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HomeMy WebLinkAboutWater Well Permit Application0 Ron DeSantis Mission: ; d f�F , LEOIE Governor To proled, promote & improve the health ' - - ofallpeoplelnFloddathroughintegrated Scott A. Rivkees, MD state, county & community efforts. HIGf�6.9H ��8 aR",LM1'. State Surgeon General y� (eP ^v �{.Y�9 • Vision: To be the Healthiest Stale in the Net 5t ��c\a Florida Department of Health in St. Lucie County Conditions for Issuance of Water Well Permits Effective July 24, 2017 • Contact the Florida Department of Health in Saint Lucie County (FDOH — St. Lucie) prior to constructing or abandoning any well. a. Call the FDOH — St. Lucie Well Line at 772-873-4936 or email SLCDOH-WELLS(cDFLHEALTH.GOV b. Provide the following information: i. Permit number ii. Driller name iii. Address iv. Date and time to begin construction/abandonment • A minimum of 24 hours' notice is required before constructing any public water supply wells. Please call our main office at 772-873-4931 and speak with Environmental Health Staff or provide notification by email to SLCDOH-WELLS@FLHEALTH.GOV • Submit revisions to permit and/or site map and associated fee within 48 hours of well construction or abandonment. Florida Department of Health 5St.16 Lucie County Im Accredited a ent PHONE: E: Milner Drive • Pod St. Lucie, -5 60 Rlbli[; ��} I n rd PHONE:772/462J600 • FAX: 772I8715360 StLucieCountyHealth.com 0 STATE OF FLORIDA PERMITAPPLICATION TO CONSTRUCT, REPAIR, MODIFY, OR ABANDON A WELL ❑Southwest PLEASE FILL OUT ALL APPLICABLE FIELDS ❑Northwest (^Denotes Required Fields Where Applicable) O�•S�L Johns River mouth Florida ThewotuaellmmracrorareWonsi6!e lormmpletlrq l�Suwannee River I& farm ondfonouNblg thepermlrappamdon to the apprapdare dekgmedaarhodry Mare appamble ODEP O Delegated Authority (if Applicable) 1440 N Lawnwood Circle #20A FL Pierce, FI 34950 'Well Location - Address, Road Name or Number, is t10 5l� -SF - a•Oa2•a'-1 I No, 59-30158 Unique ID Stipulations Required (See Attached) Quad No. Detheatbn No. 3.3211-701-0012-000-6 10 *Parcel ID No. (PIN) or Alternate Key (Circle One) Lot Block Unit 4.11 36S .36E St Lucie Check if 62524f] Yes ❑ No *Section or Land Grant 'Township *Range 'County Subdivision 6, James P. Tyson 11352 954-81114269 downthehole@att.net 'Water Well Contractor 'License Number 'Telephone Number E-mail Address 6. PO BOX 881496 Port St Lucie FI 34988 'Water Well Contractor's Address City State 71P 7. *Type of Work: EM96nst uctlon ❑ Repair ❑ Madificallon❑ Abandonment B. *Number of Proposed Wells 1 9. 