HomeMy WebLinkAboutWater Well PermitsMission:
To protect promote & Improve the health
of all people in Florida through Integrated
slate, county & commun ty efforts.
Vision: To be the HeaBhlest State In the Nation
Ron DeSantis
Governor
Scott A, Rivivoos, MD
State Surgeon 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-WELLSAFLHEALTH.GOV
• Submit revisions to permit and/or site map 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
Location: 3855 S US Hlghwayll, Fort Pierce, FL 34982
Mailing: 5150 NW Milner Drive, Port St Lucie, FL 34983
Phone 772-873-4931
Fax 772.595-1306
FloridaHealth.gov
Accredited Health Department
Public Health Accreditation Board
STATE OF FLORIDA PERMIT APPLICATION TO CONSTRUCT,
REPAIR, MODIFY, OR ABANDON AWELL
❑southwest
❑ Northwest
PLEASE RLL OIITALL APPLICAaIE FlEIOS,
('Denotes Required Ffelda Where Appkcable
❑8LJohns River
[]South Florida
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❑Suwannee River
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❑ DEP
❑ Delegated Authority (HAppliicable)
Blvd, Fort P(efce, FL 34951
No . 5u-SF- 0;LOV11009
No. 59-30143 __
Unique ID _
Stlpdatldis R&Mmd (Sea Attached)
,rn
j 'Mil Location -Address, Road Name or Number, City
3.1301.802-00724000-0 2 14 2
Parcel 10 No. (PIN) or Alternate Key (Circle One) Lot Block Unit
4.11 34S 39E St Lude Lakewood Park Check If 62-624C] Yes ❑ No
•Section or Land Grant-rovArship -Range 'County Subdivision
6. SDOR's Drilling, Ira 11213 772-489-6117 seottsdrIlINGbe118oAmet
-Water Well Contractor *Ucense Number -Telephone Number E-mail Address
6.6014 Palm Drive Fort Pierce FL 34982
'Water Well Contractors Address city Slate ZIP
7. 'Type of Work: Q Construction ❑ Repair ❑ Modification[] Abandonment
8. -Number of Proposed Welk ONE meswnrarRepdr,
9. -Specify Intended Use(s) of Well(s):
Domestic Landscape Ian Agrlaiheai Irrigation Site Investigations
Babied Water Supply 8 Recreation Area Irrigation 8 Livestock 8Monthormil
PuhADlNetersupplypJrtntadtlaelDOFQ 8 Nursery litigation rest EC — 5 20i9
Public water sappy (Community or Nm-Comtrnadh/DEP) caknmeruawrkm,sbkl Eanhcoupk d caomekmal
Class I trierbak Golf Cakma Irrigation WAC Sappy Cour•,�
AC
Class V Injection: ❑ Recharge ❑ ComnerciaglndusMal Disposal ❑ Agnifer storage and Recovery HEALTH
M ® HEALT
Remedistion: ❑ Recovery❑ Atr spurge ❑ Other loerabe) I ONAIENTA se Orly H
Otdcel lire D
I-1 Other ION- e)
10.-Distance from Septic System N 5 200 ft�b 11. FeoI ty DesaiptionS_12 a Famgy Re9Ide11Ce 12. F_stimeted Slert Date
13.-Estimated Well Depth 120 iL -Estimated Casing Depth 100 R Primary Casing Diameter 2 in. Open Hoc: From To fL
14. Estimated Screen Interval: From 100 To 120 fL
15.-PrimaryCasing Material: Black Steel Galvanized PVC Stainless Steel
Not Cased Ocher:
16. Secondary Casing: Telescope Casing Liner Surface Caakg Diameler in.
17. Secondary Casing Material: Bieck Steel Galvanized PVC Stainless Steel
78.-Method of Construction. Repair, or Abandonment: Auger Cede Tool Jetted ,/ Rotary Sorre
Combination (Two or More Methods) Hand Driven (Well Point, Sand Point) m (Direct Push)
Horizontal DOng Plugged by Approved Method Other (oewnbe)
�19. Proposed Grouting Interval for the Primary, Secondary, and
From 0 To 100 Seal Material ( Benton8e Neat Cement)• Other 1
From To Seal Materiel ( Bentonite Other )
From_ To Seal Material ( Bentonge Neat Cement Other )
From To Seal Material ( Bentonite Neat Cement Other T
20. Indicate total number of wdsting vre0s on site Ust number of edstirg unused wells on site
21.1s this well or any eziwell orw,ater a oxmers contiguous oropeAv covered under a ConsumptivelWater Use Permit (CUPIWUP)
or CUPNVUP Appficatiorit Ye No ,complete the Idlowing: CUPNWP No. Disrict Wei ID No.
22. Latitude
23. Data Obtained From: GPS Map Survey Datum: _HAD 27 _NAD 83 WGS 84
11213 k 6 �/
-kJrnue No. SgnaWke ar t 'Oats
Approval Ghented By hmle DateW&O -L EVkedMDst* WST HydrobgistAppmrel
�.
Fee ReoNvad $ /rf Receipt No, Check No.
THIS PERMIT IS NOT VAUD UNTIL PROPERLY SIGNED BY AN AUTHORIZED OFFICER OR REPRESENTATIVE OF THE VYMD OR DELEGATEDAUMORITY. THE
St. Lucie County Health Department
5150 NW Milner Dr Port Saint Lucie, FL 34983
PAYING ON: a:56-SF-2017788 DILL Doc x,56-13ID-4492953 CONSTRUCTION APPLICATION W: AP1454065
RECEIVED FROM: Reliable Treasure Coast Services AMOUNT PAID: $ 545.00
PAYMENT FORM: CREDIT CARD 039626 PAYMENT DATE: 11/20/2019
MAIL TO: Marius Bradescu
FACILITY NAME: _
PROPERTY LOCATION:
7605 Roberts Rd
Fort Pierce, FL 34951
Lot: 2 Block: 14
Property ID: 1301.602-0072-000.0 1
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
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: WhighamJL AUDIT CONTROL NO. 56-PID-4235313