5 CARROLLTON STREET - WELL 77
F r
; CITY OF SALEM MASSACHUSETTS ' s �� . z '
OARDI'OF,<H EALTH e'" x ,µ "" rz.,=T':,+
g . >.
3 ' 1201WASHINGToWSTREET 4TH FLOOR 'S >4# -
` SALEM MA 01970 -
qq t..at d TEL. 978-741-1800
i '?'t rr' 4,s - FAX 978-745-0343
STANLEY USOVICZ, JR. JOANNE SCOTT, MPH;;RS, CHO
MAYOR HEALTH AGENT
e A �, ,+ n •, t 2
a4.t s a * WELEli CONSTRU'CTION3PERMIT
Location 5 Carrollton Street
OwnerKeith Nadeau ''
E
Address 11 Green lawna Ave,'Salem' "
y
This permit is granted in,conformity with the statutes and ordinances relating to
well permits,' E=,•xa � � r
Well construction permits are no transfeFable
This permit shall beton site at all<timesthat work.is takong,place: Permit shall .
expire one (1) year from'the date of issuance unless revoked from cause.
Thes p'e
rmit does not constitute a,Water Supply Certificate.
Permit # 2-02
Date issued, : 4/26/02
(domestic well) (C.M. Rollins—.Reg .#305) , : 0
Health Agent
t.!l ,'mi 'f3t'3£ $ �5 ' £' q fe 1 .FEW"%t' C`�i'}trF- i'< ' '-�4 {r pvS.Y".x, d a } 'kI;•,r ' -
f
144
l yi - § ,S i $7 ss�.'. +`�{�•fe • Fri i ,4} sy 'x �'`:Tf rw 3, s ,: Ee 24 t •x q i_;
WRFR7 CHARLES M. ROLLINS CO. 9788879491 P. 02
.25.2002 10:03AM NSPr/S.H. MED STRFF OFFICE NO.233 P.2/3
R i'r
9�
i
M
V
CITY OF SALEM BOARD OF HEALTH
Salem, Massachusetts 011970
JOANN£SCOTT. MPH. fiS. CHO
MEAI,Tti eGEN' 120 Washington Srreet 0 floor
cENTel:(978)741.1goo
Fax; (978)%44 0343
11 Construction Perm t A lication
Date:�� Fee: $40. Check payable to the City of Salem (no cash)
Location: GAR2hIfr7A -Salem, MA. 01970
Clwner: �Q,�V Address
11Iel.yJ ol6a��
Type of well: rr Well use: D e i /,_ ``—
Well Contractor: C, M . R,3t L j ; o. x„� . Pump COnfractor:
Address: iii r>y or ti.,!_
F l3oycver� . Address:
Phone: I-7tl_bb,-, _ Z. 3 z o Phone:
Reg. #: 3� �.
Have abutters been notified? (y) How?�[�
--------------------------------- -----------
In the space provided below(oron back)show the location of the proposed wall 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.
..............................—...........
B.(),H. use only, Check#: __._._....__.._-..-..-.,._•
3/a Check date: qbs–lob Permit#: a .-0 a I
r_
CHARLES M. ROLLINS CO. 9788879491 P. 03
AFR.25.200a 10:e3AM NSMC/S.H, MED STAFF OFFICE 1`10.233 P.3/3
4
*a
CITY OF SALEM BOARD OK HEALTH
Salem, Massachusetts 01970,
JOANNE SCOrT, r,4PH, RS.CHO 120 Washington Street 411'floor
HEA_ fi AGENT Tek(978)741-1800
Fax:(978) 745 0343
Well Water 3u I Certificate A lication
The issuance Of a Water Supply Certificate by the Board of Health shall
certify that the private well may be used as a drinking water supply. A Water
Supply Certificate must be Issued for the use of a private well prior to the
issuance of an occupancy permit for an existing structure or prior to the issuancor,
of a building permit for new construction which is to be served by the well.
The following must be submitted to the Board of Health to obtain a Water Supply
Certificate :
'copy of the Well Construction Permit
'copy of the Water Well Completion Report as required by the DEM
Office of Water Resources (313 CMR 3.00)
'copy of the Pumping Test Report
copy of the Water Quality Report
� Ref -^Salem, MA.
