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Water submeter certificates - Units in the 2s MASSACITUSETTS DEPARTMENT OF PUBLIC HEALTH SU33KMRING OF WATER AND SEWER CERTIFICATION FORM *In aaonlance with M.G.L.c.196,§22 and 105 CMR 410.000:Minimum Standar&of Fitness for Human Habitation (State Sanitary Code Chapter 01 the Eollowing dwelling unit is eligible for the imposition on the tenants of a charge for water and/orsewer service. _ �PROPERTY INFORMATION - Address: 205 Highland Ave 24 Ci, nown: Salem MA Zip Code:01970 EQUIPMlI:NT 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 far water arAVor sewer.The devices must meet the following specifications: I Sbowerheads with maximum flow rate not to exceed 21e gallons per minute(2.5 Spin) Faucets with maximum flow rate not to exceed 2 wo gallons per minute(22 Spin) Ultra Iow flush water closets(toilets)not to exceed 1 6"0 gallons per flush(1.6 gpf) 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 Wo&Association or similar accredited association. A licensed plumber must install the water closets and submetering equipment. Submetering equipment inforu don: Master Meter Flexible Axis Manufacturer Model# Licensed Plumber Certtflcatlan Joseph B_ellefeuille 9793 12-16 2019 Print Name of Plumber - — License# Date I certify that(check all that apply): Jhave 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- 0 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. 1 � � Signed under the pains and penalties of perjury, uSin�t of icersed Fir a:�rcr Property Owner CertiQeation - 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 ate water conservation devices that meet the standards specified above;(3)The water submeter measuring the use of water in the dwelling tacit 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 pentaities ofpe jury, Print Name of Owner S ignatum efOwner bate The property has been ttsunsferred to owner above and the unit Received remains in w liaace with the emttirements of M.G.L c 166 22 Date: b BOH: FEB 21202 'THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBMETERING CITY OF SALEM MDPH-CSPSubmcteeingForm,Rev 114-16 BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM *In accordance with M.G.L.c.1 B6,i 22 and 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation (State Sanitary Code Chapter ED,the following dwelling unit is eligible far the imposition an the tenants of a charge for water and/or sewer service. PROPERTY INFORMATION Address: 206 Highland Ave Unh a23(17 24 Ci frown: Salem MA Zipcode:01970 EQUIPD M 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 for water and/or sewer.71te devices must meet the following specifications: Sbowerheads with maximum flow rate not to exceed 2:Ilona per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 gallons per minute(2.2 gpm) Ultra tow!lush water closets(toilets)not to exceed 16'1°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 Wotks 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 0 Licensed Plumber Certification s Joseph Bellefeuilie 9793 12-16-2019 Print Name of Phrmbcr License 0 Date I certify that(check all that apply)- CRT 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 sad,in accordance with M.G.L.c, 186,122(p),does not require the installation of a subareter. Signed under the pains and penalties of perjury, _ S' f Licensed Plumber Property Owner Cedifleation I certify that:(I)Tbis dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer usage in accordance with the water submetexing low(MGL c.196,in),(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 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 of water in this dwelling unit was installed by a"water company" as defined in M.G.L.c.186,§22; (a)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 ofwater and/or sewer service,and a copy of this certification fame;(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, y Print Name of Owner Siatruc of Owner W r-D Date O The property has been transferred to owner above and the unit Received FEB 2120 0 remains in compliance with the reaniremenls of M.G.L.e. 186 22 Date: by BOH: *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SU FtP%ALEM BOARD OF HEALTH MDPH-CSP Submctering Form,Rev 11-4-I6 MASSACHUSETTS 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 Humus Habitation (State Sanitary Code Chapter II),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 Eli hland Ave Os aucas in ihiricr 24 g mown: Salem MA z! Code:01970 EQUIPMENT INSTALLA ION INFORMATION 105 CMR 410.000 requires the installation of water conservation devices prior to a dwelling unit becoming eligible for the imposition on tenants ofa charge far 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 Spin) Faucets with maximum flow rate not to exceed 2 gallons per minute(2.2 gpm) Ukra-low flush water closets(toilets)not to exceed 1616 gallons per flush(1.6 gpQ Toe 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# Liceand Plumber Ceriiticatfoo Joseph Bellefeuille 9793 12-16-2019 Print Name of Plumber License# Date I certify that(check all that apply): tolI 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 requited,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 submcter. Signed wader the pains and penalties of perjury, S' atun of Licensed Plumber Property Owner Cerdficadon 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,§22k(2)Ali 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 KG.