50 FREEDOM HOLLOW
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
TEL. 978-741-1800
FAX 978-745-0343
WWW.SALEM.COM
Kimberley Driscoll
Mayor JOANNE ScoTT, MPH, RS, CHO
HEALTH AGENT
WELL CONSTRUCTION PERMIT
Location: 50 Freedom Hollow
Owner: American Property
Address: 50 Freedom Hollow, 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#: 005-07
Date Issued: 11/6/07
`(Monitoring Wells) (TED Inc. — Reg. #560)
HEALTH AGENT
OCT-18-2007 THU 01 :45 PM RANSOM ENVIRONMENTAL FAX NO. 1 978 465 2986 P. 02
mDot 16 07 03136P Joanne Sooto Salem BON 978 745 0343 P. 2
CITY OF SALEM, MASSACHUSETTS
BOARD of HEALTH
o v 120 WA9NINGTnN STREET.ATH FLOOR
SALEM,MA 01870
S TEL.978741.1800
FAX 979.745.0343
STANLEY J, USOVICZ, JR, JOANNE 5COTT, MPH, RS, CHO
MAYOR HEALTH.AGENT
Well Ccinstruction Permlt Appy ac tion
Doter L4L Fee: 3100. Check payable to the City of Salem (no cash)
Location: 3 eec VYLn ��(l�� Salem, MA. 01970
Owner: Vh , Address Tel.
Type of well:0W � Well use: y / j.L'
Well Contractor: ca iCsf clerk �fi 4;, Pump Cor r: N
Address:-lSl e kinod �tK / Or,6 ,ly-i A Address.
Phone:Sn`6$S(-j LA t4 3. - Phone:
Reg. #:
Have abutters been noHfled7 (y)—)L How? Ca {n , Pa e Icflak V/LlCuNflea
In the spar,%pmvided below(or on back)show the location of the proposed well in relation fo
existing or proposed above or below groundstrucfures. A description of Visible prior and current
land use within(200)feet of the proposed well location, which represent a potential source of
contamination. ;!'r.StD r
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OCT-18-2007 THU 01 :45 PM RANSOM ENVIRONMENTAL FAX NO. 1 978 465 2986 P. 01
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CITY OF SALEM9 MASSACHUSETTS
BOARD OF HEALTH
m
120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
TEL. 978-741-1800
FAX 978-745-0343
KIMBERLEY DRISCOLL JSCOTT@SALEM.COM
MAYOR
JOANNE SCOTT
HEALTH AGENT
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Board of Health News ----------------------------------------------------------------For Your Information
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