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HomeMy WebLinkAboutHEALTHSTATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT FOR: OSTDS New APPLICANT: Gary Williams PROPERTY ADDRESS: TBD S Indian River Dr Fort Pierce, FL 34982 LOT: BLOCK: 2 SUBDIVISION: PROPERTY ID #: 3532-503-0020-000-3 PERMIT #:56-SF-2089461 APPLICATION #: AP1508768 DATE PAID: FEE PAID: RECEIPT #: DOCUMENT # : P R 1377322 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] [OR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION 381.0065, F.S., AND CHAPTER 64E-6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS, WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY. SYSTEM DESIGN AND SPECIFICATIONS T [ 900 ] GALLONS / GPD Septic new CAPACITY A C ] GALLONS / GPD N/A CAPACITY N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK-1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps [ ] D [ 375 1 SQUARE FEET Drainfieid new SYSTEM R [ ] SQUARE FEET N/A SYSTEM A TYPE SYSTEM: [x] STANDARD C ] FILLED j ] MOUND j ] I CONFIGURATION: EXI TRENCH [ ] BED [ ] N F LOCATION OF BENCHMARK: Site BM, top of 4x4 concrete monument, SE corner Of property I ELEVATION OF PROPOSED SYSTEM SITE [ 28.001 INCHES FT ][ ABOVE BELOW 1 BENCHMARR/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 2.00 ][ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT L D 7 0 T H E R _�-U' tcrylulrtru: L V.UU ] INCHES EXCAVATION REQUIRED: [ ] INCHES 1The system is sized for 3 bedrooms with a maximum occupancy of 6 persons (2 per bedroom), for a total estimated flow of 300 gpd. SPECIFICATIONS BY: Brian J Ing TITLE: Environmental Specialist IT APPROVED BY: F TITLE: Environmental Specialist II St. Lucie CHD r DATE ISSUED: t07/7Z7/2!02!0! EXPIRATION DATE: 01/10/2022 DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E-6.003, PAC Page 1 of 3 1 1-1.4 APISOS7J68 S?1336193 NOTICE OF RIGHTS A party whose substantial interest is affected by this order may petition for an administrative hearing pursuant to sections 120.569 and 120.57, Florida Statutes. Such proceedings are governed by Rule 28-106, Florida Administrative Code. A petition for administrative hearing must be in writing and must be received by the Agency Clerk for the Department, within twenty-one (21) days from the receipt of this order. The address of the Agency Clerk is 4052 Bald Cypress Way, BIN A-02, Tallahassee, Florida 32399. The Agency Clerk's facsimile number is 850-413-8743. Mediation is not available as an alternative remedy. Your failure to submit a petition for hearing within 21 days from receipt of this order will constitute a waiver of your right to an administrative hearing, and this order shall become a 'final order'. Should this order become a final order, a party who is adversely affected by it is entitled to judicial review pursuant to Section 120.68, Florida Statutes. Review proceedings are governed by the Florida Rules of Appellate Procedure. Such proceedings may be commenced by filing one copy of a Notice