45-49 CONGRESS STREET APPLICATION FOR MONITORING WELLS 8-17-21 ift I CITY Or SALEM, MASSACHUSE.TTS lu
BOARD OF HEALTH
98 WASHINGTON STuF.T 3R.D FLOOR PubUcHealth
prevent.Promote.Protecl.
TET- (978) 741-1800
KIMBERLEY DRISCOLL healthe,saiem,com
I)EIVID GREEtvs�'1I_M
MAYOR HEALTH lAGI;NT
- I
Well Construction Permi lica#ion
Fee: 0.00 Check payabl a City of Salem (no cast,)
rge for monitoring wells-
Date: August 17, 2021
Location: shgtiand Park 45-49 Congress Street Salem, MA 01970
Owner: Prime Storage Shetland, LLC
Address85 Railroad Place, Saratoga Springs, NY 12866
Telephone - - 5 6
Email c/o tcampbell@partneresi.com
Type of Well:mo itoring wells (12)Well Use: Environmental assessment
Well Contractor: -TWA inc Pump Contractor:
Address: Po-IL,) .5 my:; Address:
Phone: q-7 _ `-fC7..oco Phone.
Reg. #:
Have abutters been notified? (y) How? Not applicable
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.
Note: There is no fee for monitoring wells, but a permit is required for installation.
B:O.H. use only Check# Check date: Permit#: