142 CANAL STREET m ,,�iM'Y'IS w .aq '?2� .rY#xw.gcak ���,y. vv�.mr "�"^• rp�S.�...a '�' ' Ni.;���° .`1s.�" jn i;k�; '� � ,.� �! f .
" -CITY OF SALEM9'MASSACHUSETTS
r BEARD OF HEALTH
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
WELL CONSTRUCTION PERMIT
Location: 142 Canal Street
Owner: 142 Canal Street Realty
Address: 142 Canal 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#: 003-05
Date Issued: 4/19/2005
(Monitoring Wells) (TED Inc. — Reg. #560)
HEALTH AGENT
s CITY OF SALEM, MASSACHUSETTS
�]L BOARD OF HEALTH
® 120 WASHINGTON STREET, 4TH FLOOR
t SALEM, MA 01 970
.� TEL. 978-741-1800
FAX 978-745-0343
STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO ��yy
MAYOR HEALTH AGENT
rt�Ha
3- MAR 2 5 2005
CITY OF SALEM
BOARD OF HEALTH
Well Construction Permit Application
Date: 3�aSlos Fee: $100. Check payable to the City of Salem (no cash)
Location: J y-2 C4na./ / Salem, MA. 01970
Owner:/wC4041 STs2Egc7cyAddress S8W__1e_ Tel. 7,?3-�'S-'SS711
cr-
Type of well: Well use:
Well Contractor. yqve//hu INS// EAjpV Pump Cont ctor: F1vcLllrvo We/l,`19147_
Address: /Y3 Mc,,, St Address: 11--13 Ana.N Sr
Phone: 7d'/- 91/11-5'�-Sel Phone: 7�/- y yy- SYS-!
Reg. #: 685.
Have abutters been notified? (y) OW?
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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.
ONC�5
oring wells but a permit is require or ins allation.
----------------------------------------------------------------------------------- — — —
B.O.H. use only. Check#: o�T Q % Check date: 3_a5-0 D Permit#: �DcJ'6 7
Well const permit appl revised 11/25/02