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 ofwater and/or sewer service,and a copy of this certification f imi;(6)That all information included on this certification is trete and accurate to the best of my knowledge. Signed under the pains and penalties ofperjury, a - � - (L&4(4 Print Name of Owner 4 Signature LUIA&Date O The property has been transfemd to owner above and the unit Lb eived remains in cam liance with the uir>:sments of M.G.L.c. 186 22 Date: BOH: FEB 272010 *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SU"tt,IF�ALEM MDPH-CSPSubmctcringFonnr Rev 11-4-16 BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMET,ERING 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 10,the following dwelling unit is eligible for the imposition on the tenants of a charge for water andlorsewer service. PROPERTY INFORMATION Address: 205 H hland Ave tin 4 t 4305 af unite ip hidcr 24 C' bows: 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 ou tenants of n charge for water and/or sewer.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 2 UAlons 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 ara 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 Mode[# Licensed Phtmber Certification Joseph Beilefeuille 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 1.6 gallons per flush. Determined that existing water closets do not exceed 1.6 gallons per flush. The plumbing permit issued by the cityRown,if rcquired,is attached. ❑DwelHugunit is comaected 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, Signature of 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(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 ibis dwelling unit was installed by a"wawr 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 true and accurate to the best of my knowledge. Signed under the pains and penalties of perjury, /J Print Name of Owner Si attire ofOwner D Date The property has been haasfemd to owner above and the unit Received- remains in compliance with the mouirements of M.G.L,a 186 22 Date: by Bog EB 21 2020 'THIS FORM MUST 8E FILED WITH THE LOCAL Al BOARD OF HEALTH PRIOR TO INITIATING S�ITYET FINE SALEM MDPH-CSP Submctc&gForm,Rev 11-4-16 BOARD OF HEALTH MASSACEFUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMTERING OF WATER AND SEWER CERTIFICATION FORM *In accordance with M.G.L.c.1 R6,§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 and/or sewer service. PROPERTY INFORMATION Address: 205 Highland Ave Lwj gg()4-- 24 Ci (Town: Salem MA Zip Code:01970 EQUI PMENP 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: Showerheads with maximum flow rate not to exceed 2:Xallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 gallons permute(2.2 gpm) Ultra-tow flush water closets(toffets)not to exceed 1 610 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 ofthe American Water Wocks Association or similar accredited association. A licensed plumber must install the water closets and submetering equipment Submeteriog equipment information: Master Meter Flexible Axis Manufacturer Model# Ldcensed Plumber Certification Joseph Beilefeuille 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 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,ifrequired,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 pahts and penalties of pctjury, n r/ w Si tune Qr Licerised Phmhaber Property Owner Certification l cartit)r that:(1)This dwelling refit 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 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" es defined in M.G.L.c.186,§22; (4)The water meter or submeter mcasures 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 parjury, &, " -(w� L Print Name of Owner 61 Sismatum of Owner ate la The property bas been ttansfemd to owner above and the unit DReceiv remains in lianc a with the uirements of M.G.L.c. 186 22 Date: BOH EB 1 2�2� "THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING 5#R4EMIjgALEM BOARD OF HEALTH MDPH-CSl Submetaing Fomi,Rev 114-16 MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMXTERI'NG OF WATER AND SEWER CERTIFICATION FORM *In accordance with M.G.L.c-186,§22 and 10S CMR 410.000:Minimum Standards of Fitness for Human Habitation (State Sanitary Code Chapter R the Fallowing dwelling unit is eligible for the imposition an the tenams of a charge for water and/or sewer service. PROPERTY INFORMATION Address: 205 Highland Ave Unit*2303 9 Qrunibc in h1dy 24 Ci flown: Salem MA Zip Code:01970 EQUIPMMW INSTALIAATION 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 speciticatims: Showerheads with maximum flow rate not to exceed 2 x gallons per minute(2S gpm) Faucets with maximum flow rate not to exceed 22M gallons per minute(2.2 gpm) Ultra-low Bush water closets(toilets)not to exceed f 6"gallons per flush(1.6 g'pf) The submetering equipment used to measum the quantity of water used for each dwelling writ and comnian 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 submete wg equipment. Submeteting 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(check all that apply): I have installed the submeteting equipment fisted 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 ❑Dwc flag 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, W Siomature ofUcensed Flumber 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 submctering law(MGL c.186,§22);(2)All showcnccads,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 am and accurate to the best of my knowledge. Signed under the pains and penalties ofpcdury, Print Name of Owner Signature of Owner - Date The property has been transfarred to owner above and the unit Received FEB 21 20 remiss in compliance a with the requirements of M.G.L.c.186 22 Date: by BOH: "THIS FORM MUST BE FILED WITH THE LOCAL HOARD OF HEALTH PRIOR TO INITIATING SU MALEM MDPH.CSP Subntetering 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 