1S ecify Intended Use(s) of Well(s): tv Domestic 'Reason far Repair, Modr.Von, !,1 ar AbaWawnent j', Landscape irrigation® Bottled Water Supply Recreation Area Irrigation 8 Agricultural Irrigation Livestock ® Site Investigations Monitoring ❑ Public Water Supply (limited Use/DOH) Nursery irrigation ❑ Test ❑ Public Water Supply (Community orNon-CommunilylDEP)� ❑ Class I Injection CommeraaVlndusbial0 Golf Course Irrigation rLH�—J Earth -Coupled Geothermal HVAC Supply JAN 2 4 2020 HVAC Return Class V Injection: ❑ Recharge ❑ Commerclallndustrial Disposal ❑ Aquifer Storage and Recovery ❑ Drainage 2emedlation:❑ Recovery❑ Air Sparge ❑ Other (Desalbe) Hi i CT oust ] Other (ooscdeo) 0.'Distance from Septic System if 5200 R + 11. Faciray Desaiption Proposea KeS—ide—nce 12. Estimated Start Date 13.•Estimated Well Depth 120 ft. 'Estimated Casing Depth 100 ft. Primary Casing Diameter 2 in. Open Hole: From=To '� R I4. Estimated Screen Interval: From 100 To 120 ft. IS'Primary Casing Material: Black Steel Galvanized -49Z:1 Stainless Steel Not Cased Other. 16. Secondary Casing: Telescope Casing Liner Surface Casing Diameter' in, 17. Secondary Casing Material: Black Steel Galvanized PVC Stainless Steel Other I VMethod of Construction, Repair, orAbandonmenb Auger Cable Tool Jetted 46ota Sonic Combination (Two or More Methods) Hand Driven (Well Point, Sand Point) Hydraulic Paint (Direct Push) Horizontal Drilling Plugged by Approved Method Other lDesrn'be) 19. Proposed Grouting Interval for the Primary, Secondary, and Additional Casing: From 0 To 95 Seal Material.( Bentonite ement Other 1 From To Seal Material( Bentonite Neal Cement 'Other ) From To Seal Material ( Bentonite Neat Cement Other 1 From To Seal Material ( Bentonite Neat Cement Other 1 20. Indicate total number of existing wells on site 0 List number of existing unused wells on site 0 21.•Is this well or any extstirtgwell or water wilt I an the owner's contiguous proper�ttyy covered under a Consump9ve/Water Use Permit (CUP/WUP) or CUPANUP Application. Yes If yes, complete the following: CUPIWUP No. District Well ID No. 22. Latitude Longitude 23. Data Obtained From: GPS Map Survey Datum: _NAD 27 63 WGS 84 EIim,q,pervemr/notlMampy epperaRlaNHollV,ee,MddepdW,bv,Wa Ode, a,ddWewelm mR arKmmnde,ae eded,ne[bemlHMJbe ermined pdorlemmmmrxneatolwN _NAD leemlp Mll,mne ew,HelneprepJM.Rminonbmullenp+ait:dk.eemlgmddml dvpH,kmJ,erndH OIeMH ]ri.Fbddv S,Wxlo manbL,v I°°pHlreR.ndal nb Mo imhuvtlan.INTH¢NNnHU[,M•OonpmHadFNbeppkeOmkCCevnre.MMl.O odtln .Hy.pprenl MnohJ bdnd.. U.Hb[N 11�� OHMnmrno.YMpraOk.IHlev n� de ,ver . - • �.o. J+ o,�M„+•me,µ /^;rn,u,.a✓n+• I do<vw.ui,.. e.u. ,+.,rweL� .ri�J%i t.+lu.«tales ,. ea� ++�.MTy, ww.rwyt,. t.Jn,ii mrmkeonrKea lens PgMRteen]ddrye RRH<ongl ern olbe w,mwulon,repW. ®emaxH NmeR.xMemRakNRY pwmR a.>u knwNdmw, eemn. Ml w, +reH + v^w ,w •sm'Rww,n. +m + J.nrnemJ, �,.w+me.e., l: .a;yy r.✓�� urwr.M+. w.•^,,.—..,. N...+...