MONITORING WELLS - BRIDGE STREET OVERPASS CITY OF SALEM, MASSACHUSETTS
o e
BOARD OF HEALTH
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: Land south from end of Pearl St. to Lemon St.
Owner: Mass. Highway Department
Address: 10 Park Plaza, Boston, 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#: 003-07
Date Issued: 7/5/07
(Monitoring Wells) (TED Inc. — Reg. #560)
HEALTH AGENT
CITY OF SALEM} MASSACHUSETTS
BOARD OF HEALTH
w 120 WASHINGTON STREET, 4TH FLOOR
r o'' SALEM, MA 01970
TEL. 978-74 1-1800
- FAX 978-745-0343
JOANNE SCOTT, MPH, RS, CHO
HEALTH AGENT
Kimberley Driscoll
Mayor
Well Construction Permit Application
Date: 7 5 o7 Fee: $100. Check payable to the City of Salem (no cash)
Location: 14,a gee,4.,,71 $oyM �,r Fn/ >F Parr Sl oop J. /ew n Sf wk. Salem, MA. 01970
Owner:P.tFr.cr'S Tr m6 r MRt �t�{TAddress to 1-:!`
pt.:«, R.a� 7360 Tel. bl7- 47�- 73o q
Dep IM.nr Q MA tl2116
Type of well: Moo,tnrinh Well use: mon.!„;nti
WellContractor: T-',,--1 0r.71:� ser-',os Pump Contractor: [A/5R
Address: 2 Poor Dr,vc Pu N.. 10 Address: z. Te,*" j PKx
Phonet97g) Ilzz -000stPhone: 4ve'&rhrd' M, 0106
Reg. #: (979) 4'fi- 3o U
I
Have abutters been notified? (y) Ye y_ How? AsAp. fr uF - 9UJoe Slvenf- 6y-,t� r c�n,tr rhm
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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.
There is no fee for monitoring wells but a permit is required for installation.
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B.O.H. use only. Check#: Check date: Permit#:
Well const permit app] revised 11/25/02