HomeMy WebLinkAboutSubmetering of Water Sewer Certification - 10 Ashland Street Unit 12-2 - Miscellaneous - 10 ASHLAND STREET 10/23/2024 MASSACIfUSETTS DEPAR'I'MEN'I' 01 l'UHLlIL HLAU1 H
SUBMETERING OF WATER AND SEWER CERTIFICATION FORM
In accordance with M.G,L. c. 196,§22 and 105 CNIR 410.000; fltarrau Ilabltailon, Smie
SrrullarV Coda, Chapter/I(the"Housin Code" ),(lie Iollowin t dwellin►unit is eligible lbr Subincierin =water and sewer.
PROPERTY INFORMATION
Address: /v Unit It /d ': ? ft Okmits in bld r. /
city/Town: cf • MA Li Code:
EQUIPMENT INSTALLATION INFORMATION
105 CMR 410.130((') requires the installation of water conservation devices prior to a dwelling;taut becoming eligible For
submctering for water a ndlor sewer Services. The devices must sleet the following speciClcaltions:
Showerheads with maximum flow rate not to exceed 2.5 gallons per minute(gpm)
Faucets with maxim urn n now rate not to exceed 2.2 gallons per minute(gpm)
Ullra-low flash toilets not to exceed 1,6 gallons per flush(g;pf)
The submctering equipment used to measure the quantity of water used for each dwelling unit and common area utust
nice( the standards of accuracy alld testing of the American Water Works Association or similar accredited association.
A Massachusetts licensed plumber niust install the toilets and sobinetcring equipment.
Stibmetering equipment informatioll: /14 �
Manufacturer Model #
LICENSED PLUMBER CERTIFICATION
I certify that(check all that apply):,
❑ I have installed or inspected the submctering equipment listed above and have determined that they meet accepted plumbing standards.
❑ I have installed or illspeetcll all the Illile(s ill this nail and have determined that they meet accepted I)Iumbing slalndalyds,
❑ The plumbing permit itisued by the city/town,if required, is attached.
EThis dwelling unit is Connected direetly to ai meter installed by a Witter company amd, in accordance with M.G.L.e. 186, 22(p),does
not require the installation of it Wbmetcr,
Licensed Plumbei's Name Plumber` Signature License# Date
OWNER CERTIFICATION
certify that:
(l)This dwelling;unit is eligible for sttbmetering of water and/or sewer usage in accordance with the waiter subinctering;law
(MOL e, 186, k22).
(2) All showerllcads, faucets and toilets in this dwelling;unit meet the conservation standards specified above.
(3)The wafter submeter(if present) measuring the use of wetter in (his dwelling;unit was installed by a licensed plumber and
complies with the standards of accuracy and testing;required by(Ile water submetering law(M,G,L, c. 196, § 22),
(4)The water meter or subineter measures tilt;water usage exclusive to (Iris unit.
(5) L will provide to the tenants of this dwelling unit,prior to occupancy,a writtell rental ag;rcemettt that clearly provides for the
separate charging of water and/or sewer service,and a copy of this certification forth.
(6) All information included on this certification is true and accurate to the best of my knowl;Ag e.
THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERINC
Signed tinder the pains and penalties of perjury,
Name of Owner Si mature of Ow tier Date
rtM 11rolk;rty 11k1S been(CAOSICIY'lfi to the owner above and the unit mmalns la t!ommiaucc with the r1q ui vmcnk oI ALU,L C. hate Sri III It Local hI aitlti
36 '22- Depailit;
t 4 Nor Owners Signature. gate
410-23-Submelering;of Waiter and Sewer Cerlitication I'mn 5-12.23