HomeMy WebLinkAboutWaterwell Permits.It
Mission:
To protect, promote & Improve the health
of all people in Florida through integrated
state, county & community efforts.
Vision: To be the Healthiest State In the Nalior 0 C T 17 1019
6UPIP_
Ron DeSantis
Governor
-A.- rvkees, MD
State urceon General
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(&FLHEALTH.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(a)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
St. Lucie county
5150 NW Milner Drive • Port St. Lucie, FL 34983
PHONE:772/462.3800 • FAX:7721871-5360
StLucieCountyHealth.com
Accredited Health Department
Public Health Accreditation Board
.14
ntasTtT
STATE OF FLORIDA PERMIT APPLICATION TO CONSTRUCT,
oe
y so
REPAIR, MODIFY, OR ABANDON A WELL
Permit No. 59-29546
�O
OSouthwest PLEASE FILL OUT ALL APPLICABLE FIELDS
Florida Unique ID
w
❑ Northwest (*Denotes Required Fields Where Applicable)
Permit Stipulations Required (Sea Attached)
-£
❑ St. Johns River
t
-�'iS'oulh Florida The water wen contracroris responsible rnrrompletlnq
this(ormandror rdiWrhepermitappUwtiontothe
62-5240ved No. Delineation No,
Cdr/I92Th
Suwannee River alrPrnydnro delayaredmnhorirytvhere Wplimhle.
❑ DEP
CUPANUP Application No.
❑ Delegated Authority (If Applicable)
WJH LLC 3300 Battleground Ave Ste 230 Greensboro, NC 27410 772-453-4143
'Owner, Legal Name if Corporation 'Address *City 'State *ZIP Telephone Number
2.6504 Santa Clara Blvd Fort Pierce FL 34951
'Well Location - Address, Road Name or Number, City
3.1301-611-0339-000-8 12 116 9
'Parcel ID No. (PIN) or Altemate Key (Circle One) Lot Block Unit
4, 01 34S 39E St. Lucie Check if 62-5240 Yes ❑ No
*Section or Land Grant 'Township *Range *County Subdivision
6, Scott's Drilling, Inc. 11213 772-489-6117 scottsdrilling@bellsouth.net
'Water Well Contractor 'License Number 'Telephone Number E-mail Address
6.5014 Palm Drive Fort Pierce FL 34982
'Water Wall Contractor's Address City State ZIP
7. 'Type of Work: ❑✓ Construction ❑ Repair ❑ Modification❑ Abandonment
B. *Number of Proposed Wells One 'Reason for Rcpair. Modification, or Aboadonment
9. 'Specify Intended Use(s) of Well(s): /p� M�
✓ Domestic IrI k-- Landscape Irrigation Agricultural Irrigation I�—'It Site Investigations Lr-�l 1J
Bottled Water Supply (J Recreation Area Irrigation LJ Livestock I_1 Monitoring
❑ Public Water Supply (Limited Use/DOH) ❑ Nursery irrigation ❑ Test
Public Water Supply(Community or Non-Community/DEP)® Commercial/Industrial Earth -Coupled Geothermal JUN 2 5 2019
Class I Injection Golf Course Irrigation HVAC Supply
u HVAC Return
lass V Injection: ❑ Recharge ❑ Commercial/Industrial Disposal ❑ Aquifer Storage and Recovery ❑ Drainage F OH in St LUCie Coun
?emediation: ❑ Recovery ElAlr Sparge El Other (oc.cdb.) Iil
;;;I 'Other (Describe)
10.' Istance from Septic System if 5 200 ft. _ ti 11. Facility Description esl enee 12. Estimated Start Date
.'Estimated Well Depth 120 ft. "Estimated Casing Depth 100 ft, Primary Casing Diameter 2 in. Open Hole: From—To—ft.
14. Estimated Screen Interval: From 100 To 120 ft,
'15.'Pdmary Casing Material: Black Steel Galvanized ,/ PVC Stainless Steel
Not Cased Other.
16. Secondary Casing: Telescope Casing Liner Surface Casing Diameter in.
Secondary Casing Material: Black Steel Galvanized PVC Stainless Steel Other
Method of Construction, Repair, or Abandonment: Auger Cable Tool Jetted ✓ Rotary Sonic
Combination (Two or More Methods) Hand Driven (Well Point, Sand Point) (Direct Push)
Horizontal Drilling Plugged by Approved Method Other (Describe)
19. Proposed Grouting Interval for the Primary, Secondary, and Additional
From a
To 100
Seal Material (
Bentonite
NedTCement ✓ O r )
From
To
Seal Material (
Bentonite
Cher )
From
To
Seal Material (
Bentonite
Neat Cement Other )
From
To
Seal Material (
Bentonite
Neat Cement Other )
20. Indicate total
number of existing wells on site
list number of existing unused wells on site
21 'Is this well or any existingwell orwater wilhdrrr�����rrrr''' waton t{he owner's contiguous property covered under a ConsumptivelWater Use Permit (CUPANl1P)
or CUPANUP Application. Yes yes, complete the following: CUPM/UP No. District Well ID No.