✓+ 4iry✓ ' 11352 *Signatureo actor •Ucense No. .LZL �." -a'nl Snun>fa A it w Approval Granted By / + e+—.+ Issue Dale Expira0dn Date fHydr3%1a!st Approval I f Fee Reeelvetl s _ Receipt No. •• Cheek No. THIS PERMIT IS NOT VAUD UNTIL PROPERLY SIGNED BY AN AUTHORIZED OFFICER OR REPRESENTATIVE OF THE WMO OR DELEGATED AUTHORITY. THE PERMIT SHALL BE AVAILABLE AT THE WELL SITE DURING ALL CONSTRUCTION, REPAIR, MODIFICATION, OR ABANDONMENT ACTIVITIES.I ff SITE PLAN LOCATED IN SAINT LUCIE COUNTY, FLORIDA W I R r .. 11 NII']]l1•/ _ _ elu NIY]fIY/ �] S ��L NLf]' n. � 0•e rA1W6PHINlFE1. bYlC -Y Y36rr� _ �_ T°�il0�v v u Ir0.� LEGEND B ABBREVIATIONS .rc KVM 6 zvr � rmv KY�st4�rs �A VRreU11 1 d` wl el• rm4RrE kVkR �axt Yr'M2�'a 6LI oQ rKYAM �J I4 YF 11m e[YVM I r°w / r.c � a.m LtN SOT 11 OCCUPIED Wu FFE - 255' MIL uo w YQm. Imrcu Y]w vv W1My ]]q(K \PY4 WIIY kI NLm ML ]ul] °vweu v\u4s W 4A Tm 0°i N11 IY. rNfl ruq]1 NKK Ir415N\u Yq 9v4\gl K41 Q m®qp KK RNI Q(vi44(KII LW/41QYfe W]ap1 KV wQf[mY ]uLL\u Mv]nO W.K ROtIIRo V�O DAI4M rry uqf-Q-W� 9 WIP NO A m]] D vWnmY Mo. i ezE yq � LOT 10 / VACANT Mpm • I. LOCATION MAP STREETADORESS IA41r]mINOL I rm-YQ n 31Y1 LEGAL DESCRDTON bl Ip VAltll mnM/ 6fLR; .VmN91E m T6 mal°m4w cb mos04n si a\[4ezun�r nmw GENENAL NOTES M Qrt°1O uX Q w pYKr,vmpf uY N d6mmY L NYmn m sanmN m Ab snRY+A1Ym1 uY n � Y�RQ°0 m M 9OIu81]Rm[ 1126N 4aKm1 R ' LOT a ImnmucmG QmR UN•YL ror rum NEWI aR ezx] VACANT Wyrv4 um mile XN.Q [ nam41m1Xo 4lKlRY a u]rzL¢ U L n[srueX°sx°m k4vl zse wvYi®lo uc yQ'u� nm[vurtQ Wcmmrtu. v]4 WKA 4eLwmQ XH61p-[ .VCgyiq r0 M FLr Q d\IIN (NIIiY D�_ illLm.YxRsm°N lur mlt .4 N¢y wmA 4mml swr w°L mam,nmat �QS12 y n rsko Wlu m Q]De aarYA vL4 w remkE N tNK 110DmWwk YL1[VN. r4yf0 I'll IV.I YPAYnQ vu[L m INR c 0]L° a m[LT1[ 8In W�r4 O G[[ KRIM`1®0 AY R°[0.w.ml kPVFLiL pW' i D. neY]ID14I 9mR4 NY N H°PN YpCYI KRfFII `•L °Lb! IM1\\y Q Ik6 e. .440.601E Me N 1[LMN/NY NG WRD m EfLffi SrA1°NRS YI RCr N9 kOeMS °@XQ. � Ma YO1e eMMI lOm °RYOIf1414 0 Yry WH OmIIOL.\RD Ym R8Y1 YOL°4 j Y 0. KMPPRPm VRIQ41HI Y1YN RRxrQ IRY IAr M ]ML RNKM NK IA[Wne8k W..fap411q °MRSm61Mm Wr °S0.Y ]YA SWLLXP fP IYCQ E(YQR W tPN n TN -R 91°M IG[m MIC mT ]LSIpICm' Rm RD Ntt.vYPIIe f ,VAkLIR-M-Mr. GID'Y113Dr 4fmD. NWWmai6 0MIDmVYMMWOIIh kd k[4QOx1ym WMlr �„ Yr mm a_ _ _ _ — — — — � n uc Lvr Y]rz a rao Y°k w m6ek sL [m4 .7313 enwx�w roNr ____-------- _________-___-�- _ �rGLOBAL POSRIONINO SYG EM IOPSI NOTES a, � _ � _ � _ �14 m414AOtr 1]IIDyQQ W r fEh I(It L lye<<. r+a mYbNnu.�0.Q YD+/Bml4 \w�NQR Yw mn ].n tmmwq M °io a0. CHMIFSA Vim fQ`In40.