9 COLBY STREET - WELL Cny OF _
BOARD OF_HEAU
120 YYASHINGTGN STREET,4TH FLooR -
SAteM, MA-1019M
ZFI Q7R:.7�1$QQ
FAx 978-745-0343
W W W.SALEM.COM
Kimberley Driscoll JOANNE SCOTT, MPH, RS, CHO
Mayor KEALTH/AGENT
WELL CONSTRUCTION PERMIT
Location: 9 Colby Street
Owner: S-RR�
Address: 9 Colby Street
This permit is granted in con well
permits.
Well Construction permits are nontransferable.
This permit shall be on site at all tirnes that wodr,is taking place. Permit shall expire one
(1)year from the date of issuance unless revoked from cause.
This permit does not constitute r"Tte.
Permit#: 004-07
Date Issued: 9/18/07
(Monitoring Wells) (TED Inc. —Reg. #560)
HEALTH AGENT
09/18/2007 11!13 9786350980 HYDRDENVIRO PAGE 01101
Sep 14 07 12: 11p Joanne Scoot Salem BOH 878 745 4843
P. 13
CITY OF SALEM} MASSACHUSETTS
BOARD OF HEALTH
120 WASgIWCT0N STREET, 4TH FLOOR
SALCM,MA O 1970
TEL. 978-741-t$00
FAX 978^7450348
STANLEY J. USOViCX, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH ADEN-r
Well Construction Permit AnuRc tl n
Date:9-!x'-07 pee: $100. Check payable to the City of Salern(no cash)
Location: q (oL 13 Y 577- Salem, MA. 01970
Owner: C rr Address-cCba &y ST Tel.
Type of welt: Well use:
Well Contractor: )' #tzl[At- +_�P.II.UW, S,ls?ump Contractor: �o G
Address: x. PC T J>A,, 151-Mij4c f(A Andress.,
Phone: q-7 f- yt zy-apo 5 Phone:
Reg.#: 5( O
Have abutters been notified? (y)_y HOW? TEt ptror
to the spore provided hetow for on back)show Me JOCauan of the proposed well in station to
extsung or proposed abova or below ground slructun+s A description orvtstbfa pdw and curronf
land use whin(200)reef of the proposed well locarlon,which represent a potential source Of
oorrtaminatmn # tgot^N15 ALV-
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There is no fee for mondoring wads but a permit is squlred for instadaiion.
B.O,H.use rntty. Check# Check date: y -- Permit#.
Wes most pem+it aPPt revises tt25Ja2 .
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