of Appeal with the Agency Clerk of the Department of Health and a second copy, accompanied by the filing fees required by law, with the Court of Appeal in the appropriate District Court. The notice must be filed within 30 days of rendition of the final order. St. Lucie County Health Department HEALTH 5150 NW Milner Dr Port Saint Lucie, FL 34983 PAYING ON: #: 56-SF-2089461 BILL F}oc u.56-BID-4724153 CONSTRUCTION APPLICATION #: AP150V68 RECEIVED FROM.- Pace 2000, Inc PAYMENT FORM: CHECK 7270 -- --. AMOUNT PAID: PAYMENT DATE: $ 545.00 _.�...., ._ 06/08/2020 MAIL TO: Gary Williams FACILITY NAME: PROPERTY LOCATION: TBD S Indian River Dr Fart Pierce, Fi- 3494B Lot: 2 Block: Property ID: 3532-503-0020-000-3 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 RECEIVED BY: VanceMl-i AUDIT CONTROL NO. 56-PID-4444734 _ STATE OF FLORIDA .--. DBPARTMFNT OF HEALTH rF ONSZTE SEWAGE T T'ATMUT AND DISPOSAL SYSTEM APPLICATIOIJ FOR CONSTRUCTION PERMIT APPLICATION FOR: t ✓ j Neer System I ] Existing System ] Repair L ] Holding Tank [ 7 Abandonment I ) Temporary APPLICAINT:✓ , 4 l 1 Q� tYiS AGENT: k } ii i" e �f'i I , \ t MA-11,IIN ADDRESS: � '?-z i PERKIT NO. 5 DATE PAID: c-w- r 7 70� 4,19f 2® FE D RAID: 'd! l�rH . RECEIPT 4h I ] Ir.LuovativG I 7 TELI 1Paom, z TO BLi COMPLETED BY APPLICANT OR APPLIU_AN'T' S AUTHORIZED AGENT, SYSTEMS MUST HE CONSTRUCTED BY A' PERSON LICENSED PURSUANT TO 489.105 (3) (m) OR 489.552, FLORIDA STATUTES. IT IS TIIl APPLTCANT" S RESPONSIBILITY TO PROVIDE DOCUMCNTATZON OF THE DATE TE3E LDT Ti4AS CREATED DR PLATTED (MNI/DAIYY} IF REQUESTING CONSIDERATION OF STATUTORY ORANDFATI71ER PROVISIONS. PROPST2Y ITI CORIATION - -- — — LOT:. .^ BLOCK, �} per s✓,'I sUiSDSrISION: PLATTED: PROPERTY ID ft.:: ZONING: I/M OR EQUTVALENT_ [ X / N ] PROPPRTX SIZE: ACRES WATER SUPPLY: IXl PRIVATE PUBLIC I ]<=2000GPD I 1>2000GPD TS SEWER AVAIL -ABLE AS PER 381.0065, FS? I Y•/0] f DISTANCE TO SETr7ER: FT PROPERTY ADDRESS: 11 ,.,f . /i , Ci . - 11 .. - - DIRECTIONS TO PROPERTY, L BUILDING INFORMATIOIT L7nit Type oL "To Establls4me:nt 1 2 3 [ , ] Floor/Iacluipzuerzt I KJ RE, SIDENTSAL �70 I ] COI-INSERCTAL No_ of Bualdizzg Commercial/Institutional System Dosign Bedrooms Area 9 t Table 1, Chapter 64E-G FAC (specify) S TGNATURE : DATE J�} DH 4015, 08/09 (Obsolete.s Previous editions wl-lieli may not be used) -- Inc=POrated 64E-6.001, FAC Page I Of 4 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATION APPLICANT: Gary W[liams CONTRACTOR / AGENT: Pace LOT: Inc .BLOCK: 2 SUBDIVISION: ID# : 3532-503-0020-000-3 APPLICATION # APJ508758 PERMIT # 56-SF-2089461 DOCUMENT # SE1336193 TO BE COMPLETED BY ENGINEER, HEALTH DEPARTMENT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEERS MUST PROVIDE REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS. PROPERTY SIZE CONFORMS TO SITE PLAN: [X]YES [ ]NO NET USABLE AREA AVAILABLE: 0.57 ACRES TOTAL ESTIMATED SEWAGE FLOW: 300 GALLONS PER DAY [ RESIDENCES —TABLET I/ OTHER —TABLE 2 ] AUTHORIZED SEWAGE FLOW: 854.99 GALLONS