HomeMy WebLinkAboutMass Dep Public Health - Submetering of Water and Sewer Certification - Correspondence - 505 SUTTON STREET 5/22/2024 (3) MASS ACHUSIt31'S DEPAR'117MEWI' OF PUBLIC HEALTH
SUBMIE'll'El ZING OF WATER AND 'WPR (w'ERTIFICA110N FORM
*In accordance with K(3.1— c. 186, §22 and 105 CIVIR 410.000: Minimum Standards of Fitness for Human Habitation
(State Sanitary Code Chapter 11),tile folowing dwelling"unit is eligible for the imposition on the tenants ofa charge for
water and/or sewer service.
PROPER'll'Y INFORMATION
Address-. 511 SUtton St Unitil ,Uo� #C Lf�uLs in bld Li, 44
(,'jjL/L(Lwjr North Andover MA
l�.Ql.11l)Mr�.N'T' INSTAI.I.,A'riON INFORMA110N
105 CMR 410,000 requires the installation ofwaterconservation devices priortoa dwelling unit becoming eligible for the
illiposition oil tellants ofin charge lor water and/or sewer. The devices must rneet the ['61lowing specifications:
Showerheads with maximum I-low rate riot to exceed 2 gallons per n-thrute(2.5 glair)
I"aucets with iiiaxiinuin flow rate not. to exceed 2 2/10 gallons per minute(2.2 gprn)
Ultra-low flush water closets (toilets) not to exceed 1 6/10 gallons per flush (1.6 glad')
"I'lie subtTietering CCILlipment, used to measure the quantity of water used I-or each dwelling unit and common area must
meet the standards ol'accuracy and testing of"the American Water Works Association or similar accredited association.
A licensed pluniber must,install the water closets and submetering equipment,
SUbmetering equipment,iril'ormation: Next Centi udatrretcrr Solutions M201C
Manufacturer Model ItLicensed Plumber Certification
Michael W Harrison Master 16101 3/11/2023
Print Narne offIlurnber License Date
I cerlif wy that(check all that apply):
F911 have installed the subuietering equipment listed above in accordance with accepted plumbing standards.
I have installed one or more water-closets riot exceeding 1.6 gallons per flush.
Deteri ifiried that exislingg water closets do not exceed 1.6 galk:)its per flush.
]'lie plumbing;perinit issued by the city/town, ifrequired,is attactied,
Dwelling Llohl is connected directly to a motes insuffled by as water company and,in accordance with
M.G1.,.c. 186, §22(p),does riot require the installation of a subincter.
Signed under the pains and penalties OfflerjLWY,
'Siapatr"V of Licensed Plumber
Property Owner Certification
I certify that: (1)This dwelling unit is eligible lor the itriposition can the tenants ofa charge liar water and/or sewer usage
it)accordance with the Water Sl,lbrneleringy haw(WA.c. 186, §22);(2)All showerheads, f'aILICCts,and water closets in this
dwelling unk are water conservation devices that meet the standards specified above;(3)The water subrueter rnCaSUring
tire rise of water in the dovelling unit wits installed by a licensed plurnberand is in compliance with the standards
specified above,or-the water irieter measuring the USe of waver ha this dwelling unit was installed by as"water company"
as defined it) M.G.L. c. 186, § 22; (4) The WatfffndCror subineter ineZISLINS the water Usage exclusive to this unit;(5) 1
will provide to (lie tenants of"this dwelling unit, pri(:)r to occupancy,a written rental agreement that clearly provides for the
separate charging of water and/or sewer service,and a.a copy ofthis certification form;(6)'Fhat all information included on
this certification is true and accurate to[lie best ot'n-ty knowledge,
Signed under the pains and penalties ofper'ur�y,
—Sutton Street Re.developmer.it,.LLC,-,by.its,P-roject Manage-171---
" , r0wner Date Print Name of Owner
Date
0 'fhe property has been transferred ter ow tier above and the iinit Submitted
rernairis in con lince with the recjra�Irei�,,
r M.(' 'L mac
.c. 186,J Date: to 13014:
*THIS FORM MUST BE 1:11 ED WITH THE LOCAL,BOARD 01:HEALTH PRIOR TO INITIATING SUBIVIETERING
MD111 I-CS11 Subrnetering,Forin Rev. I 1.8.202].(Iocx
MASSACHUSE,rrs DEPAR"I'MENTOF PUBUC HEAL.T11
SUBMETERING OF WATER AND SEWER CERTIFICATION FORM
I'll naccordance with M.G.L. c. 186, §22 an(] 105 (-",MR 410.000- Minimum Standards of`Fitness for 1_lU111,111 I labilation
(State Sanitary Code Chapter IF), the following dwelling unit is eligible fior the imposition on the tenants of'a charge for
water and/or sewer set-vice.
PROPERTY INFORMA110N
Address: 511 Sutton St. Unit it 14 Of'units in bid
C LitYl-rowiv- North Andover MA
EQUIPMEN"f INSI'Al.,LA"FION INFORMATION
105 CMR 4 10.000 requires the installation ol'water conservation devices prior to as dwelling unit becoming eligible for file
I
imposition oil tenants of'a charge 1br water and/or sewer.1"'he devices must,niect the following specifications.
Showerheads with inaxiniurn flow rate not to exceed 2 "gallons per minute(2.5 gpin)
l-'aUCetS With maxiinrun flow rate not,to exceed 2 2d 0 gallons per minute(2.2 gprn)
Ultra-low flush water closets(toilets) not to,exceed i 6/M gallons per dish(1,6 gpf)
The subriletering equipment used to measure the quantily of'water used for each dwelling Unit and corrinion area Must
meet tfie standards of accuracy atid testing ol'the Aniericni Water Works Association or sinlilaraccredited association.
A licensed plumber must install the water closets and submeternig equipment.
Subilictering cquipment inf'orniation: ___Next C�.enttEL�, )rnetexing SoLq ons,.. M201 C
Manuracturcr model
1,iCeIISM 141111116U CeftifiClltiOR
Michael W Harrison ------- --Master.16101 3/11/2023
Print Narne ol'Phunber License if Date
certit*y that(check all that apply):
I have installed the subtrictering equipment listed above in accor(hurce 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 11US'll.
Dq 'The plunibing perinit issued by the,city/town, it'required, isattached.
E-1 Dwelling unit is connected directly to as meter installed by as Nvatercompany and, in accordance with
NU;J, . c. 186, §22(p),does not require the installation ol'a subrileter.
Signed under the pains and penalties of perjury,
114'q�e of Ucensed Ilurriber
...........
Property Owner Cerfification
I certify that: (1)]"his dwefling unit is eligible for the irripositiori on the tenants ol'a charge I'm- water an(VorSeWff usage
in accordance with the water subtrictering law(MG1.,c. 186, §22);(2)All showerheads, faucets, and water closets in this
dwelling unit are water conservation devices that triect the standards specitted above-,(3)J'he water subtlieter measuring
the use of'water in the dwelling unit was installed by as licensed plurnber and is in compliance with the standards
specified above, or the water racier measuring the use ol'water in this dwelling unit was installed by a"water company"
as(Jcfined in M.G.L. c. 186, §22; (4)'Hic water nieter or subineler measures the water usage exclusive to this unit; (5) 1
will provide to the tenants ol'this dwelling unit, prior to occupancy, a,written rental agreement that.clearly provides 4`i 1.the
separa,te charging of water and/or sewer service, and as cop),ol'this certification lbrin; (6)fliat all intbri-riation included oil
this certification is true and accurate to the l.)esl ol'rny knowledge,
Signed under the pains an(] penalties ol'per'l t I ry,
Sutton Street Redevelopment, LLC, by its Project Manager
Print Nanic of'Oviner Lirch_ol*Q%vner Date
Date
0 "1"lrw property has been transferred to owner above and the unit SUbIllitted
remains in cone fia ice wide the of M.G.1,. c, to Rol 1:
...............wm*FORM MUST BE FILED WITH'rHE LOCAL BOARD OF HEALTH PRIOR TO WITIATING SUBMUERING
MDPlJ-CW Submetering Forai Rev. 1 1.8202 1 doex
MASSACH USETTS DE.PARTIVIENTOF PUBLIC HEALTH
SMIMETERING OF WA']I ER ANI) SEWFA 'EIZ11FICATION FORM
'"iti accordance with M.(.';.t.,. c, 186, §22and 105CMR410.000: MillillIL11iiStaii(lat-dsolI�itiiessfoi-f-ILiinan1-fabitation
(State Sanitary(.;ode Chapter 11), the 161lowing dwelling linill is eligible for the imposition on the tenants(:)f*a ellarge Cur
water and/or sewer Service
PROPERTY INFORMAnON
Address: 511 Sutton St. Unit Of Units in bldg. 44
ow�lv North Andover MA Zip Code; 0184
EQUIPMENT INSTALLATION INFORMATION
105 CMR 410,000 requires the installation ol"water conservation devices prior toa dwelling unit becoming eligible for the
imposition on tenants of a charge for water and/or sewer.The devices must rneet the following specifications-
Showerineads with maximum flow rate riot to exceed 2 "'gallons per ininute(15 gpm)
Faucets with niaxii-nurn flow rate not to exceed 2"gallons per minute(2.2 gprn)
Ultra-low flush water closets(toilets)not to exceed 1 (00 gallons per flush(I A gpl)
The subinetering C(ILlipritent used to measure the quantity of water used for cacti dwelling unit and common area must
nicet the standards ofaccuracy and testing of the Arnerican Walcr Works Association or similar accredited association.
A licensed plumber niust install the water closets and SUbirletcring equipment,
Submetering equipi-nent intbrination: Next Century Subtrietering olutions M201 C
Mauld'aCtUrer Model ht
Licensed Plumber Cerfirication
Michael W Harrisorl blaster 16101 3/11/2023
Print Name ol'Plumber License 11 Date
I certily that(check all that apply):
[011 have installed the submetering CqUipluCrIt liStWilbove in accordance with accepted plurribing standards.
0 1 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.
ThO PlUrl'ibing permit issiled by UIC City/lOW11, if reClUired, is attached.
Dwelling unit is connected directly to a.meter installed by a %witer company and, in accordance with
M.G.L, . c. 186, §22(p),does not require the installation oFa suhnicter.
Signed under the pains and penalties ofpci-Jury, W
iL;rrature of Licensed Plumber
Property Owner Certification
I certify that: dwelling unit is eligible for the imposition oil the tenants ofa charge for water and/or SCWCI'usage
in accordance with the water submetering law(MGL c. 186, �22); (2)All showerhon.cls, fiaticets, and water closets in this
dwelling unit are water conservation devices that incet the standards specified above;(3),rhe water subirieter measuring
the USC of water in the dwelling unit.was histallcd by a licensed plumber and is in compliance with the standards
specified,above,or the water rneter 111MASuring[Ile use of water it this dwelling unit was installed by a"water company"
as defined in M.G.L.c. 186, §22; (4)The water meter or submeter tricasurcs the water usage exclusive to this unit; (5) 1
will provide to the WualltS OfthiS dwelling unit, prior to occul3ancy,a written rental agreement that clearly provides for the
Separate charging cif water and/or sewer service, and a copy of(his certification 1`6rm-, (6)That all hi formation included on
this certification is true and aCCUratc to the best ofmy knowledge.
Signed under the pains and penalties of perjury,
Sutton Street Redevelopment, LLC, by its Project Manager
Print, Name of Owner Sit'lliltUrC OFOWnCr Date
Date
Cl 'rhe property has been transferred to owner al:)oveand the unit Submitted
remains in cornpliance with the rccLLirern(Ljts o c. 18 L) §2-2 Date: to 1,301-1:
*TKIS FORM MUSTBE FILED WITHTHE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBMETERING
MD111 I-CSP Subinetering Forma Rev. 11.8.202 l.doex
I I
MA SSAC34 LIS ETTS DEPAR'I'MEXI'OF PUBLI(I HEAuruli
SLJIIMEI'ER),fN('a' OF'WA'1'1±,'R AN I)SEWER CERTIFWATION FORM
I
*In accordance with M.G.L. c. 186, §22 and 105 CMR,4 ftOOO: Minimum Standards offilness for Hurrian I labitation
(State Sanitary Code Chapter 11), the following dwelling unit is eligible for the imposition oil the terrants ofa charge for
water and/or sewer service.
PROPERTY INFORMATiON
Address: 511 SLJtton St. Unit H JL 4 OflilnitS 44
L- ,'it��Fown: North Andover
EQUIPMENT INSTALI.AnON INFORMATION
I 05CMR 4.10,000 requires the installation of water conservation devices prior to dwelling unit becoming eligible for the
imposition on tenants ofa charge fiw water and/or sewcr,T'hr-,devices most niect the following specifications:
Showerheads with maximum flow rate not to exceed 2 "gallons per ininute(2.5 gprn)
Faucets with maxiinurn flow rate not to exceed 2 2/1'gallons per nrinutc(2.2 gpirl)
Ultra-low flush water closets(toilets)riot to exceed I W10 gallons per flush (1.6 gpf)
The subtlielering equipment used to measilre the ciminlity ofwater used for each dwelling unit and connnon area niust
rnect,the standards OfaMiracy and testing of'the Arncricaii Water Works Association or similar accre(Jited association.
A li�criscd Plumber Must inSWII the wafer closets and submetering equipment.
Sub.,,netering equipment hilornialion: N xt C M201 C
Manufacturer Model 11
Licensed Plumber Certification
Michael W Harrison Master 16101 3/11/2023
Print MUM Of'Phiniber License ff Date
I certify that(check call that apply):
E011 have installed the subinetering equipment listed above hi accordance with accepted Plumbing standards.
I have installed one or more water closets not exceeding,, 1.6 gallons per flush.
Deterininccithat existing water closets do not exceed 1.6 gallons rCr flush.
The plurnbing permit issued by die city/town, it'requirod, is attached.
Dwelling unit is connected directly to a meter installed by as water company and, in accordance with
NIXi.L . c, 186, §22(p),(foes not reqUiN,the installation ofa subtoetei,.
SigoCd under the pains and penalties ofperjury,
nature,of Licetised I hit be
Properly Owner Cet-fification
i certify that: (i)"rhis dwelling unit is cligible for the imposition on the tenants ofa charge tor water and/or sewer usage
in aiccordancc with the water subinetering la\v(MGL c. 186, §22)-1(2) All showerheads, l'aucets,and water closets in this
dwelling unit are water conservation devices that meet the standards specified above;(3)The water subtricter 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 ineasuring the use of water in this dwelling unit was installed by a"water company"
as defined in M.6.1—e. 186)„ §22,; (4)"I'lic water rrieter or subincler measures the water usage exch.lSive to this unit; (5) 1
will provide to the tenants OfthiS(INVOling Unit,prior to occupancy,a written rental agreement that clearly provides for tile
separate charging of water and/or sewer service,anda copy ofthis certification tbriri; (6)That all illfOrMatiOn ioClUded oil
this certification is true nand accurate to the best ofiny knowledge.
Signed under[lie pains and penalties of'perjury,
Sutton Street Redevelopment, LLC, by its Project Manager Z-et�
..................
Print Narne of Owner S, riatUre of Owner [)are
0 Date
The property has been trans6erred to owner above and the unit Submitted
rernants in con t ie to 1301-f:iL)liance with L reqL.fir iiqrlts of M.G.L.c. 186, 2 Date:
*TICS FORIVI MU%T BE FILED W1.1'H 114E L.00AL BOARD OF!.IEALTH PRIOR TO WrrIATING SUBMETERING
MDVJ I-f:SP Subinctering Form Rev, I l X202 1 docx
MASSA(.'1JUSE7FS D]IPAR']'MENI' 01? PUBLIC HEALM-1
SUBMUEMM"A OF WA'I'ER AND SITMER CE101FICA'r[ON FORM
*11-laccordance with IVIXI'L. c. 186, 22 and 105 CIVIR 410.000: Minimum Standards of Fitness for Human Habitation
(State Sanitary Code Chapter 11),the following dwelling unit is eligible for the imposition on tile tenants of a charge for
water and/or-sewer service.
PROPERTY INFORMATION
Address., 511 Sutton St. Unit# 90`UllitSillt!dE. 4�
City/'"fown: Norte, Andover MA zin Code:
EQUIPMENTINSTAIA,ATION 1NF01ZMA-TFJ0&—'-'----'
105 CMR 41 IU00 I-MILlil-CS the installation ol'water conservation devices prior to dwelling unit becoming eligible Im the
imposition ori tenants of"a charge t6r water and/or sewer. The devices must meet the [ollowing specifications:
Showerlicads with maximum flow rate not to exceed 2 �',gallons per minute(2.5 gpin)
Faileets with maximum flow rate riot to exceed 2 2)1 U gallons per minute(2.2 gprn)
Ultra-low flush water closets(toilets)not to exceed 1 6/10 gallons per flush (1,6 gpl)
The submetering equipment used to measure the quantity ofwater used fior cacti dwelling unit and common area must
meet the standards ofiaccuracyand testing ol'thc American Water Works Association or similar accredited association.
A license([ plurnbcr must install the water closets and SUbinctering equil.xilent.
SUbinetering equipment information: — Next Century M201C
Model #
lAcensed Pluxuber Cei-tifivatimi
Michael W Harrison Master 16101 3/11/2023
print Nanic,ofillurnber License il Date
I certify that(check all that apply):
Do I have installed the submetering eqUipulent listed above in accordance with accepted plumbing standards.
0 1 have installed one or more water closets riot exceeding 1.6 gallons per flush.
LN Determined that existing water closets do riot exceed 1.6 gallons Per flush.
Do The plumbing perinit issued by the city/town, if'required, is attached.
El Dwelling unit is connected directly to a.nicter installed by a water company and, in accordance with
M.G.L, . c. 186, §22(p), does not.require the instillation of submeter.
Signed under the pains and penalties of"perjury, N
;mature o Wised Plumber
111,operty Ownes-Certification
I certify that: (1),rhis dwelling unit is eligible for the imposition on the tenants ofa charge for water and/or sewer usage
it) accordance with tile water submetering law(MG1f., c. 186, §22);(2)All showerheads, faucets, and water closets in this
dwelling unit arc water conservation devices that meet(lie standards specified above; (3)The water subaieter measuring
[fie use ofwater in the dwelling unit was installed by a licensed plumber and is in conipliance with the standards
specified above,or the water aleter measuring the use of water in this dwelling unit was installed by a"water company"
as defined in N/I.G.1— c. 186, §22; (4)The water rnetcr 01 SUbmeter measures the water Usage exclusive t:o 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 ofwaterand/or sewer service, and a copy ofthis certification form; (6)That all infion-nation included oil
this certification is true and accurate to tire best of my knowledge.
Signed Under the pains and penalties of perjury,
Sutton Street Redevelopment, LLC, by its Project Manager
..........
Print.Name of Owner ire of Owner Date
Date
property has been transferred to owner above and the unit SUbinitted
remains in Compliance With Lhe rej uireawnts of' M.6.1— c. '212 Date: to 1301-1:
_.
*THIS FORIVI MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBMETERING
MIDPI-I-CS11 Subinctering Forni Rev. I 1.8.202I,docx
MASSACHUSE11"'S 01(,'PAR'1'f%4EN'1'0F PUKACI-11KALT'll
SUBMETERING OF WAT ER AND SEWRd,R CER,rIFICA'rJON FORM
,',In accordance with M.G.L.c. 186, §22 and 105 CMR 410.000: Minimum Standards ol'i"itness For Hurnan Habitation
(State Sanitary Code Chapter 11), the fbilowing dwelling unit is eligible for the imposition on the tenants ol'a charge for
Water and/or sewer service.
PROPEM'FY INFORMATION
Addmss� 511 Sutton SL Unitil J, )(0 #0 f I t., ire tL1(if�; . 44
Cit /Town: North Andover MA .Zi.Lj ode: 4
EQUIPMENT Ns,rALLATION INFORMATION
105 CMR.410 000 MClUirCS the installation of water conservation devices prior to as dwelling unit beeonling eligible for tile
imposition on tenants ot'a charge fta-water and/or sewer."file devices musi meet the following specifications:
Showerheads with maximum flow rate riot to exceed 2 "gallons Per Minute(2.5 gpm)
Faucets with maximum tlo%v rate not to exceed 2 210 gallons per rninute(2.2 gprn)
Ultra-low flush water closets(toilets)not to exceed 1 (1/10 gallons per flush (1.6 gpl)
"I'lle slibilletering equipment used to r)aeasure the quantity of`w,'fler used fear each dwelling unit and common area nurst
arect the standards of accuracy and testing of the American Water �orlcs Association or similar accredited association.
A licensed plumber nrust install the water closets and subilictering equipment,
Subinctering C(ILlipirrent inforniation: Next C,entur Sub lieterin I Solutions M201C
ManuCacturer M odel It
Licensed Plumber C'ertification
Michael W liarrison Master 16101 3/11/2023
Print Narne off"hin)ber License fl Date
I certitv that(check all that apply):
E011 have installed the SUbmetering equipment listcd above in accordance with accepted PlUrnbing standards.
