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23 CEDARCREST AVENUE - WELLS eT $ p Y �rF'""�•�e 5 ; %e r �Aa'� ,$,. ♦ t� ''" �.�a1. W rm43. � x fiv31.' Y S ay l gg FF '7n '. .e,,, k*f'+!''x>+yr f ^y{ ..`y 5 i+Sz "i'' w Y`'�+.�t" r i- r ,+E'�1� 4 yy a<h y NA .4't4- - `+ � #n s ,@"' �'" P rx M �y,{e ✓�j, tiu�' �g �!M' e i.tS'f t s Y+, `tY ,�,s s J � <cr"4s. '.ji< '444] "'2..-it's '^ +k ik s "} Y, '[ Fte h xZa'ps,.$''"'�'S �t,'rtiYi{�' ^iy" r *`+i`f r F d eiC^" ��'"� �- .�stk'�' "t{F��, y,w ,L`. ,w r�•;� t. ^S*�°.., �t7`t v y -z s c s:. 5 >• r at � '^i� f s `.� ,°' ''3.,r3 4� �1� 1F y.xc sa $'si ,^" t. �r q � +, ,�..f' �tr 5a.` S jai .1 s . q W s + Ul_ '�-Nd,'`��` Ti VXITY OF SALEM BO MM HEALTH f f r' a1`> '^ta JOANNE SCOTT MPH';RS CHOP" NINE;NORTHSTREET Tel;(508)741..1800 - ro � e 4 iy �+ 2 9705 z i� � 3xi i. ° ��, F� _s �� !<46s`7. r 'R A. :fir y♦ g� p s��C �f p '� y � # f s'.. r Y �'. t 'Ah y'a-��*`shV•r z a ° ' lr^±ar , $ `3i ° a ai . t a r '`'-- y "Y 5 FrY •�. t 'ti. +E K. a+' J' 4}s '• of t �^1a+.J h.�u. � <J A Y '�•sY ^1 �t��� � Y fail 1 �!. 4 PJ t'rz�r�'1 S � .,t ki fd` I_..,.t .,x•..a.w�.m SWi �k� d " w Yy�' S r,+4 e� � .� r gx��^ y :a ft& } C wr r t�t k >« _tJ> ? Axl� y' i ^i. a s t f y r p ,v COMMONWEALTHEOF�MASSACHUSETTSr " "° ' ` ? ' y o r 1 #�✓' '" wK t T 3� l.1? >� a fes. Y�°uk cn ry 3n '� rLS to y e x F + rt r� 0 'Ar ..Y N` a- x •T r a. r CITY gOFaSALEMr�3 ! a P « gs t 'ti E '".,Y.{+' " ff �n` .BZW a z a d�,r <'• W. Wffi.LI DRILLINGIPDMP�"TESTING , xrt ru,rs 4, t r - ?, - xk r 5x w y 'y a IY 4 f C �c -C h-' w1• }' k_' Y d 1.>f t 'i� 'l .M1 4 'H {f _ Location 23 'Cedar�est Avenue ' " r ,�5 a & Ln. @' �`�'�.,� rt:- a �'tr' �� (Owner PeterW& Barbara Maitlandu , �: � ;1 y r > '4A $et 5 � r* x., �y •a< L, f a� s 6P r •�'aY z'��*.1p311' y '�r fi=7S �'�� n' �..,' = v�d'L �}, yFj�r � t r,� wEa" cwt 3%Et,`iy} a � r +� . r k+ Address 23Cedarc'rest Avenue, ,Salem;' MAST c; Thisjlicense',is granted in conformity with #the Statutes �,. £and 'ordinances relating to Well-Permits }.. � 1 r e Permit # 2"97 Date `.10/17/97 z� r I 3 OCT .) 4 1997 y� H.IALTH L,_PT. CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET HEALTH AGENT ✓ Tel:(508)741-1800 �j Fax:(508)740-9705 Permit# Date Application for Well Drilling and Pump Testing A permit is requested to: drill a welly install a pumpy other LOCATION: 2-3 Lot# y.3 S/ Owner � C±&j W&b4ddress 2-3 6�7R /CKCS% fdE Tel. 7 Well Contractor AQl/� i Add. j2c�7D7 /j/%�/B67Te1. � � j`/Sy Pump Contractor E40 Pl¢ Add. (S //4.T)(-,Tel. !o/�' ���✓fys� { 6a y 1991 CITY OF SALEM BOARD OF HEALTH HEALTH!DEPT. Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(508)741-1800 Fax:(508))740-9705 Permit# Datej�7 — Application for Well and Pump Permit A permit is requested to: drill a well install a pump other LOCATION: 23 Lot# 0036 Owner Rer52 t Bn&&m* my;7zA z Address ?3 CrOge Cit£ST A Tel. 7y5--73-21 Well Contractor 9Yi //i,vo Add. PG�ADinIG. rhi9• Tel. 6/?- 9yy SYSS` Pump Contractor,41/E//;,wo wt✓/r Add. /lF o✓ G. Tel.6a- q?V -'g "-r- ---------------------------------------------------------------------------------------------------------------------- Wells (To be completed at time of pump test.) Type of well Use Well Diameter Size of casing j Depth to bedrock Depth of casing into bedrock Was it seal tested ? yes( ) no ( ) Date of testing Depth of well Well ended in what material ? Depth to water Delivers Gallons per minute. Drawdown feet after pumping hours at Gallons per minute. (Please sketch map of well location with tie down lines on reverse side of this form.) Completion date: Well contractor signature: Reg# ---------------------------------------------------------------------------------------------------------------------- Pumps (To be completed before installation.) Name and size of pump: Type Water pump delivers: GPM. Size of tank Pipe material used in well: cast iron ( ) galvinized ( ) plastic( ) Circle one : Well pit or Pitless adaptor. Was sleeve used to protect pipe? yes ( ) no ( ). Well seal type: Date: Pump installer signature: Reg.