HomeMy WebLinkAboutSLC Conditions for Issuance of Water Wells PermitsMission:
To protect, promote & improve the health
of all people in Florida through integrated
stale, county & community efforts.
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HEALTH
Vision: To be the Healthiest State In the Nation
Florida Department of Health in St. Lucie County
Conditions for Issuance of Water Well Permits
Effective July 24, 2017
Ron DeSantis
Governor
• 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-INELLS(a)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(o)FLHEALTH.GOV
r
• 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 • Division of Disease Control and Health Protection
Bureau of Environmental Health
5150 NW Milner Drive
Port St. Lucie, FL 34983
PHONE: 772/873-4931 • FAX: 772/595-1306
FlorldaHealth.gov
Accredited Health Department
Public Health Accreditation Board
STATE OF FLORIDA PERMIT APPLICATION TO CONSTRUCT,
REPAIR, MODIFY, OR ABANDON A WELL
❑ Southwest
❑ Northwest
❑St. Johns River
,�" auth Florida
❑ Suwannee River
❑ DEP
❑ Delegated Authority (If
PLEASE FILL OUT ALL APPLICABLE FIELDS
("Denotes Required Fields Where Applicable)
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Permit No. 5g-29547
Florida Unique ID
Permit Stipulations Required (See Attached)
62-524 Quad No. Delineation No.
CUPPMIP Application NoOug 9-11
1, WJH LLC 3300 Battleground Ave Ste 230,Greesboro, NC 27410
2.5711 Eastwood Dr Fort Pierce FL, 34951
"Well Location - Address, Road Name or Number, City,
3.1301.61-0041-000-8 6 138 11
'Parcel ID No. (PIN) or Alternate Key (Circle One) Lot Block Unit
4.12 34S 39E St. Lucie Check if 62-5240 Yes ❑ No
'Section or Land Grant 'Township "Range "County Subdivision
5•Scott'sDrilling, 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 Well Contractors Addreos City Stale ZIP
7. 'Type of Work: ❑✓ Construction ❑ Repair ❑ Modificalion❑ Abandonment
8. 'Number of Proposed Wells One 'Reason rot Repair. Ala II
9. "Specify Intended Use(s) of Well(s):
✓ Domestic Landscape Irrigation Agricultural Irrigation Site Investigations
Bottled Water Supply ® Recreation Area Irrigation ® Livestock e Monitoring
Public Water Supply (Limited Use/DOH) ❑ Nursery lnrigation Test NOV 5 2019
Public Water Supply (Community or Nan-CommunitylDEP) Carnmerciallindustrial Earth -Coupled Geothermal
Class I Injection Golf Course Irdgation HVAC Supply
HVAC Return
Class V Injection: ❑ Recharge ❑ CommercialAnduslrial Disposal ❑ Aquifer Start ge and Recovery ❑ Draina eF OH In St Lucie Cour
DODOatimated
iatian:❑ Recovery❑ Airsparge ❑ Other (oaacnba) EN IROf�j�P T VEAI
her (0esviva)
nce from Septic System If 5200 ft. 11. Facility Descriptionresi is 12. Estimated Start Date
Well Depth 'Estimated Casing Depth'A LO ft. Primary Casing Diameter in. Open Hole: From _To _ft.
14. Estimated Screen Interval: From W To I ZJft.
15.'Pdmary Casing Material: Black Steel Galvanized PVC 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 her
18.'Methad of Construction, Repair, or Abandonment: Auger Cable Tool Jetted ✓ Rotary Sonic
Combination (Two or More Methods) Hand Driven (Well Point, Sand Point) Hydreu fc' pint (Direct Push)
Horizontal Drilling Plugged by Approved Method Other (Dasadm)
19. Proposed Grouting Interval for the Primary, Secondary, andtWrtaF(ising:-
From d To _� Seal Material ( Benlonite Neat Cemen �.� Other )
From To Seal Material ( Benlonite Neal-CCerrTent Other )
From To Seal Material ( 6emonite Neat Cement Other )
From To Seal Material ( Benlonite Neat Cement Other )
20. Indicate total number of existing wells on site List number of existing unused wells on site
21..1s this well or any existing well or water witl}dsawal ar,the owner's contiguous properl covered under a Consumptive/Water Use Permit (CUPAVUP)
or CUPANUP Application$ Yes 1,-_-No 14yes, complete the following: G IWUP Nu. District Well ID No.
22. Latitude Longitude
23. Data Obtained From: GPS Map Survey Datum: _NAD 27 _NAD 83 WGS 84
I lwrpW eMNNal l win cvm*l ,Rh 0u appneaIvN nlea of"ade40 Flatlda •1dMnlaYatvo Coda, andlhal arn,a IemE(y lFall am qa wme,or0ep,upeM1g,hntn,e lnlommion pmN,l+tll^. a:cumin.an,I lFallam awnmurmy
11213
"License No.
Approval Gran dBX4 Issue
Fee Received S Receipt No.
Y22,
'Date
Expiradcn Date VzZf Hydrologist Approval
Inlnals
Check No.
THIS PERMIT IS NOT VAUD 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.
Date: October 7, 2010
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