FW I have installed one or more water closets not exceeding 1.6 gallons per Ckish.
F9 Detenriined that existing water closets do riot exceed 1.6 gallons per flush.
Rnie plumbing permit issued by the city/town, if required, is attached.
E:j Dwelling unit is connected directly to meter installed by a water company arid, in accordance with
M.G.l_ . c. 186, §22(p),does riot.require the installation ofia submeter.
Signed under the pains and penalties ol'perjUly,
3 igi!q t� Licensed Number
_ _E _�jf.....................
11roperky Owner Certification
I ccrtily that: (1)This dwelling unit.is eligible for the imposition on the tenants ol'a charge for water and/or sewer usage
in accordance with the water subi-netering law(MG1,c. 186, §22);( )fall showerheads, finucets,and water closets in this
dwelling unit acre water conservation devices that rneet,the standards specifiedabove;(3)T'he Water SUbmeter measuring
the LISC of water in the dwelling unit was installed by a licensed Iflurnber and is in compliance will) tile standards
specified above,or the water ineter VVICEISUring the use Of'Willel'in this dwelling unit was installed by a"water company"
as defined in M.G.L.c. 186, §22; (4)The water ureter or subineter rneasures the water(150ge CXCILISiVC to this unit-, (5) 1
will provide to the tenants of this dwelling unit, prior to occupancy,as written rental agreement that clearly provides for the
separate charging or water and/or sewer service,and a copy ol'thin certification form-,(6)That all intbrination included on
this certification is true and accurate to the best,oftily knowledge,
Signed under the pains and penalties of perjury,
n a ��r
-Sutton Street .........
print Name of'Owner Sr mature of Owner Date
Date
°1'11c,prolx, ,rty has been transferred to owner above and tile unit Submitted
in CoLnI'LliaLlce\ Ith the rcc a.rirc Ln!,nts of M.G.L. c.,,186, U2 Date: to 1301-1:
;IOTHIS FORM MUST BE 1"'ILED WITH Tl�[E LOCAL BOARD OF HEALT14 PRIOR TO INITIATING SUBMETERING
M13111-14"S11 Submetering 1orm Rev. 11.9.202 l,doex
MASSACHUSF,'rTS DEPAR]'MENT OF PUBLIC 11EAL'rH
S1JBMF,'FF,R1NG 0FWA'rER AND SEWli,R CERTIFICATION F011M
",'ln accordance with M.G.L. c. 186, § 22 and 105 (,11MR 410.000: Minirriurn Standards off-'itness for Human Habitation
(State Sanitary Code Chapter 11), the following dwelling unit is eligible for the imposition on the tenants of a charge for
water and/or sewer service.
PROPERTY INFORMATION
Address: 511 Sutton St. Unit 11 ti of units in 1 44
Cily/Town: Nortli Andover MA
EQU IFIFWI�,N—TTN-*,�"rAIIA'r-l-"'O"-N—INF?O—RM—AI'ION
105 CMR 4 1.0.000 requires the installation ofwater conservation devices prior to a dwelling unit becoming eligible forthe
imposition on tenants of-a charge for water and/or sewer.The devices inust Triect the lWlowing speci-ficati oils:
Showerheads with maximum flow rate not to exceed 2 ``gallons per minute(2.5 gpin)
Faucets with inaxitnurn flow rate not.to exceed 2 2/10 gallons per minute(22 gpin)
Ultra-low flush water closets(toilets)not to exceed 1 6110 gallons per flush (1.6 gpf)
The submetering eqUiptneill, LUSCd to measure the qua.ritity ofwater rascal for each dwelling unit,,.I.rid common areanli.)SL
incet,the standards ofaccuracy and testing of the American Water Works Association or similar accredited association.
A licensed plumber must install the water closets and subaietering eqUiproCnt.
Subinetering equipment information: Next Century Submeter jig, Solution's M201C
Manufacturer model #
I.Accused Plumber Certification
Michael W Harrison Master 16101 3/11/2023
Print'Name ol'Plurnber License 4 Date
I certify that(check all that a,pply):
& have installed the SUbinctering equipment listed above in accordance with accepted plumbing standards.
I have instal led one or more water closets not exceeding 1.6 gallons per flush.
Determined that existing water closets do not exceed 1.6 gallons per flLJSh.
EelThe plumbing permit issued by the city/town, ifreqUired, is attached.
F-1 Dwelling unit is connected directly to tricter installed by a water company and, in accordance with
M.G.L . c. 186, §22(l.,)),does not require the installation Of a Albrndff.
Signed under the pains and penalties of'per jury,
Property Owner Certification
I ccrtity 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(MG1,c. 186, §22);(2)A]I showerheads, l'aucets, and water closets in this
dwelling unit are water conservation devices that meet the standards specified above; (;I)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 OrAibrneter 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 Im-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 ofiny knowledge.
Signed under the pains and penalties of perjury,
Sutton Street Redevelopment, LLC, by its Project Mangier
Print Dane ofOwner Sit'natule of,Owner
Date
'I'lic property has been transferred to owner above and the unit Subrnittcd
s�LmL� ijj!c �with the Lquirernents of M G.1- c. 186, 22 Date: to 1301-1:
_
'OTI-115 FORM MUM"BE FILED WITH"114E I OCAL BOARD OF HEALTH PRIOR TO INITIATING SUBMETERING
NADPI-1-(41I Submetcring Form Rev. 11.8,202 I.docx
MASSACHUSIaTTS 10TAR"I'MUNI' OF PUBlAC 11FA1,T11
SUBMETERING OFWAT'lUZ ANI) SEIVER CERTIFICATION FORM
fln accordance with NI.G.1,. c. 186, §22 and 105 C'MR ,410.000: Mininiurn Standards of Fitness Rw Hurnan Habitation
(State Sanitary Code Chapter 11),the following dweHing unit is eligible for the imposition on [lie ter-rants of acharge fior
water and/car sewer service.
PROPERTY INFORMATION
Address: 511 Sutton St" I Jnit 11
11 Ol'units in bld 44
City 1°t)NtIILi forth Andover MA Zifj-�',Od -Q.Ja4F
EQUI I'M ENT IN STAL1,ATION INI�ORMATION
105 CMR 4 10.000 requires the instalkaion ol"water conservation devices prior to to dwelling unit becorning eligible 661°the
imposition on tenants ofa charge for waterand/or sewer. The devices must incet the following specifications:
Showerheads with maximurn flow rate not to exceed 2 "gallons per minute(2.5 gpin)
F'MICeIS with rnaxiinUni flow rate not to exceed 2 <"`gallons per minute(2.2 gpin)
Ultra-low flush water closets(toilets) not to exceed 1 610 gallons per flush(1,6 gpi)
The stibinetering equipment used to measure the quantity ofWateTused for each dwelling Ullitand common area 111(ist
meet the standards ofaccuracy and testing of the Arneriedn Water Works Association or sirnilaraccredited association.
A licensed I)lUrnber nnist install the waier closos and subrnetering equiprnent,
Submeterhig equipment inforn,uniow Next Cent 1 201 C
MMUdactUrer Model #
[Jeensed Plumber Certification
Michael W Harrison Master 16101 3/11/2023
Print Name 01'PlUrnber License 11 Date
I eerflt'y that(check all that apply):
ES]f have installed UIC SLibinetering equipment lisledabove innecordance with accepted plurnbing,standards.
I have installed one or more water closets not exceeding 1.6 gallons per flush.
Determined that existing water closets(to not exceed 1.6 gallons per flush.
EgijThe plumbing permit iSSUCki by tyre city/`own, il'required is attached.
F-
J Dwelling unit is connected directly to a ineter installed by a water company anti, in accordance with
MX;J, . c. 186, § 22(p),does not require the installation of"a submeter,
Signed under the pains and penalties of per 7ejUry, FY ""
_____.__. __._.. __,.._..__ ._.___ ___.____.._._... ..._._ gargRaar urt )�IjUcensed Plumber
Property Owner Cerfification
I certify that: (1)This dwelling unit is eligible for the imposition on the tenants of charge liar water and/or sewer usage
in accordance with the water subinctering law(MG1, c. 186, §22);(2)All showerheads, filUCCts, and water closets in this
dWC11ing Unit are water conservation devices that rnect the standards specified above;(3)]"he water submeter rneasuring
the use of water in the dwellinc,unit was installed by as 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 histalled by a."water company"
as defined in M.G l-c. 186, §22; (4) The water nieter or suhnieter IncaSUres the water usage exchviive to this unit; (5) 1
will provide to the tenants ol'this dwelling unit,prior to occupancy,as written rental agreement that clearly provides for the
separate charging of water and/or sewer service,and a copy of this certification fort-n-,(6)That all inforination included on
this certification is true and accurate to the best ol'iny knowledge,
Signed under the pains and l)011altiCS 0t'JVrjUr)1,
Sutton Street Redevelopment, LLC, by its Project Manager
l"rint Narne of'Okvner SrI)natUrC Of'OVVacr Date
Date
'I'lic property has been transferred to owner above and tile unit Subi-nitted
-.!n!1--1!J-u1s Ln-s-o of M.G.L.,c, 22 Date: w to BC."H:
"'THIS FORM MIS BE FILED UTHTHE 1.0('AL BOARD OF WEEALTH PRIOR TO INITIA"I'ING SUBIWE"TERING
ME)PI I-CS11 Submetering Forni 1'a"ev. 1 f.8.202 l.doex
MASSACHUSUIA'S I)EPAR'TmE�rr or; PUBLIC I-WALTH
SWIMETERING CWWAI'ER AND SITWl�,R cFwriFICA110N f'01ZM
*In accordance with M.G.L. c. 186, §22and 105 CMR Z1 10M00: Minirmlin Standards 01"FitfleSS lot'I-lUnian Habitation
(State Sanitary Code Chapter 11), the following dwelling unit is eligible fiorthe imposition on the tenants of charge for
water arid/or sewer set-vice,
PROPERTV INFORMATION
Address: 511 Sutton St. Unit# 1/ 01"units ire bidg. 44
sty/ North Andover MA 71* '2d
EQUIPMEN'l,INSTALLATION INFORMA110N
105 CIVIR41 0.000 requires tile installation oi'watcr conservation devices prior to as dwelling Urlit becoming eligible for tile
imposition oil tenants ora charge for water and/or sewer. The devices must 111cet tile following specifications:
Showcrlicads with maximum Clow rate not to exceed 2 "gallons per IllinUtC(15 gpin)
FaLIC&S with rnaxinli.1111 flow rate not to exceed 2 21rt)gallons per minute(2.2 gpi-n)
Ultra-low flush water closets(toilets)not to exceed 1 6/10 gallons per flush(1.6 gpf)
The subilictering C(lUipillOnt Used to measure the quantity of water used for each dwelling unit and common area MUSt
meet the standards ofaccuracy and testing ol*the American Water Works Association or similar accredited association.
A licensed J)lUJllbCr MUSt install the water closets and subilletering eqUiplyiellL
Submetering equipment inl'ormation: 'Next tLftr SubT� in Solutions M201 C
Manufacturer Model#
Licensed Plumber Certification
Michael W Harrison Master 16101 3/11/2023
Print Nanic Of PlUrnbcr License It Date
I certify that(check a)I that apply):
Do❑I have installed the subilietering equipment listed above in accordance with accepted plumbing standards.
I have installed one or more water closets not.exceeding 1.6 gallons per fltjsll.
Determined that existing water closets do not exceed 1.6 gallons per flush,
nO ']'Ile plumbing permit issued by tile city/town, if required, is attached,
El Dwelling unit is connected directly to a meter installed by a water cornpany and. in accordance with
M.GJ— c. 186, §22(p),does not require tile installation ofa subrileter.
Signed under.[lie pains and penalties ofperjury,
01, Licensed Pluniber
Property Owner Certification
I Certify that: (1)'I'llis dwelling ralit is eligible liar the imposition oil (lie tenants of charge Im water and/or sewer usage
in accordance with tile water SUburictering law(MG1.,c. 186, §22);(2) All showerlicads, 61LICetS,and water closets in this
dwelling unit are water conservation devices that meet the standards speciried above;(3)7'he water submeter measuring
tile LISC Of*Wdterin the dwelling tinit was installed by a licensed plumber and is in compliance with the standards
specified above.or tile water meter measuring the use of'water in this dwelling unit was installed by a"water company"
as defined in M.('I,t,. c, 186, 22; (4)'I'lle watel,exacter or subincter rneaStIrCS tile MAU 1ASagO OXCILISiVC to this Unit; (5) 1
will provide to the tenants ofthis dwelling unit, prior to occupancy,a written rental agreement that clearly provides or the
separate charging of water and/or sewer service,anal a copy of this certification Jorm; (6)That all information included on
this certification is true and accurate to tile best ofrny knowledge.
Signed unden,tile pains and penalties of perjury,
Sutton Street Redevelopment, LLC, by its Project Manager
——----------
11r.i.i.i.L.Nan.).c o..,f.*.Owner Date
Date
property has been transferred to owner above and tile Unit Submitted
remains in cotj)L]lance with tile requirenients or M.G.L.c. �-2 Date: to 1301-1:
*THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEAuni PRIOfR"'I'O INITIATING SUBMETERING
MD1111 I-CS11 Submetering,horny Rev, 11.8.202 I.doex
AUSSACHUSETT'S IWPAR'rMENT (Ne 111,1131AC HEA1,111
SIAIMETERING OF WATER ANI) SEWER CERTIFIC'ATION FORM
"fraccordance with NIXIA", c. f 86, §22and 105 04R 4 1 OMOO: Minirnurn Standards ofFitness for Hunlan Habitation
(State Sanitary (.,o(le Chapter 11), the fik°tllowing dwelfing unit is eligible fior the irripositiort on the tenants ofaa charge for
water and/or sewer set-vice,
PROPERTV INIrORMATION
0
Address-. 511 Sutton St� ("hut#1 m
11 1 � 9 Of units in bl( : 44
_.L,'j!yLlLow�iy North Andover MA
-0-1-l3A-5 ..,-,.........
EQLJIPMEN'I' INS'I'Al.,[.,A'Fl()N INFORINIATION
105 CMR 410.000 requires the installation of'%vaterconservacion devices prior toa dwelling unit becoming eligible fiorthe
imposition on ten-antsol"a charge* lbr watei-aiid/or-se",et`, 'I"lied(,viCCS ITIUSI,niect the t'ollowingspecifications:
Showerheads with rnaximurn flow rate not to exceed 2 `` gall011S J)Cr IlliflUte,(15 gpin)
Faucets with rnaxiolUill 110W rak'oOt to MeCd '? 2/10 gallons per rninuto(12 gpin)
Ultra-low flush water closets(toilets)not to excced 1 6,10 gallons per flush (I.6 glit)
The sulanielering equipment used to rneasure the quantity ofwater used for each dwelling unit and common area musl
rne,x(the standards ol'accuracy and testing or the American Water Works Association or sirnilar accredited association.
A licensed plumber inust install the water closetsand sublaetering equipment.
" C
Submetering equipment information: Next,Centu 3ribineterin olutions M201 C
Maim flacturer model 14
Ueensed Number Certification
Michael W Harrison Master 16101 3/11/2023
Ilrint Name of ftlumber fAcense H Date
I certity that(check all that apply):
I have installed tile sit btrict,eri ug C(lUipolCut fisted above in accordance with accepted IllUrnbing standards,
I have installed one or more water closets not exceeding 1.6 glallons J)er flUSh.
Determined that existing;;,water closets do not exceed 1.6 gallons per flttsh,
00 The JAUrnbing perrint issued by the city/town, if'required, is attached.
I)welling unit is connected directly to trieter installed bya water company and, in accordance, with
M.GA., . c. 186, §22(p), does not require the instaWition Of',I.SUI.UnCter.
Signed under the pains and penalties ofperjury,
mature of Licensed Plumber
Property Owner Certification
I certify that: (1)This dwelling unit is eligible fior the irnposition on tile tenants ofa charge for water and/or sewer usage
in accordance with Ille Water SUbilletering law(MG1,c. 186, §22);(2)All showerheads, faucets, and water closets in this
dwelling unit are water conservation devices that meet (lie standards specified above-,(3)The water subineter nleaSUring
the use of water in the dwelling Unit was installed by a licensed plurnber and is in compliance with the standards
specified above,or the water meter measuring 111C use of'waler in this dwelling unit wm installed by as"water company"
as defined in M.G.L. c. 186, §22; (4)The water ineter or subrncter measures the water usage exclusive to this unit;(5) 1
will provide to the tenants ofthis dwelling unit, prior to occul.)ancy,as written rental agreement that clearly provides for the
separ,,.,te charging of water and/or sewer service,and a copy of*this certification forrn,- (6)That all ird"611-flatiOn included on
this certification is true and accurate to the best of tily knowledge,
Signed Under tile pains and l)CnallieS 01"l)(N-jUry,
Sutton Street Redevelopment, LLC, by its Project Manager 44��_��"4 4,
Print.Nanic ot`Owner LircLof'Owner Date
..... .......
Date
['Ile property has been transferred to owner above and the unit Submitted
remains in corn Ehatj�(�Nvith of AG.L. c. 186, s22 Date: to 1301.1:
*THIS IFORM M1J5,T BE FILED WITH THE LOCAL BOAM)OF 14EALTH PRIOR TO INITIATING SIJBMETERING
NIDPH-CS11 Submeterino Form Rev. i L8,202 hlocx
MASSAUJUSETTS DEPA1UWN'r 0F PUBLIC HEALTH
SUBMETEIZING 01;'WATER ANII) SEWI CERTIFICATION F011M
*Ill accordance with M.G).L C. 186, ,�22and 105 CIVIR 414000: Minimum Standards ofFitness for Human Habitation
(State Sanitary Code Chapter 11), the f`0I[OWi1lg dwelling unit is eligible for tile imposition oil the tenants of a charge for
water and/or sewer service.
11110PE11TY INFORMATION
Address: 511 Sutton St. Unit 11 8 Of units in bldy. 44.
orth Andover M A A r-
ZipCode- 01a 4, 5_
EQUIPMENT INSTALLATION INN?011MATION
105 C'Mit 4 10.000 requires the installation ol7water conservation devices prior to a dwelling unit,becoming eligible for the
imposition Oil tenants of charge I'm water and/or sewer.The devices must meet the following specifications:
Showerheads with inaxii'llUID flOVV rate not to exceed 2 "gal Ions per minute(2.5 gpril)
Faucets With maximum flow rate not to exceed 2 2/10 gat I o ns per nl i ri ute(2.2 gpin)
Ultra-low flush water closets(toilets) not to exceed I W10 gallons per flush (1.6 gpf)
"me submetering equil.,)II'lent used to measure the quantity ot'water~used fior each dwelling unit and common area must
meet the standards ofaccuracy and testing of the American Water Works Association or similar accredited associatiori.
A licensed plumber must install the water closets and SUbmetering equipilient.
Subinetering cqUipment intbrination: Next Cent,LIry--Submeterill&.S2lutions .,-- M20I.C.----.—
Mari ufacturer Model
Licensed 111111mber certification
Michael W Harrison Master 16101 3/11/2023
Print Marne of Number License 11 Date
I certify that.(check all that apply):
I have installed tile subinctering 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.
D The plumbing permit issued by the city/town, it'required, is attached.
1 Dwelling unit is connected directly to as meter installed by a water company 2arrd, in accordance with
MXIL . c. 186, § 22(p),does not require the installation ofa sublTletcr.
Signed under the ixtins and penalties of perjury,
4re of Licensed I-)Iujnl.)er
Property Owner Certification
I certify that: (1)This dwelling unit is eligible for the imposition oil the tenants of a charge for water and/or sewer usage
in accordance with the water SUbinctering 1mv(MCK.c. 186, §22);(2)dull showed mads, faucets, an(.]water closets in this
dwelling unit are water conservation devices that meet the standards specified above;(3)The water SLibi-noter measuring
the rise ol`water in tile dwelling unit was installed by a licensed plumber and is in compliance with tile standards
specified above,or the water meter measuring tile Ilse of`water in this dwelling unit was installed by a"water company"
as defined in M.G.L.c. 186, § 22; (4)TIle water meter OrSUbmeter measures the water usage exclusive to this unit,- (5)1
wi H provide to the tenants of this dwelling unit, prior to occupancy,as written rental agreement(flat clearly provides for tile
separate charging of water and/or sewer service,and a copy of this certification form; (6)'That all information included oil
this certification is true and accurate to the best ol"iny knowledge.
Signed under the pains and penalties Of perjury,
Sutton Street gex--
... .......
