7 LAURIER ROAD t CI-L
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CITY OF SALEM9 MASSACHUSETTS
BOARD OF HEALTH
« 120 WASHINGTON STREET, 4TH FLOOR
o SALEM, MA 01970
TEL. 978.741.1800
FAX 97$-745-0343
STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
i
Well Construction Permit Application
Date: -a Ill-a V Fee: $100. Check payable to the City of Salem (no cash)
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Location: 7 1-4-A l tv-Q. Ad- Salem, MA. 01970
OWnermpAy T-YleriNI3k-A { Address )st'a�,7t Sift-t,.. Tel. 60-S90-./83 -9
Type ofwell: 5evA-cAWell use: 00mv Sr' ,c
WeI1 Contractor. !?hgat<s vn. IQ.Ll s =,,c. Pump Contractor: SAA-C,
Address: t-).9 O--ePor P--J . (fou'r - Address:
Phone: 9 78- 8 87- Z 3 20 Phone:
Reg. #:
E
Have abutters been notified? (y) ✓ How? VeKfSatL�
---------------—---------_—______ ___ __--__--------------- --_
In the space provided below(or on back)show the location of the proposed well 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.
i iAr�lL r 5 r *1 >_-
Aj4ome.S c.oWN-e.crro T-� 'f-e- *fL, I'A4t`y-eo r"f 40-'2o5S
rte S Zt°C at i s A 9 14 1 L (y
PL, r-e e A T--T-AT-c,rl co /tet A u Fart
There is no fee for monitoring wells but a permit is required for installation.
B.O.H. use only.. Check#: � s Check date~ :5- _ Permit#:�
Wellconstpermit appl revised 11/25/42 `� / j} 1/
.S Lv �f a
a ID�r#V49 }� Jaa"K t te
fo wucson Jareer
N/F Poussard /
I Map 23 Lot 44
33 Willson Street
N/F DeMeule
Bk. 5780 Pg. 138
Map 23 Lot 43
31 Willson Street
40' — WI D E SET N/F Lauranzano
DRAINAGE S, ` Bk. 17685 Pg. 73
EASEMENT o $5oo4j'e I.R.
New DMH on SET �la�
Map 23 Lot 48 Exist. 24' RCP
1 Story :Road Drain. Mai v. o 0
N/F Sulu;back syfo New 24" RCP SSS
Double CB '� Drain. Class V o 2j20y
Rim=23.5 \ Req'd. See \8$ F
lout=TBD ' Slope Note ""c, 00•
Map 23 Lot 49 below• o l� Isolatec
5 Laurier Road o \ \ Wetland
N/F St. Pierre rn Q\ 4 \ 12
Bk. 10513 Pg. 144 � o 2 / -
\ LR• '�
\ Double CB - A, 2
—24" RCP Drain \ SET
\\ (Abandon) / - 60" RCP Drain \
i ♦ 24X5- (Partially Exposed
® elev. 23.6±) X
CO \Proposed � Lawn
25
1 2 Star % f
Prop. 1'0 Type \ J
K Copper 71' - Residence
H.P.
/ 1 I FF EL=28.0
/ \ \ 25xQ
_ 42 X24 Propose
..—.. I.R.
�x�\ 20'x30'
Prop. 6" CI. 52 D.I Water Line SET /
MARK—.._,f_ _ \ � �-- Garage
L Floor--26.0±
/ � RIM = 26.19 � - x8 �
R I E R R O A D INV = 22.89 / r� 1 S 4"0 Sch. 40 RV _••- 100'R Min.
6X0
I�•-� S
Prop.
Sewer2 \
U b I C o eo6.Nc 40 P e Pump Chamber I \ 2 \
V C sure Sew ICIV
I
5 Laurier Road \ \�� \ wetland
N/F St. Pierre `� \ 12 13
8k. 10513 Pg. 144
\ \ Double CB - — 24" RCP Drain SET
(Abandon) / 60" RCP Drain 2?,j• \
(Partially EXD)ed \ 607
rr" - ® elev. 23.61 �'
\
Proposed Lawn ^� \ ' 4All
- \
Prop. 1'0 Type 25 1/2 Stor _
K Copper ��• Residence \ �- _ I i 25 i I.R.
