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2005 WELL CONSTRUCTION PERMIT `� �rY"y ?�$x"�"§' 'f:"��r � aCV.t m•tA-`�,.'"°t �'•�"'.' l�a� n �'"-.x'_sf«pYs" 9syb; "--'a"x3ti ax�S a"`twy.. ,w",�±n "y' ._ ' i 9vU w...dt v�:T..:. -.«4+ :0" m•-'.R,"}'.2 t::. '�._.....,��-.r. ...� CITY OF SALEM 'MASSACHUSETTS ' 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 Location: Salem Transfer Station Owner: Northside Carting, Inc. Address: 210 Holt Road, North Andover, 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#: 006-05 Date Issued: 5/23/05 (Monitoring Wells) (TED Inc. — Reg. #560) i HEALTH AGENT 21 04 01:51p Joanne Scott Salem HON 878 745 0343 P•2 G1TY OF SALF-Ml MASSACHUSETTS HOARD OF HEALTH 120 WASNINa-rom STRKgT,ATN F,000 SALEM, MA 01970 TEL.978-741-1800 FAX 978.745-0343 / 5TANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT � ��9-1—ds-Well Construction Permit Application bate;-C1 Fee: $100. Check payable to the City of Salem (no cash) Location: Sa/e'. raS"l oto lUSalem, MA. 01970 Owner. Ton Address p In' AA y_ Tel.q2.-?- EF6 -9-604 14, A14% Type of well:, Well use: Well Contractor: Soil Ex0loration Corp. Pump Contractor. Address: 148 Pioneer Drive Address: Leominster, MA 01453 Phone: Phone: Reg. #: (978) 840-0391 #681 M Have abutters been notified?Alo (y) How? In the space provided below(oron 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 contammahon. SSE �47r.YGtl�vfFvT �� 11 There is no fee for monitoring wells but a permit is required for installation. 8,0.H Use only Chark#' Check date: Permit# - WQIIMMtPerm12PPI revlsedliR5l02 2 --------------- 06 ..303 /YAW - g 7UND`- 302 � — - - %4 ; i iii J P 'I EXIST. � \q', 'tltti 60�Q Y STACK JBE MOUND \„ 05I1413f FORMER INCINERATOR � CURRENT \% W ASTEBZ TRANSFER P 0CCESSING STATION I •i' > _ --- AREA -4-_--- ! `1`LOVERHANG - .—.� �� ENT-- / r _ i SIE PI HYD p .94. R (D ' ' ; ofi CB BIT CONC CURB LEGEND TTROAD -5>.44",-s"7r <ofo 405 BORING WITH CORE (0 305 BORING TO BEDROCK REFUSAL -- - - — - - _ _ _ ' /j'1 W /YJONzT7�,c.ZN 6 WEtL /!?c �no� r of cu,,,?- land USc- ;2v0 p L_ SJZt ryati . rarolco� •�7on,�vn4� "n5� r '�i� �1-a�s� S�u�io.. �s vrcc✓ � Ga/lcc�c%�. o� GcnST>•✓�/�7�'L Massachusetts Department of Environmental Management 0 Office of Water Resources 855 TYPE OR PRINT ONLY Well Completion Report 1. WELL LOCATION G(/PS (OPTIONAL) LATITUD�lE. _ I _ 11 LONGITU 1 ! DATUM Address at Well Location: A +II w� I Pro a Owner/Client: / ii "1 �• , 4. u@Y�'t`y� Subdivision N e: �yy�N FI!) T/y i�UTW ailing Address. / 4-9 n y� ��y a City//Town:: P- 4 i I r i City/Town: `y VJm4 nA .'©"'+�V._:. i'1 j Assessors Map Assessors Lot#: NOTE: Assessors Map and Lot# mandatory if no-street address available Board of Health permit obtained: Yes k" Not Required ❑ Permit Numbero06 Date.lssued' J, Aar a� 2.'WORK PERFORMED „- - '3. PROPOSED USE,*' ',, ! ¢.a y '4 DRILLING METHOD 'M_ g ET'New Well ❑ Abandon D.,poWestic ❑ Irrigation ❑ Cable ;01M,'NAW,-- r ugerF El Deepen El Recondition Monitoring EI Municipal El Air Hammer°® Direct Push ElRe lace ElOther ❑ Industrial ❑ Other ❑ Mud!(Ro[a ❑ Other 6. WELL LOGWater Unconsolidated Consolidated 6. SITE SKETCH(use permanent roaermwtm.`drsmeces) Bearing m c a 8 Other Rock Type From (ft) To (ft) Zones v N w o 12 M Material Description IY2 f YYJJ �;rte IAj Sfd'7�" 7 WELL,CONSTRUCTION =` 8."CASING^,` "x 1 •,, ova $" re Total Depth Drilled t From (ft) To (ft) Casing Type and Material Size I.D. (in) Well`Sea l Type Date Co ple 7 .', ,' C. 1l 9. SCREEN: From (ft) To (ft) Slot Size Screen•Type and Material Screen Diameter 7 10. FILTER PACK/GROUT/ABANDONMENT MATERIAL , Ur _= 11 ADDITIONAL WELD INFORMATION .