94 BRIDGE STREET WELL
94 BRIDGE STREET
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CITY OF SALEM9 MASSACHUSETTS
4 BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR -
SALEM, MA 01970
.� TEL. 978-741-1800
FAX 978-745-0343
STANLEY J. LISOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
WELL CONSTRUCTION PERMIT
Location: 94 Bridge Street
Owner: Sam's Mobil
Address: 94 Bridge Street, Salem, MA
This permit is granted in conformity with the statutes and ordinances relating to
well permits.
Well Construction permits are non-transferable.
This permit shall be on site at all times that work is taking place. Permit shall
expire one (1) year from the date of issuance unless revoked from cause.
This permit does not constitute a Water Supply Certificate.
Permit#: 002-05
Date Issued: 4/11/2005
(Monitoring Wells) (TED Inc. — Reg. #560)
HEALTH AGENT
DEBORAH A. HAMBLETr CURRIER
-PROJECT ENGINEERl
tel(617)715-1840
E B I fax(781)Z
dhamblett@ebiconsulting ng.cOmm
C O. N S U L I I N G www.ebicon ulting.com
ENVIROBUSINESS, INC.
FOUR A STREET .BURLINGTON,N4A 01803.
CITY OF SALEM, MASSACHUSETTS s
m3! BOARD OF HEALTH
s 120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA O 1970
TEL. 978-741-1800
FAX 978-745-0343
STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
j Well Construction Permit Application
Date: Fee: $100. Check payable to the City of Salem (no cash)
Location: ? m 50O i °I Irl 2 4t Salem, MA. 01970
Owner: C004UC K?Xzrv� Ad ress bo (t?I�1 Telkl'--(*4'a—�5�
—�
Type of well: mon iW Well use: v�vJLi�
Well Contractor:��ffOy -( Pump on ractor:�1�(�
Address:aU *Krl6rkh 'Dr, 4�W5, M4101q JoAddress:W/4
Phone:(jjj)3L/F-)qVA Phone: N��
-Reg. #:�52' M
Have abutters been notified? (y)NIII How?
----------------------------------------------------------------------------------------------------------
In the space provided below(or on back) show the location of the proposed well in relation to
existing or proposed above or below ground structures. A description of visible prior and current
land use within (200) feet of the proposed well location, which represent a potential source of
contamination. �SicQ t I1zP
VIAS UrSY�l�Yla,
�sidertfiip � cc��,,
There is no fee for monitoring well ut a pel`�i'ift is required for installation.
------ ------- - 1'1 Ffi ----------------------`----------
----------- ---------- - - -------------------------
B.O.H. use only. Check#: %(jtvrh heck date: Permit#:
Well const permit appl revised 11/25/02
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BURLINGTON,MA
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AI " I J DALLAS,TX
DENVER,CO
B1r�r _ SALEM EXETER,NH
C O N S U L T I N G HEALTH Los ANGELES,CA
NAPLES,FL
Four A Street,Burlington,MA 01803 PHOENIX,AZ
TEL 781-273-2500 FAX 781-273-3311 PORTLAND,OR
www.ebiconsultin-.cont SAN FRANCISCO,CA
WARWICK,RI
FAX TRANSMISSION
To: Joanne Scott
FROM: Deborah Hamblett Currier
DATE/TIME: 4/06/05 -
FAXNUMBER: (978)745-0343
PLEASE FIND A TOTAL OF 2 PAGES INCLUDING THIS COVER SHEET
Joanne,
Attached is the Well Construction Permit Application for Sam's Mobil, 94 Bridge Street. EBI will be doing the work on
Tuesday, April 12, and I will be overseeing GeoSearch, Inc. for the well installations. The Dig Safe ticket number is
20051506573.
Please contact me with any comments or questions. I will stop by your office on Tuesday April 12 between 8-9am to pick up
the permit. I appreciate your help`.
Respectfully,
Deborah A.Hamblett Currier
Project Engineer
EBI Consulting
(617)715-1840 office
(781)552-9176 mobile
If there are any problems with this transmission please call(781)273-2500
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