of Owner Date 0 The property bas been transferred to owner above and the unit Ra:civcd remains in compliance with the rwuirements of M.G.L.c. 196 J22 Date: by HOH:r EB 21 2020 *'THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUgMETERING CITY OF SALENJ MDPH-CSP Subnrctering Form,Rev 11-4-16 BOARD OF HEALTH5 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. FRO'FERTY INFORMATION Address: 205 Highland Ave Unit# 1101 _ #Of units in bid+;.24 Cirv/Town: Salem MA 4,Code:01970 EQUIPMENT INSTALLATION INFORMATION 105 CMR 410.000 requires the installation of water conservation devices prior to a dwelling unit becoming eligible for the imposition on tenants of a charge for water and/or sewer.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2%gallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 v10 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: Master Meter Flexible AXIS Manufacturer Model# Licensed Plumber Certification Joseph Beliefeullle 9793 _ 12-16-2019 Print Name of Plumber License# � Date I certify that(check all that apply): ®I have installed the submetering equipment listed above in accordance with accepted plumbing standards. ❑I have installed one or more water closets not exceeding I.6 gallons per flush. ®Determined that existing water closets do not exceed 1.6 gallons per flush. ❑The plumbing permit issued by the city/town,if required,is attached. ❑Dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c. 186,§24),does not require the installation of a submeter. Signed under the pains and penalties of perjury, N _ Sikynature of icensed P! er Property Owner Certification I certify that:(1)This dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer usage in accordance with the water submetering law(MGL c. 186,§22);(2)All showerheads,faucets,and water closets in this dwelling unit are water conservation devices that meet the standards specified above;(3)The water submeter measuring the use of water in the dwelling unit was installed by a licensed plumber and is in compliance with the standards specified above,or the water meter measuring the use of water in this dwelling unit was installed by a"water company" as defined in M.G.L.c.186,§22; (4)The water meter or submeter measurrs 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, �. r r- ,,4- Print Name of Owner Si tore of Owner a _ q Date The property has been transferred to owner above and the unit Received remains in compliance with the requirements of M.G.L.c. 186,j22 Date: _. by sox:FEB 21 2020 *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBMETERING CITY OF MDPH-CSP Submclering Form,Rev 11-4-16 BOARD HEALTH