-- Developed •- ` r ? E] Yes From (ft) To (ft) Material Description Purpose Fracture . / Enhancement? ElYes EJ No Method r , Disinfected? ❑ Yes ❑ No 12. WELL TEST DATA'(ALL'SECTIONS MANDATORY FOR PRODUCTION WELLS)" '`'. 13.STATIC WATER LEVEL(ALL WELLS) " Yield jime Pumped Drawdown to Time to Recover Recovery to Depth Below Date Method (GPM)`�(hFs& min) (Ft. BGS) (his & min) (Ft. BGS) Dae Mea ured Ground Surface (FT) r .. : r I N. V 14. PERMANENT PUMP (IF'AVAILABLE) "" ` , =" '"' 15.NAMHADDRESS OF PUMP INSTALLATION COMPANY Pump Description Horsepower Pump Intake Depth -` (ft) Nomina Pump Capacity (gpm) 16. COMMENTS 17 WELL DRILLER'S STATEMENT: This well was drilled, altered, and/or abandoned under my supervision, according to applicable rules and regulations, and th a ort cc mplete and correct to the best of my knowledge. f�jj✓a� Driller: k � � )� pervising Driller Signature "� ' Registration #:� 61� ��� �� g Firm: Da e: %rRi Permit #: L lj J Leonfifft#ftl Mlee j4Wrts must be filed by the registered well drillel within 30 days of well completion.. BOARD OF HEALTH COPY . ................ .. �06�ilc�5 1'SI. 781 78Y�4T80...............PA68�@(GINEERING-NORWOOD plu�� /�I/NT : siKE+�1 W'7X.bNSff.C. S7M�f Q}�•' � . � �`��`` rn µ�.• � fir_ fM^ v,.l • :' �.. i• �.: ' r11 ' 1 EXIST- ii � j ' i r rI i• I''%Y, gsACK V•1= JDE #4 CVVD NCINFRATDR t • '. .. .�: i � ;�• 11 \'' �: 'tip RENT `' ;� %�••" ]�• :' 'r `.• `• "1��•� � ' 1pgNSfER :(( jl r i ;•' j '. �" t . WASTE $7ATION ':;7 i• f ;•' e-Z SING ,'. :•\`• i. ',�� �. PROCCES AREA ^•l�i'':1 / � ( ! i ff• I j . r. STE PI ;• ,'• , R-YAC6 .p � SIT, CONC CURB EGEN (Die_ ITT ROADS --- . RD To REFUSAL l 'rho 7�4 . v,,o1/ /f r.,vw•v�**j � �� L nsfiCi s ! f7ei. K Lfcd '/•cr Oma-" s I { I i 3 Y kill. Y r"k`i?^,ej `fi• udx °bz;4 .�-'+'� �' t�� '`'y4'd"�'4 e''F4 CWu»., �' v. t � "� d CI+TrY' OF SAL' M ASSACHl1SETrTS � Hni'"�'i`� ^aL jF10�R 413 SJOANNEiSZEA O'TS IT i J' R� 2t IFF �ii y,.4 e , qy4 w, K 7 r31rr t k 'fir +� x st-y' ♦�y, '"gl'u°i'c }r i r �P'h- �'� A£: at��,�F3�r"r °c 3Es, ''�> rtw":r"+, a t. E ,ih tr ry'�d,J�ifr�d.'id'33y.r i a nbha-'t i�4a`t t 1i r,�'v�'6 a�.-y,f '�x jF,Yi k 7 WELL°.CONSTRUCTION PERMIT , > kit #i� � 'V{4 f .Y < �F � y1�; Y Vh t � �y_�'ik.�( 1 �..��eJ:•^s� � '` t v;iwF � na d':. �h :.A.a'y +'t ai`';• p r 4 '� . t7A'x 1, # Salem7ransfer,Station , oca r 4 •Owner M` Northside Carting;Inc' "ex &`� �, Add J'M • tn'%.�. v Y., a t f .,ar'' g a i 4A ..eL'Fe sass 3: ry r �e�:3t rr ''L -t. ti*'ry.slL ror ti+ ua .ter rT 1b 4 ` f,=Address .1 " 210 Holt Road,:North Andover, INA ° � f 4Y.,:F:'f�� & 9�� Ed f �'r �x ;�' Fs u, •-Ins permit is granted in conformity with the statutes and.ordinances relating to,well �' F .1fy. fn �V`ari, , pemlltSr� e«<s t*•�' '; . ^S'`,.,` '' P i 1} a S`air-"=k?. y> 38 `. � y•� .�1+ '�" � d Fin 7 ,Well Construction permits are nontransferable -7 This permit shall be on site at all times that work is taking place Permit shall expire one r + (1)year from the date of issuance unless revoked from .�[t i y` t s -, Ms perrrid does not 6o a,Water SupplyrCeifificate Pemtit#:` 006-05' r Date Issued: 5/23/05 p(Monitoring Wells) (TED Inc. —Reg. #560) HEALTH AGENT 'v JUN B 2005 Ty