Print Name of Owner .--...Si Lmaturc.L)f Qwner Date
Date
property has been transferred to owner above and the unit Submitted
remains in conipliance with 1121LOremlirenients of' M.G.L. C. 186,�22 __ Date: to 13011:
j
*THIS FORM MLIST BE FILED vvi'fly"11,1E LOCAL BOARD OF HEAL.1"F1 PRIOR TO INITINrING SUBME"rERING
M13111-1-CSI)Subffletering Fonn Rm 11.U021 dmx
MASSACHUSETTS DEPA,RTMENTOF PUBLIC HEAUH
SUBMETERING OF WATER Atilt) SEWER CERTIFICIATION FORM
*In accordance with 1`wa,.t.J1. c, 186, §22and 105 CMR 410,000: Minimum Standards off"itness lbr Hurrian Habitation
(State Sanitary Code 11),the following dwelling unit is eligible lot-the hirposition oil the tenants(Wa,charge flor
water and/or
PROPERTY INFORMATION
Address: 511
_ Sutton St. t,Bart
il Of'units in1i dL
4 l
Liy/Town: North Andover MA zi
EQtJll''WF,N't' INS'I'Al,[,,AT'IO"al INFORMATION
W5 CMR 410.000 requires the installation aaf wr atcrconservwion devices prior to a dwelling unit becoming eligible for the
fiTIPOSitiffl on tenants ol'a charge: flor water and/or sewer.The,devices Illust niect the l'"ollowing specifications:
1
Showerheads with niaxinlLan flONV rate 110t to CXCCCd 2 gallons per nlioUtC(2.5 gpni)
Faucets with niaxinittul 110W rate 1101.to CxCeed 2 21 B 0 gallons per rninute(2,2 gpi-raj
Ultra-low flush water closets(toilets)not to exceed 1 6/10 gallons per flush(1.6 gpf:)
The sribinetering equipment used to MUSUre tile Cltlffllfit.), of water used for each dwelling unit and cornnion area must
meet the standirds ol'accuracyand testing ofthe Atmxican Water Works Association or similar accredited association,
A. licensed I)JUniber ritust insiall the water,closets and SUIAlletering C(lUiproellL
Subt-ndoring eqUil)[TICut information: Next CCntLUX_S 1,2jzieterinR.Solutions M201 C
Marrut'acturer Model 4
14censed Plumber Certification
Michael W Harrison Master 16101 3/11/2023
print Narne of I'llumber [Jecrise Date
I certify that(check all that apply):
Foll have installed the SUbtrictering equipment listed above ill accordance with accepted plumbing standards.
1 have instilled one or more water closets not exceeding 1.6 gallons per Harsh..
Deterni i tied that existing water closets do not exceed 1.6 gallons per flush.
gThe plumbing permit issued by the city/town, Wrequirecl, isattache(L
El Dwelling Unit is connected directly to a ineter installed bya water company and, in accordance with
M.GJ, .c. 186, §22(p),does not require the installation ofa submeter.
Signed Wider tile pains and penalties of'peijury,
Sri ire of Ucensed 11killiber
Property Owner Certification
f certify that: (1)This dwelling, unit is eligible liar the imposition on the tenants ofa ch,rge for water and/or sewer usage
in accordance with the water SUbt-netering law(MG1.,c. 186, §22); (2)All showerheads,faticets,and water closets in this
dwelfirIg 0114,91-C water,conservation devices that meet the standards specified above;(3)The water submeter measuring
the use of water in file dwelling unit was installed by a licensed plumber and is in compliance with the standards
specified above, or the water incter measuring the use ofwater in this dwelling unit was installed by a"water company"
as defined in c. 186, §22; (4)The water racier or submeter tricasures the water usage exclusive to this unit; (5) 1
will provide to the tenants olthis dwelling unit, prior to occuparicy,a written rental agreement that clearly provides flor the
separate charging of water and/or sewer service, and ii copy of this certification fiorni; (6)That all inflormation itlClUded oil
this certification is true and aCCUratc, to the best of knowledge.
Signed under the pains and penalties of'perjury,
Sutton Street Redevelopment, LLC, by its Project Manager
.. ..............
Print Natric of Owner Sig11�Lqrreof0vvncr Date
Date
The property has been transferred to owner above and the unit Submitted
remains in corn liance with thc!eqrtirenlents of M.G,t,. Date: to 1301-L
�P,THIS FORM PAUSTBE FILED INITH THE LOCAL BOARD OF HEALTH trial ORTO INITIA,r[NG SUBrOETELUNG
ME)PH-CS11 Submetering Forin Rev. 11,8.202 Ldocx
MASSACHUSETTS DEPARTMENT OF PUBLIC HEA1,TH
SUBMETERINGOF WATER AND SEWER CERTIFICATION FORM
1naccordance with M.G.1_c. 186, §22 and 105 CMR 4 10.000: MinirulArn Standards of Fitness for Human flabitation
(State Sanitary Code Chapter 11),the following dwelling unit is eligible for the imposition oil the tenants of charge for
water and/or sewer set-vice.
PROPERTY INFORMATION
Address: 511 Sutton St. Unit# #Of units in h14&:..44
City/Town: North Andover MA _Zip Code: 01845
EQUIPMENTINSTALLA,riON INFORMATION
IM CMR 410.000 requires the installation of water conservation devices prior to a dwelling Lit-lit,becoming eligible fertile
imposition on tenants of`,.).charge for water and/or sewer.'I"he devices must meet the following specifications:
Showerheads with inaxiii-nini flow rate not to exceed 2 "gallons pet-minute(15 gpm)
Faucets With rnaxin11.1111 flow rate not to exceed 2 2/1'gallons per minute(2.2 gprn)
Oltra-low flush water closets (toilets)not to exceed 1 6/10 gallons per flush (1.6 gpf)
'HIC SUbinotering equipment used to ineasure the quantity of water used for each dwelling unit and common area must
rneet the standards ofaccuracy and testing of the American Water Works Association or similar accredited association.
A licensed pluniber nuist install file water closets and submetering eqLlil)lllCllt.
SUbillet cri jig equipment information: __ Next
ions M201 C
MariLd'acturel. Model fl
Ucensed Plumber('ertification
Michael W Harrison Master 16101 3/11/2023
Ilrint Name 01'PlUniber License# Date
I certify that(check all that apply):
Rdl have installed the SUbinctering equipment listed above in accordance with accepted plumbing standards.
0 1 have installed one or more water closets not exceeding 1.6 gallons per flush.
M1 Determined that existing water closets do not exceed 1.6 gallons per flush.
[9 'rhc plumbing permit issued by the city/town, ifl-C(IlAired, is attached.
El Dwelling Unit is connected directly to a nicter installed by a water company and, in accordance with
M.G.L.c. 186, §22(p),does not require the installation ofa subincter.
Signed UrIdOr the pains and penalties ofperull-Y,
Si nature L)E1.,icenscd plumber
Property Owner Certification
I certify that: (I)ThiS dwelling unit is eligible lor the imposition on the tenants of a charge for water and/or sewer Ll%lge
in accordance with the water subinctering law(MGL c. 186, §22);(2)All showerheads, faucets, and water closets in this
dwelling unit,are wager conservation devices that meet the standards specified above;(3)'The water sUbmeter measuring
the use of water in file dwelling unit was installed by a licensed plumber and is in compliance with tile standards
Specified above,or the water meter tricasuring the use ofwater in this dwelling unit was installed by a"water company"
as defined in M.G.1— e. 186, 22; (4)Thc water meter or subi-noter tricasures the water usage exCILISiVe to this unit; (5) 1
will provide to the tenants ol'this dwelling unit, prior to occupancy,a written rental agreernent that clearly provides For the
separate charging ofwater and/or sewer service,and a copy ofthis certification form,(6)'I'hat all information included on
this certification is true and accurate to (,Ile best of my knowledge.
Signed under,the pains and penalties ol'perj Jury,
Sutton Street Redevelopment, LLC, by its Project Manager
Print Name of Owner of Owner Date
Date
0 11"he property has been transferred to owner above and the unit Submitted
remains in cornl2liancC with the fell UJj.-.e.jil,ej,q,s of M.G.1— c. 186, Date: to 1301-1:
g THIS FORM MUST BE FILED W11+1 I'HE LOCAL BOARD OF HEALTH PRIOR 70 IN111AI'ING SUBMETERING
MD PI I-C S11 Submeterin F'orin Rev. 11.8.202 L(Jocx
L,
MASSAC11USE11"I'S DEPAR,rMEN1' 0F11UB1.1C UEALTtl
SU BmE,rERJNG OF WXTER ANOD SEWER CEWFIFICA110N FORM
*1naccordancewith Wi.L. e. 180, § 22and 105 CMR 410.0W MitiirratitiiStatidarcisof:'17iniessfi)rl-itiiiiati I labitation
(State Sanitary Code Chapter i I),the following dwelling unit is eligible for than imposition ori the;tenants ora charge fi)r
waterarld/or sewer service.
1111OPER'I'Y INFORMATION
Address: 511 Sutton St. 4 Of units in b1g.L 4j
North Andover MA -i
EQUIPMEN'r 1NS1'AL1,A'1'10N INFORMA110N
105 CMR 410.000 requires the installation ofwater conservation devices prior to a dwelling unit becoming eligible tart the
irnposition on tenants ofa charl,,,e for water and/or sewer, The devices must nice,(the following specifications:
Showerheads with rnaximurn flow rate not to exceed 2 "`gallons Iier nimute(2.5 glim)
Faucets with maxitiann flow rate not,to exceed 2"gallons per munite(2.2 gpni)
ubra-iow (hash water closets(toilets)not to exceed I W10 gallons pet,flush (I.6 gpf)
The submelering equipment used to ineasure the quantity ofwater used for each dwelling unit and coini-non area 111USt
meet the,standards ol'accuracy and testing of(lie Arnerican Water Works Association or similar accredited association,
A 1 cerrscd plumber rmist install the water closets and subnietering equiprilent,
Submetering exjuiprnent infilrinatiotu Next Centut Submetering Solutions M201
Marnif',cturer Model 4
Licensed Plumber Certification
Michael W Harrison Master 16101 3/11/2023
Print Narne Of Number License ti Dale
I certify that(check all that apply):
[031 have installed the su bmetering
equipment listed above in accordance with accepted plumbing standards.
99 1 have instilled one or niore water closetz',not.exceeding 1.6 gallons Per JIUSIL
FM Determined that existing water closets do not excced 1.6 gallons per. flush.
[Do The plumbing permit issued by the city/town, if'reqUired, is attached,
E3 Dwelling talit is connected directly to a meter installed by as water company and, in accordance with
M.G1, 186, § 22(p),does not require tile installation ofasubincter.
Signed under the pains and penalties ol'perlury,
Licensed Plumber
Property Owner Certification
I cerfif°y that: (1)"I'his dwelling unit is eligible Jbr the imposition oil the tenarws of"a charge fair water and/or Seaver usage
in accordance with the water subinetering law(MG1,as. 186, §22),(2) All showerheads, flailects,and water,closets in this
dwelling unit are water conserviltion devices that meet the standards specified above;(3)'The water SUbilleter meaSUring
the use of water in the dwelling Unit was insuilled 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, 186, § 22, (14)Thc water nicter or submeter mcaSUreS the Water USagC CXClUSiVC to this Unit; (5) 1
will provide to tile tenants of this;dwelling unit, prior to occupancy,as written rental agreement that clearly provides for the
separate charging of water aird/or sewer service,,and.as copy of this certification form; (6)That all illfOrruilti011 included on
this certification is true and accurate to the best oftily knowledge.
Signed under the Pains and penalties of'perjUry,
Sutton Street Redevelopment, LLC, by its Project Mana er
Print Mirnes of0wrier Sit!iauirc-of Owner Date
Date
'flie property has been transferred to owner above and tile unit Submitted
remains in coi11L)Lmnc�,.Lyitlr lie Lc:gj!irernents of M.G.L. c, 186, §22 Date: to B01-1:
*THIS FORM MUMT BE FILED iW�T-(5'C' LE,-B--0, A—R-D 01:HEAL."m PRIOR TO INITIATING SUB
MET'ERING
MD111-1-C'SP Subinetering lorin Rev. 11,8.2021 doox
MASSAUIUSETTS DEPAIaMENT OF PUBLIC IJEALTH
SUBMI?XERING OF WATER AND SEWER Cli'WrIFICATION FORM
*ln,,iccordance with M.G.L.c, 186, §22 and 105 CMR 410.000: Minimum Standards of Fitness for Human 1-labitation
(State Sanitary Code Chapter 11),the following dwelling Unit is eligible for the imposition on the tenants of charge rot-
water and/or sewer service.
PROPEXTY INFORMATION
—Address: 511 Sutton St. Unit 11 44
Sit it North Andover MA Zip Code: 01845
EQUIPMENTINSTALLATiON INFORMATION
105 CMR,410.000 reqUiNS the installation ofwater conservation devices prior to dwelling unit, becoming eligible for the
imposition on lenants ol'a charge for water and/or sewer. 'rhe devices must meet the following specifications:
Showerheads with maxiniurn flow rate not to exceed 2 1''�gallons l)Cr Minute(2.5 gpru)
Faticets with rilaxinium flow rate not to exceed 2 2/10 gallons per rninute(2.2 gpni)
Ulti-a-low flush water closets(toilets)not to exceed I W10 gallons per flush(1.6 gpfl
The SLIN1101cring eqUipinCrIt used to measure tile quantity of water used for each dwelling unit and coninion area must
meet the standards ofaccuracy and testing,of the American Water Works Association or similar accredited association.
A license(] plumber must insWIl the water closets and SUbtlictering equipitiont.
S
Subriletering equipment information: — Next M20 I C
marnit'acturer Model 4
Licensed Plumber Certification
Michael W Harrison Master 16101 3/11/2023
Print Nanic ol'i'lurnber [Jeense ff Date
I certify that(check all that apply):
[oil have installed tile SUbmetering equipment listed above in accordance with accepted plurnbing standards,
M I have installed one or more Nvater closets not exceeding 1.6 gallons per flush.
WJ Determined that existing water closets do not exceed 1.6 gallons per flush.
gThe plumbing permit issued by the city/town, if required, is attached.
Dwelling unit is cotinecled directly to a meter installed by a water company and, in accordance with
M.G,L 186, §22(1)),(toes not require tile installation ofa subilleter.
Signed under the pains and penalties ofperiury, .......
Number
Property Ownel.cel-fification
I certify that: (i),rhis dwelling unit is eligible for the irnposition oil the tenants of a charge for water andlor sewer usage
in accordance with the water SUbmetering law(MOL,c. 186, §22),(2)All showerheads, falicets,kind water closets in this
dwelling unit are water conservation devices that niect the standards specified above;(3)Thc water subrileter measuring
the use of water in the dwelling unit was installed by a licensed plumber and is in compliance with (lie standards
,specified above,or tile water meter awasuring the use of water in this dwelling unit was installed by a"water company"
as defined it) M,(;,[.,. c, 186, § 22; (4)The Mter meter Or SUbtfleter InCitsures the water usage exclusive to this unit; (5)1
will provide to(lie tenants of this dwelling unit, p601*to OCCUINIncy,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)'Fliat all information included on
this certification is true nand accurate to the best:of ally knowledge.
Signed under the pains and penalties of perjury,
Sutton Street Redevelopment, LLC, by its Project Manager
print Name of0wner Llurc—()f Date
Date
0 "I'lie property has been transt"orred to owner above and the unit Submitted
remains in cop Le_qLlil�ernents of M.(,;.I,l c 186 t?2 Date: to 1301-1
*THIS F010A MLiST BE FILED WITH THE LOCAL BOARD 01- HEALTH PRIOR TO INITIATING SUBIVIETERING
1-(,Sr)Subinctering Forin Rev. 11.8,202 Ldocx
MASSACHUSETTS DEPARTMENT (W PUBLIC 141�,ALTFI
SUBw.-rERING 0F WA,rER AND SEWER CERTIFICATION FOIZM
*ha accordance with M.G.L.c. 186, § 22 and 105 CMR etl().000: Mininlum Standards offittless for Hurnan Habitation
(Stvte Sanitary Code Chapter 11),the fbilowing dwelling unit is eligible liar the imposition on the tern ants ot'a charge Cor
water and/or sewer service.
PROPERTY INFORMATION
Adclress: 511 Sutton St. Unit 11 #Of units in bl 44
City/Town: North Andover MA Zip Code:Zia �a
)J 4a___
EQUIPMF!',NTINSTALLATION INFORMATION
105 CM R 410.000 requires the installation of water-Collservad oil devices prior tott dwelling unit becoming eligible For the
imposition oil terrants of'a charge 6or water and/or sewer. The devices inUSt rneet the 6ollowing specifications:
Showerhmids with maxi"ILlro flow rate not to exceed 2 ` allons per MirIUte(2.5 gpin)
F'ilLICCIS With ITlIXiIIlLHll fIOW MI:C 1101 to eXCCCd 2 gallons per ininute(12 gprn)
t fltra-low flush water closets(toilets)riot to exceed I gallons per flush (1,6 gpf)
TIIC SLIbrnetering equipirlent used to measure tile quantity cal'water used lor each dwelling unit and conlmon area must
rneet tire stamIards of'accuracy and testing of'the Arnerican Water Works Association or similar accre(Jited association.
A licensed plurnber MUSt install the water closets and SUbtrietering equiprnem.
Subtyietering equipment information: Next Century . - 2t I C
lutions M
Manufacturcr Model 4
Licensed Plumber Certification
Michael W Harrison Master 16,101 3/11/2023
..........
Print Narne ol'11urnber License# [)are
I certify that (check all that apply):
REI have installed the submetering equipment listed above in accordancc with accepted phimbing standards.
0 1 have installed orie,or more water closets not execTding 1.6 gallons} per flusli,
VA Deterrroned that existing Nvater ciose(s do not exceed 1.6 gallons per flush.
g'I"he plumbing permit issued by the city/town, il'rC(lUirCd, is attached.
Dwelling unit is connected directly to at nicter installed by rr Nvater company and, in accordance with
1 .G.1— c. 186, §22(p),does not require the installation ol'a subrneter.
Signed urlder the pains and penalties of'perlury,
..................... ........ t�of
Properly Owner Certification
I certify that:(I)This dwelling Unit is eligible for the imposition oil tire tenants ol'a charge lor water and/or sewer usage
in accordance with the water SUbinetering law(MGL c. 186. §22)-1(2)All showerheads, fitucets,and water closets in this
dwelling unit are Nvater conservation devices that rne et.diet sLindards spceifiedabove-,(3)The water SUbtileter measuring
the rise of'water in the dwelling unit was, installed by, a licensed plumber and is in compliance with the standards
specified above,or the water*nicter measuring the use of'Nvaler in this dwelling unit wvs installed by a"water company"
as defined in K(31-c. 186, § 22,- (4)The water meter or subloeter measures the WItCrUsage 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 l7or the
separate charging of'waterand/or sewer service,and a copy ol'this certification fiorrn; (6)That all ird'on-nation inClUded oil
this certification is true and accurate to the best of'rny knowledge.
Signed Ull(Iff the pains and penalties of'perjury,
Sutton Street Redevelopment, LLC, by its Project Manager
Print Narne of Owner Sianature of Owner Da i e
Date
'flie property has been trans6erred to owner above and the unit. Submitted
remains in corn aliaance with Q-re 1!,cLp i re i n e n t s o F M.("J.I . c. 18 6, e to 13014:
:#THM FORM MU51'BE FILED WIT14 IIIE LOCAL BOARD OF HEAum PRIORTO INITIATING St BMETERING
MDPI I-CSI)Submelering Form Rev. 11 X202 1 xhxx
MASSACHUSETTS DEJ1AR.TML�N'1' 0F PUBLIC HEALTH
SUIMETERING OF WATER AND SITWER CERTIFICATION MRM
*ln accordance with M.G.L. c. 186, § 22 and 105 CMR 410.000: Mininlurn Standards off-Itriess for Human Habitation
(State Sanitary Code Chapter 11), the following dwelling unit is eligible for the imposition oil the tenants of a charge lor
water and/or sewer service.
PROPERTY INFORMATION
Address: 511 Sutton St. Urlil,U 53JA) Of units int��
Cit.y/'Fo n: North Andovor MA Zip C
EQUIPMENTINSTALLA110N INFORMATION
105 CMR 410.000 requires the installation of water conservation devices prior to adwelling unit becorning eligible fertile
imposition oil tenants of charge for water and/or sewer- I'lie devices must ineet the R.)llowing specifications:
Showerheads with tilaxiffluin flow rate not to exceed 2 `gallons per minute(2.5 gpni)
Faucets with maximum flow rate not:to exceed 2 2/1()gallons per Minute(2.2 gprn)
Ultra-low flUS11 water closets(toilets)not,to exceed 1 6/10 gallons per flush (1.6 gpl)
"File submetering CqUipinellt used to measure;tile quantity ofwatcr used for each dwelling unit rand common area must
meet the standards of accuracy and testing of the Aincrican Water Works Association or similar accredited association.
A licensed plumber must install the water closets arid SUbilietering equipmeriL
SUbinetering equipment information: Next Centl.,rr.y ,'ubin!eterin& olutions M20 I C
Manufacturer Model 11
Licensed Plumber Certification
Michael W Harrison —Master 16101 3/11/2023
Print Naine ol'Plumber License Date
I certify that(check all that apply):
W1 have installed the subirietering equipritent listed above in accordance with accepted plumbing standards.
W I have installed one or more water closets not exceeding 1.6 gallons per flush.
WA Determined that existing water closets do not exceed 1.6 gallons per flUSIL
F-ml The plulllbirl�,-,,iwriuit issued by the city/town, ifreqUired. is attached.
