IRRIGATION WELL • �� CITY OF SALEM, MASSACHUSETTS
BOARD OF I-II-ILTH
120 WASHINGTON STRLGT 4"'FLOOR Pll1f1�1CHC8)a
e Preveot,Promote.Protect.
'T' L. (978) 741-1800 FAx(978) 745-0343
KIMBERLI;Y DRISCOLL Iramdin e salem.com
LARRY RrAnUMIN,RS/RL;HS,CHO,Cl)-];,S
MAYOR HFAIXH AGENT
Well Construction Permit Application
Fee: $180. Check payable to the City of Salem (no cash. No charge for monitoring wells)
Date: - f S IS n�
Location:-/y �9 d'La4v, D; l� Salem, MA. 01970
Owner: �"tt4 1-kjo1X.4e1W& Address ,rt, 4.yu)JTel. 7P/ -581 - N 5 7
Type of well: 3ep(10cle_ Well use:
Well Contractor: CAaa.tEs t✓1. /lo ,.ds cc. roc. Pump Contractor: S &M-0—
Address: la(. o4Pp; /18. Address:
Phone: 1-18- 88rl- 2.32-c Phone:
Reg. #: 3oS
Have abutters been notified? (y) ✓ How? y Me)Ai,
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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.
A-Tc 4-ei3 rf
There is no fee for monitoring wells but a permit is required for installation.
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B.O.H. use only Check#:)4A63 Check date: 7/) JPermit#: 1�L - I ,
Well const permit appl. UPDATED 5/23/11
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GEORGE W.ROLLINS OFFICE: 978-887.2324
President FAX: 978-352-8236
CHAKES M.Ile JL OLL INS Cd, C.
WELL DRILLING CONTRACTORS
Domestic-Geothermal•Irrigation p Industrial
Full Pump System Installation t&Service
126 DEPOT ROAD www.roliinswell.com _
Bovet,MA 01921 George@rollinrwell.com
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LEACHFIELD TO CONSIST —
PROP. t 15-LF TRENCH `MTM —
pjACENT RESERVE AREA
�t5.o' +58.7
58.7+ Y
PROP. 30-LF 4" PVOUT AT PPE �D — �'I— DENSE
WITH 0%INV AT TRENCH=55.95 GRADE
(S 2. ) o to
1500 GAL SEPTIC I o � RAW
PRO(TWO
COMPARTMENT) LOAM
TANK ( ININ,4V. IN-56.55 I+59.3 I G PWE
59.0+ O 10-LF
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• +59.3
LOCUS MAP
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30.4! SCALE: 1:25,000
LAND USAGE TABLE o
11 PROP. STAIRS (I ZONING DISTRICT)
/PROP. 4 OUTCOFSB ILDIN SEWERCH 40) °
INV• NPROP• R K ITEM REQUIRED PROVIDED ;; v = o h o
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COPPER W \ p� ;' a Z 00 � 0 0 i o
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�Z \ MIN. LOT AREA 40,000 S.F. 163,681 S.F. c o
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100' WELL RADIUS MIN. FRONTAGE 150 FT 615.5 FT a 0 m 1° ti
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MIN. LOT NADTH 150 FT 615.5 FT J a°
/ J ► \ TAX MAP 11 LOT 4P�/�
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� AREA=3.751 acres �! MIN. FRONT YARD SETBACK 30FT 119.4 FT
PGGESS MIN. SIDE YARD SETBACK 30FT 30.4 FT — t
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3 I MIN. REAR YARD SET BACK 30 FT 45.6 FT 0
! MAX. BUILDING HEIGHT 45 FT <45 FT m ° ^rn o
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I _ MAX BUILDING COVERAGE 45X 22X � c� o 3 0 M �o
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- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - — SURVEY NOTES: .- Cn�n0 N 4. 1*
1) ELEVATIONS SHOWN HEREON REFER TO MEAN SEA LEVEL (N.G.V.D. ;
I / OF 1929). p�p
- STUMP 1n
EXIST. 2) BASE TOPOGRAPHIC INFORMATION SHOWN HEREON WAS PREPARED N
BY HANCOCK ASSOCIATES, INC. AND OBTAINED BY 0
SHED TRAILER EXIST PHOTOGRAMMETRIC I PHOTOGRAMMETRIC METHODS BY PHOTOGRAMMETRIC TECH., INC.- y
FROM PHOTOGRAPHS TAKEN ON APRIL 18, 2004 AND SUPPLEMENTED -� N
�. NTH A TOPOGRAPHIC FIELD SURVEY PERFORMED ON DECEMBER 8, o
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I PROP. OFFICE TAX MAP 11 LOT 4
BUILDING / I
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