22. Latitude r 6wgilude
23. Data Obtained From: GPS Map Survey
bn.eby eaNN Dvl I.11 wordy torn Na apldrmbry runt orT o, e0. Florida Ago, uhlrnW r cede, and root—.r
eso prarit or:mib'dnlrna,mgo pem,it Ifpaeda, Imobem, or%A be alb taint I poor to rammeneoment ofNnb
oebot" n. MWvr cetllh Inatapiniwniativn preWJeuN W'a epplluuenhacemnlo.mdiLvihto cbtaln
nvoeooeryappmvol apm eUmr lWiNn 3 days rloval mphrim rot
Ie conabrble, . ra,u to prwldv a wn'I
wmpledon robot Ito No Dly N paran10 dapabmrcnmpietlan NMvvre,Ia 0,, repair, nmdi0ta]pn,u
abaneonmemnup,or¢va by ptla pennR wNepttn0ary1ra0m,e.Mq,evm vmm Nal.
11213
'Signature of Contractor 'License No.
Approval Granted By
Fee Received $
Receipt No.
Datum: _MAD 27
Agent
Issue Date(a 7>(17 Expiration Date
83 _WGS 84
-J
'Date
Initlah.
THIS PERMIT IS NOT VALID UNTIL PROPERLY SIGNED BY AN AUTHORIZED OFFICER OR REPRESENTATIVE OF THE WMD OR DELEGATED AUTHORITY. THE
PERMIT SHALL BE AVAILABLE AT THE WELL SITE DURING ALL CONSTRUCTION, REPAIR, MODIFICATION, OR ABANDONMENT ACTIVITIES.
. I
• 576 srsff2- 55- zssY6-
. MAP OF SURVEY
BOUNDARY & TOPOGRAPHIC SURVEY
OF
LOT 12, BLOCK 116, LAKEWOOD PARK UNIT 9, ACCORDING TO THE PLAT THEREOF RECORDED IN
PAGE(s) 27, 27A-27D, OF THE PUBLIC RECORDS OF ST. LUCIE COUNTY, FLORIDA. (Contains
I I
WEL
LOT
LOT /I BLOCK166 I BLOCK 116a/ LOT 14
RESIDENCE RESIDENCE BLOCK 116
RESIDENCE
FF EL ENCE FF EIDENCE3
FF EL=22.66
SEPTIC OUT OF RANGE
�B�' 4 �' µ /
\ � 21.85
Ix 23.29 \ x 22.29 21.34
x 22.43 3 89'56'20"/ E\ \90.00' 21.75 R s/8•
FIR 1. OS 0/8'S . o N H0105PUBLIC�UPUtt & DRAINAGF%EA MHO C .
FENCE CORNER •IB 20.84 x21.33
9.8'S, ON LINE .O 7 ,I �"�' ISB.S.L. �I 2208.
2zo1 83 I a LOT 12
I BLOCK 116
CD 0 _
_(VACANTZ 7"J-8
FROM WT11 O
PROPOSED 3.3 O
CONIC PAD O
54' 37.61LOT
Pt'SB' M
BLL OT K1116 I \ ` PROPOSED I BLOCK116
RESIDENCE w A �ESIDENCE zzo3 RESIDENCE
FF EL=24.34 / \ '612.A FF EL=23.58
UNABLE TO ACCESS ` n a SEPTIC OUT
YARD FOR SEPTIC x22.95� \ 8 \ \ 3 OF RANGE
22.85 Z ¢/n p
FENCE CORNER \ a1 O
30.ON. 0.5'W. .69, $4.21S• in O
1J.75'.1 8.
6 9.67' N
x 22.85 25' B.S.L , 8 21.65
/ PROPOSED CONIC .'p 21.84
23.05 / COVERED ENTRY \ 'W
PROPOSED S' PROPOSED \
CONIC WALK 1� 16' CONIC 10.5' 21,62
22.16 DRIVE
22.05 2
_ 0.21'N.,0.03'E.
FIP 3/4• N 89'56'20" W 90,00' •� -
0.18'S.,0.06'W. CATCH BASIN (NO SWALE) 21.36 _
nTOP EL=20.59 o W 7?3540•
21.50 'D AsoAso21.55 21.42 � �
22.0' 719•
21.57
Bm-I SITE
_ ElE 21 J9 SANTA CLARA E1.-2M28 21.53 _ N 8958'20' W _ 114.40'
21.37 BOU VARD
(70' PUBLIC R/W 20'f ASPHALT ROAD 21.17
WELLS ACROSS STREET OUT OF RANGE
CONTROLLING BENCHMARK
NGS PID AF7506
PUBLISHED ELEVATION 23.51'NAVD 1988 GRAPHIC SCALE
SETBACKS: 30 0 15 30
SURVEYORS NOTES:
1. LEGAL DESCRIPTION PROVIDED BY CLIENT. ADJOINERS SHOWN HAVE NOT BEI