Dwelling unit is connected directly to as meter installed by a water company and, in accordance with
M.G.L . c, 186, §22(p),does not require the installation of a subi'lleter.
Signed under the pains and penalties offiejury,
of Licensed Number
Property Owner Certification
I ceri[H° that: (1)"Phis dwelling unit is eligible for the irnposition oil tile tenants of a charge for water and/or sewer usage
in accordance with the w,.iter submetering law(MGL c. 186, §22);(2)All showerheads, faucets, and water closets in this
dwelling Unit arc Water COIASerVati oil device.,.,,that meet the standards specilied above;(3)The water SUbmeter measuring
the use of waler 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.(.1L. 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 tile
separate charging of water and/or sewer Service,arld a copy of this certification forin; (fir)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,
Sutton Street Redevelopment, LLC, by its Project Manager_
Print Name of0wrier Si�Irvaturc=f0W!lCr ---Da.tc
Date
property has been transferred to owner above and dIC Unit Submitted
reirlaills in conn2plia!lce with theig of M.G.L. C. 186,J22 to 1301-1:
THIS FORM Rjiusr BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATiNG SUBMUERING
MIA41-C SP SUbnicleriiig Forin Rcv, 11 AU02 1 docx
Z11
MASSACHUSEl"I'S DEPARTIVI ENT OF PUBIA(' 14EAL341
SLAIMETERING OF WA'FER ANI) SEWER CER'r1F1CA'H0N FORM
flni,ccordance with M.G.L. c. 186, §22 and 10S CMR 4 10.000: Minimum Standards of f'itness f6r Flurnan Habitation
(State Sanitary Code Chapter 11),the following dwelling unit is eligible lot-the imposition on the tenants of a charge fior
water and/or sewer service.
PROPERTY INFORMATION
Address: 511 Sutton St. 1 4 Ofunits in bidg: 44
C MA
._L,ity1roww North An dove
EQU HIM ENT'INSTAIAATION INFORMATION
JOS CMR 410.000 requires the installation ofwater conservation devices prior to dwelling unit,tecoryiing eligible for the
imposition or)tenants of charge f6r water and/or sewer. The devices must rnect the following specifications:
Showerheads with maximurn flow rate riot to exceed 2 "galkins PCr roinUtC(2,S gpni)
Faucets with rnaXiolUrrl flow rate riot to exceed 2 V10 gallons per ininute(2.2 gpiri)
Ultill-10W (lush MAU CIOWAS(toilets)not to CXCCed I W10 gallons per flush(1.6 gpf)
The subtrietering equipincitt used to measure the quantity ofwater used 6or each dwelling unit and common area must
ineet the standards of accuracy and testing of the American Water Works Asso6ation or similar accredited association,
A licensed plumber o1USt install (tie water closets and submetcring equipment.
SUbtinctering e(JUipment information: Next Century Sularraelerin ,S(IL nots. M201 C
McUlUfacturer Model 4
Licensed Plumber Certification
Michael W Harrison Master 16101 3/11/2023
Print Name 014'lUrriber l..icense It Date
I certify that(check call that apply):
Wl have installed the SUbriretering equipment listed above in accordance with accepted plumbing standards.
I have installed One Or more water closets riot exceeding 1.6 gaH011S pCr 11Uqh.
Determined that existing water closets do not exceed 1.6 gallons per ffijsh
The plumbing peri-nit,issued by the city/town, if'required, is,attached.
Dwelling unit is connected directly to a meter installed by a watN-company and, in accordance with
M.G.l, J 86, §22(p),does not require the installation of a subincter.
Signed under the pains and penalties ot'perjury, ...........
S nature of 1.,icensed Plumber
Pr pefty Owner Certification
I certify that: (1)'"Ibis dwelling unit is eligible fior tire imposition on the tenants ofa charge For water and/or sewer usage
in accordance with the WatCr SUbinctering law(MGI, c. 186, §22); (12)All showerheads, fiUlCetS,and water closets in this
dwelling unit are water conservation devices that rnect the standar(k, specified above;(3)The water subtrieter ineasuring
the use ofwater it) the dweilirq..,unit was installed by a licensed plumber and is in compliance with tile standards
specified above,or the water meter measuring,the us(-ofwater in this dwelling unit was installed by a"water company"
as defined in KUL,, c. 186, § 22, (4)"I"he water rooter or subtrieter measures the water usage exclusive to this unit; (5) 1
will provide to the tenants ofthis dwelling unit, prior to occupancy,as written rental agreement that clearly provides for the
separate charging of"water and/or sewer set-vice,and as copy of this certification form; (6)That all iril'briiiation included on
this certification is true and accurate to the best of'my knowlcdge.
Signed under the pains and penalties ofper
I lury,
Sutton Street Redevelopment, LLC, by its Project Manager 1146, 1" "'4" L&ti
............
Print Name ol'Owncr .......
�wnattrre of"Owner Date
0 Date
The property has been transferred to owner above and the unit Submitted
remains in cotmliaricc with tile rf;qltiEcLrne,il,ts of M.G.1—G.11 186, -2 to B014:
*THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBMETERING
VIDPH-C'SP Stibinetering Form Rev. 11,8.202 l.docx
MASSACHUSETTS DEPARTMt4,NTOF PUBUC HEAUM
SUBMETERING OF WATER AND SEWER CERTIFICATION 1?01!M
*In accordance with M.G.[,.c. 186, § 22 and, 105 CMR.410.000: Millinn,1111 Standards of Fitness for Flurnan Habitation
(State Sanitary Code Chapter 11), the following dwelling unit is eligible for the imposition can the tenants of a charge for
water and/or sewer service.
PROPEwry INFORMATION
Address: 511 Sutton St. Unit# it Of L11
_L,itLfTown: North Andover MA Zip Code: 0184_5
EQUIPMENT INSTAL1,ATION INFORMATION
105 CMR 410,000 requires the installation ofwater conservation devices prior to a dwelling unit becoming eligible for the
imposition oil tenants ol'a charge fior water and/or sewer,The devices must rilect the following specifications:
'
Showerheads with maximum flow rate not to exceed ). V,gallons per minute(2.5 gpm)
Faucets with inaximurn flow rate not to exceed 2 211()gallons per minute(2.2 gprn)
Ultra-low flush water closets(toilets) not to exceed i N10 gallons per flush (1.6 gpf)
'rbe 81.1binctering equipment used to measure the quantity Of Water Used for each dwelling unit and common area must
meet the standards of accuracy and testing ol'the Anicrican Water Works Association or similar accredited association.
A licensed phlnlf)Cr IntlSt illStall the water closetsaild subilletering equipment.
Subt-notering equipment inl'orrriation: Next,Century Submeteringy Solutions M201C
Model #
Ueensed 11111"Iber Cel-fification
Michael W Harrison Master 16101 3/11/2023
Print Naine of'Phunber license Date
I certify that(check a]I that apply):
Rl have installed the SUbinctering equipment listed above in accordance with accepted J)hArribing standards.
§ I have installed one or more Water closets not exceeding 1.6 gallons per flush.
IN L)etermined that,existing water closets do not exceed 1.6 gallons per flush.
Eel'fhe plumbing permit issued by the city/town, if*required, is attached
El Dwelling unit is connected (fircctly to a,meter installed by a water company and, in accordance with
M,Gl— c. 186, §22(p),does not require the installation of a subilleter.
Signed under the pains and penalties of'pei-jury,
ignature,of-Ilicensed plumber
Property Owner Certirication
I Certify that: (1)This dwelling omit is eligible for the imposition oil the tenants ol'a charge for water and/or sewer usage
in accordance With the Water SUbinct'ering 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)117e 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 rricasuring the use of"water in this dwelling unit was installed by a"water company"
as defin
ed in M.G.1—c. 186, § 22; (4)The water meter or subineter 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 ot'wa.atcr and/or sewer service,and a copy of dais certification forma; (6)'f'hat all information included oil
this eerti fication is trLICand accurate to the best of any knowledge.
Signed UndCr the pains and penalties ofperjury,
Sutton Street Redevelopment, LLC, by its Project Manager
—T1 r i i—it N al-Y—le'"'—of"'0 '- ----w- nCr "-------- S of Owner Date
Date
property has been transferred to owner above and the unit Submitted
remains in C2!21P!j��c with the-rnqLlirenlents—or M.G.L.-c� to 1301-1:
t"ttlD
ro. RM MtJSTBE FILED vvrm THE LOCAL BOARD OF I-1EALTH PRIORm INITIA,rING SUBMETERING
NIDPH-CSP SUbtrietering 1,onn 1�cv. 11.8,202 Ldocx
MASSACHUSE'll'I'S DE]"ARTMEN'I'OF PUBLIC t1EA1311
S1JBME'1'F,R1NG OF WXrER AND Sf,WER (7ERT'IFICAIJON FORM
*In accordance with M.G.1,, c. 186, §22 and 105 CMR 410.000: Mininturn Standards of Fitness for I lunlan Habitation
(State Sanitary Code Chapter 11),the f'ollowing dwelling unit is eligible lot-the imposition on the tenants ota charge for
water and/or sewer service.
PROPERTY INFORMATION
P, r"Acldress. 511 Sutton St. Chit 11 Y Of units in bl k.
orth Andoverw. 5
........ NIA -i lcode:
EQUIPMENT INSTAIA,ATION INFORMATION
l05 CIVIR 410.000 requires the installation ofwater conservation devices prior to a.dwelling unit becoming eligible for the
in position cart tenarns ol'a charge fior watcrand/or sewer, 'I"lic devices must.tineel the following specifications:
Showerheads with niaximuin flow rate not to exceed 2 "gallons Per ruinUtC(2.5 gprn)
Faucets with M�MinWrn flow rate not to exceed 2 2/'10 gallons per.minute(12 gpin)
Ultra-low thish water closets(toilets)not to exceed i W10 gallons per flush (1,6 gpl)
The subinetering equipirient used to nleaSLIN the quantity ofwatcr used for each dwelling unit and common area must
triect the standards ol'accuracy and testing ofthe Arnerican Water Works Association or sirnilar accredited association.
A licensed plumber must install the water closets and submetering 0(itlipillCtIL
SUbMetering equipment infionnation: Next.,Centt ry '1atLne erin.6 Solutions M201 C�.
manul"dettirer Model #
Licensed Plumber Certification
Michael W Harrison Master 16101 3/11/2023
Print Narne ot'Plurnber L'iceltse It Date
I certi I-'
y that(check all that apply):
E4011 have installed the submetering eqUipolCut.listed above in accordance with accel'xed PhInibing standards,
IS I have installed one or more water closets not exceeding 1.6 gallons per flush
JJ Determined that existing water closets do not exceed 1.6 gallons pff flush.
[oil The plumbing permit issued 1)), the city/tovvri, ifrequircil, is attached.
Dwelling Unit is connected directly to as nicter installed by as w,"iter cornp,.'iny and, in accordance with
M,GJ— c, 186, §22(p),does not require the installation ofa SUbineter.
Signed Under the pains and penaltics of perlury,
off,icensed Plumber
Property Owner Certification
I ecoffy that: (I)Tliis dwelling Unit is eligible R)r the iniposition on the tenants of a c.harge flor water and/or sewer usage
in accordance with the water subinctering law (NIGI.,c. 186, §22);(2)All showerhetids, fi'MCCtS, and water closets in this
dwelling unit are water conservation devices that niect the slandards specified above;(3)The water submeter meaStIring,
the use ofwater 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 1" .G.1—c. 186, §22; (4)"111C Water ITICter M subincter measures the water usage CXCIUSiVC to this Unit; (5) 1
will provide to the tenants ofthis dwelling unit, prior to OCCUl'Yincy,a written rental agreement that clearly provides fior the
separate charging,ofwaterand/or sewer service,and as copy ofthis certif ication fonic (6)'That all infornialion included can
this certification is true and accurate to the best of'my knowledge.
Signed under the pains and penalties of perjury,
Sutton Street Redevelopment, LLC, by its Project Manager z '4"'
Print Narise of Owner 'IjLaore cf' )wncr Datc
Dale
property has been transrerred to owner above and the uni Ubmitted
remains in compliance with the,Ke gjrEo!jjents of M.(J.1- c,186, 22 Date: to 1301-1:
*THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATIN UBMETERING
I
1 D111-14 ISP Submetering Fonn Rev. 11.8.202 klocx
MASSAC11USETTS DEPAWrMEN'r OF PUBIAC HEALTH
SU11ME'VF,R1NG,, OF WA'rER AND S'EWER("ERT)[FICA110N FORM
11n accordance with M,G.I.,.c. 186, §22 and 105 CMR 4 10.000: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 set-vice.
PROPERTY INFORMATION
1)
Address: 511 Sutton St. Unit# z 11A D /10f units inn bldg. 44
(;;it �1'own: Forth MA z--Z,Ji)Cod : )11
--y 0 1 a4a—
EQUIPMENT INSTAI,LATION INFORMATION
105 CMR 410.000 requires the installation of water conservation devices prior to as dwelling unit becoming eligible for the
imposition on tenants of charge For water and/or sewer.'"Flic devices must meet the Following specifications:
Showerheads with maximum flow rate not to exceed 2 '/ gallons per minute(2.5 gpni)
Faucets with maximum flow rate not to exceed 2 V10 gallons per minute(2.2 gpin)
Ultra-low 11LISh water closets(toilets)not to exceed I ('110 gallons per flush (1.(i gpi)
The submetering equipments used to measure the quantity ofwater used fbr each dwelling unit and common area must
meet the standards of accuracy and testing oftlic American Water Works Association or similar accredited association.
A licensed plumber must install the water closets and subinctering equipment.
SLibiiietei-itigC(ILlipt-r)ClltiiiforiTiatioii: Next Centur�SLuibrn�eterin�.Solutions M201 C
Maaanufiactrarer Model It
1jeensed Plumber Certification
Michael W Harrison Master 16101 3/11/2023
Print Name ol"Plurnber License if, Date
I certify that (check all that apply):
Rl have installed the subi-netering equipment listed above in accordance with accepted plumbing standards.
I have installed one or more water closets not exceeding t.6 ga lloisper flush.Determined that existing water closets do not exceed 1.6 gallons per flush.
F01 'file Plumbing permit issued by the city/town, if required, is attached.
Dwelling unit is connected directly to as meter installed by a water company and, in accordance with
M.G.1, .c. 186, §22(p),(toes not require the installation ofa submeter.
Signed under the pains and penalties Of per jury,
nr1—aTe—of 1-Jeensed plumber
P1,operty Owner Certification
I certify that: (1)This dwelling unit is eligible R)r the imposition on the tenants of a charge for water and/or sewer usage
in accordance with the water submetering law(M(3'L c. 186, §22);(2)All showerheads, fauccis, 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
specific(]above,or the water meter measuring the us(,,of water it) this dwelling unit was installed by a"water company"
as defined in M.(J'J.- c. 186, §22; (4)The water meter or submeter measures the water usage exclusive to this unit; (5) 1
will provide to the tenants ofthis dwelling unit., prior to occupancy,as written rental agreement that clearly provides for the
separate charging of`water and/or sewer service,and a copy of this certification form,(6)1"hat all intbrination included oil
this certification is true and acetirate to the best of zany knowledge.
Signed under[lie pains and penalties ol'peijury,
Sutton Street Redevelopment, LLC, by its Project Manager /1Fl
ri 1n aine ofOwner Sivilature ofowner Date
Date
0 'I'lic property has been traiisficrred to owner above,at'(] the unit Subt-nitted
remains in conn)liancc with tile re il-CITICIItS oI* M.("31- c- 186, V2 Date: to 1301-1:
*,n-us FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUB�METERING
Mfol-l-CS1,Subi-netering Form Rev. 11.8,2021 docx
I
MASSACIJUSE'll"S DEPARIWWOF P1,131,WHEALT14
SUBME'J'ERING OFWATER AND SEWER CF'RT'1F1CA'r10N FORM
*ln accordtince with M.G.1—c. 186, §22and 105 CMR 4 10.000: Minimum Standards rat'Fitness for Hurnan Habitation
(State Sanitary(,ode Chapter 11),the 6011ONVing dwelling unit iS eligible lbrthe imposition oil the tenants of.a charge tor
water and/or sewer service.
PROPI'.�,RTY INFORMATION
Address: 511 Sutton St. Unn'-d cl)"'a 4(Yunits it) bld 44
A ZiP Code:
ljb,.Andover NI
PMF,NT1NSTA1A,AT10N INFORMATION
105 CMR 410.000 requires the installation ol'water conservation devices prior to ft(INVC11ing Unit becorning eligible for the
imposition on tenants ot'a charge lor water and/or sewer. The devices anim.meet the hallowing specifications:
Showerheads with maximurn flow rate not.to exceed 2 ",gallons per minute(2.5 gpin)
Faucets with maxin-lUrn flow rate not to exceed 2 gallons per minute(2.2 gpin)
Ultra-low flush water closets(toilets)not to exceed I rµ<wrr gallons f.ier flush (1.6 gpl)
The subinetering equipment used to measure the quantity ol'water used for each dwelling unit and common area must
meet the standards ol'acCUraCy and testing ol'the American Water Works Association or similar accredited association.
A, licensed plumber must install the water closets and subi-netering eqUipluent,
SUbi-netering equipment.intbrinatiow Next:Cernu qt(lf�Solutions M20 I
Maratfiacttirer Model 11
[Acensed Plumber
Michael W Harrison Master 16101 3/11/2023
print Name 01:'PlUrnber I.,icense It Date
I certify that(check all that apply):
[q]1 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 g,,fflons per flush.
Dcterniined that existing water closets do not exceed 1 A gallons JlCr 11USh.
ES] The I)lUmbing permit issued by the city/town, if'recluired, is attached.
El Dwelling unit is Connected directly to meter installed by a water coiripany and, in accordance with
MX11, . c. 186, § 22(p), does not require the installation ol"asubincler,
Signed under thca pains art(] penaftics of'perjury,
itqrc of I-licensed Plumber
Propert-,s, Owner(,ertification
f ceftif'y that; (1)This dwelling unit is eligible fior the impositkni on the tenants of'a charge for water and/or sewer usage
in accordance with (fie water ubmetering law(MG1.,c. 186, §22);(2)Al I showerheads, IIIUCetS,and water closets in this
dwelling unit are water conservation devices that nicel,the standards specified above;(3)The water.submeter rneCISLU'ing
the use olwater in the dwelling unit wars installed by a licensed 11lUrnberand is in compliance with the standards
specified above,or the water meter measuring the use ol'water in this dwelling unit was installed by a"water company"
as del'ined in M.G.L-e. 186, §22; (4)The water rnoter or subtricter rneaSUres the water Usage exclusive to this unit; (5) 1
will provide to the tenants olthis dwelling Unit, prior to occupancy,a written rental agreerneat that clearly provides for the
separate charging or water a,.uid/or sewer service, and a copy ol'this certification form; (6)'Fhat all information included on
this certification is true and atccurate to the best of'rny knowledge.
Signed Under the pairlsand pertalfles ot'perjury,
SiAton- _L t5..E Aect Manager
Print Nalne ot'Owner sigr,LqLfc�,ofowner Date
Date
flie property has been trans icrred to owner above and the unit Submitted
rernains in con ia ice with the rcclrrirernerrts of M,(,;,[,,.c. 180 822 Date: to B01 k
*THIS FORM IVIUSTBE F11 ED VVITH THE LOCAL BOARD OF HEAUM PRIORTO INITIATING SUBMETERING
I
MDPI I-CISP Submetering Form Rev, 1 1,8202 Ldocx
MASS ACtl U SE17S DEPAR'rMENTOF PUBUC IIEAL'I'H
SUBM'E'1'ER1,N'G OF WAIER,AN D SFWFR (TRUIPICA110N FORM
*In accordance with M.(j'.[.,,c. 186, § 22 and 105 CMR,410.000: Minimum Standards of Fitness for Hurntin Habitation
(State Sanitary Code Chapter 11),tile 1,011owing dwelhng unit is eligible Forthe irnl'.)osition oil the tenants of a charge, for
0
waier and/or sewer service.
PROPEAUY INFORMATION
411
Address: 511 Sutton St. Unit If �1�oi�ullit, in bldL,.
------- L _44
Lorth Andover MA ZiE�( o cl L
-EDI.45
l�Q[.J]I"MEN'I' IINS'I'AI,LA'1'1()N INIZORIMATV.01V
105 CNIR 410.000 requires the installation oC Nva ter conservation devices prior to a.dwelling unit becoming eligible for the
imposition on tenarits ol'a charp for Water and/or sewer. 'the devii.es as meet the ibilowing specifications:
Showerheads with maximum flo%v rate not to exceed 2 V,gallons per minute(2.5 gpin)
Faucets with maximom flow rate not to exceed 2 " gallons per ni'mute,(12 gpin)
Uttra-low flush water closets(toilets) not tea exceed 1 6110 gallons per flush (1.6 gpi)
The submetering,equiprient,used to ulecISUre the quantity ol"water used liar each dwelling unit and common area,must
meet the standards 01',ACCUracy an(] testing,ol'the Arnerican Water Works Association or sirnilar accredited association.