FF E1.=28.0 (� \ 25PQ \ ! /1 SET
I.R. 42• \ \ x'24'— _ _ Propose '
SET / �x� \\� 20'x30' —24'—
aRK—.._.f— •_..L.. \ \ � \8 .-- Garage
s.ts�"— - S - xFloor--26.0 23 \
2.89 4'0 Sch. 40'PV
__ \ \\ 100'R Min. 26X0 23•\ A2
PI Prop. Sewer -v
r
+ oP. 1�'0 Pump Chamber \
0 2
( PVC Pressure Se I M I \ I.R.
si /�sr• SET �f S 9
00
See Note 9 \ A2
0
O j R. BVW J LOto
o
E 4 Concrete Headwall a)
w/ Chain Link Fence
_..a.._.._.._f \ TOW = 23.5'f
s\ 4x5 20' \\ A INV = 17.34'
astle Hill Playground" 4.5 k Thrust
Block Req d
Map 23 Lot 51
14 Story Road 4'0 Deep Deep Sump CB w/ Hood `0' SET
N/F City of Salem \
Q Rim=2 \ �\
10" Inv. Out = DMH Inv. +12'12"
10" CI.V RCP DMH \ 0
s=0.01 Rim=23.51 \ O
Match Inv.
-Test Pit Required prior to \4ET R%
construction to locate pipe and \
— AREA OF LOCUS = 22,333 t S.F. determine elevation. \
�� A
CITY OF SALEM
/ ROUTING-SLIP
J CHECKED DEPARTMENTS REQUIRE SIGNATURES BEFORE BUILDING PERMIT WILL BE ISSUED.
LOCATION: 1 LAoPiF_?, '1&A DATE: 3�Z t1
APPLICANT: M4-w_ � (Ar'"6LdLi
Q
ASSESSORS OFFICE
@93 WASHINGTON ST. �
Y'I - J
FRANK KULIK � � DATE:
CITY CLERK(if involving anew street)
@93 WASHINGTON ST.
DEBBIE BURKINSHAW ;���� � DATE: � L/
PUBLIC SERVICES(Engineering Dept.)
@120 WASHINGTON ST,4TH FL.
BRUCE THIBODEAU DATE:
WATER DEPT.
@120 WASHINGTON ST,4TH FL.
M CROSS CONNECT SUP'R
BGRBEsefBi£ i, - 3 I e�:.;
@120 WASHINGTON ST,30.0 DATE:
�r {k�C>=T �E{o5� +315 ��5- 73c� PRs7lE
PLANNING
@120 WASHINGTON ST.,30.D FL..
3,11 Ea DATE: N! D
CONSERVATION COMMISS#QN(Pla ing ept.)
@I20 WASHINGTON ST.,3RD FL.
DON CEFALO _ DATE: 3 ��' V
�--1
LJ ELECTRICAL
@ 48 LAFAYETTE STREET,2ND. AR '3
..,,
JOHN GIARDI DATE: �(
FIRE PREVEN ( '
@29 FORT AVE(WILLOWS REA)
CAPT.HUDSON --�7;—^ o.i . _. DATE:
r
HEALTH
@120 WASHINGTON ST.,4TH F .
JOANNE SCOTT Yx�itLf DATE:
BUILDING DEPT
@ 120 WASHINGTON ST.,30.D FL.
TOM ST. PIERRE DATE:
***SUBMIT WITH PERMIT APPLICATION WHEN COMPLETED***
!�t �orrtntonbnea[t�j of �a��ac�ju�ett� ,,,`e}��� MAIAIOd�,f��,
6 State Reclamation Board
k r NORTHEAST MASSACHUSETTS MOSQUITO CONTROL
ri AND �os�pl Mpg°`
��, •�" WETLANDS MANAGEMENT DISTRICT wirbAna
P.O. Box 5068
Walter G.Montgomery Andover, MA 01810 Telephone:
Director (978)474-4640
Jack A. Card,Jr. Fax:
Operations Manager (978)470-0175
Emily D. W. Sullivan March 22, 2004
Wetlands Project Coordinator
Mr. Mark Tremblay
22 Forest Street
Salem, MA 01970
Dear Mr. Tremblay:
West Nile Virus (WNV) is now a resident pathogen in the Northeast. The primary vector
mosquito species Culex pipiens preferred breeding habitat is highly organic and polluted
conditions typically found in catch basins and storm water structures. For this reason, the
design construction and maintenance of storm water structure is of particular concern to
mosquito control and public health officials. We understand these storm water structure
are mandated and our review is intended to reduce the potential for storm water structures
to become mosquito breeding problems.
I having reviewed the plans and inspected the site of proposed construction at 7 Laurier,
Road. It is my understanding catch basins only are proposed for this site. Catch basins
should be maintained annually. Removing accumulate organic debris, makes catch
basins less habitable for vector mosquitoes.
Best Regards,
alter G. Montgomery
Dir _ r
cc: Joanne Scott, Salem Board of Health
G
L1 Committed to a partnership of the pr"fes of mosquito contro[and wetf rods management