26 HERSEY ST
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�� Cmr OF SALEM MASSACHUSETTS
fFyy} z kE BOARD OF HEALTH 5, r
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A?. 120 WASHINGTON STREET,4TH FLoofl ° 'p.. > ;"", a i •�y r s='.
2 "r SALEM, MA 01970 ;.F TEL. 978-741-1800
FAX 978-745-0343
WWW.SALEM.COM
Kimberley Driscoll JOANNE SCOTT, MPH, RS, CHO
Mayor - HEALTH AGENT
WELL CONSTRUCTION PERMIT
Location: 26 Hersey Street
Owner: Kevin Talbot
Address: 26 Hersey Street
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 #: 005-06
Date Issued: 5/25/06
(Monitoring Wells) (TED Inc. — Reg. #560)
HEALTH AGENT
MAY-12-2006 15:15 IES, INC 617-623-6880 617 629 2920 P.02
�:!• Jun 21 04 01:51F Joanne Scott salem sOH- 97a- 745-0343.- P..-Z
CITY OF SALEM, MASSACHUSETTS
SO&RO OF HEALTH•
120 WASHIN6TQN ST46ET•ATH In Call
SALEM,MA 01970
j rcL.97e•741�1800 -
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FAX 97&745-0343 ZIA
STANEEY J. USOYICZ, JR. JOANNE SCOTT,MPhf.FM. CFO ( U
! MAYOR HEALTH AGENT
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Well Conatfvction Permit App—RE4 i n
Date:-2 )9 °J Fee:$100.Check payable to the City of Salem(no Cash)..
Location: i6 ?3t � Salem,MA. 019M
Owner: t9d✓r,-' r9tA�°.rr Addres6 76 r +!aJl77r lei. 9-7e°-3I1
Type of wall: Wett use;
Well Contractor: soil Exploration Corp. Pump Contractor:
Address: 148 Pioneer Drive Address,
Phone: Leominster, KA: 01453Phone:
Rey.#. (978) 840-0391
f681 M
Have abutters been notified? (y)� How?
In the space provided below(oron back)show Me location of Me proposed well in relation to~�
exitqorproposedabovtorbe/owgtm$Wabudum AdeemofmofV WlePOWand-COMW
land use wi im 00 feat bf Me Pesod wef!focahw. which MPM wnt a polentie!SwrOv of
� (2 ) pra
I contaminaliorz. � ,.
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ne+e is no fee for mom w"&buts permilis-requir®d.ror k 4fift�
A.A..N uwa only Chetk a; Check date: Pemlit 0:
Wev a"at peff"apps I ASA 11+4y03
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MRY-12-2006 15:15 IES, INC 617-623-8860 617 629 2920 P.01
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:. 1ES INC.
FWARONMENTALCONSULTANTS
265 Medford Street,Somerville,MA 02143.
(617)776.2715 • (617)629.2920(fax)
www IESInc-Environmental.cmn.
rrJ ffe@IESfne-Envirenmental.cgm
DATE. SENT: May 12, 2006
SENDER'S NAME: Daniel-Jaffe-
NUMBER OF PAGES: This Cover and 2
NAME: Joanne Scott
COMPANY NAME: Salem Board of Heahir
DEPARTMENT:
TELEPHONE:
fAX NUMBER: (978) 745-0343
TIME SENT: 3:15 p.m.
Attached please find a permit for environmental test borings and monitoring well
installation for the property at-26=Hersey Street. Thepurposeof theborings is to better
delineate the known contamination at the site associated with RTN 3-10329. The borings
are scheduled for Friday. May 19'", andtheabutters were all-notified-today(May t2 )by
myself and by Mr. Kevin Talbott, the site owner.
Daniel Jaffe, LSP(42347)
IES, Inc.
MAY-12-2006 15:15 IES, INC 617-623-BBBO 617 629 2920 P.03
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WELL
0 PROPOSED BORING
SITE-PLAN FIGURE �
26 HERSEY STREET, SALEM, MA APPROXIMATE SCALE
IES PROJECT#706-100 e 0 18Pr f�`S= INC.