A licensed plumber must install the water closets arid submetering. equipment.
SUIM-nelerilig C(ILlipruCHI ill 1*01-Mati0fl: Next,Cerium SLI, eterillL., S lutj( M201 C
Model
Ucensed Plumber Certification
Michael W Harrison ....... Master 16101 3/11/2023
11'rint Nan'le of,Plualbel. l'icensc Date
I certify that(check.all that apply):
W1 have installed the submetering eqUil)ment listed above in accordance with accepted plumbing standards.
I have installed one or more water closets not exceeding 1.6 gallons per flUS11.
Determined that existing water closets (to not exceed 1.6 gallons per flush.
The Plumbing permit issued by flie city/town, if required, is attached.
])Welling Ullit is connected directly to a meter installed by a water cornpany and, it) accordance with
KCC1.f_1. c. 186, §22(p),doc�s not require the installation ot'at submeter.
Signed Under the pains and penalties of pet-jury,
Property Owner Ci"crl'ffication
I ccrfif� that: (1)'['his dwelling unit is eligible tbr the imposition oil 1[w tenants ofa charge fbr water and/or sewer Usage
in accordance with the orate SUINT'letering law(MGL,c. 186, §22); (2) All showerbeads, faucets, and water closets in this
dwelling unit are water conservation devices that iriect the standards specified above; (3)'Fhe water subrymor measuring
the USC 01'WatCr irl 111C dW(flljjq"'unit Was installed by as liccrtsod plurriberand is in compliance with the st;ludords
specified above, or the waier nleter tueasurinpl,the use ofwatm-in this dwelling unit was installed by a"water company"
definer! in M-G-1-c. 186, §22, (4)"I'lie WatCl'01CtCrcar SUbinoter mcasures the water usage CXCILISiVC to this Unit; (5) 1
wih provide to Cher tenants of this dwellinj-,unit, prior to oc"cupancy,a written rental agreement that clearly provides for the
separate, Charging of water and/or sewer service,and a copy ofthis certification fibral; (6)That all illfbrulati011 illClUded on
this certification is truce and accurate to the best of'my knowledge,
Signed under the pains and penalties ol'peijury,
Print Name of'Owner Silmatta-L,of'Owner Date
Fhe property has been transferred to owner above and the Unit Submitted
remains in c Date: to 1301-1:
"THIS FORM MUSTBE FILED mirm THE LOCAL BOARD OF 11EALTH PRIOR'ro INITIATING SUBME"ITRING
MDPI 1-CS11 Submetering Form Rev, 1 k8.202 Ldmx
MASSACHUSETTS I)EPARTMENTOF PUBLIC HEALTH
SUB METERING OF WATER AND SEWER CERTIFICA,nON FORM
*In accordance with M.CU,,c, 186, § 22and 105 CMR 410.000: Minimum Standards of Fitness for I-Innian Habitation
(State Sanitary Code Chapter 11),the following dwelling unit is eligible for the imposition on the tenants of charge for
water and/or sewer service.—
PROPE11TY INFORMATION
Address: 511 Sutton St. 4 Of
North Andover MA z 45
EQU1PMFNT1NS7'A,L1,A'J'10N INFORMATION ---
10-5 CMR 410,000 reqUires the installation of water conservation devices prior to a dwelling unit becoming eligible for the
imposition on tenants of charge for water and/or sewer. The,devices nuist rneet the following specifications:
ShK)wcrheads with rrU1Xiu1Urn flow rate, not,to exceed
.gallons per ininute(2.5 gpin)
Fftucets with indximUrn IIOW rate [lot Io eXCeed 2 "'gallons per naintite(22"gpi-ri)
Ultra-low ffi.ish water closets(toilets)not to excee(f I W10 gallons per flush(1.6 gpf)
'11-w subirietering Cquip"ne"t used to measure tile cinantity of water used for each dwelling nnit and conu-non area mist
meet the standards of accuracy and testing of the Anierican Water Works As: or shnilar accredited association.
A iicensed Plumber nuist install tile water closets and stknictering ecItApnient.
Sn"Jinetering equipment: information: Next Cen Subra1cterin2jq1.RLJ(Ln, M201 C
ManLifileturer
Is eensed Plumber Certification
Michael W Harrison Master 16101
3/11/2023
!Tint Name OfFlumber Ucense ft Date
I certify that(check all that apply):
WJ have installed tile SUbinetering C(lUiprnent listed above in accordance with accepted plumbing;standards.
I have installed one Or inore water closets not exceeding 1.6 gallons per flush.
Determined that existing water closets do not exceed 1.6 gallons per flush.
IT11C plUnibing permit issued by the city/town, if required, is attached.
FO
EJ Dwelling unit is connected directly Ina meter installed by a water company and, in accordance with
M.G.I.—c. 186, § 22(p),does not require the installation ofa si.rbnicter.
Signed under the pains and penalties Of pCrjUrY,
Siniature of Licensed 111nniber
Property Owner Certification
I cerfify that: MThis dwelling unit is eligible 6(,ir the imposition on the tenarits cif charge for water and/or sewer Usage
in accordance, with the water submeterin",law(MGM,c. 186, §22);(2)All showerh&ads,faucets,and water closets in this
dwelling unit are water conservatiol-t devices that meet the standards specified above; (3)The water submeter measuring
the FIse of water in the dwelling tinit was installed bya licensed phiniber and is in corripliance with the standards
L
specified above,or the water meter measuring;the iisc 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 OrSUbrneter nicasilres the water US,19C exclusive to this unit; (5) 1
will provide to the tenants ofthis dwelling unit,brier to occupancy,a written rental agreement 1hat clearly provides lbr t'he
separate charging ofwater and/or sewer service, ,in(]a copy oj'this cer-tification [brin, (6)That all inforrnation included 011
this certification is true and accurate to the best of knowledge.
Sigred under the pains and penalties or perinyy,
Sittoia-Street Redevelopment, LLC, by its Project Manager
a 2—wner ___ �1wpqire.oaf 0wner Date
Date
-he property has been transferred to owner above and the unit SLibmitted
reamins in coljjpliarice with tJlc 1,
the 01' M.G.L.. c. I S�, 22. Date: to BOH:
*7141S FORM MUST BE FILED WI2""14THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUB ME "EKING
MDPH-CSP Stibmetering Form Rev. 1 I.S.2021 docx
MASSACI-I USE TTS DEPARTMENT OF.PUBLIC HEALTn
SUBMETERING OF WATER AND SEWER CERTIFICATION FORM
"In accordance with M.G.L. c. 186, §22 and 105 CPVIR /I 10.000: Minirl"111111 Standards of Fitness fiw Flurnan Habitation
(State Sanitary Code Chapter 11), the Following dwelling unit is eligible l'orthe imposition oil the tenants of acharge for
water and/or sewer service.
PROPERTY INFORMATION
Address: 511 Sutton-St. #0runits in bldg. 44
City/'fawn: N�®rjh Andover MA
z iE f,—()c I—C
EQUIPMENTINSTA1.1,ATION INFORMATION
105 CMR 410.000 requires the installalliorl,cal water conservation devices prior to a dwelling unit becorning eligible Im the
imposition oil lowirits of a charge for water and/or sewer. 1"he devices must meet the following;specifications:
Showerheads With TMAXil"LILUT) flow rate not to exceed 2 `''gallons per minute(2.5 gpirl)
FaUCCtS With MaXilnuln fjOW Llie not to eXeCed 2)/'()gallons per minute:(2.2 gpin)
1.11tra-10w flLlsll water closets(toilets)no[:to exceed I W 10 ga I I oils per Harsh (1.6 gpf)
The subnictering e(jUipulCllt used to rne,,.isure the quantity ofwater used for each dwelling unit and C,011`1111011 area must
meet the standards ofaccuracy and testing of'11-le American Water Works Association or similar accreditedassociation,
A liCCIISCd phAnlbCl-uILVA install the water closets and subnietering eqUiINTICut,
Stibnictei•iiige(Ittipr)ici-itiiiicariii,,itioii: — Next Centug.§i bipctciriji 'qL4tions M201 C
Modef li,
I.,iceillsed Plumber Certification
Michael W Harrison Master 16101
3/11/20
P 23
rint Narne Of PlUniber 1.,icerlse I/ Date
I certify that(check all that apply):
[0:11 have installed the SUbinetering equipment listed above in accordance with accepted plumbing standards,
1 have installed one or more water closets not exceeding 1.6 gallons per flush,
Deteri-nined that existing water closets(10 not exceed 1.6 gallons per flush.
[9The plumbing permit issued by the city/town, ifrequinzd, is attached.
Dwelling unit is connected directly to a meter installed by a water company and, in accordance with
M.Gl— c. 186. §22(p), does not require the installation ofa.subriletcr.
Signed Under the pains and penalties of pcjjury,
_nature of Licensed Plumber
Property C Owner ertification
I certify that: (])'['his dwelling unit is eligible for the irilpositi(:)n on the tenants of a charge 1'or water and/or sewer Lisage
in accordance with the water sub"rieftring late(M(;1.,c. 186, §22); (2)All showerheads, faucets,and water closets in this
dwelling unit are water conservation devices that meet (lie standards speciliedabove;(3)The water subincter measuring
the use Of Water in the,dwelling;unit was installed by licensed pluiriber and is in compliance with the standards
specil'i
led above, or the water meter nicasuring the use Of Water in this dwelling unit was installed by a"water company"
as dellned in M.G,L,. c. 186, § 22; (4)T'he water rneter or subineter rneasures the water usage exclusive to this unit; (5) 1
will provide to the tenants of dais dwelling unit,prior to Occupancy,a written rental agreernent that clearly provides for the
separate charging of water and/or sewer service, and a copy of this certification l7bru"); (6)That all information included oil
this certification is true and accurate to the best of illy knowledge.
Signed under the pains arid periallies,of perjury,
,auttoLn S&�qpLRedevelopment,._L q, bits Project Manager /I
Print Narne of Owner Silzna�-Urc of�O—Wncr Date
Date
I"lle property has been transferred to owner above and the unit Submitted
-remains in s of MX-r.l- c. 186,_`22 !)aLe- to 1301-1:
'THIS FORM MUSTBE FILED WITH THE LOCAL BOARD 01:1-1EALTH PRIOR TO INITIATING SUBIVIETERING
M 101-1-CSP Sabinetering Forrn Rev. 11.8,202 Ldoex
MASSACHUSETTS DEPARTMENT OF FUBLIC HEALTH
sui3w,rERINCOF WATER AND SEWER CER'nFICATION FORM
*In accordance with M.G,l_ C. 186, § 22 and 105 C',MR 4 10.000: Minimum Standards of Fitness for Human Habitation
(State Sanitary Code Chapter 11),the following dwelling unit is eligible for the in1positio, on t e tenants of a c a r
water and/or sewer service. h rge 66
11ROPERTY INFORMATION
Address: 511 Sutton St. Unit#
A Of units in b1da 44
MA
Z'
,I L)
FIQUI.PMENT
FOIZMATION
l 0 5 C M R 4 10 000 MCI 11 i res flee i i i stal I ati oil ofwi tor consel-W, I I dev i ces p ri or to a d we i I j rig orbit becorn i ng e I i gable J b r the
imposn oil tenants ofa charge for water and/or sewN% The devices"last 111cet the fiflJONVing specifications:
Sh3werheads with rnaxilyujul flow rate not to exceec, 2 ` 911110flS pOr Minute(2.5 gprn)
Faucets With ulaXill'Min not to e XC,c d 2/10
2 fyallons per minute(2.2 gpin)
(.111-Ul-10w flush water closets(toilets)not to exceed I t,(m gaifOrls per flush (1.6 gpf)
The subilletering equipment used to measure the quantity ()fNvaler used for each dwelling unit and coninloll area Must
meet the standards ofaccur,'IcYalld testing of(lie American Water Wo""/�ssociatiOrl Or similar accredited association.
A licensed plumber Must inStIll I the Watel'-'closets and SUbmetering cqUipluef1t,
Subinctering eqUipMent in-formation: Next Century Sub
M201 C
MantillaCtUrer Model #
_Michael V �-Jarrison Master 16101
3/11/2023
I certify that(check al I that apply): License 4 Date
Rl have installed the submetering equipment listed above in accordance with accepted plumbing standards,
I have installed one or rnorc water closets not exceeding 1.6 gallons per flush.
Determined that cNisting water closets do not exceed 1.6 gallons pet,flush.
The plumbing perinit issued by the city/town, i`f'rCClUirCd, is attached, I
D Dwelling Unit is connected directly to as meter instal led by a water company and, in accordance with
M.G.L . c. 186, §22(p),does not require the installation of a subrilcter,
Signed under the pains and penalties of per'jury,
of Licensed Plumber
Property Owner Certification
I cellif�that: (1)7'his dwelling, unit is eligible for tile ilylpo,sition oil tile tenants ofa charge for water and/or sewer usage
in accordance with tile water Stribinetering law(m(;I,c. 186, §22),(2)All showerheads, filUcets, 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'ovater in the dwelling unit was installed 1_)Y a license(,] PIUMber and is in c011"Pliallce with the standards specified above,or the water 111eter measuring the use
:e 0j,ovater in this dwelling unit was installed by a"water company"
as defined in M.G.L. c. 186, § 22; (4)The water richer or submeter measures the;water usage exclusive to this unit; (5) 1
will provide to tile 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 cell,ification form; (6)That all inibralation included on
this certification is true and accurate to the best of my knowledge,
Signed under the pains all(]Penalties ofperjUry,
utten—%tree�emetqam-ent.—LL-Q__by_gs Project Manager
Print Name of0wner
Si na,ur' of owner
Date
0 property has been transferred to ownerabove and the unit Date
Submitted
Lrernatrins in cone Ltan�L�vitt�tj,je r� 1, M G I C Date: to 130H:
OF HEALTH PRIOR TO INITIATING SUBMETERIN—G
*THIS FORM MUST BE FILED WITH THE I. )6ii_BO
.1
N1DPH-CSP Submetcring Nonni R.ev, 1 .8.202 Ldoex
MASSACHUSETTS DEPAIUMENT OF PUBLIC HEALTII
SUBMETERING OF WATER AND SEWER CERTIFICATION FORM
*In accordance with M.G.L.c. 186, §22 and 105 CMR 410.000: Mininutril Standards orl'itness For Human Habitation
(State Sanitary Code Chapter 11), the following dwelling unit is eligible for the imposition oil the tenants of a charge for
water and/or sewer service. PROPI�,RTY
Address: 511 Sutton St. ..... Unit 11 1 Of units in bld& 44
r.
.....
-Li-ty/Towir-North Andover MA Zik(,,ode: 01
28-4-55—
EQUIPMENT INSTAL LA"rION INFORMATION
105 CMR 4 I(WOO rcqLlirCS the installation of water conservation devices prior Loa dwelling unit becoming eligible for the.
iilillosition on tenants ofa charp ge for water and/or sewer.Tbe devices must Ince't,the, ffillowing speci,fications:
Showerheads with rnaxina)urn flow rate not to exceed 2 "gallons Per onilU10(2.5 gpin)
Fancets with inaxinlurn flow rate not to exceed 2 210 gallons per ininute(2.2 ()pill)
Ultra-low ffil,'.dl Watff CIOSCIS(toilets) not to exceed 1 6/10
gallons per flush (1.6 gpl)
'I'lle subinctering cquipment used to measure (lie(ItLantity of water used for each dwelling unit.and common area 111LISt
meet tliestandards ofaCCUracy and testing of the Anwriciin Water Works Association or sinlilaraccredited association.
A licensed phlInbCr FrIUM,install file water closetsand SU bill eteri ng equipment.
Submetering eqUiplTIC111 n1l"0111lation: 'Next CentTY_'S MLtt, �n_�l -g-Soluflons M201 C
Manufacturer Model #
Licensed 1"Itutuber Cerfification
Michael W Harrison Master 16101 3/11/2023
License 4 Date
I ccrtity that(check all that apply):
Rl have installed file submetering eqUif)rnellt listed above in accordance with accepted plumbing standards.
1 have installed one or inore water closets not exceeding 1.6 gallons per flush.
Determined that existing water closets do not exceed 1.6 gallons per f1LlSh.
nO The plUrnbing permit: issued by the city/town, if required, is attached.
F)WCllil'lg Lit-lit 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"at subrileter.
Signed Under the pains and Penalties of perjury,
of Licensed Plumber
Propefty Owilier Certification
I certily ghat:
hat: (J)This dwelling trait is eligible for the irnposition oil the tenants ol'a charge for water and/or sewer usage
in accordance with the water SUbilletering law(M(,'jl,,c. 186, §22);(2) All showerheads, faucets, and water closets ill this
dwelling unit are water conservation devices that meet the standards specified above:;(3)'T'he water SUbrn0tCr measuring;
the use of water in the dwelling unit was insialled by as licensed plumber and is ill corripliance with the standards
specified above,or ille water meter nicasuring the use ol"waler in this dwelling unit was installed by a"water company"
as defined ill M.G.L.c. 186, § 22; (4)The water meter or SlAbincter measures the water Usage exclusive to this Unit; (5) 1
will provide to the tenants of this dwelling unit, Prior to occupancy,as written rental agreenlent that clearly provides flor the
separate charging of`water and/or sewer service,and a copy of this certification lbrin; (6)That all information included oil
this certification is tl'UC and aCGUratc R.)the best of)ny knowledge.
Signed Llod(-.,,r the pains and penalties of'peril.W.Y,
3utton Street Redevelopment, LLC, by its Project Manager
......------
l)rint Name SignatUre of Owner Date
Date
171 "fhc property has been transferred to owner above and the unit Submitted
remains in coila.liance with M.G.L. c, 1.§��2 Date: to 1301+
*THIS FORM haus"r BE FILED WITH THE LOCAL BOARD OF HEAum PRIORTO INITIATlNG SUBMETERF14—G
MI'VI-I-CS11 Subincterhig Form 1tev. 11.8.202 Ldoex
MASSACU USETTS DEPARTMENT OF PUBLIC I-JEALTI-11
SUBMETERING OF WATER AND SEWER CERTIFICATION FORM
*ln accordance with M,('jj_ c, 186, §22 and 105 CMR 41 0.0ft Minima Standards of Fitness for 1--lurnan I labitation
(State Sanitary Code Chapter 11), the following dwelling Utlit is eligible for the imposition on the tenants ofa charge for
water and/or sewer set-vice.
PROPERTY INFORMATION
Address: 511 Sutton St.
Ofunits it,) bid(, 44
PJ!LLAr&ovgr MA
EQUIPMENT INSI',Al"i,—rvFoWIN—F,O—IZ—MA—T—'I--ON-
105(.'MR 410.00o re(p,tires tile lstalhition ofwaterconservation devases prior to a dwelling unit be eligible fear the;
in"Position oil tenants ofa charge for water and/or ,sewer, 'I'lle devices 11lost meet tile following specifications:
SlIciwerlicads with maxinjoly, flow rate not to exceed 2 ' 91111011S Per Rliluft(2.5 gpin)
FaLICCUS With maxirnUrn flow rate not to excee(I 2 211()gallons per minute.(12 gpni)
Ultra-low flush water closets(toilets)not to exceed 6,10
ga I tons per fl USil(I A gp 1)
The SUbirletering equipment LISCd to measLire the qw.nitity of water Used for each dwelling unit and common area must
nice(,the standards of accuracy and testing ofthe Aincricart Water Works Association Or similar accredited association,
A licensed plumber must instal I the water closets and submetering equipment.
Submetering equipment inForniation: _., NextSolutions M201C
Manufacturer — Model 4
Licensed 11 urn ber Certifiem—tion ---
Michael W Harrison Master 16101 _ 3/11/2023
Print Name of Plurnber Uccnsc Date
I certify that(check a]I that apply):
Rl have installed the submetering eqUipluent listed above in accordance with accepted 1')lUrnbing standards,
0 1 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 POrrnit issued by the city/town, if required, is attached.