'------
Location of well: _�1j G/t(� � n N ,�
Owner of property: fj� JVA& t�_ Tel. ` - O/ 7Owner's adldress: 11_ 2e�Pn� /AWN `
----------------------
O.H, use only Permit#
FA.JM :HRMS_ COHTR`Y_TING �rlX N0, :978 745 31559 "Uri. 12 0131 07:34W. R3
—,� Crry OF SALEM, MASSACHUSETTS
904RD OF HEALTH
120 YJAGHI\'GTON STREET, -ITH FLQJa
�y 1
SALEM, MA 01970
\ _ti Tel. Q7R--d1-1800
FAX 078 :45 0343
51111LEV l)soVV:Z. J.Y. JIIMh NE S�CTi MPH, R�. CI-10
�1�VOR HcnlTh An E'JT
Salem Board of Health Pumping-Test_Report
Name of well owner C . Si."14 �Ppj ``)r Address. / 7n
Well location(referenced to aneast two permanent structures or landmarks): ] 90 O Toll 5T
Date pumping test Was ae6ormed: e0{,a06
Cil at which pump wds set for the test:
I
Horatian of the discharge line,
)
Sialic water level immediately before pumping commencedLC,1._
Discharge rate (if appllcattie.time the discharge rate chanced)
i
Pumping water levels and respective times after pumping commenced: We _
�(ool.16d S '5i� (Fpm
Maximum drawdown during the lest
Duration'of test. a)purn'vng time.
b)recovery time during which measurements were taken
wellyc41Ci -
Recovery water levels and respective times after cessation of pumping: C�
Reference point used for all measure ents m71 (- .�j j� !tA L.hgn6P I u/P��
Please fill out form completely and retum to the Salem Board of Health
along with the Water Well Completion Report. Pump test report is a
requirement prior to issuing a Water Well Supply Certificate.
GROUNDWATER WELL&PUMP
213 ORCHARD ST.
BELMONT, MA 02478
Z 'd 5100-GOb (Li 91 dWfldR3l31M d31Umawl-tods EDEtLO 00 21 unr
FAt��
�fic�'2�eru3e�n ��6ata�a��, ��yec.
86LITTLFTON ROAD.WESTFORD.MA01896 (978)6924395 FAX(078)692-0023 1-800-648-1 EST
Report Number 65286 Rcpon Date: 6(!2/02
Clteov Sample lafruvsation:
Omtmdv afar Well+Pump Cousins Realty
211 Oichatd Si. 5 Carrollton St.
Belmont MA 02478 Saiem MA
Sampled by: Client Date Received. 6/10/02 Datc Sampled6110102
Certificate of Analysis
/
Test Paramotcr E A Lunn Result liao
11 TmelColiform(P) 0 0 pe-100m1
,I Fecal Coliform!E.coli(P) Absent Absent per 100ml
Calcium Not Spec.7pO'� 22.6 �,p� mglL
Copper(S) 1.3 <0.02 7ngIL
Iran(S) 0.3 0.14 tngJ1
Magnesium Not Spec. 8.2 mg:'L
J Nlanganese(S) 0.05 0.04 mg`E
potassium Net Spec. 3.( 7141
Sodium See Nose 37.0 mg/L
Alkalmury(S) Not Spec. )0-100 75 mg/L
Ammonia-N Not Spec, - <0.03 1719/1.
;/ Chloride(S) 250 42 1119111-
Chlorine
g/LChlorine Not Spec. 7.1 mg/L
Color(S) i5 5 CPU
Conductivity Not Spec 393 umhosicm
Hardness Not Spcc.Sp-V 90 mg/L
./ Nurate-N(P) 10 - 0.20 mgh
✓ Nitrite-N(P) I <0 01 mg/1-
Odor
g/LOdor 3 0 TON
s/ PH(S) 6.5.8.5 �'l�.$S< g.1 SU
d Sulphate(S) 250 32.7 mgt
Twbidity Not Spec, 1.1 NTU
Sediment poa/neg neg
Legends:
(P)=POmary EPA Standard,(S)=Secondary EPA Standard,x-Eacecds EPA Lintit,
TNTC-Too Numerous to Count,a-Background Bacteria Noted,'-Exceeds Advisory Limit
Sodium Advisory Limits,Mas.-20,NH=250.
This water samPic as submitted,meets BPA guidelines for the parameters listed above.The
quatity of tnn water is accepted as POTARLE according to EPA standards.