.________ EfNwONYEMq CONS1h ixi:
MAY 2006
TOTAL P.03-
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Massachusetts Department of Environmental Management
Office of Water Resources 142255
TYPE OR PRINT ONLY Well Completion Report
1. WELL LOCATION GIPS (OPTIONAL) LATITUDE LONGITUDE DATUM
Address at Well Location: 6/ " Sr Property Owner/Client: I-LsC
Subdivision Name: V Mailing
/ Addr`
! /! A
City/Town: S7 � Citylfown: il1
Assessors Map Assessors Lot#: NOTE: Assessors Map and Lot# mandatory if no str et address available
Board of Health permit obtained: Yes Not Required El Permit Number Da-.Issued
2:W0 K PERFORMED , : , - 3:PROPOSED USE.- a W ,r . 14.-DRILLING METHOD; x <r„
L�New Well ❑ Abandon ❑ D estic ❑ Irrigation ❑ Cable ❑,A er
❑ Deepen ❑ Recondition Monitoring ❑ Municipal ❑ Air Hammer irect Push
❑ Replace ❑ Other ❑ Industrial ❑ Other ❑ mud;;Rota '`-,❑ Other
w _.. ..
5. WELL LOG_ ,•5: Water Unconsolidated Consolidated 6.°SITE SKETCH(use germane rt aMma ka w ib distances)
Bearing m = a m a a other Rock Type
From (ft) To (ft) Zones 6 °' run Q m Material Description n��`/
1 vJv. _ ®
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1V
P
7. WELL CONSTRUCTION.,„ .; 8..CASING•-;�..r- u �" ,.v ...,.a:...- ...:;� •:- ,a-t. r u=. y ., ...�. 4,c;,
' s"
Total Depth Drilled From (ft) To (ft) Casing Type'arid Material Size I.D. (in) Well Seal Ty
Date Com lete 819/ ,9O� �� � /l
3
9. SCREEN`
From (ft) To (ft) Slot Size Screen Type and Material Screen Diameter
10.'FILTER PACK/GROUT/ABANDONMENT MATERIAL`" :" 11:ADDITIONAL WELLINFORMATION
41[, " Developed? ❑ Yes ape
From (ft) To(ft) Material Description'� Purpose Fracture It i
Enhancement? ❑ Yes El No
t Method
' 1d' Disinfected? ❑ Yes ❑ No:
12. WELL TEST DATA ALLSECTIONS MANDATORY FOR PRODUCTION WELLS 13. STATIC WATER LEVEL ALL WELLS }
Yield , Time Pumped Drawdown to Time to Recover Recovery to Depth Bow t
Date Method (GPM){ (his'& min) (R. BGS) (hrs & min) (Ft. BGS) Date eas red Ground Surface (FT)
14. PERMANENT PUMP(IF AVAILABLE) _.� : . ,. . _;. Al' z _' „: 15.NAMEIADDRESS OF PUMP INSTALLATION COMPANY"
v
Pump Description � Horsepower
Pump Intake Depth (ft) Nominal Pump Capacity (gpm)
16. COMMENTS
17. WELL DRILLER'S STATEMENT,-; -;�,_� This well was drilled, altered, and/or abandoned under my supervision, according to applicable
v1
; -q rules and regulations, and this report is com fete and correct to the best of my knowledge.
Driller: I 4 n Su ervising Driller Sinn at . Registration #:
Soil i ploration r�.
Firm: Date: Val Rig Permit #: a-
N os 9v.7
M' y�rrynust be filed by the registered well driller within
41e 30 days of well completion.
=Plo1
' EIGARB,OF HEALTH COPY
MAY-12-2006 15=17 IES, INC 617-623-8880 617 629 2920 P.03
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"ENTERPRISE RENT-A-CAR"
(151 CANAL STREET)
E7Ct3TN6 MONITORING
WELL
PROPOSED BORING
SITE PLA" FIGURE 3
26 HERSEY STREET.SALEM,MA APPROXIMATE SCALE
IES PROJECT 0 706-100 s 0 is FT \ I ES NC
MAY 2006
TOTAL P.03
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OO/12/08 02u97pm P. M2Jun 21 04 01:510 Joanne SeOt:t: Salem 813" 978 7450343
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CITY OF 5ALE740 MASSACHuarrTs
HOMO OF HGALTH
120 wws"wWP0N SrgeeT.ATN Fl ung
' - SALEM,MA 01970
iT1et...97a741.1 e00
FAX 97a'74S0348
RYANLET J.USOViCZ,Jii. JOANNE SCOTT.MPH. R$,CHO
MATOR
j HEALTH AGENT
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well
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Fee:$'Do. Check Payable to the CRY pf Salem(no cash)
i I Loadlon: Z6 d OR•fe Yr-qj salern, ria OIQ70
Owner k6�N �e Address�6 -CV).
IType of ureU: F#dle. ,,,,4.,/ Well use: c'r,,,y,(,,,.A•
W90 con"C(Or; SoilBcplorakioa Corp, Pitmp CWMt tor:
I Address: 148 Pioneer Drive AddfBSG-
Phone: Leominster, MA 01453
#. (978) 840-0391 / Fhonac
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