PER DAY [ 1500 GPD/ACRE I OR 2500 GPD/ACRE ] UNOBSTRUCTED AREA AVAILABLE: 1000.00 SQFT UNOBSTRUCTED AREA REQUIRED: 750.00 SQFT BENCHMARK/REFERENCE POINT LOCATION: Site BM, tap of 4x4 concrete monument, SE corner of property ELEVATION OF PROPOSED SYSTEM SITE 28.00 [ INCHES / FT ] [ FL-1/ BELOW ] BENCHMARK/REFERENCE POINT THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES SURFACE WATER: 75 FT DITCHES/SWALES: FT NORMALLY WET: [ ]YES [X]NO WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE: 75 FT NON —POTABLE: FT BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 30 FT POTABLE WATER LINES: 60 FT SITE SUBJECT TO FREQUENT FLOODING? ( ]YES [X]NO 10 YEAR FLOODING? [ ]YES [X]NOi 10 YEAR FLOOD ELEVATION FOR SITE: FT[ MSL / NGVD I SITE ELEVATION: FT [ MSL / NGVD Ch TT. DAnL'TTT+ Ylii•�Taix mr..r SERIES: #/Color Texture Depth EUSDAL Sand 0 To 9 Sand 9 To 14 Sand 14 To 28 10YR 6/1 Sand 28 To 72 SOTT. P1Z0TPTT.T?.. TATTY\ MAmrnw v USDA SOIL SERIES: IVlunsell #[Color Texture Depth 10YR 4/2 Sand 0 To 15 10YR 411 Sand 15 To 22 1 OYR 5/1 Sand 22 To 31 10YR 5/1 Sand 31 To 72 OBSERVED WATER TABLE: 72.00 INCHES [ ABOVE / BELOW j EXISTING GRADE TYPE: [ PERCHED / APPARENT ] ESTIMATED WET SEASON WATER TABLE ELEVATION: 72 INCHES t ABOVE / BELOW ] EXISTING GRADE HIGH WATER TABLE VEGETATION; [ ]YES [X]NO MOTTLING: [ ]YES [X]NO DEPTH: 72.00 INCHES SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: Sand/0.80 DEPTH OF EXCAVATION: INCHES DRAINFIELD CONFIGURATION: [X ] TRENCH [ ] BED [ ] OTHER (SPECIFY) REMARKS/ADDITIONAL CRITERIA WSWT determined using USDA WSS and soil borings. No WSWT indicators observed. WSWT determined to be below 72" in both soil borings. S131 20" above BM. SB2 28" aba SM. SITE EVALUATED BY: DATE: 06/19/2020 Ingram, Bria tle: Environmental Specialist II} (ENVIRONMENTAL HEALTH[ DE 4015, 08/09 (Obsoletes Previous editions ich may not be used) Incorporated: 64E-6.001, PAC Page 3 of 4 AP1508768 E102089461 v 1,0.2 7y .' STATE, 0F FLORIDA s DEPARTmUT a �z RLTH PrRhUT ONSTTE, SRwA , a p -T TI�T:�T� sy.T A�7D DISPOSAL SYSTEM L�iF�aT�Uk4 TO AM SYSTEM SPECIFICATIQNs APPLICANT_ �� } AGENT LOT: BLOCEC: SUBDIVISION: PROPERTY ID Sect'Q)i/Tc-J-l§ jJ3/PuvcC1 No. or Tax ID Number To BE CONS LI;TED 13Y ENGIN)aEFt, FJIaALTH DP-PARTMENT VNIPLOYI',i OR OTI-WR MUST PROVIDE PEGISTRATION QUAi2�IED D�RSON. E�TGINEE�S NUI�JBER AITIJ SIGN A1TI7 a$AT TACIT PAgr OF STTRMTmlrrnT_ Pk30PEITy SIZE CONFORMS T. SITE PLAN: ,TOTAL EST71'%TED SEW-PI.GE FLOW, I� �S C ] NO NET USABLE A AVAIL,AEILE= .ATITHORIZED SEWAGE FLOW. ®—��'LLONS PER DAY `s' ACRE, T RESIDENCES -TABLE Ilp'I'1-1CR-TA.3LC 2 7 UNOBSTiJCTED AREA AVAILAB:Ta ,- 'LON5 PER DAY [1500 GPD/ACItL OR 2500 GPDIACRC. UNOBSTRUCTED .ARri A REQUIRED : l 731rTC CP SQFT {/R� RENCE POINT LOCATION: EVATIOAi OF PROPOSED SYSTEM S' 1 t3[ ti s 7' f7 V/�,` SITE 4 TF RENCE POINT MINU4UM SET CZ{KHICH CAN' BE �� SURP.ACR WATER- � �NTA�NED EROI� TM P POSED SYSTEM TO TIIG FOLLOWING. � FT DTTCTTCS ST�7 S:�y ATUi�ES T^TELLS PUB f1(� &T r e FT P Iy WET? [ I Y 3 HCTILDING FOUNDATIONS- fLIi�ITED USE: gT PRIVATE - ( 7 NO I T F T NON —POT TABLE C) T'ROFI RTi LINES: FT E T POTABLE WATER LTI;M, S : SITL FRE SUAJECT TO QUENT FLOODING: T IO YDAR FLOOD E- jxVATIOT7 F'OR SxT1 f � YES T" L T - NO ti 10 YEAR k LOODTDTG % i 1 T MSL/FTGVp ] yEs lX I'To SITE, EZEVAIxON. .FT MSL/NGvp 1 USDA SOIL SERIt, l7DT� PT" TO O TO TO TO TO To —�TO` _ —.