Massachusem Certification It he (MA048 ficP.f'.at��fn�
111orstensen Lahoratory Inc
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2 chusetts Department of Environmentaf Management i
Office of Water Resources 108690
TYPE OR PRINT ONLQJ Y 4.,- .:r-tL�M Well Completion Report
Address at Well Location:,4/s 6 r47- era Sf Property Owner: Cuo5W -\s ' tpf)k f y
Subdivision Name: Mailing Address:
Cityfrown: - Cityfrown: A1P.rvl 11(1SS -
Assessors Map Ole,, Assessors Lot#: NOTE: Assessors Map and Lot#mandatory if no street,address available
Board of Health permit obtained: Yes Not Required ❑ Permit Number Date Issued .l
95 New Well ❑ Abandon IM Domestic ❑ Irrigation ❑ Cable ❑ Auger
0 Deepen El Recondition ❑ Monitoring ❑ Municipal � Air Hammer -❑ Direct Push
i
❑ Replace ❑ Other ❑.Industrial ❑ Other ❑ MUORota ..:. [3 Other
—
a: Unconsolidated Consolidated
' Lit Pemeebliry .
m 12
from(ft) To(ft) Rock Type
zZ
0 �
I-
i
�+S: sP
Total Depth Drilled S From(tt) To(ft) Casing Type;and Material Size QO.(in). Well Seal Type16
_ I
Date Drilling Complete C> �C f4/16-sle 6- y�� "a}!!�i Zkr/vP e.
(o GAZ -
I yy T
- - I
From(ft) To(ft) Slot Size Screen Type and Material Screen Diameter
- fl - - •]�a'effr'+iilw . �d.� �'" emh._zws'- , � xe "£� �[� INF_: � -=3� j
�- Developed? - Yes E3 No
From(ft) To(ft) Matenal Description -` Purpose Fracture
Fnhanoement? ❑ Yes -_ ❑ No
_ t Method
Disinfected? Yes ❑ No
- lF Yield Time-Pumped Drawdown to Time ReCovery to Depth Below _
Date Method (GPM) %Jhrs-& min) (Ft- BGS) (hrs &min) (Ft. BGS) Date eas�uJred Ground Surface (FT)
T�CU72t
Pump Description Horsepowe ;
Pump Intake Depth _ �t7Q (ft) Nominal Pump Capacity (gpm)
- I
t _ This well was drilled and/or abandoned under my supervision, according to applicable rules
" - and regulations, and this report is complete,,correzct to the best of my knowledge.
�. y'
Driller; � .�e tir�C'{a Ll Supervising Driller Signature: 9 "`max{� �«�-'Registration #:1 1 �I`S 1�
Firm: Alty)?{ _ih) 9-1'I k! �(✓i ce Date: li — Rg Permit #: I ISI`/Iy l
NOTE: Well Completion Reports muse be filed by the registered well driflWivithin 30 days of well completion.
BOARD O!F HEALTH COPY
T 'dh S108-681PUT91 dwnd1l131M 83liut70Nn0mo esSrLO 20 bZ 400
IMPORTANT MESSAGE
FOR lTE/cF
DATE /O/l.2-O _TIME /2-A-0 A.M.
M if�17t/ AlAp cat., /
OF
PHONE4y7f )
Af�SA CODE NUMBER EXTENSION
O FAX
O MOBILE
AREA CODE NUMBER TIME TO CALL
TELEPHONED PLEASE CALL
CAME TO SEE YOUWILL CALL AGAIN
WANTS TO SEE YOU RUSH
RETURNED YOUR CALL WILL FAX TO YOU
MESSAGE .Gly
SIGNED
OSSFORNA c
. 400MAAOE IN9
DOTES ----- - - -- - -- - -
I
CHARLES M. ROLLINS CO. 9788879491 P. 01
-CH-ARLES MMOLLINS CO-, NE,
WELL DRILLING CONTRACTORS
FAX Cover Sheet
TO: Jeff Vaughan, Sr. Sanitarian T'�
Salem Board of Health
OCT 2 3 2002
FAX #: (978) 745-0343 , ; _m
BOARD OF HEALTH
FROM: Christopher Rollins
DATE: 10-22-02
SUBJECT: Water Well Completion Report
Keith Nadeau, 5 Carrollton Street
Jeff,
I received your Fax requesting a copy of the water well completion report for
Keith Nadeau at 5 Carrollton Street, Salem, MA.
As of date we have not drilled a well for him. Therefore, I can't complete a
DEM Water Well Completion Report.