�T`�°iK IYI[Ire/1�im AaY[v° mvro4mm uovzrrQ ws aaK.EmrE '^MPG 0..4 fFO�°dl Q rWpa N 1\Qe. WYRWQY m[Y oOi 1 ys HEALTH PAYING ON: RECEIVED FROM PAYMENT FORM: St. Lucie County Health Department 5150 NW Milner Dr Port Saint Lucie, FL 34983 #:56-SF-2022271 BILL DOC#:56-BID-4503084 CONSTRUCTION APPLICATION #: AP1456842 Dave Golden Homes AMOUNT PAID: $ 660.00 CHECK 26912 PAYMENT DATE: 12/10/2019 MAIL TO: Kimberly Sparacio FACILITY NAME: PROPERTY LOCATION: 18001 Wagonwheel Ln Port Saint Lucie, FL 34987 Lot: 10 Block: Property ID: 3211-701-0012-000-6 EXPLANATION or DESCRIPTION: QUANTITY FEE 128 - OSTDS Construction System Inspection Research Fee 1 $ 5.00 -1 - Surcharge (All) 1 $ 45.00 -1 - OSTDS New Permit Surcharge 1 $ 100.00 -1 - OSTDS Construction Application and Plan Review,New 1 $ 100.00 123 - OSTDS Construction Site Evaluation 1 $ 115.00 126 - OSTDS Construction Permit (New or Mod, Amendment) 1 $ 55.00 127 - OSTDS Construction System Inspection 1 $ 75.00 133 - OSTDS Construction Reinspection 1 $ 50.00 -1 - Well Construction 1 $ 115.00 RECEIVED BY: MontanezNM AUDIT CONTROL NO. 56-PID-4246246 ,'�ropetty Card Page 1 of 1 Michelle Franklin, CFA -- Saint Lucie County Property Appraiser — All rights reserved. Property Identification Site Address:18001 Parcel ID: 3211 -701-0012- Account#:160769 Sec/Town/Range: Wagonwheel LN 000-6 11/36S/38E Map ID: 32/11X Zoning: Planned Un Use Type: 0000 Jurisdiction: Saint Lucie County ownership Legal Description Justin Sparacio CARLTON COUNTRY ESTATES (PB 46-29) LOT 10 (5.195 Kimberly Sparacio AC) Brenda Wectawski 1440 N Lawnwood CIR Apt20A Fort Pierce, FL 34950 Current Values Historical Values 3-year Just/Market: $89,400 Assessed: $89,400 Year Just/Market Assessed Exemptions Taxable Exemptions: $0 Taxable: $89,400 2019 $89,400 $89,400 $0 $89,400 2018 $89,400 $89,400 $0 $89,400 2017 $89,400 $89,400 $0 $89,400 Sale History Date Book/Page Sale Code Deed Grantor Price 04-09-2019 4255 / 1428 0001 WD Miller (TR) Joseph G $149,000 10-13-2017 4053 / 1082 0001 WD Freeman Costonya S $95,000 01-05-2017 3950 / 2648 0112 WD PSL Forclosures LLC $99,900 Primary Building Information Finished Area of this building: 0 SF Gross Sketched Area: 0 SF Exterior Data View: Roof Cover: Roof Structure: Building Type: Year Built: N/A Frame: Grade: Effective Year: N/A Primary Wall: Story Height: No. Units: 0 Secondary Wall: Interior Data Bedrooms: 0 A/C %: 0% Electric: Primary Int Wall: Full Baths: 0 Heated %: N/A% Heat Type: Avg Hgt/Floor: 0 Half Baths: 0 Sprinkled %: 0% Heat Fuel: Primary Floors: hno Total Areas or Finished/Under Air 0 {(; . 1 (SF): Gross Sketched Area 0 (SF): Land Size (acres): 5.19 Land Size (SF): 226,294 Total Building Count: I Type Special Features and Yard Items Qty Units Year Blt All information is believed to be correct at this time, but is subject to change and is provided without any warranty. © Copyright 2019 Saint Lucie County Property Appraiser. All rights reserved. https://www.paslc.org/RECard/ 12/10/2019