El Dwelling unit is connected directly to a '"noter installed by a water company and, in accordance with
M.G.L, . c. 186, §22(p),does not require the installation of a SUbrnetCl%
Signed under the pains at'id penalties of perjury,
------ c of Ucensed PlUrnber
Property Owner Certification
I certify that: (1)'['his dwelling unit is eligible for the imposition on the tenants of a charge for Water and/or sewer usage
Ina
will, the water sub"110tering law(MG1.,c. 186, §22); )III
showerficads, fGIucets, alld wale,,closets in
-vation devices that 1-nect the stan(hirds spcci11e(,J above;(3)The Water subm' clor rneaSUring
dwelling unit',are water consci this
tile use ofwater in the dwelling unit was installed by a licensed PlUrnberand is in compliance with the s tanctards
speci-.`ied above,or water meter MCMIJ-ing the use()f Watel-irl this dwelling unit was installed by a"watercornpany"
as defined in M.G.[_ c. 186, §22� (4)The water meter or,sublnetcf�InCaSUreS the water usage eXCIUSiVC to this unit; (5) 1
Nvill provide to tile lenants ofthis dwelling unit, prior to OCCUpancy,a written rental agreement lhat clearly provides for the
separate charging ofwater and/or sc\ver service, and a copy ofthis eertification 6orm; (6)Tlintall information inClUded 01l
this certification is true.and accurate to the best,of toy JUMIAlledge,
SigoOd under tile 1)airls and penalties offter
.Jury,
utton Street Redevelopment, LLC, by its Project Manager
Print Narne of 0 net'
au. "�fOwner
Date
TI-0 property has been transferred to owner above rand tile ,nit Date
Submitted
Lrernains in corn with QIC requirements (�)rwij_ c. 186 2 [)atc:
to B014:
*THIS FORM MUSTBIE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBMETERING
M1011-CSI'l Soblnetcring Forni Rev. 1 1,8.202 1,(Iocx
MASSACHUSE17S DEPARTNtEN'll' OF PUBIAC HEAUFH
SUBM'EI'ERING, 01?WA'FER AND SEWER CE.WFIFICA110N FORM
*In accordance with M.G.I,. c. 186, §22and 10.5CMR410.000: Minima Standards of fitness tiarl-lUnlan Flabitation
(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.
PROPER'FY INF'ORMATION
Address: 511 Sutton St. Unit 1�, 0.7 Of units in Bldg. 44
-L'IYD��'�Y_n�- NQdh—AndQ-V—(,r .---...-_. MA Zip Code: 01 84S
EQUIPMENIANSTALLATION Nprio
105 CMR 410,000 require'.,,the installation ofwater catidevicer to a dwelling unit becoming eligible for the
imposition on tenants of a charge for water and/or,sewer. 'Flit devices Trust meet the fiollowing speci fi cati oils:
Showerheads with niaxilnUIll flow rate not to exceed 2 �!,gallons per rniflUtC(2.5 gpin)
Faucets with inaxit-nuin flow rate riot,to exceed 2 2110 gallons per minute(2.2 gpill)
Ultra-low 11U.Sh water ctosets(toilets) not to exceed 1 o/10 gall0flS Per flush (1.6 gpf)
The subuletering C(Itlipillent used to nleaAire the quantity OfWatel'Used'for each dwelling unit and conirtion area]Trust
Jilect the standards OfiACCU111CY and testing of the American Water Works Association or similar accredited association,
A licensed phlIllber MUS( ilislalf tile water closets and SlIbroOrCrilIg eClUitmient.
SLII)I))Cterillg equipment iril'oi°ii,ial.ion: 'Iq'L'21c,10611L' S 1u110ns M201 C
MallUl'aCtUrer Model
Licensed Plu C mber ertification
__'Michael W Harrison .-Master '161Lit 3/11/2023
Print Name 01'PlUniber License 4 Date
I certify that.(check all that apply):
W1 have installed the subinetering equipment listed above in accordance with accepted plumbing standards,
[d I have installed one or more water closets not exceeding 1.6 gallons per flush.
Determined that existing writer-closets do not.exceed 1.6 gal lons per flush.
ThC plumbing permit issued by tile city/town, if'reqrlircd, is aturc lied.
Dwelling unit is connected directly to a illcLer installed by a.water company and, in accordance with
M.G.1,- c. 186, § 22(p),does riot require tile installation of a subiticter,
Signed Under tile pains and penalties of perjury,
...... _Sj�iature of Ucensed Pluniber
Property Owner Certification
y that:(I)TIlis dwellint.;unit is eligible flor the inipositiol,or]tile tcolants of a charge for water and/or sewer usage
in accordance with tile Water SUbonctering law(MG1.,c. 186, §22); (2)All showerheads, faucets, and water closets in this
dwelling ullit are water conservation devices that rneet tile standards specified above;(3)The water submeter measuring
tile use of*water it)the(I\Vcllitlg Unit wars installed by a licensed plurnber and. is in compliance with the standards
specified above,or the water meter nicasuring the use orwater in this dwelling unit was installed by a"water company'"
as defined in M.G1,.c, 186, §22; (4)'Fhe water meter or submeter nicasurcs tire water usage CXCILISiVe to this unit; (5) 1
will provide to the tenants of this dwelling unit, prior to occupancy,as written rental agreernerit that clearly provides for the
separate charging of waler and/or sewer set-vice,arld it copy of this certification fbrin; (6)'I'llat all information included on
this certification is tRIc acid accurate to the best ofilly knowledge.
Signeofirroder the pains and peyraltic,4 ofperj,J it ry,
Sutton Street Redevelopment, LLC, by its Project Manager
Print Nanic of Owner § Date
jgLl'�IWT of Owner
Date
I'lle Property has been translerred to owncrlbove a tile ll(] unit
renlaini, incompliance with fit Submitted
—0 IL(I!��1 �11crtts of M.G 1- C. -t-,o 1301-1:
"THIS FORM_�AUST BE FILED V11lTH_"flop L0C_ALB 0ARD OF HEALTH PRIOR TO INITIATING SUBMETE Ful�_G_,
MD111.1-CS11 SUI)DICtel-irIg Form Rev, 11.8202 JA10CX
MASSACHUSETTS DEPARTMENT OF PUBLIC HEAI�TH
SUBME"m RING OF WATER AND SEWER CERTIFICATION FORM
"In accordance with M,(U. c. 186, §22and 105 CIVIR 410.000: Minimunr Standards ofFitness for 1--lurriall Habitation
(State Sanitary Code Chapter 11),the following dwelling unit is eligible for the imposition oil the tenants of a charge for
wat,�-r and/or,sewerservice.
PROPEMTY INFORMATION
ddress: 511 Sutton St. t.trait 2) )
Of Uni
MA -Ji Cod
EQUIPMENTINSTALL,ATION INFORMATIOIN
105 CN/IR 410.000 requires the installation ofwaterconservation devices prior to a dwelling unit becoming eligible Liar the:
im-,position on tenants ofa chai-e 4�or waterand/or sewer.111C&ViCeS Must ITICCt the following specifications:
`shower heads with maximurn flow rate not to exceed 2 ',,,gallons per MitILItC(2.5 gpni)
Faucets with rriaximurn flow rate not to exceed 2 "/'()gallons per minute(12 gprn)
Ultra-low flush water closets(toilets) not to exceed 1 6/10 9,11lons per-flush(1.6 gpt)
The subineteri rig eCJUipn1Cnt Used to 111CaSUre(Ile(IL1,111tity Of�Vatcr used for each dwelling unit and common area most
meet the standards ol'aCGUracy and testing of the Arnerican Water Works Association or similar accredited association.
A licensed I)lUmber must install the water closets and Atbimtcring eqtlif)[IlCrit.
Subtrictering eqUipillent inficirmation: Next Centu ubrneterin� Solutiq�ns M201 C
MaimfilCftlrer Model #
Ueensed Plumber Certitlelition
Michael W Harrison Master 16101 3/11/2023
Print NalTle 01TIntriber License 11 Date
I certify that(check all that apply):
901 have installed the submetering eqUil)JI1011t listed above in accordance with accepted plumbing standards.
111 have installed one or more,water closets not exceeding 1.6 gallons per 11U.Sh.
Determined that existing water closets do not exceed 1.6 gallons per flush.
The plumbing permit issued by the CitY/tOW11, ifl-eClUired, is attached.
E] Dwelling unit is connected directly to as meter installed by a water cornpany and, in accordance with
M,GJ, . c. 186, §22(p),does not require the installation of a subilleter.
Signed under the pains and penalties of per'JUI-Y,
S aatuae of Licensed Plumber
Property Owner Certificatioll
I certify that: (1)'rhis dwelling tinit is efigible for file imposition on the tenants of charge for water and/or sewer LlSag
in accordance with the water-subnletcringL�law(MU,c, 186, §22);(2) Ml showerheads,11,111cels,arid water closets in dais
dwHing unit arc water conservation devices that meet tile standards specifieclabove; (3)The water SUbineter measuring
the use of'water in the dwelling unit was installed by as licerised [flUmber arid is in compliance with the standards
specified above, or*1he water meter nicasuring the Use Of Water in this dwelling unit was installed by a."water company"
as defined in KGJ.- c. 186, § 22; (4)"file water meter or,submeter measures the water usage exclusive to this Unit; (5)1
will provide to the tenants of'this dwelling inlit, prior to occupancy,a,written rental agreement that clearly provides for the
separate charging of water and/or sewer service,and,,,)copy ofthis certille'ation form; (6)]"'hat all information included on
this certification is true and accurate to the best,of my knowledge.
Signed under the pains and penalties of'perInry,
LS.gd(�y&p-Mpq�, LLq, by its Project Manager
Print, Narne shalki�rt ----Da—te
I
file property has been transferred to owner above and the unit S I ubmitled
17 c � orX
remains in corrrpjLan�c with the 7c'n—ais, _ —n�j,�q�jiretjicnts of M.(Y.L,. c. 186, §22 Date: to 1301-1:
�THIS FORM MUST BE FILED WITI-f 7-1—M L0r-."A—LB0A—R -------a(
D OF 1-1 EAUM PRIOR TO IN]"TIATING SUBMETERING
rVIDPI-1-CSI)SUbrnetering Forin Rev. 11.8.202 Ldocx
MASSA(;HUSE'rrs DEPARTMENT OF PUBLIC HEALTH
SUBMETERING OF WATER AND SEWER CER,r]FICAT ION FORM
*In accordance with c. 186, § 22 and 105 CMR 4 10,000: Minimum Standards offitnessfor Hunian Habitation
(State Sanitary Code Chapler 11),the following dwelling unit is eligible for the imposition on the tenants of a charge for
water and/or sewer servic.c.
PROPERTY INFORMATION
Address: 511 Sutttf
on St, Unit 11 4 Of Un i ts in blot*. 44
Sityfl`own: North Andover MA Zip C ode:_QJ_8A,5___._
EQUIPMENTINSTAIAXI-ION INFORMATION
105 CMR 410.000 requires the installation of water conservation devices prior to dwelling unit becoming eligible for the
imposition on tenants of',,.i charge for water and/or sewer.The devices must meet the JbIlowing specifications:
Showerheads with niaxinium flow rate not to exceed 2 �gallons per minute(2.5 glim)
Faricets with maxiiinini flow rate not to exceed 2 2110 gallons per minute(2.2 gpin)
Ultra-low flush water closets(toilets) not to exece(l 1 61lO gallons per flush(1.6 gpl)
The submetering equilinient used to rneasure the quantity of,water used Im-each dwelling snit and common area must
triect the standards ofaCCUr8cy and testing of the American Water Works Association orsinii lar accredited association.
A licensed plumber must install the water closets and submetering equipment.
Submetering C(JUipnlCllt fill*01-11lation: Next Ccntu §u
M201 C
Manufacturer Model
Licensed Plumber Certification
Michael W Harrison Master 16101 3/11/2023
Print Name of I'llumber License;4 Date
I certify that(check all that apply):
no I have installed the stibirictering equipment listed above in accordance with accepted plumbing standards,
1 have installed one or more water closets not exceedii-q.41 1.6 gallons per flush.
Determined that existing water closets do not exceed 1.6 gallons per flush..
Eel The PlUrnbing permit issued by the city/town, if required, is attached,
El Dwelling unit is connected directly to a meter installed by a water company and, in accordance with
M.G.1, . c. 186, § 22(p), does not require the installation of a,subilieter.
Signed UndCr tll(,'pains and penalties Of JMJUry, 7W
Signature of Licensed Plurnber
Property Owner Certification
I certify that. (1)This dwellillg Unit is eligible for(fie imposition on the tenants ofa charge for water and/or sewer usage
in accordance with the water submetering law('MCI.,c. 186, §22); (2)All showerlicads,filLICOts,and water closets in this
dwelling unit are water conservation devices that niect the standards specified above; (3)"nice watersubmeter nicaAlrillg
the USO of'\,Yalci-in the dwelling Unit was installed by a license(] I)ILIMber and is in compliance with the standards
specified above,or(lie water meter nicasuring the use of'water in this dwelling unit was installed,by a"water company"
as defined in M.GJ— c. 186, § 22; (4)The water meter or subilieter measures the water usage OXCILISiVe to this unit; (5) 1
will provide to the tenants ofthis dMlling Unit,Pri0rtO occupancy,a written rcntal agreement that clearly provides for the
separate charging of"water and/or sewer scrvice,and a copy of this certification forma;(6),rhat all information included oil
this certification is true and accurate to the be,,St of my knowledge.
Signed tinder the pains and penalties of'perjury,
Sutton Street Redevelopment, LLC, by its Project Manager
Print Naine of Owner Signature of Owner
Date
Date
property has beer) transfIct-rcd to owner above and the unit SUbinitted
remains in cqtp li �e r�quirenlents of M.G,L—.�I. I LO, .2 Date: to 1301-4:
compliance��iL_L_
*THIS FORM MUST"BE FILED INITH THE LOCAL BOARD OF HEALTH PRIOR TO INITIATING SUBM—ETE—RING
I
NIDPI J-("SP Subniclerin,.!,Form Rev, 11.8202 kdoex
MASSACHUSETTS DEPARTMENT OF PUBIAC fIEALTH
SUBmETERING OF WATER AND SEWER CER'r]FICATION FORM
*In accordance with M.(j,L,, c. 186, 4 22 and 105 C'MIZ 410.000: Minim UM Standards of Fitness Cor Human Habitation
(Statz Sanitary Code Chapter 11),the following dwelling unit is eligible flor the imposition oil the tenants of'a charge for
water and/or sewer service.
PROPERTY IN FORMATION
-Address: 511 Sutton St. Unit# -L It Of units in bidg, 44
-Citv/"f'owri: North Andover MA Z i 1)Code:
EQUIPMENTINSTALLATION INFORMATION
105 CW 410.000 requires the installation of water conservation devices prior toti dwelling unit.becoming eligible for the
imposition oil tenants ofacharge tbr water and/or.,ewer. Tire devices must meet:the following specifications:
Showerheads with triaxiniurn flow rate not to exceed 2 gallons per minute(2.5 gprn)
Faucets with maximum flow rate not to exceed 2 2/10 gallons per minute(2.2 gprn)
Ultra-low flush water closets (toilets)not to exceed I W10 gallons per]Irish (I.6 gpl')
The submetering equipment used to fl1CaSUrC,tile quantity of water used for each clowellirig unit and common area 111USt
rnect the standards of accuracy and testing of the Arnerican Water Works Association or similar accredited association,
A licensed plurriber must install the water closets and SUbruCtCring equipment.
Subtrictering equipment inl'onnatiow "(Next Century Subtrieteria! Solutions M201C
Mari Lifiacturer Model#
.......... —------
Licensed Plum ber Certification
Michael W Flardson Master 16101 3/11/2023
Print Natne of Number I.,i cel Ise-11 Date
I certify
that(chQck all that apply):
WI have installed the subtrietering equipment listed above in accordance with,accepted Plumbing standards.
" 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.
1�
Eel Tile plumbing permit issued by the city/town, if required, is attached.
F-1 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 SUbilleter.
Signed under the pains and penalties of'perjury,
_Si nature of Licensed Plumber
Property Owner Certification
I certify that: (I)This dwelling unit is eligible for the imposition can the tenants of a charge J�or water and/or sewer usage
in accordance with the watersubinetering law(MGL,c, 186, §22); (2) All showerhmids, tailcels,and water closets in this
dwelling unit are water conservation devices that meet the standards specifie(i above; (3)'Flic water SUbilleter measuring
the use of water in the dwelling unit was installed by a licensed plumber and is in compliance with the standard,,;
.specified above,or the;water rneter 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)'rhe water meter car subilreter 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 tile
separate charging of water and/or sewer servicc,,alid l copy of thins certification ibrin; (6)'That all iril'onri,tioll
a included on
this certification is true and aCCUrate to the best ot'rny knowledge.
Signed under the pains and penalties of pea
3utton Street Redevelopment, LLC, by its Project Manager
Print Narne of 0wner Signature of'Owner Date Date
❑ I'lic property has been transferred to owner above and the unit Submitted
—remains in cot22121j!!!Ice with the rcqui!�ep tints of KLG.1__,. tL 1_86,_§22 Date: to 13011:
THIS FORM [V11JST BE FILED wrm THE LOCAL BOARD 01' 1-1EALTH PRIOR TO INITIATING SUBMETERING
N4Df'Fl-(,'S1l Subinetering Forin [Zev. 11.8.202 Ldoex
MASS ACHUSETTS DEPAR'll"MENTOF 1"U14 LIC HEALTH
SU13METERIN(; OF WATER AND SEWER CERTIFICAIJON FORM
"'Ili accordance with M.G.L_ c, 186, §22 and 105 CMR 410.000: Millill"IL111-1 Standards of IN for Human Habitation
(State Sanitary Code Chapter 11),the following dwelling unit is eligible for the imposition oil the tenants of charge for
water and/or sewer service.
PRO,PERTY IN FORMATION
Address: 511 Sutton St. lit # (_", -
_#0rUrdt_qinbldg_ 44
MA Zi�)Code: 0
EQUIPMENT IN, ION INFORMATION
105 CMR 41 0=0 RX11.61'eS [Ile installation orwater conservation devices prior to a dwelling unit becoming eligible for the
imposition on tenants ol'a chari.,w for water and/or sewer.The devi(,'Os Must rucct tile following specifications:
Shows rheads with inaxillinul flow rate not to exceed 2 "',gallons per rninute(2.5 gprn)
l'allcets with "'TaxinlLflo (low rate not to exceed 2 2/10 9,111011S per minute,(2.2 gpin)
I.Atril-low flush water CJoSCtS(toilets) lot to exceed I W10
gal Ions per flush(1.6 gpl)
'file submetering equipment use(l 1,o ruca18til-C the(JUantity ofwater used fiv each dwelling unit.and C01111-non area antst
"lect (he standards ofaccuracy and testing of'the American Water Works Association or similaraccredited association.
A licensed plumber inust install the Witter closets and subitictering equipillent.
M201 C
Marnifiacturer Model
Licensed Plumber Cerfification
Michael W Harrison Master '16101 3/11/2023
Print Name of'Pluniber License Date
I Celli 1y that(check al I that.
apply):
E011 have installed the SUbriletering equipment listed above in accordance with accepted plumbing standards.
I have installed one or more Watcl-closets nol,exceeding 1.6 gallons per fILIS11.
Detert-nined that existing water closets do not exceed 1.6 gallons per flush.
Do The plumbing Pel'"I't issued by the city/town, it'required, is attached,
EJ Dwelling unit is connected directly to a meter installed by a water cornpany an(], in accordance with
M.G,L . c. 186, §22(p),does not recloire tile insta'llation,ofa submetcr.
Signed under tile pains and penalties 01'perJiUrY,
Sjgn!tturq�of Licensed Plumber
certil' Piroperty Ownel-Ceirtirle:1tion
y(,flat: (I)This dwelling unit is Clij,.1,ible l'or (11c irilposition oil the tenants ol'a charge for water and/or sewer usage
in accordance will, tile water SUbInCtOring Ja JW(M(;J_,C. 186, §22);(2) All showcrheads, faucets, and water closets it, this dwelling unit are water conservation devices that Illect the standards specified above;(3)The water sUbilleter uleaSUring
the use of water in UIC(INVCHing unit, was installed by as licensed plumber and is ill compliance with the Standards
specified above,or tflc water,inel'er measuring the use of wajcr ill this dwelling unit was installed by a"water company"
as defined in M.G.J,_c, 186, § 22; (4)'I'lie, water tnetcr or subilieter measures the water usage CXClUS'iVC,to this Unit;(5 1
will provide to(lie teriants ofthis dwel"t'19 unit, 1)1-iOl'to OCCUPWICY, a written rental agreement that clearly provides for the
separate Charging of water at sewer set-vice, and a copy ofthis certil teat i0i i 11orill; (6)That all inlorniation included on,
this certification is true all(]accurate to tile best of-'rny knowledge,
Signed Under the pains and penalties 0l'pCrjLU-.Y,
Sutton Street Redevelopment, LLC, by its Project Manager
0w'oer
')iz"tu.'-e of Owner
Cl Il"he property has been transferred to owner above and the unit Date
_!:(�,rnains c with theSubmitted
M,G.L. c, 186, �V2 Date: to 1301-1:
*THIS rORRO IVILIST BE FILED WITH THE, i70&A_L136A1i D_0F H-EALTH PRI011TO INITIATING SUB METERING
MDPlJ-CSP Submeterilig Forin Rev. 11.8,202 1.doex
l"ASSACtitisi,rrS DE13ARrMEN'1' 01;' PI.JBI,I(' IIEAI.,']"I-I
SUBMETERING' OF WATEIZ AND SEWER CERTI F1 CATION FORJU
*III accordance with M.G.L.C. 186, §22 and 105 CMR 41 U00: Minill-IL1111 Standards of itness 6or I lurnan Habitation
(State Sanitary Code Chapter I]), the following dwelling unit is ei4ziblc for the imposition on the tenants of a charge for
water and/or sewer service,
PROPERry INFORMATION
J 0 LT 1
.4
Address: 511 Sutton St. Unit 11, 9 Of units in bldg, 4
_gjtfVq�L . North Andover MA -Code:p� -
EQUIPMENTINSTALLATION INFORMATION
105:"MR 410.000 requires the installation of water conservation devices prior toa dwellin-gy unit becoming eligible for the
imposition on tenants of charge For water and/or sewer-"The devvices must meet the following sl:)ecifications:
Showerheads with maximum flow rate not to exceed 2 "'-gallons per minute(2.5 gl)m)
Faucets with maximum flow Rite not to exceed 2 2/10 gallons per rninute(2.2 gpm)
1.11tra-10W JIUSII water closets(110iletS)not to"Ceed 1 6/10 gallons per flush(1.6 gl)f)
The subinetering eClUipolUlt Used to lfle,'isure the qUalltity ol'ivater riled for cach dwelling linit.and comt-noll area muss
imc--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 SUbi-netering eqUipulClIt.