A permit was pulled April 24, 2002 by Keith Nadeau — He Faxed us the
application and we filled in our information on the permit. Then he never
contracted with us to drill.
I have tried to reach Keith Nadeau several times since receiving your request
for the Water Well Completion Report. He has not returned any of my calls.
His telephone number is 978-580-9228.
Please call me if you have any further questions (978) 887-2320
Sincerely,
Christo her C. ollins /
P
129 DEPOT ROAD, BoXFORD, MA 01921 • 9781887.2320 • FAX 978/887.9491
Salem Board of Health
120 Washington Street 4'"Floor
Salem,MA.01970-3523
+ror'srT,� � .. 'a •�i<.i • [` ,— .`..§q.. aeE+ � �h � ,�i vEc
978-741-1800 !If�f�[x 978-745-0343
LU "
T*"ui
m
facs�m�leansrnital ¢ s
To: � . /�I- /�cCCioS Co. Fax: (� 7�) 97-2
From: Jeff Vaughan, Sr. Sanitarian Date: �6 a
Re: � ��o�r Pages: (including cover)
CC:
❑ Urgent ❑ For Review ❑ Please Comment ❑ Please Reply ❑ Please Recycl
41-1
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IMPORTANT MESSAGE
FOR VZ4
A.M.
DATES A -Da- D`/3-- TIME /D•'s"�
MP
OF
PHONE I�'r $4� - 9a a 9-
AREA CODE NUMBER EXTENSION
O FAX
O MOBILE
AREA CC OE UMBER TIME TO CALL
TELEPHONED PLEASE CALL.
CAME TO SEE YOU I WILL CALL AGAIN
WANTS TO SEE YOU RUSH
RETURNED YOUR CALL WILL FAX TO YOU
MESSAGE .4
D
SIGNED
wMOpsFORM 4009
MADE IN U.S.A.
NOTES - ----- -
coNar UITY OF SALEM, MASSACHUSL i i a
"6� ',� BOARD OF HEALTH
f
,� * 120 WASHINGTON STREET, 4TH FLOOR
��\., j SALEM, MA 01970
�s
qPQ TEL. 978-74 1-1800
'� FAX 978-745-0343
STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
Facsimile
Transmittal
To:
Fax #
Re: {i'� n/ iLllge%e✓ G Aft/K%/Tz< Si G/JTZ T jT�� �.� C.�%�
Date: /c /a /,3
Page(s): including this cover #
Message:
/�2 fC llr '-ct7 7'C �F %'c-vc' � ��- /.n_= .�✓�ic�=tJy-
Inorganic compounds
Parameter Maximum Contaminant Level (MCL)
Antimony .006 mg/I
Arsenic .05 mg/I
Asbestos 7 million fibers/[
Barium 2 mg/I
Beryllium .004 ri
Cadmium .005 mg/I
Chromium(total) .1 mg/I
Cyanide .2 mg/I
Fluoride 4 mg/I
Lead (action level) .015 mg/I
p�jrJ -�CepperjacttbMevel) 1.3 mg/I
10;1 Mercury .002 mg/I
�4t 611N .urate-M) 10 mg/I
tj .1 y 10 mg
S, . . 9
Lrc
/I
I r,5'(d Selenium .05 mg/1
P
1p, y Thallium .002 mg/I
'indicates parameters that should be monitored once every year.
k' The most recent certified lab list can be obtained by calling the Wall Experiment Station at(978)682-5237
or by accessing the information at http://www.state.ma.us/dep/bspt/wes/wespubs.htni
W'co---3 T& (73rI)/ b:sso�'4 sC,-/S�
7n ��
7ej—,e!
HP Fax Series 900 Fax History Report for
Plain Paper Fax/Copier Joanne Scott Salem BOH
978 745 0343
Oct 02 2002 11:17am
Last Fax
Date Time Type Identification Duration PagesResult
Oct 2 11:16am Sent 919782836296 0:28 1 OK
Result:
OK - black and white fax
Biomarine
16 EAST MAIN STREET, GLOUCESTER, MA 01930
TELEPHONE:(978)281-0222 FAX:(978)283-6296
CERTIFICATE OF ANALYSIS
Mr. Keith Nadeau Report No.: 26929
11 Greenlawn Avenue October 10, 2002
Salem, MA 01970
RE: ANALYSIS OF WATER FOR LEAD AND TOTAL DISSOLVED SOLIDS
SOURCE INFORMATION: New well located at 5 Carrolton Street, Salem, MA. Well owned by
Cousins Realty Trust.