� TO SOIL, PkZOI ILI IN r �xv1'1' SON SITE 2 M[JATSl;LL Ih/COI OIi xI ��7URE 1E mr, TO TO TO TO TO TO TO 20 TO USDA .SOIL SERIES: OBSRRVE1) WATTWATr ,P,FABTE_ —� INCI ESTTUATED ----� TES [ASOVB/BLLOW ] EXISTING GRADE _ WET SEASON WATEk� 7'RR� ELEVATION. TYPE,= � PHRCE�IC,D /fi,1'PJ1ItiNT ] HIGI3 TIATIaR T INCIT V-�GETA.TION: C ]. XE,S N NO ES. (.AT30VBl8GLOW ] L?CISTIPTG GRADE, 1 ] yES [ j NO DEPTFI: IT1Cki S SOxI lTE-NT'URE/LOADIXG FATE DRA;CNF3:1I,D COI�'xGURATION: TO TxBNCMRE, SIZIITG: DEPTH OF EXCA_VAAIOAT: T {SdAI7DITION�lC; CRITERIA: T 1 z3ED i OTI ,R C TCIILS ------------------ ST'TF' LVF,LU.A.TED B _ I?.f[ 4015, z2Jz1 f0l5saletes �.tevzb DATE . ` Q us ad Lions whickx may not ba uaed) Incorporated: 64E-6.001, J AC Pa e 3 of 4 'a I I Property Card Page 1 of 3 Michelle Franklin, CFA -- Saint Lucie County Property Appraiser -- All rights reserved. Property identification Site Address: S INDIAN RIVER DR Sec/Town/Range: 32/36S/41 E Map ID: 35/32N Zoning: RS-4 Count Ownership Garry L Williams 350 NW Sth ST Williston, FL 32696 Legal Description B S HARRIS S/D BLK 2 THAT PART OF UNNUMBERED TRACT LYING NLY OFCO DR ESMT AS IN OR 253-1130 MPDAF: FROM SW COR LOT 10 RUN E 254,97 FT,TH S 25.17 FT FOR POB,TH CONT E TO WLY R/W IND RIVER DR,TH N ALG SD WLY R/W TO NE COR LOT 8,TH E TO SHORELINE OF IND RIVER TH SLY ON SD SHORELINE TO PT E OF S LI CO DR ESMT,TH W TO PT OF 1NT OF W R/W IND RIVER DR AND S LI CO DR ESMT,TH NLY ON SD W R/W TO N LI CO DR ESMT,TH W ALG SD N LI 250 FT,TH N 25 DEG 50 MIN 01 SEC W 90 FT M/L TO POB-LESS IND RIVER DR- ALSO LESS AS IN ORS 2824-0517:0520 (OR 979-1464: 1363-2822) (0.57AC) Parcel ID: 3532-503-0020-000-3 Account #: 116374 Use Type;000o Jurisdiction: Saint Lucie County current Values Total Areas Just/Market Value: $126,300 Finished/UnderAir (SF): 0 Assessed Value: $126,300 Gross Sketched Area (SF): 0 Exemptions: $0 Land Size (acres): 0,57 Taxable Value: $126,300 Land Size (SF): 24,830 Property taxes are subject to change upon change of ownership. • Past taxes are not a reliable projection of future taxes. • The sale of a property will prompt the removal of at1 exemptions, assessment caps, and special classifications. Taxes for this parcel: SLC Tax Collector's Office Download TRIM for this parcel: Download PDF Sale History Date Book/Page Sale Deed Grantor Price Code Jul 26, 2018 Apr 1, 2009 4166/2808 3123 / 1430 0001 WD Goodman (TR) Richard F 0111 QC Goodman $150,000 Apr 1, 2009 Dec 19, 2000 3123 / 1427 1363 /2822 Richard F 0111 QC Goodman (TR) Margaret E $100 $100 Oct 5, 1995 0979/ 1464 XX02 WD Goodman Margaret E XX02 WD $100 $100 Building Information (1 of 1) Finished Area: 0 SF Gross Sketched Area: (] S P Exterior Data View: Roof Cover: Roof Structure: Building Type: Year Built: NIA Frame: Grade: Effective Year: NIA Primary Wall: https.