Fib=for Human Habitation (State Sanitary Code Chapter UX the following dweUing unit is eligible for the imposition an the tenants of a charge for water and/or sewer service. PROPERTY INFORMATION Address: 206 Highland Ave unit# 2302 24 ci frown Salem MA Zip Code:01970 EQIIIPMINT 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 specifiCidORs: Showatheads with maximum flow rate not to exceed 2 K"gallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 gallons per minute(22 gpm) Ultra-Iow Bush water closets(toilets)not to exceed 1 6"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 similaraccreditedassociation. A licensed plumber must install the water closets and submetering equipment Submetering equipment infamuition: Master Meter Flexible Axis Manufactum Model# Licensed Plumber Certification Joseph Bellefeuille 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 1.6 gallons per flush. Determined that existing water closets do not exceed 1.6 gallons per flush. The plumbing pehmit issued by the cityltown,ifrequired,is attached ❑Dwelling unit is connected directly to a meter installed by a water company and.in accordance with M.G.L.c.1116,§22(p),does not require the installation of a submeter. Signed under the pains and penalties of perjury, Si 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)All showerhaeds,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 meta measuring the use of water in this dwelling unit was installed by a"wata:r company" as defined in M.G.L.c.186,g 22; (4)Tine 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 forma;(6)That all information included on this certification is truer and accurate to the best of my knowledge. Signed under the pains and penalties of perjury, .p. 4 Print Name of Owner Sienatum of Owner Date ❑The property has been transferred to owner above and the unit ltuetveA.EB 212020 remains in coin liance with the uire meats of M.G.L.a:. 1 22 Date: BOH. `THIS FORM MUST BE FILED M41TH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING!WEMVALEM MDPH-CSP SubmeteaingForm,Rev 11- -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 Hurtm Habitation (State Sanitary Code Chapter Ile;the fallowing dwelling unit is eligible f-the imposition an the tuts of a d:arge for water and/or sewer service. PROPERTY INFORMATION Address: 205 Highland Ave 01 units i,wit 24 City/Town: Salem _ MA Zi Codc:l319T0 EQUEPMENT 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 far water and/or sewer.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed gallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 gallons per minute(2.2 gpm} [litre-tow flush water closets(toilets)not to exceed i s'1°gallons per flush(l.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 simitar accredited association. A licensed plumber must.install the water closets and submetering equipment. Submacting equipment information: Master Meter Flexible Axis Manufacturer — Model# Licensed Plumber Cettilleadon _ Joseph Beilefeuille 9793 1_2-16-2019 Print Name of Plumber - License# Date I certify that(cheek 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 cityAtown,ifrequir d,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 patios and penalties of perjury, ' p Stynature 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 accor+d&=with the water submetering law(MGL c.186,§22);(2)All showerbcads,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 ofwater in this dwelling unit was installed by a"water company' as defined in M.G.L.c.IK j 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 mad accurate to the best of my knowledge. Signed under the pains and penalties of perjury, 4, C4 A4 0, -o Print Name of Owner Siemture ofOwna _.T c Date The property has been transferred to owner above and the unit Received remains in compliance a with the rwulrements of M.G.L-c.185 22 Date: by$OH:FEB 21 202;1 *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING Sl.1BllsdEfEl)JT1 LEM MDPH-CSP Submetedng Form,Rn 11-M16 BOGATRYDOOrFSHEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM !In accordance with M.G.L. an e.196.§22 d 105 CMR 410.000:Minimum Standards of Fitness for Human Habitation (State Sanitary Code Chapter III:the 56111owing dwelling unit is eligible for the imposition cn the tec--.ts of a chmgc for water and/or sewer service. PROPERTY INFORMATION Address: 206 Highland Ave mini. 24 ci frown: Salem MA zits Code:819T0 EQUIPbMMT 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 for water and/or sewer.The devices must meet the following slmocations: Showerheads with maximum flow rate not to exceed 2 Uallons per minute(2.5 Spin) Faucets with maximum flow rate not to exceed 2 gallons per minute(22 ilpm) Ultra low flush water closets(toilets)not to exceed 1 Wo gallons per flush(1.6 gpf) The subnMering equipment used to treasure the quantity ofwater used for each dwelling unit and common area must meet the standards of accuracy and testing of the American Water Wotks Association or similar accredited association. A licensed plumber must install the water closet and submetering equipment. Submetering equipment information: Master Meter Flexible Axis Manufacturer — _ Model# Licensed Plumber CerMcation _ Joseph Bellefettille 9793 12-16-2019 Print Name of Plumber License# Date I cenify that(check all that apply): I have installed the submetering equipment listed above in accordance with accepted plumbing standards. I have installed we or more water closets not exceeding 1.6 gallons per flush. Detetanined that existing water closets do not exceed 1.6 gallons per flush. The plumbing permit issued by the cityhown,ifrequired,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, -� - f _ Sienature o icensed Plumber Property Owner Certification 1 certify that:(1)This dwelling unit is eligible for the imposition on the tenants of a charge for water andfor sewer usage in accordance with the water submetcring law(MGL c.186,§22);(2)All showenccads,faucets,and waterclosets in this dwelling unit aft 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" ns defined in KG.L.c.1116,§22; (4)The water meter or submeW measures the water usage exclusive toads unit;(9)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 peujury, Print Name of Owner Si tore ofOwner — Date ❑The property has been transferred to owner above and the unit RReceiv remains in compliance with the requirements of M.G-L.c.Ig6 22 Date: h BOl : 21 2020 'THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING VWU MA EM MDPH-CSP Submewring Fomr,Rev 114-16 BOARD OF HEALTH MASSACHUSETTS 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 rode Chapter II),the following dwelling unit is eligible for the imposition on the teaacts ofa chart for water and/or sewer service. PROPERTY INFORMATION Address: 205 H19 hland Ave LTnb M 2207 24 City/Town: Salem MA Zip Code:01970 EQt?IPMENT 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 o charge for water and/or sewer.The devices must meet the fallowing specifications: Sbowerheads with maximum flow rate not to exceed 2 x gallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 x" gallons per minute(2.2 gpm) Ultm-low flush water closets(toilets)not to exceed t'yt°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 Wodcs 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 Cerdflestdon Joseph Bellefeuille 9793 12-16-2019 Print Nairn 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. 196,§22(p).does not require the installation of a submeter. Signed under the pains and penalties of perjury, Si tune dtLicensed Pkanber 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 M.G.L.c.1116.122; (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. Sighed under the pains and penalties ofpmjury, Print Name of Owner ;�—Signatum of Owner Date O 11c property has been tmwferrcd to owner above and the unit Receive�- remains in compliance with the requirements of M.G.L.c. l 22 Date: by BOH: EB 21 2020 *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBMETERING CITY OF SALEM MDPH-CSP Submetering Form,Rev 114-16 BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORM *In accordance with M.G.L.c.196,122 and 105 CMR 410.000:Minimum.Standetds of Fitness far Human Habitation (State Sapitary Code Chapter M the fallowing dwelling unit is eligible for the im;asitiea on the tanc--ts of a chmle for water and/or sewer service. PROPERTY INFORMATION Address: 205 Highland Ave _ [laiLL 2206 24 Ci rC'own: Salem MA Zi Code•01970 EQUIPhMNT 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 far water and/or sewer.The devices must meet the fallowing specifications: Sbowerheads with maximum flow rate not to exceed 2%jallons per minute(L5 gpm) Faucets with maximum flow rate not to exceed 2 m gallons per minute(2.2 gpm) Uhra-low,flush water closets(toilets)not to exceed 16"gallons per flush(1.6 gpQ The submeteriag 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: h4astet Meter Flexible Axis Manufacturer Model# Licensed Plumber Cerd ication Joseph Sellefeuilie 9793 12-16 2019 Print Name of Phunber 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. Thu 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 requite the installation of a submeter. Signed under the pains and penalties of perjury, �•<- __ Sismature 6Y Licensed PUmber Property Owner Certliication 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(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 eater company" as defined in M.G.L.c.186,§22; (4)The water meter or submeter measures the water usagc 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 ofpcdury, Print Name of Owner Si cure of Owner ,i Date O The property has been transf a ed to owner above and the unit Receiv remains in coo liana with the requirements of M.G.L.c. 186 22 Date: by B01EB 21 2020 *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBMETERING CITY OF SALEM MDPH-CSPSubmdedng Form,Rev 11-4-16 BOARD OF HEALTH MASSACHUSE77S DEPARTMENT OF PUBLIC HEALTH SURM(ETERING 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 (Statue Sanitary Code Chapter II),the 6ollowicg dweHicg unit is eligible for the imposition on the tear.-ts efa charge far water and/or sewer service. PROPERTY INFORMATION Address: 205 Wiahland Ave Z205 24 Ci !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.Tha devices must meet the following specifications: Sbowerheads with maximum flow rate not to exceed 2 UAIons 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 m4 gallons per flush(l.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 Manufacturer Model# Licensed Plumber Certification Joseph Bellefeuilie 9793 12-16-2019 Print Name of Plumber - - License# Date I certify that(check all that apply): IThehave 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 hush. Determined that existing water closets do not exceed 1.6 gallons per flush. 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. Signed under the pains and penalties of perjury, r ALq.