SAMPLE COLLECTION: Samples collected by Keith Nadeau on October 2, 2002 at .
12:00pm.
FINDINGS:
PARAMETER RESULT RECOMMENDED DATE ANALYZED
GUIDELINE
Lead (mg/L) 0.003 0.015 10/9/02
Total Dissolved Solids 297 500 10/08/02
REFERENCE: Standard Methods for the Examination of Water & Wastewater, 19th Edition,
1995.
REMARKS:
Lead is often used as a material in the plumbing of residential and commercial buildings, and
sometimes in plumbing fixtures. Lead contaminating drinking water as a corrosion by-product
occurs as a result of the corrosion of fixtures, lead pipes or solder that remain in contact with
water for a prolonged period of time. Lead is also a common metal found throughout the
environment in lead-based paint, air, soil, household dust, food, certain types of pottery porcelain
and pewter. Lead builds up in the body over many years and can cause damage to the brain, red
blood cells and kidneys. The greatest risk is to young children (especially under age 6), pregnant
women, and their fetuses.
Total dissolved solids are all the dissolved materials present in water from natural sources or
otherwise. A high level may be caused by hard or salty water contamination. At high
concentrations, a white residue may be left behind when the water evaporates.
WDhn Madetta/tab Dire,.-tor
Massachusetts Certified Laboratory#MAI 23
10/10/2002 13:21 976-667-7871 STL BILLERICA PAGE 02/02
al
sin modes
149 Rangeway Road
North Billerica, MA 01862
Tel 978 667 1400
Lisa Groleau Fax:978 667 7871
Biomarine www.sainc.com
16 East Main Street
Gloucester, MA 01930
Dear Lisa: October 9,2002
Please find enclosed results for one(1)sample,Project Ref.26929,STL lob 9202807,which you submitted
for asbestos analysis by Transmission Electron Microscopy(TEM).
The results according to the USEPA Phase Il Primary and Secondary Drinking Water Regulations EPA Method
100.2(fibers longer than 10 microns)are listed under column A. ("<'is equal to the value of the detection limit)
A Date& Time Date&Time
SAMPLE ID (million fibers/liter) Filtered Analyzed
26929 <0.188 10/03/02; 11:04 10109/02; 10:35
The final maximum contaminant level Goal(MCLG)and maximum contaminant level(MCL)for asbestos in
water is 7.0 million fibers/liter.
STL Billerica is accredited by NYELAP(#10838)and the Commonwealth of Massachusetts(41YI-MA038)for
asbestos analysis of water samples.
The test results in this report meet all NELAP requirements for parameters for which accreditation is required
or available. Any exceptions to NELAP requirements are noted above.
Severn Trent Laboratories is not responsible for incorrect sampling procedures since these water samples were
not collected by our lab personnel. STL is only responsible for the analysis and reporting of submitted samples.
Accreditation in no way constitutes or implies product certification,approval,or endorsement by NELAC. This report
relates only to the specific samples tested herein. The enclosed report shall not be reproduced except in full,without
the written approval of STL.
Should you have further questions,or need additional information,please feel free to contact Client Services
or me any time.
Sincerely,
Ernest T.Dobi, Ph.D.
Manager-Microscopy Services
STL Billerica is a part of Scam Trent laboratories,Inc.
MASSACHUSETTS DEP/DIVISION OF WATER SUPPLY IOC
INORGANICS REPORT (FORM4IA.3)
I PWS INFORMATION:
1. PWS ID# 2. City/Town: SALEM
3. PWS Name: 4.PWS Class(circle one): COM NTNC NC
5. DEP Source Code/Location ID 6.Sample Location 7. Date Collected 8.Collected By
SEE BELOW* 10/2/0212:OOPM KEITH NADEAU
9.Is the Source Treated? NO 10.Was the Sample collected after Treatment? NO
10.Manifolded(multiple) [1 If applicable,list the connected sources:
12: Routine Special (explain below)
Notes: *Samples taken from a new well located at 5 Carrolton Street,Salem,MA.Location owned by Cousins Realty Trust.