-//WWw.paslc.org/RECard/ 6/8/2020 11-2�- r g - WIT f 9 9 Ci •� 9 its iy yk �= C". j ��'}G' FS I IARR -'_ 9 Custom Soil Resource Report St. Lucie County, Florida 42—St. Lucie sand, 0 to 8 percent slopes Map Unit Setting National map unit symbol: 2tzwp Elevation: 0 to 70 feet Mean annual precipitation: 49 to 60 inches Mean annual air temperature: 70 to 77 degrees F Frost -free period: 350 to 365 days Farmland classification: Not prime farmland Map Unit Composition St. lucie and similar soils: 90 percent Minor components: 10 percent Estimates are based on observations, descriptions, and transacts of the mapunit. Description of St. Lucie Setting Landform: Dunes on marine terraces, knolls on marine terraces, ridges on marine terraces Landform position (two-dimensional): Backslope, summit Landform position (three-dimensional): Side slope, interfluve, riser Down -slope shape: Convex, linear Across -slope shape: Linear Parent material: Eolian or sandy marine deposits Typical profile A - 0 to 6 inches: sand C - 6 to 80 inches: sand Properties and qualities Slope. 0 to 8 percent Depth to restrictive feature: More than 80 inches Natural drainage class: Excessively drained Runoff class: Negligible Capacity of the most limiting layer to transmit water (Ksat): Very high (19.98 to 39.96 inlhr) Depth to water table: More than 80 inches Frequency of flooding: None Frequency of ponding: None Salinity, maximum in profile: Nonsaline to very slightly saline (0.0 to 2.0 mmhoslcm) Sodium adsorption ratio, maximum in profile: 4.0 Available water storage in profile: Very low (about 2.4 inches) Interpretive groups Land capability classification (irrigated): None specified Land capability classification (nonirrigated). 7s Hydrologic Soil Group. A Forage suitability group: Sandy soils on ridges and dunes of xeric uplands (G155XB111 FL) Othervegetative classification: Sand Pine Scrub (R155XY001FL) Hydric soil rating; No 10 Custom Soil Resource Report Minor Components Paola Percent of map unit: 5 percent Landform: Ridges on marine terraces, hills on marine: terraces Landform position (two-dimensional): Summit, backslope Landform position (three-dimensional): lnterfluve, side slope, riser Down -slope shape: Linear, convex Across -slope shape: Linear Othervegetative classification: Sand Pine Scrub (R155XY001FL) Hydric soil rating: No Pomello Percent of map unit. 3 percent Landform: Ridges on marine terraces, knolls on marine terraces Landform position (two-dimensional): Sackslope, summit Landform position (three-dimensional): Side slope, interfluve, riser Down -slope shape: Convex, linear Across -slope shape: Linear Ecological site: Sand Pine Scrub (R155XY001 FL) Other vegetative classification: Sand Pine Scrub (R155XY001FL) Hydric soil rating: No Satellite Percent of map unit.