-p- Signature A Licensed Phmnber Property Owner C rtilleation 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 waiter 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 subinder 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 tinder the pains and penalties ofperjury, Print Name of Owner Sionatuure of Owner D Date 13 The property has been transferred to owner above and the unit Received remains in cum liance with We rtnnirements of M.G.L.c. l86§22 D_ate: b $OH:FEB 21 202 *THIS FORM MUST BE FILED WITH THE LOCAL HOARD OF HEALTH PRIQ NG CITY OF SALEM MDPH-ESPSubmetering Form,Rev 114-16 BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBM>ItiTERING 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 Il),the following dv--Uisg unit is eHg'ble for the imposition on the ten=ts of a die far water and/or sewer service. PROPERTY INFORMATION Address: 205 Highland Ave 2 i�,n3�s in�1 24 a crown: Salem MA zip Cade: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 ofa charge for water and/or sewer.The devices must meet the fallowing specifications: Sbowerheads with maximum flow rate not to exceed 2/antra per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 gallons per minute(2.2 gpm) Uhra low flush water closets(toilets)not to exceed I dt°gallons per flush(1.6 8pf) The submgWmg 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 similaracxredite d association. A licensed plumber must install the water closets and submetering equipment. Submetering equipment information: Master Meter Flexible AXIS Manufacturer - - Model# W Licensed Phimber Certification Jowph Benefeuille 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. 1T1 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. he plumbing permit issued by the cityhown,ifrequired,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, - o V Si ture dF 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 submctering law(MGL c.186,§22),(2)All showenccads,faucets,and wawa closets in this dwelling unit ads 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 twit 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 sdrviee,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, o, Print Name of Owner Sinature of Owner 1_ Date 13 The property has been transfeaed to owner above and the unit Receive¢E6 21 2020 remains is co liance with the miniremerits of M.G.L.r. 186,_ z2 Dace: b�BO *'THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING S8"IMIALEM MDPH-CSP Submeteding 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.1.11,t.:a fallowing dwelling unit is elig;'rie rzr the irWsition on the tenant;of s chargo.or water and/or sewer service. PROPERTY INFORMATION Address: 205 Highland Ave 2203 it nr unin in bmv 24 Ci Imown. Salem _ MA Zi2 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: Sbowerheads with mataimm flow rate not to exceed 2"gallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 gallons per minute(2.2 Spin) Mtra-low flush water closets(toilets)not to exceed I d10 gallons per flush(1.6 gpf) 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 Works Association or similar accredited association. A licensed plumber must install the water closets and submetering equipment. Submeterfng equipment information: __ Master Meter Flexible Axis Manufacturer Model# v Llceased Plumber Certification Joseph Belletsuiile 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 1.6 gallons per flush. 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. Signed under the pains and penalties of perjury, n _ 5i lure o icensed P cr l Property Owner Certification I certify that:(1)This dwelling unit is eligible for the imposition on the tenants of a charge for water mWor sewer usage in accordance with the water submetering 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)71e 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 ibis dwelling unit was installed by a`heater counpany" as defined in M G.L.c.186,-§22; (4)The water meter or submeter menums 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 trnc and accurate to the best of my knowledge. Signed under the pains and penalties ofperjury, r 10-1— Print Name of Owner Signature ofOwner Date 13 The property has been transferred to owner above and the unit Received remains in ca_mr�fiance with the mquirements of M.G.I..n 186 22 Date: b 9OH:FEB 21202] 'THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING S� 6TNCALEM MDPH-CSP Subttrrtering Fame,Rev 1 t-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 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 andror sewer service. PROPERTY INFORMATION Address: 20S Highland Ave 2202 ibt in hial, 24 Ci !Town: Salem MA Zi Code.-019T0 EQ1i190MYr 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 andlor sewer.The devices must meet the following specifications: Showerheads with maximum flow rate not to exceed 216 allons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2"' gallons per minute(22 gpm) Ultra-taw flush water closets(toilets)not to exceed 1&10 gallons per flush(1.6 gP0 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 CertlfIcation Joseph Bellefeuille 9793 112-16 2019 Print Name of Plumber License# - — Date I certify that(cheek 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!lush. Determined that existing water closets do not exceed 1.6 gallons per flush. The plumbing permit issued by the cityhown,if required,is attached C]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 submete r. Signed under the palm and penalties of perjury, � ` � �- `' Sictnature 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 andforsewer usage in accordance with the water submetering law(MGL c.186,§22);(2)All showeAcads,faucets,and waw closets in this dwelling unit ate water conservation devices that meet the standards specified above;(3)The water submater 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 submetermeasur,es 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 andler 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 ofpctury, ` JR1, 61M - a (Nj -- 42-1f 6 /t Print Name of Owner Si mature of owner Date la The property has been trartsf ed to owner above and the unit Receiv remains in emp lianc a with the requimments of M.G.L.c. 186 22 Date: __jby BOIEB 21 2020 *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBMETERING CITY OF SALEM MDPH-CSP Submetering Form,Rev 114-16 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 Jr),the fallowing dwelling unit is eligible for the imposition an the tenants of a charge for water and/or sewer service. PROPERTY INFORMATION Address: 205 H hland Ave 2201 LOf 1 ink in h1di, 24 cityrrown: Salem MA Zil)Code:01970 EQUIPMl$NT 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: Showerheads with maximum flow rate not to exceed 2 u gallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 arc gallons per minute(22 gpm) Ulha-tow flush water closets(toilets)not to exceed 1`0 gallons per flush(1.6 gp0 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 It v Licensed Pl under Certification �Y R Joseph Bellefet,lille 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. 5 Determined that existing water closets do not exceed 1.6 gallons per flush. The plumbing permit issued by the dtyAown,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, _ S_iatu__re o� " 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. 1,86,§22);(2)All showerheads,faucets,and water closets in this dwelling unit are water conservation devices that meet the standards specified above;(3)'Ile water submeler measuring the use of water in the dwelling unit was installed by a licensed plumber end 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)7be 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 orwater and/or sewer service,and a copy of this certification foci;(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 store of Owner Date °The property has been transferred to owner above and the unit R,xei`re EB 2 1 2020 remains in FgWliance with the tanukernmis of M.G.L.r- 186 22 Date: by Bt 'THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING S8BMI:iFF TRLEM BOARD OF HEALTH MDPH-MP Subacekriag Form,tier 114-I fi MASSACHUSETTS DEPARTMMNT OF PUBLIC HEALTH SUBMETERMG 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 Ei,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 uik# 210 24 Ci frown: Salem MA Zip 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 far water and/or sewer.Tito devices must meet the following specifications: Sbownhends with maximum flow rate not to exceed 2 x m)�gallons per minute(2.5 gp Faucets with maximum flow rate not to exceed 2 gallons per minute(2.2 ggm) Ultra-low flush water closets(toilets)not to exceed l 6'10 gallons per flush(1.6 Slit) 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 Iicensed plumber must install the water closets and submetering equipment. Submetering equipment information: Master Meter Flexible Axis Manufacturer Model 0 Ucensed Plumber CertiIIcadon Jweph Bellefeuilie 9793 12-16-2019 Print Name of Plumber License 0 Date I certify that(check all that apply): CK"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 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, . Siznaftw6 of upwam Plumber Property Owner Cerdficatioa 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 submctcrarg law(MGL c.186,122);(2)All showerheads,faucets.and water closets in this dwelling unit ate water conservation devices that meet the standards specified above;(3)The water submeter measuring the use of water in the dwelling unk 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.196,§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, Print Name of Owner Sienature of Owner e- Date 'Me property has been transferred to owner above and the twit Receiv remains in compliance a with the requirements of M.G.L.r~196 22 Date: b B01 EB 112020 'THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBMETERING CITY OF SALT=M MDPH-CSP SubmetetingForm,Rev 11.4.16 BOARD OF HEALTH hMSACHUSETTS 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 Il),the following dwelling unit is eligible far the imposition an the tenants of a chm3e for water and/or sewer service. PROPERTY INFORMATION Address: 205 H Wand Ave 2107 24 flown: Salem MA ZinCode•01970 EQAJVMNT 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 a charge for water and/or sewer.The devices must meet the following specifications: Showeaheada with maximum flow rate not to exceed 2 Uallons 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&10 gallons per flush(1.6 gpf) The submetesing 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 Wrier 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 Beliefeuiile_ _ 9793 12-16 2019 Print Name of Plumber License# Date I cadfy 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,ifrequired,is attached. []Dwelling unit is connected directly to a meter installed by a water company and,in accordance with M.G.L.c.186,1 22(p),does not require the installation ofa submeter. Signed under thek! 4 g° paitis and Penalties of perjury. Sisaature of Licensed Phimber Property Owner CertificaUon 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 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 melee measuring the use of water in Ibis 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 agroemcat that clearly provides for the separate charging ofwater and/or sewer service,and a copy of this certification fatrn;(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 SiPnatura of Owner Date 0 The property has been transferred to owner above and the unit Received FEB 21 20 0 remains in compliance with the requirements of M.G.L.c. 186 22 Date: by,HOH: *THIS FORM MUST