II LABORATORY ANALYTICAL INFORMATION:
Lab Name:BIOMARINE INC. Lab Cert.#: MA026
Subcontracted? (Y,N) YES Lab Sample ID# 26929
Sub.Lab Name: THORSTENSEN LABORATORY Cert.#: MA048 Lab Symbol: MA048
Sub.Lab Name: NORTHEAST ENVIROMENTAL -Cert.9: MA123 Lab Symbol: NEL
Sub.Lab Name: NEW ENGLAND CHROMACHEM Cert.#: MA072 Lab Symbol: MA072
Composite[]If applicable,list the composited sources(DEP Source Code/Sample Location:
Notes:
Compound Lab Sample Result MCL I Detection Analytical Date Lab
ID# m m Limit mg/L Method Analyzed Symbol
Arsenic 42747 <0.005 0.05 0.005 200.9As 10/07/02 MA048
Barium 42747 0.01 2.0 0.001 200.7 10/10/02 MA048
Cadmium 42747 <0.005 0.005 0.0005 200.9Cd 10/10/02 MA048
Chromium 42747 <0.001 0.1 0.001 200.9Cr 10/10/02 MA048
Fluoride* 42747 0.14 4.0 0.03 300.0 10/03/02 NEL
Mercury 42747 <0.0002 0.002 0.0002 245.1 10/10/02 MA048
Selenium 42747 <0.001 0.05 0.001 200.9Se 10/08/02 MA048
Sodium 42747 34.5 20 0.1 200.7 10/07/02 MA048
Antimony 42747 <0.001 0.006 0.001 2009.Sb 10/08/02 MA048
Beryllium 42747 <0.001 0.004 0.001 200.7 10/10/02 MA048
Nickel 42747 0.011 0.1 0.001 200.9Ni 10/08/02 MA048
Thallium 42747 <0.001 0.002 0.001 200.9Ti 10/10/02 MA048
Cyanide 42747 1 <0.01 0.2 0.01 4500-CN 10/09/02 MA048
Compound Lab Sample Result MCL Detection Analytical Date Lab
ume ulat ID# mg1L m Limit mg/L Method Analyzed Symbol
Sulfate 42747 50 250 0.1 300.0 10/03/02 NEL
*There is also a secondary MCL for fluoride which is 2.0 mg/L.
**Please note that if method 245.1 is used for mercury,only method revision 3.0 will be accepted by DEP.
***Samples tested as monitoring wells.
Biomarine Laboratory Director Signature and Date 10/10/02
FOR DEP/DWS USE ONLY PLEASE INITIAL AND DATE AS COMPLETED
Accepted: Disapproved: Date entered into WQTS:
Comments:
(p:\csocher\rep-frms.97\iocla.3, 10/15/96)
Fri, Oct 4, 2002 4:49 PM
Page 3 of 9
ti
FAY 97 a 7 45-0 343
STANLEY USOVICt,J,f. JC"I"M SCOTT, MPH. Pr. CLIO
Meson NE4'_TH Ac[NT
Sale 8Qard of Health Pumping Test ReDOrt
Name of well owner. l.Qi HL5 VMal Address. O / ,T 1C-Rf V Rlfi CO
Well location(referenced to atleast two permanent structures or landmarks). C, izo 5 T,
Date pumping fest wag performed: .
Depth at which pump was set for the test: 'r g Cr?
Location of the discharge line:— U-2 _ r}-c oorf1D eI i
Stalir.water levef immediately before pumping commenced
Discharge rate 1.5 Gin_(if applicable,time the discharge rate changed)
i
Pumping water levels and respective limes after pumping commenced:
nr_I "It 5e ran,. — ---
(
Maximum drawdown during the test: JIfO/VQ lA/f)r zST)1YL L /5 �
Duration.of test a)pumping time: ' n�
b) recovery time during which measurements were taken:
tUFUN� _ {hDUfir1VA,e li DI C1IG r'inlPmt71 it
Recovery wafer levels and raspecNre times after cessation of pumping [�
Reference point used for all measurement$' A�� `i 1��i C 'UT- G-61n P I n
Please tip out form completely and return to the Salem Board of Health
along with the Will Well Completion Report. Pump test report is a
requirement prior to issuing a Water Wel/Supply Certificate.
GRCUNDWAtER WELL&PUMP
i f 213 ORCHARD ST.
MA 02478
r
I 'd S108 68b (Li91 dwndRl33fn Nzliu90Nf10ds e30 :0i ao 80 400
Nn7Fc•
1. UTIUTIES SHOWN HEREON SUPERCEDE 4/2/02
PLANS BY EASTERN LAND SURVEY ASSOCIATES, INC.