SUbmetering,eqUiprnent nil'onnation: Next Centut 'S brne ri T Solutions
"Y
te M201C
Marud'acturer Model #
Licensed Plumber Certification
Michael W Harrison Master 16101 3/11/2023
Print Name Or PlUrnber License It Date
t CUlfify that(cheek titl 11tal.apply):
EQ-11 have installed the subinetering C(jLliPIllCut 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.
gThe plumbing permit issued by the city/town, if`required, is attached.
El Dwetiing unit is connected directly to meter installed by as water company and, in accordance with
M.GL . c. 186, §22(p),does not require the installation of'a subrileter.
-
Sigrcd under the pains and penalties oil'per W jury, ;7YaA4.ed.&,�r,
-Si nature of Licensed Plumber
fir opellqy Owner Cerfification
I certify that:(1)This dwelling unit is eligible for the imposition on the tenants of charge fior water and/or sewer usage
in accordance with the water subriletering law(MGL c. 186, §22); (2)All showerheads, ffittects,and water closets in this
dwelling unit are water conservation devices that ineet the standards specified above;(3)The water SUbirieter measuring
the vise cat'waiter in the dwelting unit,was installed by to licensed plumber and is in compliance with the standards
C,
specifited above, or the water meter rneasurilig the use ofwater in this dwelling unit was installed by a,"water company"
as defined in M.G.L.c, 186, §22; (4)The water ineter or SUbilneter nicasUIVS the water usage CXclUSiVC to this Unit; (5) f
wilt provide to the tenants of this dwelling unit,prior to occupancy,,I written rental agreernont,fliat clearly provides for the
separate charging of water and/or sewer service,aincl a copy of this certification form-, (6)'neat.all information included on
this certifluition is true all(]accurate to the best of knowledge,
Signed under the pains and penalties fper-j lily,
Sutton Street Redevelopment LLC by its Proiect Maq_qc
�ra re c
Print Name of Owner S, fowner Date
Date
0 °1"he property has been transRA-red(�O 0WIler above sand the unit Submitted
reinains in compliance with the requirements of KG.L c,_L��), 2'2 to BOH:
*THIS FORM UST BE RUED WITH THE LOCAL BOARD W-AlEAUTH PRIOR TO INITIATING SUBMETERING
M D131-1-CS11 Subinetering Form Rev. 11 X202 1 Aocx
MASSACHUSE'"rns DEJARTMENTOF PUBLIC HEALTH
SUBMETERING OF WATER,AND SEWER CEWFIFICATiON FOIZM
*In accordance with M.G.L.c. 186, §22 and 105 CMR 4 100)0: Millinlurn Standards of Fitness f'Or I lUrnall Ulabitation
(State Sanitary Code Chapter 11), the following dwelling unit is eligible for the imposition oil the tenants of a charge for
water and/or sewer service.
PROPERTY INFORMATION
Address: 511 Sutton St.
Unit 44
_C�t /"1"owrl_: No j IIA I— MA Zip Code: nims
EQUJPMENT1Ns'rA1J,A1' oN INFORMATION
105 CIVIR 4.10.000 requires the installation Ofwater Cone d oil devices prior to a dwelling unit becoming eligible for the
imposition oil tenants of charge f6r water and/or sewer.'rbC devices most MCct the following specifications:
Showerhe'ads With nlaxinalm flow rate not to exceed 2 "'gallons per rninute(15 gpnl)
Faucets with maxi In tint flow rale not to cxccc(
* 1 2 2/1'gallons per minute(2.2 gpnl)
1.1It"a-10w IlUsh water ClOSets(toilets) not to exceed I 6M gallons per flUS11 (I.6 gpr)
The SUbmetering eqUiPoWnt erred to nleasurc,the qnantity of water used (bl'CaCh dwelling Unit and corninon area must
rriect the standards of'accUracY and testing ol'the Artlerican Water Works Association or sirnilar accredited association.
A licensed plumber must install the water closets and submetering equipment.
Submetering equipmerit.infiormation: Nex C t entui
Submetering Solutions
M201 C
Mvlanurfia_
cLurci Model
Ueensed Plurnbei-C,'ertification
VV Harrison Master 16101
3/11/2023
Print Narne Of Plumber License Date
I certib, that(check all that apply):
[O:]l have installed the subinctering C(]Llipl)lCllt listed above in accordance with accepted plumbing standards.
I have installed one or more water closets not exceeding 1.6 gallons per 1711,1,911.
Determined that existing water closets do not exceed 1.6 gallons per fInsh.
The plumbing permit issued by the city/town, if required, Isattached.
Dwelling unit:is connected directly to a meter installed by a water company and, in accordance with
M.GJ, . c. 186, 22(p),does not require the installation of a subrileter.
Signed UndCl-the,pains and Penalties OfPCI-JUry,
attire Licensed Plumber
Propell-ty Owner Certification
I certify that: (1)This dwelling unit is clig n i jitli(^t:ctiar)tsol'�ieliai-gefc)i-,A,atet,�,ir)d/orsewei•usige
,ible I,()r tile it posit'i0i 0
in,aGcordance with file water SUbinctering law(NIGil.,e. 186, §22);(2) All showerheads, faucets,and water closets in this
dwelling unit are water conservation devices that meet tile standards specified above;(3)The water SUbmeter measuring
the use of water in the dwelling unit was installed by a licensed plu'llberand, is in compliance with the standards
specified above,or the water,meter measuring;file use of writer in this dwelling unit was installed by a"water company"
as defilled in M.G.1-c. 186, § 22; (4)Tlic water meter or submetcl,mcast-WeS the water usage eXCILISiVC to this unit; (5) 1
will provide to the tellants()fthis dwelling, unit, prior to occupancy,as written rental agreement that clearly provides for the
separate charging of'water and/or sewer service,and a copy of this certification form; (6)Thal all information included on
this certification is true and accurate to the best oftny knowledge,
Signed Under the pains and penalties ol'perjury,
c
1.utton Street Redeveloriment, LLC, by its Project Manager
1110 Or Owner Signature of Owner Date
'I'lic property has been transferred to owner above and the unit Submittedre mains in c(LtpL)jiance�yi! clits of M.G,I. L., 186, §21. [)ate: o f 3()_1.
*TKIS FORM MUST BE gall ED WITH THE WCAL BOARD OF HEArl"H PRIOR 1'0' INITIATING SUBMETERING
MD11[f-CS11 Submetcring Forin Rev. 11.8.202 Ldocx
MASSACHUSEl"I'S DEPAWMI'Wr OF PUBLIC HEAUH
SUBMEl"'ER11SIG 0FWA,rER AND SFWER CERTWICA"HON FORM'
*Ili accordance with M.Ci.L. c. 186, §22 ,and 105(WR 4 10.000: Minirriurn Standards of Fitness fOr I lUrnan Flabitation
(State Sanitary Code Chapter 11), the following dwelling unit is eligible for the imposition on the tenants of acharge for
water and/or sewer service.
PR011'TF,RTV INFORMATION
Address: 511 SLItton St, it 9 Z) 0 �)
#Of Linits in bldg. !IA_
g�
!�J er MA
EQtJIP1Wf�,-I;FiINS—'T'ALI,A'I'ION I1 _F_0R_1WA'F10N
10.5 CMR 410.000 requires the installation ofwatcr Conservation devices prior to as dwelling unit becoming eligible rorthe
ini.-position on tenants ol'a charge for water and/or sewer. The devices must rneet the Following specifications:
Showerheads with maxin'll,lin flow rate not to exceed 2 /1 g0JIMIS pCr lninUtC(2.5 gprn)
Faucets with maxiinurn flow I-,Itc not to exceed 2 z,"()gallons per minute(2.2 gpffl)
Ultra-low 111,01 water closets(toilets)not to exceed I W10 gallons per 11USh (1.6 gpf)
The Subl-rictering CCILlipill(Alt Used to 11MISUre the(JUantily OfWO(er used for cacti dwelling unit and common area 111U.st
meet the standards ofaccuracy and testing ofthe Aawrican Water Works Association or shoilar accredited association.
A liCel1SCd plumber ITILISt it'lStall the water clo sets and subritewring equipment.
SUbinetering equipment information: 'Next CentLn M201 C
—Manufacturer Model #
Ueensed Plumber Certification
Michael W Harrison Master 16101
3/11/2023
Print Nance:of'11hirnber License# Date
I certify that('check all that api.)Iy):
DI 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 1111C CitY/tOW11, iflWILlired, i's attached.
Dwelling unit is connected directly toa meter installed by as water company and, in accordance with
M.G.L . c. 186, § 22(p),(toes not,require tile installation Ofa SUbmeter.
Signed under the pains and penalties of pcljLlry,
t lnzi�t ic of Licensed Plumber
P"OPe"ItY Owner C'erfification
I certify that: (I)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 hiw(MG il,c. 186, §22); (2)All showerheads, faucets, and water closets in this
(1WC11ii1g Unit are water conservation devices that meet the st.�Iltdarck specified above;(3)'Fhe water subrneter measuring
tile use ofwater in the dwelling unk was, installed by licensed Plumber and is in compliance with the standards
specified above,or the water me-rearVnCaStlrilIg tile use 0f'WatCr in this dwelling unit was installed by 8,"water company"
as defined in KG1. e. 186, � 22; (4)The water meter or SUbmetcr triwisures file water usage OXCILISiVC to this 1,111it., (5) 1
will provide to the tenants of jfli,;dwelling unit, prior to occupancy,a written rental agreement that clearly provides for-the
separate charging Ofwaterand/or sewerservice, and a copy ofthis certification forrit; (6)Thal all infionriation included oil
this zertification is true and accurate to the best,ofiny knowledge,
Signed UndCl-the pairlS and penalties cif pcKiltry,
>utton Street Redevelopment, LLC, by its Project Manager 44
Print nature er Date
E3 The property has been transferred to owner above and tile nnit Date
Submitted
rernains in c !h the rcqj�=js oil' M.G.L_ c. 186, §22 Date:nLiE���_ to 1301-1:
*THIS FORM MUST BE FILED wrm"T1 ,I'E LOCAL,BOARD OF 1-1 Uz-ALTH FRIOR TO INITIATING SUBIVIi—TERING
MDPH-CSP Subirietering I-orni 1iev, H.8.202 1.docx
MASSA('-11 U SETTS DEPARTMENT OF 1"LIBLAC IJEAI,TH
SUBMEITRING OF WATEI� AND SEWE'R CETVIPIFICATION FORM
*luaccOrdancc with M,GJ- c. 186, §22and 105 CMR 410.000: Minirru.1111 Standards off7itness for f lunlan Habitation
(State Sanitary Code Chapter 11),tile following dwelling unit is eligible 4`61'tile imposition oil the tenants of a charge for
water and/or sewer service.
PROPERTY INFORMATION
Address: 511 Sutton St. it 9, -)Idg. 44 Of units in I
, - 01 46
-Li.!Y—fFOY��I.-RQL111.8n dove r MA i
EQUIPMENTINSTAL1,ATION INFORMATION
105 CMR 410-000 require.* the installation ofWater Conservation devices prior to a dwelling unit becoming clig I tile
too,water and/or sewer. The devices m specifications:
usl mect.the f011owing
imposition Oil Loll an Ls ol'a c�harge ible 16-
ShOw0rhCadS With IllaXillftirn flow rate.not to excee,(I 2 °`gallons per minute(2.5 gpill)
Faucets With ntaximurn I'low rate not to exceed 2 2110 90,11011s per minute(2,2 gprri)
Ultra-fow flush Water Closets(toilets)not to exceed 1 6/10
gallons per flush (1.6 gpf)
Thesubmetering equipollent used to 111011SUrC tile quantity earl water used for each dwelling unit and common area must
meet the standards of accuracy and testing of the AITIOlican Water Works Association or similar accredited association.
A liCCIISCd l')lUVubCrl)lUSt ilISU'll tile water closets wand subliletering equipment.
Submetering equipment infiormation: Next Centut
01uti(TI-s—.- M201 C
MaMlfl'CtUrer Model #
Ilice"Iled—PItnnbex'-Certificatioll
Master 16101 3/11/2023
Print Narne Of Number I.,icense 1-1 Date
I certify that(check all that apply):
Rill 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.
Ficternlined that existing waiter-closets(10 not exceed 1.6 gallons per flush.
501 ]"lic plumbing ponnit issued by the city/town, ifrequired, is attached,
El Dwelling unit is connected directly to a meter installed by as water company and, in accordance with
M-Gl-- c. 186, §22(p),does not re(ILlif-C the installation of a subrileter.
Sigued under tile pains all(]penalties Of POIJUI-Y,
Si rr�ature of L,icenx-d Number
I certil' Property owlier C(,l-tifiefIlioll, ...
y that: (OThis dwelling unit,is eligible for file fillposi(ion 01) the te'nants ofa charge for water and/or sower usage
in accordance with the subDIctcriug law(MCJL C. 186, §22); (2) All Showerheads, RIUCCtS,al)(I Water Closets in dais.
dwc[lillg Ullit We Miter conservation devices that Ineet,tile standards specified above;(3)The water SUbInCteryneaSUring
the use of water in the dwelling Unit was installed by a licensed Plumber and is in compliallco with the standards
specified above,Or tile wager slitter measuring tile use of water in this dwellitig Ullit was installed by a,"water company"
as defined in M.Gu- c 186, §212, (4)The water natter or SLIbmeter Measures the water usage exclusive to this nnit; (5) 1
will provide to the tellants ofthis dwelling unit, prior to occupancy,a written rental agreement that clearly provides for tile
separate charging ofwater and/or sewer se�rvicclind a copy OFthis certification fiorrn; (6)Thatall information included oil
this certification is true andacCUrate to the best Of my knowledge.
Signed Under the pains and JVllaltiCS OfpC;JUrY,
Sutton Street Redevelopment, l-l-C, by its Project Manager
Print Name of Owner
Si011atUrC OfOWIler
Date
I'lle property has been transferred to owner above Land the Unit Submitted
remains in con I
Tliallcc with tlI ts(4, M.G.1". c� I late_: to 13011:
_��(S
,P, ��, 2
THIS FORM ivius,r BE FILED WITH THE LOCAL BOARD OF HEALNH PRIOR TO INITIATING SUBMETERFN—G
MDPI-l-CSP Submetering Ferrari Rev, 11.8,202 1.(Io(;x
MASSACHUSETTS DEPAR1'MEN'F0FPIJBLIC HEALTH
SU13METERING OF WATER AND SEWER C'ERTIFICATION FORM
*In accordance with M.G.L.c. 186, §22 and 105 (;MR 410.000: Minimum Standards offitness for Human Habitation
(State Sanitary Code Chapter 11),the hallowing;dwelling Unit is eligible for the imposition on the tenants of a charge for
water and/or sewer service.
PROPF,RTY INFORMATION
Address: 511 Sutton St. Unit it
10:> H Of units in bldg. 44
-f�tv/�Fo n: North Andover MA I z!- "-"e- -
EQUIPMENT INSTAI,LATION INFORMATION
105 CMR 410,000 requires the installation ofwater conservation devices prior to a dwelling unit becorning eligible for the
imposition on tenants ofa charge f6r water and/or sewer.The devices must meet tile hallowing Specifications:
ShowerheadsWith MaXinIllol flow rate not to exceed 2 ",gallons per minute(15 gprn)
F'aucets with niaxitnurn flow rate not to exceed 2 per minute,(22 gpin)
Ultra-low flush water closets(toilets)not to exceed 1 610 gallons per flush(I k gpf:)
The subn-ictering e(JUipilient used to measure tile quantity of water used R)r each dwelling unit and common area MUSt
meet the standards ofaccuracy and testing ol'the American Water Works Association or similar accredited association.
A HCCnSed plUrnber Most install (lie water closets iAlld srrlrrarCtc,rirag C(JLJpll1Cnt.
SUbIlletering equipme-nt int'onnation: Next Century Sublrleieliqg-§,o ntrtrls M201 C
Mal1UfhCt1JrCr Model -11
Licensed Plumber Certirication
Michael W Harrison Master 16101 3/11/2023
Print Name of Plumber License# Date
I certify that(check all that,apply):
Do❑I have installed the subinctering equipment listed above in accordance with accepted plumbing;standards.
J1 I have installed one or more water closets not exceeding 1.6 gallons per flush.
FO Determined that existing water closets do not exceed 1.6 gallons,per flush.
[-el-'he plumbing permit iSSLled by the city/town, if required, is attachcd-
❑ Dwelling Unit is connected directly to a meter installed by a water company and, in accordance with
M.G.L .c. 186, §22(p),(foes not require the installation ofa submeter.
Signed under the pains and penalties of'perlury,
at�rc of Licensed Number
Properly Owner Certificliti()n
I certfl'y that: (i) 'rhis dwelling unit is eligible for the iniposition on tile tenants of charge for water and/or seWCI'Llsage
it) 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)Tlle water subineter meaStIrill"
the use ofwater in [lie dwelling unit was installed by as licensed plurnber and is in compliance with the standards L�
specified above,or the water meter 111CaSUrilIg ill(,use ofwater in this dwelling unit was installed by a"water company"
as defined in M.65.1- c. 186, § 22; water meter or subrnmer measures the water Usage eXCIL[Sive to this Unit; (5)1
will provide to the tenants of this dwelling' ill lit, prior to occupancy, a written rental agreement that clearly provides for the
sepamte charging of water and/or sewer service, all(,]a copy ofthis certification fibrin; (6) That all inforn"IcItiOn included on
this certification is ll-LIC and accurate to the best of'my knowledge.
Sig nz-d Under the pains and penalties of per'
.Jury,
Sutton Street Redevelopment, l-l-C, by its Project Manager
Print Name of0wl)Cr
Date
Date
Hie property has been transferred to owner above and tile unit Submitted
rernams in compliance with the re m tirempnio nf M Gl- c. 18�,, §L22 Date:__ to 1301-1:
*71-11S FORM MUST BE FILED wrm TI-1E LOCAL,BOARD OF HEALTH PRIOR TO INITIATING SUBMETERING
MI)PH-CSI)Sulinietering F'orni Rev. 11.8.2021.doex
MASSACHUSETIFS I)EPARTMEN'r oF PUBLIC' HEALTH
SU13ME'FERINGOF WAI'ER ANI)SEWER CERUFKATION FORM
*In accordance with M.G.1— c. 186, §22and 105 CMK 410.000: Minirralin Standa.rds of"Fitness lor Huilian Habitation
(State Sanitary Code Chapter 11), the l'ollowing dwelling unit is eligible for the imposition on the tenants ol'a charge Ibr
water and/or sewer service,
PROPEWIN INFORMATION
Address: 511 Sutton St, Unit:g G 11 A)(0 4 Of units in bldjj. 44
11
MA -iP d�L.
EQI.Jll"MENI' INS'I'ALI-,A,rioi,q INFORMA110N
105('MR 4JO.000 requires the installition of,Nwiter Conservation devices prior to adwelling unit becoming eligible for the
imposition on tenants ofa charge, For vvatcn,and/or sewe'r,"I'lle.devices must meet the foilowing specifications:
Showerheads with maximurn flow rate not to exceed 2 V,gallons per loillUtC(15 gpin)
Faucets with rrkaxiinvni (low rate not to exceed 2")gallons per rninute(12 kprn)
Ultra-low flash water closets(toilets)not.to exceed 1 6/10 gallons per flush (1.6 gpl)
The stibinctering,equipirient used to nicasurc the quantity of'water used for cach dwelling unit and conlraort area must
erect the standards ofaccuracy and te.sting ot'die American Water Works Association or similar accredited association.
A licensed plumber must install the water closets and subinctorhig equipinci%
Submetering equipment int"orniation: — Next Centui SubrnetcrinZ_Solulions M201C
Manufacturer Model 11
Licensed Plumber('ertification
Michael W Harrison Master 16101
Narne ol'Plumber f)a t c
I ceftiCy that(check all that apply):
Foll have installed tile subtrictering 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.
nO ']'Ile plumbing pennit issued by the city/town, if required, is attached.
EJ Dwelfing,! unit is corinecte(i directly to at meter installod by a water company and, in accordance with
M,G.I.., . c. 186, §22(p), does not rocluire tile installation ol'a submeter.