BEBE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INMAT11VG SUEfLMW19 SALEM MOPH-CSP Submelering Form,Rev 11.4-16 BOARD Or HEALTH MASSACKUSETTS 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 Haman 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: 206 Highland Ave unit m 2106 24 city/Town: Salem MA Z' Code:01970 EQUIPMENT INSTALLATION INFORMATION 105 CMA 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: Showed=&with maximum flow rate not to exceed 2 ons 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 dae 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 Wades Association or similar accredited association. A Iicensed plumber must install the water closets and submetering equipment. Submetering equipment information: Master Meter � Flexible Axis Manuhchm_ Model# Licensed Plumber Ceriiflcation - Jweph Bellefemilie _ 9793 12-16-2019 Print Name of Plumber License# Date I certify that(check all that apply): have installed the submacring 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 sad,in accordance with M.G.L.c.196.1 22(p),does not require the installation of a submeter. Signed under the pains and penalties of perjury, Sienna of Licensed bar Property Owner CerOmtion 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 a.186,§22);(2)All showcdkm s,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 andlor 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, Print Name of Owner J, Si afore of Owner Date Q The property has been transferred to owner above and the unit Receiv EB 21 2020 *e*+A+ns in compliance with the nitements of M.G.L.c. 1$6 22 Date: b HO 'THIS FORM MUST BE FILED VATH THE LOCAL BOARD OF HEALTH PRIOR TO INMATING � 1lyli_ t BOARD Cyr HE',,i..'H tvIDPH-CST Svbmcterrng Form,Rey 11�-16 MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERING OF WATER AND SEWER CERTIFICATION FORK "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 a the rallowing dwelling unit is eligible for the imposition an the tcni mts of a e hmic for water and/or sewer service. PROPERTY INFORMATION Address: 205 H hland Ave _ I!n1h4 2105 im of imas in hidl 24 ciryMbwr. Salem MA ' Cade:01970 EQUIPMSNT INSTALLATION INFORMATION 105 CMR 410.000 requites the installation of water conservation devices prior to a dwelling unit becoming eligible far the imposition on tenants ofs charge far water and/or sewer.The devices must meet the fallowing specifications: Showenheads with maximum flow rate not to exceed 2%�aUons per minute(2.5 gpm) Faucets with maximum flow rate not to ence:aed 2=" gallons per minute(2.2 gpm) t Ultra-tow flush water closets(toile:is)not to exceed 1&10 gallons per flush(I.6 gpf) The submatering 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 simiteraccredite d association. A licensed plumber must install the water closets and submete ring equipment. ' Submetering equipment information: Master Meter Flexible Axis Manufacturer Model# Licensed Plumber Cerdffestion Joseph Sellefeuille 9793 12-19 2019 — —- Print Name:of Plumber � License# Date I cenify 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 a submeter. Signed under the pains and penalties of perjury, h v Signatufi of Licensed44mber Property Owner Certliicallon 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 submefting law(MGL c.186,§22);(2)All showerheads,faucets,and water closets in this dwelling unit art water conservation devices that meet the standards specified above;(3)The water submeter measuring the use of water in the dwelling unlit 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 occrupancy,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 hire and accurate to the best of my knowledge. Signed under the pains and penalties of perjury, �. oc� rwK.1� (e ►4 vef tom/ D Print Name of Owner Signature of Owner Data The:property has been transferred to owner above and the unit P=c ved FEB 21 20 remains in compliance a with the reguiremcrits of M.G.L.e:. 186 22 Date: by BOH: "THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SU "1§ALEM MDPH-CSP Submctcdng 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.a 186,§22 and 105 CMR 410.000:Minimum Standards of Fitness for Haman Habitation (State Sanitary Code Chapter In,the following dwelling unit is eligible for the imposition on th-c tenants of a charge for water and/or sewer service. PROPERTY INFORMATION Address: 205 Highland Ave unft a 21 24 Ci frown: Salem MA Zip Code:01970 EQUIPMZNT INSTALLAMION 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: Showerheads with maximum flow rate not to exceed 2 x�allons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 gallons per minute(22 gpm) Ultra-low flush water closet(toiiets)not to exceed l 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 Wodrs 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# Lieeased Plumber Certification Joseph Bellefeuilte 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.186,§22(p),does not require the installation of a submeter. Signed under the pains and penalties of perjury, S' tutc or Licensed Plumber Property Owner CeMeation 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 submctering 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.a 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 natal agmement 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 ofpmjury, t r- a a.) ' ..�T YF�-or u-�-- � D Mat Name of Owner store of Owner Pri e Date 13 The property has been transferred to owner above and the unit Rccefved FEB 21 202 remains in can fiance with the nuirements of M.G.L.c. 16 Date: hV BOH: *THIS FORM MUST BE FILED WITH THE:LOCAL BOARD OF HEALTH PRIORTO INITIATING SUOURD04SALEM BOARD OF HEALTH MDPH-CSP Submeteting Form,Rev 114-16 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 UL the following dweUi.