2. PAVEMENT REPAIRS AND UTILITY CONNECTIONS TO
MEET CITY OF SALEM REQUIREMENTS
50.00
PLAN REFERENCES: LOTS 91 & 92
PROPOSED PLOT PLAN SALEM, MA PREPARED BY EASTERN 5000± SF. LOT 96
LAND SURVEY ASSOCIATES, INC. PEABODY. MA, 4/2/02. 3
ASSESSOR'S MAP 10 LOT 52.
LOTS 91 & 92 PB 16 PL 31.
LOT 95
o S
o
o, LOT 90 — PROPOSED g
DWELLING
a• ,y LOT 94
L
m
�o NEAREST HYDRANT ON BELLEVIEW STREET 40' 28'
SOUTH OF THE INTERSECTION WITH CARROLTON
STREET APPROXIMATELY 200' FROM PROJECT SITE ,2' LOT 93
A n
a c 2 • 100t' To Calumet St.
0 1-12'
0 50.00 —y
N
PROPOSED DRINKING NEAREST TRIBUTARY CATCH BASIN LOCATED
op
,WATER WELL AT INTERSECTION OF CALUMET STREET AND
ROBERT p S ER CARROLTON STREET APPROXIMATELY 200'
GRIH.
FFIN A (HYDRAULIC LENGTH) FROM PROJECT SITE.
CIVIL W �$. CARROLTON STREET
6.a S� 9FpL TE E kN ( RIM 127.7722H III
INV. 1218
STONAI ENG
o i
`m
4" C.I. CLASS 4 'I
a
y
s` Cousins Realty Trust
Scale: 30 Feet Date: 4/22/02 Carrolton Street
Salem, MA
References:
F Griffin Engineering Group, LLC Proposed Site Plan for Figure
E ASSESSOR'S NAP 10 LOT 52
9 Bever/y, Massachusetts PLAN BOOK 16 PLAN 31 Proposed Dwelling Water P - 2
LOTS 91 & 92
and Sewer Connections
a`
a
FROM :HRMEL CONTRACTING FAX NO. :978 745 3659 Oct. 23 2001 01:59PM P1
FP:K :11 Ur- CUl111nK-,t'I N.4 -w% 1,19. :47g PIS -'cul C gum.
••—�� CITY OF Sgl_EM, MASSACHUSETTS
9CIR0 O' 11EALY4
^11 I 2 W111 JI: SIR"-..2 .. coup-
/I SAl(4, MY Ole7(1
�`hfr T:: n7A -4I.IHQ0
.%� fin 9/q 745 074J
-j.$0
Salem
c1.
^MnNf: 11••nl rp ARi'al
Salem Board of Health Pumoina Iest Report
Name of well ownc,'. ra) 11GA4dtes9: d` / Til)-le/V41{
Wel!location(roforonced to auoast wo permanent structures or landmarks)'. ,5 G R++I�7C•1�' .5-F
Date pumping rest wp�aeAnrmcd.,��•X�e , I Q.�O ,r
r
Dcptn at which pump was set for the test
I"n-Htinr.of the ev<harge tine:
$tame wmer,level immodiatety peforo pumping commen edl j r
Oischarge rate LS (rem_(if 2pptltahie.time the dis0a1ga,ale changed)
Pumpn water levii and res e!ive 6rws after um
g De D Dlrvll:anmrl„CINI. t~k/ _
Maiim:Jnl dmwdown during the lest.__ NONP ./lv,l r(Q_ ,leVQ I J"TP 1 '! 5 �
DuralOn•ol test a}pu,up.ng time.^�-� r
III reeovery time slxlrg which measurements were taken t.(
Rarovery water IrYels and respective times a$or eessatiw of pumping 0
Hetantince poin:usec for all measurements- nr lLrl.., (1T r _Oin m r C 6-r-
Please lilt out form completely and return to the Salem Board of Health
along with the Water Well Completion Report. Pump test report Is a
requirement prior to issuing a Water Well Supply Cerfineate.
GRUUNOWATER WELL 8 PUMP
/ r 213 ORCHARD ST.
BELMONT,MA 02478
G.cTGo�ro/
G.�T1Ft,� /GU /� �ta.����..d
x
14
WELL LOCATION
This section consists of the following subsections:
• General Considerations
Relation to Property Lines and Buildings
Relation to Gas Lines and Overhead
• Relation to Surface Water and Wetlands
Requirements of the State Environmental Code, Title 5
Additional Considerations
GENERAL CONSIDERATIONS
Any person intending to have a private well constructed should identify all potential sources
of contamination, which exist within 200 feet of the site. Where possible, a well should be located
upgradient of all potential sources of contamination and should be as far removed from potential
sources of contamination as the general layout of the premises and surroundings permit.