Signed under tile paiws and penalties of perjury,
............. .Signature,of Ucensed Plumber
Property ownex-Ccrifr—kCZ-(;W*
I cerfif'y that:(I)This dweiling unit is eligible for 111c,imposition oil the tenants ot'a charge Tor water and/or sewer usage
in accordance with tile Water SUbtlietering law(MGL c. 186, §22); (2)All showerheads, fbruCd"',and water closets in this
dwelling unil,are water conservation devices that niect the standards specified above; (3)'I'lic water SUbul(Aef measuring
the use,of water in the dwelling,unit was installed by a licensed plumber and is in conip)iance with the standards
specil'ied above, or tile water rileter mcaSUring tile USC ohwncr in this dwelling unit was installed by a"water company"
as define([ in M.G 1—c. 186, § 22; (4)The water meter or subincter measures the waler usage exclusive to this linit; (5) 1
will provide to the tenants ol'thiS dwelling unit, Prior to Occupancy,a written rental agreement that clearly provides For the
separate charging cif"water and/or sewer service, arld as copy oNhis certification fiorrn; (6)'Fhat all information included oil
this certification is true and accurate to the best of'rny knowledge.
Signed Llud(X tll(-IMinS cared I)C11,11tieS()J'perjury,
Sutton Street Redevelopment, LLC, by its Project Manager
Prim,Naaie of Owner 1,,'�kznatttrc orOwner Date
Date
"I'lie property has been transferred to owner above and the unit Submitted
remains in coiLi L)Ii�rnc 1" (31.c. 2 Date: to 13011:
*THIS FORM MUST BE FILED WITH THE LOCAL BOARD OF HEALTH PRIOR,ro INITIATING SUB METERING
MDPI K'Stl Submetcring Form Rcv. 11 X202 I.docx
MASSACIMSET'I'S Dr(,PAR'1'MEN'1 Cl F PUBIAC 1=IEAL.111.
SUBME'rMING OF WAI'ER AND SEWEII CERTIFICA'FION FORAI
*In accordance with M.G.L. c. 186, §22 and 105 CMR 4 10.000: MinitnUrn Standards of Fitness for Hurnan Habitation
(State Sanitary Code Chapter 11),the following dwelling unit is eligible far the imposition oil the tenants ofa charge for
water and/or sewer service.
PROffkTY IN FORMATION
Address: 511 Sutton St. U1 lit 4 1M #0f units inbldgY. 44
S,iLvf k2wn: North Andover MA 2,if)cod(_:.__Q�L__
EQU1PMF,NT1NSTA1,LA,r10N INFORIVIATION
105 CMR,410.000 requires tile installation ofwater conservation devices prior to a dwelling unit becoming eligible for the
imposition oil tenants ofa charge for water rand/or sewer. The devices rnust meet the following specifications:
Showerheads with MaXiInUm flow rate not,to exceed 2 "gallons per Illiffift(2.5 gprn)
Fat,cets with maximum flow rate not to exceed 2 gallons per minute(2.2 gpin)
Ult-a-low flush wnter closets(toilets)not to exceed I gallons per flush (I.6 gpl)
The subilletcring eqUiprIlCat used to measure the quantity of'water used (oar each dwelling unit and cornnion area most
meet tile standards of accuracy dnd testing of tyre American Water Works Association or similar accredited association,
A licensed I)lUrnber 111USt instal] the.Nvater closets rand submetering equipment.
Submetering C(JUip1nCrlt information: Next.(_�,cntiEy ;rrbraaeteritIg Sola,Ltio2is M p M201C
Mail Ufld UrOr Model #
Ucensed Plumber Certification
Michael W Harrison Master 16101 3/11/2023
Prim,Name ol'Plurnber License Date
I ccrtily that(check all that apply):
REI have installed the subirietering equipment listed above in accordance with accepted pluilibing,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.
R The Plumbing permit issued by the city/town, ifirequired, 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 subrileter.
Signed under the pains and penalties of peri ury, w/z
S4LqttZure_ofticensed Rlrnbei�'
Property Owner Certification
I certify that,: (I)This dwelling unit is eligible fior tile imposition oil the tenants ofa charge for water and/or sewer usage
in a-xordaricc with the water submetering law(MG1,c. 186, §22);(2)A]I showerheads, faucets,all([water closets it)this
dwelling unit are, water conservation devices that rneet the standards specified above;(3)Thc water sul)rnetermeaSUring
the:-ise ol'Nwlter in the dwelling unit was installed by a licensed plumber and is in compliance with the standards
specified above,or the water m0ff 11MISUring the USe Of'Water in this dwelling unit,was installed by a"water company"
as defined in M.G.I.—c. 186, § 22-1 (4)'Flic wat(-.,r rnetCr OrSUbilleter 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 t�orni; (6)'rhat all infiormation included oil
this certification is true and accurate to the best ofmy knowledge.
Signed under the pains and penalties of perjury,
Sutton Street Redevelopment, LLC, by its Project Manager
Print Narne of Owner Swriature of"f)wr7€r Date
Date
0 T'he property has been transferred to owner above and the unit Submitted
L remains in compliance with the r ycrl€,nlejq of M.G.l_c. lJ80, §22 Date: to 1301-1:
*THIS FORM MUST BE FILED WITH THE LOCAL ABOARD OF 14EAUH4 PRIOR TO INITIATING SUBMETERING
MDf11l-CSP Submetering Forrii Rev. H X202 1 docx
MASSAC14USETTS D1,J'ARTMENTOF PUBLIC HEALT11
SURMETE'RING OF WATER AND SE WER CERTIFICATION FORM
*In accordance with M.G.J.- c 'I
- 186, §22and 105 C�MR4-10.()OO: Miiii)iiiiiiiSt�itidi-(SI of Fitness for l-lunianHabitation
(State Sanitary Code Chapter 11),the following(IWCIlillg Unit is eligible for tile imposition on tile tenants of a charge for
water and/or sewer service,
PROPERTY INFOIZMATION
Address: 511 Sutton St, Unit #Of units in bldg. 44
-L-'kLI"own:-Rlorth Arldover. MA
z
EQI,Jll"MEN'I' INSI'Al,,]-,AI'ION N�FOWM.A:rION
105 ClAk 4 10-000 requires (110 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 111CU tile tolloWing specifications:
'shower ficads with maximum flow rate not to exceed 2 1/�flailons per minute(2,5 pin)
1�`aticcts with olaximurn flow rate riot to exceed 2 2110'gallons per minute(2.2 gpni)
Ultra-low flush water closets(toilets) not to exceed I W10 gal tons per Il ush (I.6 I.,,pf)
'File submetering equipment lis0d 10 ITIC11SUre tile quantity ol"water used lor cach dwelling Unit and coninlon W&I 11111A
meet the standards of'accuracy and testing of the American Willer Works Association or similar accredited association,
A licensed plumber niust install the water closets and submetering C(ItlipInCilt.
Subunetcring eqUipl-flent inij)p1lation: Next CCMU!X�Sllbrneterill solutions M201C
_Eol
Manulacitirer
Model fl.
Lkellsed Plumber Certificatioll
--ANAid1cle-1 k1 Harrison Master 16101
3/11/2023
—ani-e-o' F Plumber Ucellse Date
I certify that(check all that apply):
EGII have installed the submetering equiptrient listed above in accordance with acceptecl plumbing standards.
I have installed one or more water closets not exceeding 1.6 gallons per flush.
Detern-lined that existing water closets(10 not exceed 1.6 gallons per flash.
RThe plumbing permit iSSLIOCI by tllc'city/town, ifreqnired, is attached.
Dwelling unit is connected directly to a ureter installed by a water company and, in accordance with
KG.l, .c. 186, § 22(p),does not require the installation ofa subilletcr.
Signed under the pains all(]penalties of perjury,
if Licensed Plumber
I cerlif Property Owner Cei-tificatioll
I y that., (1)This dwelling unit is eligible 1-br the'lloposition on tile tenants ol'a charge for water and/or sewer usage
it, accordance with tile water submetering law(MGL, c. 186, §22); (2)All showerheads, faucets, and water closets in this
dwelling nnit are water conservation devices that Ineet the standards specs fiedalcove;(,I)The water submeler rileasUring
the use ofwater in (lie dwelling 1.illit was installed by a licensed plumber and is in compliance with the standards
specified above,ol,tllc water meternlCaSU61-Ig the use ofwater irl this dwelling unit waq installed by a"water company"
as delined in Mx,ij_ 186, 22, (4)The waternieter or submetermeastires the water usage exclusive to this unit; (5) 1
will provide to the tenants of this dwelling unit, priol.to occupancy,a written rental agreement that,clearly provides forthe
separate charging 01"water and/or sewer service, and a cot�y ofthis certification florni; (6)That all information il)ClUded oil
this certification is true and accurate to tile best(,-)fn,iy knowledge.
Signed under the pains and penalties of7perillry,
Sutton Street Redevelopment, l-l-C, by its Project Manager
Print Name orOwner Si rr�xur0 OfOWIlCr
Bate
Date
"lie property has been transferred to owner above sand the Unit Submitted
remains in c, cc with the re
0111k1-4T A!S��Illcffls of M.G1. c._tj1�)JZ2 — Date: to 1301-4:
*THIS FORM MUST BE FILED IT' THE LOCAL BOARD OFHEArn-i PRIOR TO I—NITIATING SUBMETERING
MDP1-1-C,Sl1 Submetering Form Rev. 11,8.202 I.doex
MASSACHUSETTS DEPARTMENTOF PUBLIC HEALTH
SIJBIWETERIN(If OF WATER AND SEWER CERTIFICATION FORM
*In accordance with N4.( c. 186, § 22 and 105 CMR 410.00W Minimum Standards of 1"itness for I-lunian Habitation
(State Sanitary Code Chapter 11), the l'ollowing dwelling Unit is eligible for[lie imposition oil the tenants ofa charge for
water and/or sewer service.
PROPERTY INF'ORMATION
J
Address: 511 Sutton St. Unitil k ff Of'units in
MA
F,QW.,JII)MEN'I' INS'f'A[,LA'I'ION INFOILMAPION
105 CIVIR 4 10-000 requires the installation orwaler conservation devices prior to a dwelling unit be corning eligible for the
un iosition on tenants of*a charge for water and/or sewer. 1"be devices must meet the followving specifications:
Showerheads with maximum flow rate not to exceed 2 `"gallons pff nlinUte(2.5 gprn)
l-'aucets with u1,9XiFnL1n1 110W rate not to CXCeed 2 ?il`g,,,allorjs per minute(2.2 gpni)
Ulfra-low flush water cloy cLs (toilets)riot to exceed I 6/jo gallons per flush(1,6 gpl)
The submetering OClUipInCilt Used to tIlOaSUre the(JUat0ity of water used for each dwelling unit:and common area must
rneet the standards ofaccuracy and testing ofthe American Water Works Association or similar accredited association,
A licensed plumber most install tile ww,Iter closets and subinctering equipment.
Subinetering equipment hil"brinatiou. Next CentUr r.alrrrreterira
M201 C
N/Iodel #
Licellsed Plurk1ber Certification
Michae�W Harrison Master 16101
3/11/2023
Print Naine of`Plumber L,icense It' Date
I certify that(check all that apply):
511 have installed the subinetering eClUipulOot 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 riot exceed 1.6 gallons per flush.
The plumbing permit issued by the city/town, if tWiLlired, is attached,
Dwelling unit is connected directly to a meter instal led by a water company and, in accordance with
M.G.]— c. 186, §22(p),does not require the installation 01'a sUbmeter.
-W I
Signed under
the pains and penalties of perJuly, �"
of Licensed Plumber
Property Owner Certification
I cerfif�that: (I)This dwelfil,ig unit is eligible fior the,imposition on the tenants ol'a charge lbr waterand/or sewer usage
in accordance with the water subirictering law(Wit,c. 186, §22),(2)All showerheads, faucets,and water closets in this
dwelling Unit arc water conservation devrees that rneet the staj idards spec ci lied above;(3)The WatCr StibolCtCr ITICaSUring
the use of water in the dwelling Unit Was installed by as licensed plumber and is it) C01opliance with the standards
s pacified abovc,or the water nicter I o0aSUri jig the tise of'Nvater in this dwelling unit was installed by at"water company"
as del ined in M,GJ.- c, 186, § 22; (4)The water meter or subrneter measures the water usage exclusive to this trait; (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)'Fhal all inf6jination included or)
this certification is true:and accurate to the best of'jny knowledge,
Signed Under the pains and penalties of'per'.jury,
Sutton Street Redevelopment, LLC, by its Project Manager
—print-Nanic of Owner Qnli—er Date
171 The property has been transferred to owner above and the unit Submitted
rernains in corn aliarace with the r ira rajents
of M.G.l- c. IA8§IJ22 Date: to 1301-1:
THIS FC RM MU51'BE FILED lAfl"11-1 THE—IOCA-l.'—80AR-D OF IqEAl.'T'lq PRIOR TO INITIATING SUB METERING
MDPI1-CSP Submetering Form Rev. 11.8.202 l.doex
MASSACHUSETTS DEPARTMENTOF'PU13LIC HEALTH
SUBMETERING OF WATER AND SEWER CERTIFICATION FORM
*Ili accordance with M.(,,I.,.c. 186, § 22 and 105 CN4R 410,000: Mininiurn Standards of Fitness for Hurnan f1abitation
(State Sanitary Code Chapter 11), the 170110wing dwelling unit is eligible lbr the imposition oil the tenants of a charge for
writer and/or Sewer service.
PROPERTY INFURMATION
Address: 511 Sutton St. Unit 11 Of Units i
!-'-i tY,-11 2—NYn:-Ma 11iAd o v e r MA 'Ode,
EQUIPMENTINSTAIA,ATION INFORMATION
105 CWR 4U000 requires the installation of'water conservation devices prior to Ca dwelling unit beconfing eligible 1-brthe
imposition on tenants ol'a charge for water and/or sewer. The;devices must meet tire following specifications:
Showerheads with i naXi Ill if ill 11ow rate riot to exceed 2 ''gallons per minute(15 gplTl)
Faucets with inaximurn flow rate not to exceed 2 2'tO gallons per rninute(2.2 gpni)
Ultna-low flush watch-closets(toilets) not to excecd 1 6/10 gallons per flush(1.6 gpl)
The SlAbriletering,equipillCul USCd to 11MUSUIV-the(ILlantitv of\vatcr used for cash dwelling unit and corntrion area, must
meet (fie standards ofaccuracy at i d testing of`the Aincrican Water Works Association or sililil-ar accredited issociatioti.
A licensed PlUrnber must install the water closets and subi-notering equipment.
Subirietering equipment information: Next.Ccntu!J.SubrrreteriaSolutions � M201 C
Manufacturer Model #—
Licensed Plumber Certification__.
Michael W Harrison Master 16101 3/11/2023
Print:Narne Of'PlUniber License 4 Date
I certify that(cliech, rail that apply):
W1 have installed the subruetering equipment listed :above it) accordance with accepted plumbing standards,
1 have installed one or more water-closets not exceeding 1.6 gaHOOS per flush.
Determined tilzit existing water closets do not exceed 1.6 gallons per flush.
[011"11C PIU1llbitlg p0rillit iSSUed by 1110,city/town, il"reqUired, is attached.
FJ Dwelling unit is connected directly to a meter installed by a water company and, in accordance with
KG.L, .c. 186, § 22(p),does not require the installation ofa subtlicter.
Signed under the pains and penalties ofpci-jury,
Licefised Plumber
Pi-opert-y Owner-Certification
I certify that: ([)']'his dwelling unit is eligible for the imposition on the tenants ofa charge for water.and/or S0WCl-usage
in accordance with the water submetcring law(MG1,c. 186, §22); (2) All showerlicads, faucets, and water closets in this
dwelling unit aTC water conservation devices that inset the standards specified above; (3)'rbe water subilleter measuring
file lise ofwater in tile d\velling unit was installed by a licensed plumber and is in compliance with the standards
specified above,or the water meter nicastiring the use,of water in this dwelling unit was installed by a"Water company"
as defined in M.G.L. c. 180, 22, (4)The water tucter or subincier measures tile water usage CXCILiSiVC W this unit;(5) 1
will provide to the terlarus oftliis dwelling unit, prior to occupancy,a written rental agreernent that clearly provides for the
separate charging ef valcr and/or sewer service, and a copy cif this certification form; (6)'I'liato.11 irrfforrriation inClUded oil
this certification is true and accurate to the best of'rily knowiedge.
Signed Under the pains and penalties Of'p01JLlJ-.Y,
Sutton Street Redevelopment, LLC, by its Project Manager
print Narne of'Oweer
Date
Date
The property has been transferred to owner above arid the orlit Submitted
rculains In corn jlhancewith the_j�ee11!jj reilie is of* M,('jj_ c�
J2, Date: to 13011:
*THIS FORM mus,r BE FILED wrm'rHE LOCAL BOARD OF HEALTH PRIOR TO hall flATING SUBMETERING
MD11-1-CS11 Stibmetering f'orni Rev. 11.8,202 J.docx
MASSA C11USETTs DEPARTMEN'r oF PUBLIC HEALTf1
SUBMETERING OF WATER AND SEWER CERTIFICA171ON FORM
"in accordance with M.G.L. c. 186, §22 ,alld 105 CMR 410.000: MillituUM Standards of Fitroess for I JUrnan Habitation
(State Sanitary Code Chapter 11),the following dwelling unit is eligible ffir the imposition on (lie tenants ofa,charge fior
water and/or sewer
PROPEAITY INFORMA110N
Address: 511 Sutton St.
Unit# Y Of units in bidg, 44--
._And.over MA W
EQ1.11PMENT INSTALLA110N INFORMATION
10-5 CMR 410-000 requires tile installation ofwaterconservatio)n ClOViCeS Pl'iorl(la dwelling unit,becoming eligible for the
imposition on teriants of as charge for waterand/orsewer. The devices JuLlSt Meet the J*ollowillg SpeCifiCaticl,S:
Showerheads with illaxiniurri flow rate not to ex(.ce(.l 2 '`gallons [let-minute(2.5 gpin)
Faucets with inaxitnurn 110w 1-ate not to exceed 2 2,'l()gallons per minute(2.2 gpin)
Uf'ra-low flush water closets(toilets) not to exceed l 6110 gallons per flLlSh (1.6 gpl)
The subriletering equipment used to Measure the quantity ofwater itscd 6or each dwellillg Unitlud COrnillon lrea ITIUSt
rnect tile standards 0l'aCCUrqCy and testing ol'the American Water Works Association or similar accredited association,
A licensed plumber must insuffl the water ciosetsanol submetering CqUipment,
Subt-netering equipment information: Next Centui
M201C
---------,,-,Manufacturer Model
Licensed I'lumbell-Cer-tirleatioll
Michael W Harrison Master 16101 3/11/2023
print Name Of License Date ---
I certify that(check all that apply):
Le—J] have installed the subinetering equipment listed above in accordance with accepted piurnbing standards.
I have installed,one or more water closets]lot exceeding 1.6 gallons Per flUS11,
Deten-ni tied that existing water closets do riot exceed 1.6 gallons per flush,
[ejThe plumbing perinit issoled by the city/town, if required, is a(tached,
Dwellillg unit is connected directly to as meter installed by a.watercornpany and, in accordance with
M.G.L . c, 186, §22(p),does not reLlUire the installation oFa SUbincter.
Signed under the pains and penalties of'perpory, N
Sig Liature_q.f Licensed Number
Property Owner Certification
I ccrtify� that: (I)This dweiling nnit is eligible lot-the intposition of, tile tenants ofa charge for water and/or sewer usage
in a-.1cordance with the writer suhnictering law(M(31, c, 186, §22);(2) All showerlicads, fa ucels,and water closets in this
dwelling unit are wciter conservation devices iliac I-neet the standards specified above;(3)The water sulAnctern-leasuring
the use of water in [lie dwelling;unit Was installed bYD JiCC`,uSC'd plumber and is in cornpliallce with the standards
specified above,or the water rnCter'l1leaSUring the use of water in this dwelling unit was installed by a"water company"
as&AIned in M.G.L. c. 186, § 22; (4)The wailer nieler or subincter incasures file Wa(Cr usage exclusive to this inlit; (5) l
will provide to the tenants of this dwelling,unit, pl-ul-to OCCUpauCY,a written rental agreement that clearly provides for the
sepal-ate charging of water and/or sewer service, and a copy ol'this certification fionn; (6)'rhat all int"brination included oil
this certification is true arld accurate to [lie best ofrny knowledge.
Signed under the pains and Penalties OfPCIJUI-Y,
Sutton Street Redevelopment, LLC, by its Project Manager
Print Name of Owner SignItUre OfOWJle1-
fhe property has been translerred to owner abOVearld tile unit Date
Submitted
rernerns in cornillfliance with the_rectiients of' KG.L.c. 186, §22 Date: to 1301+
*THIS r-ORM MUST BE HUD wrm THE LOCAt, BOARD 01: HEALTH PRIOR TO IWFFATING SUBMETERING
MI71'H-CS11 Submetcring Forul Rev. 11,8.202 1.(Iocx