# ---------------------------------------------------------------------------------------------------=------------------ Plumbing Inspector Wiring Inspector Board of Health ; 1 OWES �� . , �i�� ��� ����� . �J� � � I 0.. (X5 ' (e> �� ���, qzz;2goo � ��. -� ��u5 � �©til i,�.c c�µc s�-o-� � - -� � - •Hobby Supplies,Artist Supplies •Photo Chemicals,Chemistry Sets •Cleaners,Spot Removers •SOmming Pool Chemicals •Car Batteries,Dry Cell Batteries •Aerosol Cans •Pesticides •latex Paint Date: Saturday June 22 For More Information Call: Time: 9:00 AM- 2:001 Salem Health Department Place: Salem High Scho (508) 741-1800 Who: Salem Residents or Proof of Salem Businesses: Clean Harbors Central Customer Service Pre-Registration 1 1-800-282-0058 Ext. 6300 Sponsored by Pay Directly Neil J.Harrington, Mayor Come only at 2:( *KIDS,NEVER TOUCH HAZARDOUS MATERIALS. ASK Free, drop-off service to r YOUR PARENTS TO PACKAGE THESE PRODUCTS. i • o D:1-9 C orimur,i cat i cn Report i** SALEM HEALTH SEP 02 '97 11 : 59 AM k,i*4 y t 4 4 k i t$1 v C3, *:ok*.*.k 3: i.1.#J*4 4 4 i t*J:1:'i%k ti K4q:f 3.1. NUDE REMOTE TERMINAL ID. START TIME TIME PAGES STATUS ---- ---------------- ------ -- ------ ------ ----- ------- T 05 102 1 1 : 53 AN 2 C3 s RESk3 I TRANSIM 1 1-5 1 uh Dh To: Fax: .....CO. From: . ......... Date: ............-.........-................. ............................................... page(s) including this page..Z .............- ........ ...... .......- -..........- I �� cwd Nae- of ///50 fax from the desk of... Joanne Scott, MPH, IRS, CHO Health Agent Salem Board of Health 9 North Street Salem,Ma.01970 (S08)141-1800 fax.(508)740-970S � � a CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH,AS,CHO NINE NORTH STREET HEALTH AGENT Tel:(508)741-1800 Fax:(508)740-9705 Permit# Date Application for Well and Pump Permit A permit is requested to: drill a well install a pump_; other LOCATION: Lot# Owner Address Tel. Well Contractor Add. Tel. Pump Contractor Add. Tel. -------------------------------------------------------------------------------------------------------------------- - Wells (To be completed at time of pump test.) Type of well Use Well Diameter Size of casing Depth to bedrock Depth of casing into bedrock Was it seal tested ? yes ( ) no ( ) Date of testing Depth of well Well ended in what material ? Depth to water Delivers Gallons per minute. Drawdown feet after pumping hours at Gallons per minute. (Please sketch map of well location with tie down lines on reverse side of this form.) Completion date: Well contractor signature: Reg# ---------------------------------------------------------------------------------------------------------------------- Pumps (To be completed before installation.) Name and size of pump: Type Water pump delivers: GPM. Size of tank Pipe material used in well: cast iron ( ) galvinized ( ) plastic ( ) Circle one : Well pit or Pitless adaptor. Was sleeve used to protect pipe? yes ( ) no ( ). Well seal type: Date: Pump installer signature: Reg.# ---------------------------------------------------------------------------------------------------------------------- Plumbing Inspector Wiring Inspector Board of Health ADepartment of Environmental Management/Division of Water Resources ,-t - WELL COMPLETION REPORT - WELL LOCATIO 22 /A� /n/ GEOGRAPHIC DESCRIPTION AddressC/ NO E W of lleerl !ci¢lel City/Town owner- - /f Well n ,4ti �� �yy Ileed Address �J D' 'rte N S EW of �� !ml.In lenrhsl Iclyd Board of Health I permit obtained: yes no ❑ .intersect w/ ! . WELL USE WELL DATA , ���� Domestic E) Public C3 industrial E] Total well depth= �^2.ft. Monitoring❑ Other Depth to bedrock��ft. Water-bearing tock/unconsolidated material: Method drilled Description h�a/ /t (z,�F Date drilled CASING Water-bearing zones: ` j ` /Rn Type /�,, (/ / Q� L 1) From�TTo ' Length�ft. Dia I.I.D.) tn. 2) From _2�90 To 3Rfl 3) From To Length into bedrock Zn Gravel pack well: dia. Protective well seal: Screen: dia. Grout.❑ Other Slog_length_from_to— STATIC WATER LEVEL(all wells) Static water level below land surfaceft. Date WELL TEST(productionwells). Drawdown fl. after pumping -_hr. f2 min.at__j;2_gpm How measured--AiF'Recovery Q!O ft. after [it. 2.a min. 0 LOG of.FORMATIONS COMMENTS tlY9re�/lf?c/ Materiels F— ':To Driller /t Firm AddAVELLINO WELL&PUM P INC. cry/r Haven S eet Superv. tiler Reg.# 1 narvre w}upaivialn re amred•wee dr/Ilei-/ Par"Pnnr rvmll, `. BOARD OF HEALTH COPY I 1 'F NOV 2 '4 1997 CITY OF SALEM •. HFA'Tw DEPT. lu t �