115 SWAMPSCOTT ROAD CITY OF SALEM, MASSACHUSETTS
BOARD OFHEALTH
S
120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
TEL. 978-741-1800
Fax 978-745-0343
W W W.SALEM.COM
Kimberley Driscoll JOANNE SCOTT, MPH, RS, CHO
Mayor HEALTH AGENT
WELL CONSTRUCTION PERMIT
Location: 115 Swampscott Road
Owner: Vincent Dilisio
Address: Swampscott, 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#: 001-08
Date Issued: 3/3/2008
(Irrigation Wells) (TED Inc. — Reg. #560)
HEALTH AGENT
+p CITY OF SALEM, MASSACHUSETTS
�1 BOARD OF HEALTH -
120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
TEL. 978-741-1800
FAX 978-745-0343
STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
Well Construction Permit Application
Date: -:� S-o apFee: $100. Check payable to the City of Salem (no cash)
Location: /1-5�S�Wko-rr & Salem, MA. 01970
Owner:\/, wT Address �, kTTr Tel. '7j1 - y?9- 90 70
Type of well VX( X - Well use: �/1 � 1-i� ^j
Well Contractor:C_&At.< vm cLL/nj5 co. -i--NcPump Contractor:
Address: /�q ?1�or 44 - / c{Ar2a, KA Address: '� M�
Phone: `t-78- 887- a-5z ;C Phone:
Reg. #:3oS
Have abutters been notified? (y) x How? _\(e4_j5A-1,L7j
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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.
T-# Is r 5 Ta 9eele✓ t9�/ E?cr�T,n�G tc/�Gc
W14 IC I'S Na �J z9S' De �P
There is no fee for monitoring wells but a permit is required for installation.
- --- ------------------------------------—-----------------------------------------------------
B.O.H. use only. Check#: Check date: Permit#:
Well const permit appl revised 11/25/02
Joanne Scott
Salem Board of Health
February 22, 2008 RECEIVED
MAR - 4 2008
CITY OF SALEM
BOARD OF HEALTH
Dear Joanne,
Thank you for your consideration in allowing us to proceed with
additional drilling for the well at DiLisio Brothers Golf Range, located
on Swampscott Road in Salem.
This well has been and will continued to be used, solely for irrigation
purposes and not for consumption.
Thanks again for your assistance.
Sincerely,
Vincent DiLisio