- 2 percent Landform: Drainageways on flatwoods on marine terraces Landform position (three-dimensional): Tread, dip, talf Down -slope shape: Linear Across -slope shape: Linear, concave Other vegetative classification: Sand Pine Scrub (R155XY001 FL) Hydric soil rating. No 100--Waters of the Atlantic Ocean Map Unit Composition Waters of the atlantic ocean: 100 percent Estimates are based on observations, descriptions, and transects of the mapunit 11 Mission: To protect, promote & improve the health of A people in Florida through integrated state, county & community efforts. r c a7rrar 'i'�n Da HEALTH Vision: To be the Healthiest State in the Nation Ron DeSantis Govemor Scott A. Rivkees, 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-WELLS FLHEALTH.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 Highway9, Fort Pierce, FL 34982 Mailing: 5150 NW Milner Drive, Port St. Lucie, FL 34983 Phone 772-873-4931 Fax 772-595-1306 FloridaHealtth.gov Accredited Health Department » Public Health Accreditation Board ar r`rv. STATE OF r'LORIUA PERMIT APPLICATION To coN5TAUCT, tE i'r r REPAt.R MapiEY C)RABANDOP4AWEtL "'""'�""'�11e1elrumetnrl Peemlt �No. -ASorlthwest 59-30754 •°LEASE RL1 CUT ALL APPLICABLE F3EL1]�. FtcClda Llni ue ld I _ f North►vest ('Denotes Required Fields Where Applicable} LSL Johns River Permit Sipleiatiens Required (Sea Attached)} $ sad' Outh Florida The wgrefe✓7w?!lcan;mcrnnsrzspnnnble rnrt'omp7eiinij -.. this term ugdfutxwdilr9ljrepermitapplicghorr id that - . Suwannee River s2-S24 Quud No. Delinearpri Na, r' t3�P e+pprorl7fatedaegmedaelharirygaherec�sp,ica&te. i Oetegated Authority (If Applicable) CUPNVUP AppliceYran No. F ame it Corporation t— Address C€ver Drive PzOl' lde �'fstZIP Fetephane Number Address, Road Name or Number, uIty 020-000-3 =Parcet ID No. (PIN) br Altemate Key (C€rcle dice) d_ 32 3B_S__ 41 E 3t Lu Lot Black Unit 'Seclion or Lauri Grant Township Range Check if 52-524;© Yes ❑✓ No 5. James 'El San y Subdivssion Water Well Contractnr 3Nu 954ele 4269 downthehole@att.net -License � e Number "Telephone Number 6. PO BOX gAlAo3 E-mail Address Water Welt COntractor°s Address Port St. Lucie Ft Ity 7. Type of uoric: 349$B Construction❑ Repair ❑ MadtfcataAbaadarment state— ZIP S. Number of Proposed Wells 9, 'Sparify Intended Use(s) of Well(s); R©asan tw e°pair, °c a ® Zn Domestic ❑ Landscape Irrigation ❑ Bottled Water Supply ❑ Recreation Area Irrigation LiIrrigation Site Investigations 9 Livvestoestototal ck ❑ Publ€c'Nater Supply (Limited Uselt7pi-I) ❑ Nursery Irrigation Monitoring Public UJatt:r Supply (Community or Nan-Ctmmun€ty1QEP)❑ Commerciatllndustrial © Test t f F L� Class I Injection Earth -Couplet! Geothermal JUL ❑ Golf Course Irrigation HVAC Supply Class V InjecU'on: ❑ Recharge ❑ Cammercialflndus#rial Disposal NVAC Return Remeidiation: ❑ Recovery ❑ Air S are P ❑Aquifer Storage and Recovery ❑ Drainage ()()f j iR $t LUCIB CO P 9 ❑ t lther [lJespriCej �s�������T ❑ Other (Desuibe) VI�aA»IalEce'kE HE 4 10. Distance from Septic System if <_ 200 ft. 75± 11. Facility Qeseriptiorl esidence IS, Estimated Welf Depth �Q _ft. Estimated CasingDe IhT 1 o ry 12• Estimated Start o7afe p R_ Prima Casing Diameter 4 in. Open Hole: From = To � fL 1d. Estimated Screen Interval: From 1 'f Q TO �- �, 15.Primary Casing Material-. Black Steai Galvanized G " -..