HomeMy WebLinkAboutSubmetering of Water Sewer Certification - 10 Ashland Street House - Miscellaneous - 10 ASHLAND STREET 10/23/2024 IVIAN�Ak,HlJi5Lt I I r7 IlL' I'AKI WINN 1 VIE I'U13LlU tILA.L I I I
SUQMETERING OF WATER AND SEWER CERTIFICATION FORM
In accordance with M.G.I.. e. 186, § 22 and 105 CMR 410.000: Alinimum Slan(hu-tls q1'f imess,%nt•11timatl 1-lahiration, State
Sunion,Code, Cha)rer 11 the"l Jnusin*Code" ),the 1101lowin*dwelling unit is eligible for submeteritt water and sewer.
PROPERTY INFORMATION
Address: fU 54 Cl.,,g/ Unit # f#Of units in bldg.
city/Town: f ,lv✓ ,: MA Zip Cade:
EQUIPMENT INSTALLATION INFORMATION
105 CMR 410;130(C) requirCS the installation of water conservation devices prior to a dwelling unit becoming eligible for
submeteringg for water and/or sewer services. The devices must meet the following specifications:
Showerheads with Ittaximunt flow rate not to exceed 2,5 gallons per minute(gpnY)
Faucets with maximum flow rate riot to exceed 2.2 gallons per minute(gpm)
Ultra-low flush toilets not to exceed 1,6 gallons per 11ush (gpf)
The subinctering equipment used to measure the quantity of water used for each dwelling unit and common arcs must
dicer the,standards ofaccuracy and testily of(he American Water Works Association or similar accredited assmiation,
A Massachusctts licensed plumber must install the toilets laid submetering cquipiltcllt,
Subntctering equipment information: Alk;re4
Manufacturer Model If
LICENSED PLUMBER CERTIFICATION
1 certify that(check all that apply).:,
❑ 1 have inslalled or Inspected the subitictering equipment listed above and ha.ve dctermined that illcy meet accepted plumbing standards,
❑ 1 have insialled or inspected all the toilets in this unii and have dClCrJltinCd that 111Cy Meet 11CCCI)tcd 1}ltilllbiag standardS,
❑ •1'he plumbing permit issued by the city/town,if required, is attached.
❑This dwelling unit is connected directly to a miler insuilled by a water company and, in accordance with M.G.L. e. 186,§22(p),does
no(require the installation of a submeter.
Licensed Plumber's Name Plumber' Signature License it Dale
OWNER CERTIFICATION
I certify that.,
(I)This dwelling unit is eligible for Submetering of water Find/or sewer usage in accordance with the water subilictering law
(MGL c, 186,§22),
(2)All showerlteads, faucets and toilets in this dwelling unit meet the conservation standards specified above.
(3)The water submeter(if present) measuring the use of water in this dwelling unit was installed by it licensed plumber and
complies with the standards of accuracy and testing required by the water subme(cring law(M.Q.l.,, e. 190, § 22).
(4)The water ureter 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 Col•the
separate charging of water and/or sewer service,and a copy of(his certification form,
(6) All information included on this certification is true and accurate to the best of my knowledge,
THIS FORM MUST BE FILED WITH THE LOCAL HEALTH DEPARTMENT PRIOR TO INITIATING SUBMETERING
Sighed udder the Mains and pctlaldes nf'perjury,
Name of Owner Signature orOwiier Date
Tie prollerly has l}ren translerred to Ilte ownernhova and the unit remaiu<in comitliance wills lite requiremcnis of tvi3O,L c, Date,,SybmittQd to Local I calth
Itiro :z- De I ant;
t'dor owttcr'ti%ignnmre 1)ate
410-23-Submetering of Water and Sewer Cerlification Form 5-12-23