^.g unit is eligible for the imposition on the secants of a charge for water and/or sewer service. PROPERTY INFORMATION Address: 205 HIghland Ave imita 2103 24 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 far water and/or sewer.The devices must meet the fb lowing specifications: Sbowerheads with maximum flow rate not to exceed 2%jallous 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 1'910 gallons per flesh(1.6 gpf) The submeteri ng 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 liceaised 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(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 cityhown,if mquired,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 index the pains and penalties of perjury, d v SjeatuM ofLiaens ber Property Owner Certiicallon 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 submete: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 submeier 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 is"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 sower service,and a copy of this certification form;(6)That all information included on this certification is Onie and accurate to the best of my knowledge:. Signed under the pains and penalties ofpc4ury, (2��6 Print Name of Owner hmature of Owner — Date Ca The property has been transfeacd to owner above and the unit Received remains In corn liana with the requirements of M.G.L.c. 186 22 Date: by BoAEB 212020 *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBMETERING CITY OF SALEM MDPH-CSP Submataing Form,Rev 11.4-16 BOARD OF HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMETERWG OF WATER AND SEWER CERTIFICATION FORM 'In accordance with M.G.L.c.186,§22 and 105 CMR 410.000:Minimum Standards of Fitness far Human Habitation ,State Sanitasy Code Chapter ED,the following dwelling unit is eligible for the imposition on the tenants of a charge for water and/or sewer service. PROPERTY INFORMATION Address: 206 Highland Ave una N 2102 ginfignitsinhid, 24 ci mown: Salem MA Zip Code:01970 EQUIPMENT INSTALLATION IINFORMATION 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 must meet the fallowing specifications: Sbowerheads with maximum flaw rate not to exceed 2:jallons 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 60 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 Bellefeuille 9793 12-16-2019 Print Nam of Plumber r License# Date I certify that(cheek all that apply): I have installed the submetering equipment listed above in accordance with accepted plumbing standards. I have installed ere 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, Si true o Liccrosed P Property Owner Certification l certify that:(1)This dwelling unit is eligible for the motion 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 showenceads,faucets,and water closets is this dwelling unit an 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 license[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 forth;(6)That all information included on this certification is true and accurate to the best of my Imawledge. Signed under the pains and penalties ofperjury, Print Name of Owner AT Signature of Owner 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. 186 622 Data: by gpH; FEB 21 2021 *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SU8P, OF�9ALEIVI MDPH-CSPSubmateringFeam,Rev I1-4-16 BOARD OF HEAum MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH SUBMzTERING OF WATER AND SEWER CERTIFICATION FORM 'In accordance with M.G.L.c.186,§22 and 10S CMR 410.000:Minimum Standards of Fitness for Human Habitation (State Sanitary Code Chapter II),the 6nllowiog dwelling unit is exigible for the sturposition on the bassets of a charge for water and/or sewer service. PROPFATY INFORMATION Address: 205 H hland Ave unri# 2101 unin in but 24 Ci Mows Salem MA Zip 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 ofa charge for water and/or sewer.The devices must meet the following specificado= Sbowerheads with maximum flow rate not to exceed 2"gallons per minute(2.5 gpm) Faucets with maximum flow rate not to exceed 2 H gallons per minute(2.2 spin) [Tara-tow flush water closets(toilets)not to cereal I*'*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 acid testing of the American Water Wodcs Association or similar accredited association. A licensed plumber must install the water closets and submetering equipment; Snbmetering equipment information: Master Meter Ruble Axis Manufacturer Model 0 Ucensed Plumber Certification Joseph Bu3llefeullle 9793 12-16-2019 Print Name of Plumber License# Date i certify that(check all that apply): tai I have installed the submetering equipment fisted 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.r- 196,§22(p),does not require the installation of a submeter. Signal under the pains and penalties of penury, n � Si lure of raised Phmuber Property Owner Certlfleation I certify that:(1)This dwelling unit is eligible for the imposition on the tenants of a charge far water and/or sewer usage in accordance with the water submctering law(MGL c.186,§22);(2)Ali showerluwds,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) Me 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 a'ciid penalties ofperjury, Print Name of Owner S" ature of Owner t D Date The property has been ttansfeard to owner above and the unit Received remains in ommliance with the requirements of M,G.L.c. 186,622 Date: ---]b BOH: FEB-2 1202 *THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBMETERING CITY OF SALEM MDPH-CSPSubmcteringForm,Rev If 4-16 BOARD OF HEALTH