- 9/.�f?VC' Stainless Steel Nat Cased Other. 16. Secondary Cas€ng: Telescope Casing Liner Surface Casing Diameter_in, 17. Secondary Casing Material: Black Steel Galvanized PVC Stainless Steel 18.-Method Of Construction, Repair, Or Abandonment; Auger Cable Toot ..Other Combination (Two or More Methods Jetted ROtar� Sonic ) Hand Driven (Well Point. Sand Point _. Horizontal Drilling Plugged by Approved Method ) HydraUliO Point (Direct Push; 19. Proposed Grouting Interval for the Primary, Secondary, and Additional Other iacsnnp°, Frprtt�_ To 10� Seat Material ( Bentonitesmg- From TO (s/.-�VeatCeht Other_ 1 Seal Material ( 9entonite ` Neat�Cement Other From To Seal Material ( Bentonite Neat Cement Other From To Seal Material ( Bentonite Meat Cement _ 20. Indicate total number Of existing wells on s€te i Other? List number of existing unused welts an site 21. Is this ►veil or any existinq welt or waterrttithdravtagen the owner's conttguous property covered udder a CpnSumptivei3Nater Use Permit (CUPANUPj or CUPltAlL1P ApptiCation? Yes 1;gNoi If yes, COmplete the fall0+mng: CUP7VUtJP No, 22, Latitude District Well ID No. Lannde 23• Data Oblatned From: GP$ Inarahvicer2HNarr:Y3corrp5Y�krhrdea tablet Map Survey Datum: NAD27 NAD83 WGSBd :ILtl permd a• aiel'aW mlw PP i- u4+a �r7atle SO F7antla AdmCtiaeat.e CvgA� and Nat a Waly[ I clRt! Nat E sn lita Pn91a: vtfie Wnayr,cl �• itlirt'dJetcdid has 62 asa ar u?N ba aSlaiyee r:;aule GammcacomenwYl<tl Properly. NAl NeinhvmaEen PrCxidea3 acW raraarad Hraf trim aoi9r I fiMhc mlefy Nat ap 'armarav+Praesdtd hl has aopflcaton Ic ac rate and that I wit cLucn rr'%'°h"�^tz:IFSdarChap;e1373, F;'rda 41109", to -Anwn or o al I neeaaea3y ePpreyal'avm aelar radafal, slat¢, cr ln:'4�a, tmx, it NamlErn4mr N aonner. vwprwided Rrapvrtr have eXS Nt, or.t can`Yyratlam mmpktionrsPar. tv aalTttrict.rNm MdaY 11a•av�lvt tea hk_ fepr<ei WaN�a+ar� Rxc:urem, endlhvt[hm:nrvrmttl neaumer afnf V abandon 611tod" Nei cot ucyon. rvpvr. meWllral..eaW r�yPgrlaM1aijf'xa as ah RCR O,na abnh l6 ailox'a1g Pc'racnlml USNBVVYO ar Lto N dY Parlml..ruprr,rt.a�ar'`�waime..>ourn Oat 1a Nv rvv9 - Ing Ny avraw�an,a, kgatpd Armrml�accax +andstPtlnra-�tvnaeema,d r.ea rraadev u�a pe �, Signature of Contssctor wS iX, Licensallo.� SgnatureofOwnerar-Agent 7 Approval Granted By Fee Rep3lved $ Issue Date ( rid �a , PR Expiraton Gate �o Hydrdla4istA rovai Recalpt Nn, CftecK No. Initivly THIS PERMITiS NOT VALID UNTIL PROPERLY SIGNED BY AN AUTHORIZED OF R OR REPRESENTATkVE OF THE WlAD OR DELEGATED At3TNORITY, THE PERMIT SHALL BE AVAILABLE AT THE WELL SITE DURING ALL CONSTRUCTION, REPAIR, MODIRCATION, OR ABANDONMENT ACTIVITIES. DEP Form: 62-a32.9t1UP; Incarparated in 62-532.400(1), F.A.C. Ef(ecltve Date- October 7. 