Additionally, every well should be located so that it will be reasonably accessible with proper
equipment for repair, maintenance, testing, and inspection.
The well should be completed in a water bearing formation that will produce the required
quantity of water under normal operating conditions without adversely impacting adjacent wells.
Water quantity considerations are discussed in the section entitled "Water Quantity (Pumping
Test)" (page 38).
RELATION TO PROPERTY LINES AND BUILDINGS
Private water supply wells should be located at least ten feet from all property lines. The
centerline of a well should, if extended vertically, clear any projection from an adjacent structure
by at least five feet.
RELATION TO GAS LINES AND OVERHEAD POWER LINES
A well should be located a minimum of 15 feet from a gas line or overhead electric
distribution line and should be at least 25 feet from an electric transmission line which is in excess
of 50 W. When subsurface utilities are already in place. Dig Safe should be contacted at least
three days before drilling begins.
RELATION TO ROADS AND RIGHTS-OF-WAY
All private water supply wells should be located a minimum of 25 feet from the normal
driving surface of any roadway or a minimum of 15 feet from the road right-of-way, whichever is
greater. Additionally, it should be noted that the 'Rights-of-Way Management' regulations (333
CMR 11.00) include procedures and requirements for marking and recording the location of
private drinking water supplies, which are within one hundred feet of any right-of-way. Private
drinking water supplies that are marked and recorded in accordance with the aforementioned
regulations are protected by restrictions on the use of herbicides for maintaining rights-of-way.
Uniform standard signs for marking water supplies have been produced and are currently
available from the Department of Food and Agriculture.
12
Recommended Pumping Test Report
All pumping test data should be recorded and included in a report that the contractor should
submit to the well owner. If the well driller performs the pumping test, a copy of the pumping test
report should be appended to the Well Completion Report that is submitted to the local Board of
Health and the Office of Water Resources.
The Pumping Test Report should include, but not be limited to, the following information:
(1) name and address of the well owner
(2) well location, referenced to at least two permanent structures or landmarks
(3) date the pumping test was performed
(4) depth at which the pump was set for the test
(5) location of the discharge line
(6) the static water level immediately before pumping commenced
(7) the discharge rate and, if applicable, the time the discharge rate changed
(8) pumping water levels and respective times after pumping commenced
(9) the maximum drawdown during the test
(10) the duration of the test, including both:
a) the pumping time, and
b) the recovery time during which measurements were taken
(11) recovery water levels and respective times after cessation of pumping
(12) reference point used for all measurements
Recommended Water Quality Report
It is recommended that the local Board of Health require the well owner to submit to the
Board, a Water Quality Report any time a private water supply is tested. Recommended sampling
and testing requirements are discussed in the section entitled "Water Quality and Water Testing"
(page 61). The Water Quality Report should include:
(1) who performed the sampling (i.e., BOH member, BOH agent, lab personnel, well
owner, well owner's agent)
(2) where in the system the sample was obtained (point-of-use or point-of-entry) and, if
sampled at the point-of-use, whether or not the system was flushed prior to
sampling
(3) type of water treatment used (chemical or special device), if applicable
(4) how long after sampling the sample was delivered to the laboratory
(5) a copy of the laboratory's test results
Results that indicate no contamination are as important as those that indicate water quality
problems because these results provide background data in case of future contamination. A
complete record of all testing results is also useful when designing local water quality testing
programs.
Recommended Decommissioning Report
Within 30 days following the completion of the plugging procedure, the registered well driller
who plugged the abandoned well, test hole, or dry or inadequate boring must submit a Well
Completion Report to the Office of Water Resources and should submit a Decommissioning
Report to the owner of the property where the well, test hole, or boring is located. It is
recommended that the local Board of Health require that the property owner file a copy of the
Decommissioning Report with the appropriate Registry of Deeds or Land Court as part of the
chain-of-title. Another copy of the Decommissioning Report should be submitted to the Board of
Health. It is recommended that the copy submitted to the Board of Health include the Book and
Page reference and the name of the Registry of Deeds where the report was filed or, in the case
of registered land, the appropriate Land Court reference.