2070 Pagel of 2 ISO Wit �xa ¢e:yonyg c" r $�j ,ay��; ns Ny3�HZ q4 t i fsI . I� i Cfo 5 O o •� •W � l } rWF ^3C a- t R U a c ? j �aTFF'�z�iay. O M ��, "'oyQ, t-o�oca :rad�Prn cs idT i V ��C-a j LIOdOi� DZ CC j 4 a Michelle Franklin, CFA �-- Saint Lucie County Properly Appraiser -5AI1 r ghee errvved. 59- 37,� �,�'y Property Identification Site Address: S rND1AN Parcel 1D: 3532-503-0020- RIVERDR Account #: 116374Scc/'Town/Range:32/36S/41E 00q-3 MapaprL7: 35132NZoning: RS-4 Count Use Type; 0000 Jurisdiction: Saint Lucie County Ownership Garry L Williams 350 NW Sth ST Williston, FL 32696 Current Values Just/Markct- 5126,300 Assessed Exemptions: So Taxable; Date Book/Page 07-26-2018 4166 / 2808 04-01-2009 3123 / 1430 04-01-2009 31231F427 View: Year Built: N/A Primary Wall: Bedrooms: 0 Full Baths: 0 Hal rBaths: 0 Roof Cover: Frame: Story height: Legal Description B S HARRIS S/D BLK 2 THAT PART OF UNNUMBERED TRACT LYING NLY OFCO DR EStiIT AS IN OR 253-1130 MPDAF: FROM SW COP, LOT 10 RUN E 254.97 FT,TH S 25.17 Fr FOR POB,TH CONT E TO WLY R/W IND RIVER D1?,TF1 N ALG SD WLY R/W TO NE COR LOT 8,TH E TO SHORELINE OF IND RIVER,TH SLY ON SD SHORELINE TO PT E OF S LI CO DR ESMTTH W TO PT OF INT OF W RA'sW IND RWER DR AND S LI CO DR ESIVIT,TFI NLY ON 5D W R/W TO N LI CO DR ESkIT,TH W ALG SD N Ll 250 FT,TH N 25 DEG 50 MIN Ol SEC W 90 FT M/L TO POB-LESS IND RIVER DR- ALSO LESS AS IN ORS 2824-0517:0520 (OR 979-1464: 1363-2822) (0,57AC) Historical Values 3-year 5126,300 Year 1usyi Iarket Assessed Exemptions Taxable S126,300 2019 5126,300 2018 $117,500 $126,300 SO 5117,500 5126,300 2017 5117,500 SO $117,500 SO $117,500 $117,500 Sale History Sale Code; Deed Grantor 0001 WD Goodman (TR) Richard F 0111 QC Goodman Richard F 0111 QC Goodman (TR) Margaret E Primary Building Information Finished Area of this building: 0 SF Gross Sketched Area: 0 SF AIC %: 0% Heated %: N/A% Sprinkled %: 0% Exterior Data Roof Structure Grade: No. Units: 0 Interior Data Electric: Heat Type: Heat Fuel - Total Areas Price .$150,000 5100 5100 Building Type: Effective Year: N,'A Secondary Wall: Primary int Wall: Avg Hgt(Floor: 0 Primary Floors: Finished/Under Air 0 (SF): Gross Sketched Area 0 (SF): Land Size (acres): 0.57 Land Size (SF): 24,830 Total Building Count- I Special Features and Yard items Type Qty (,nits Year Bit St. Lucie County Health Department 5150 NW Milner Dr Port Saint Lucie, FL 34983 PAYING ON: # BILL ©ac #:56-BID-4724990 RECEIVED FROM: Down the Hole Well Drillinq _ AMOUNT PAID: $ 805.00 ENT FORM: CREDIT CARD 005188 PAYMENT DATE: 06/09/2020 MAIL TO: Clown the Hole Well Drilling Port Saint Lucie FL 34988 FACILITY NAME : Down the Hole Well Drillin PROPERTY LOCATION: Port Saint Lucie FL 34988 Lot: Property ID: _ -1 - Well Construction EXPLANATION or DESCRIPTION: QUANTITY 7 FEE $ 805.00 RECEIVED BY: Vence'MH AUDIT CONTROL NO. 56-PID-4446834 _ _ Note: 59-30748-59-30754