HomeMy WebLinkAboutWater well Permits'`tP7Y; t Ron DeSantis
Mission: t $ }�,�� tAx _` Governor
To protect, promote & improve the health
of all people in Florida through integrated
state, county 8community efforts, Scott A. Rivkees, MD
RECEIVED EALTH State Surgeon General
OCT +� Vi ! qn: To be a Healthiest State in the Nation
7
t6T. Lugle County, Permitting
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-WELLSCa�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(aD-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 Accredited Health Department
5150 NW Milner Drive • Port St. Lucie, FL 34983 Public Health Accreditation Board
PHONE: 772/462-3800 • FAX: 772/871-5360
StLucleCountyHealth.com
STATE OF FLORIDA PERMIT APPLICATION TO CONSTRUCT,
REPAIR, MODIFY, OR ABANDON A WELL
❑ Southwest
PLEASE FILL OUT ALL APPLICABLE FIELDS
❑ Northwest
("Denotes Required Fields Where Applicable)
❑ St. Johns River
OSOUth Florida
l'hewnterwellcontrnctorisrespansihlefmcornple[ing
this form end forwarding the permir application to the
OSuwannee River
appropiletedeie!)cttedanthoritytvilereopplicaWe.
❑ DEP
Delegated Authority (If Applicable)
Permit No.
Florida Unique ID 59-29544
Permit Stipulations Required (See Attached)
62-524 Quad No. Delineation No.
CUP/WUP Application No.
1. 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. Miramar Ave Fort Pierce FL 34951
*Well Location - Address, Road Name or Number, City
3.1301-601-0073-000-4 27 5 1
*Parcel ID No. (PIN) or Alternate Key (Circle One) Lot Block Unit
4.14 34S 39E St. Lucie Lakewood Park Check if 62-524:0 Yes ❑ No
`Section or Land Grant *Township "Range *County Subdivision
5. Scotts 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 Well Contractor's Address City State ZIP
7. "Type of Work: ❑h/ Construction ❑ Repair ❑ Modification[] Abandonment
8. "Number of Proposed Wells One 'Reason for Repair. Modification, orAbandormant
9. 'Specify Intended Uses) of Well(s): D ^DtaryQ
MD
Domestic Landscape Irrigation Agricultural Irrigation ❑ Site Investigations ILj-') UV
Bottled Water Supply Recreation Area Irrigation Livestock ❑ Monitoring
] Public Water Supply (Limited Use/DOH) ❑ Nursery Irrigation ❑ Test ] Public Water Supply (Community or Non-Community/DEP)® Commercial/Industrial ❑ Earth -Coupled Geothermal. JUN 4 2Q qq 1�
] Class I Injection Golf Course Irrigation B HVAC Supply 7.=:
HVAC Return �.
lass V Injection: ❑ Recharge ❑ CommercialAndustrial Disposal ❑ Aquifer Storage and Recovery ❑ Dray
'^ ^^diation: ❑ Recovery ❑ Air Sparge ❑Other (Describe) _ AN In_SI,1_uales.f!ner
Ither (DescribD)
stance from Septic System if 5 200 ft. _ 11. Facility Descrif
itimated Well Depth 120 ft. *Estimated Casing Depth 100 ft.
12. Estimated Start Date
Primary Casing Diameter 2 in. Open Hole: From To ft.
4. Estimated Screen Interval: From 100 To 120 ft,
5.'Primary Casing Material: Black Steel Galvanized - ,/^PVC '� Stainless Steel
Not Cased Other:
6. Secondary Casing: Telescope Casing Liner Surface Casing Diameter in.
17. Secondary Casing Material: Black Steel Galvanized PVC Stainless Steel er
18.'Melliod of Construction, Repair, or Abandonment: Auger Cable Tool JettedC,,l Rota Sonic
Combination (Two or More Methods) Hand Driven (Weil Point, Sand Point) 'atte-Point (Direct Push)
Horizontal Drilling
Plugged by Approved Method Other (Describe)
19, Proposed Grouting Interval for the Primary, Secondary, and d nftr�ai Cas(n�:..
From 0 To 100
Seal Material (
Bentonite Neat Cement ;•` Other )
From To
Seal Material (
Bentonite`—_VeatL-Gement Other )
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
21.1s this well or any existing well or water with ral ct the owner's contiguous proper( covered under a ConsumptiveNWater Use Permit (CUP/WUP)
or CUPNVUP Application'. Yes Nu 1 yes, complete the following: CU NVUP No. District Well ID No.
22. Latitude Long. u
23. Data Obtained From: GPS Map Survey
I hereby —lify that I vrill comply with the apidi.able rule. of Title 4n, Flnrida Admininlratve, Code, and that a water
use permit or arGflcial recharge permit, If needed, has been or will be obtained pdcr to commencement of well
aenshuctan. I further certify that all Information provided in IN apFlicaten is accurate and that 1 will obtaln
necessary approval from other federal, state, or local govemments, rf applicable. I agree to provide a well
courpieton report to the Distnet Wthn 30 days alter completion or the construction, repair, modincalion, or
abandmumon aulbodzed by th0 pennll, w ma permit erpnulrcu, nhich— u . r„al.
11213
'Sig1 re of Contractor n "License No.
Approval Granted By ens
Fee Received S Receipt No.
Datum: NAD 27 NAD 83 WIGS 84
1 carhfy that I am the owner o(the property. that the Information provided is accurate, and that I am aware of my
responsibill ea under Chapter 373. Florida Statutes, to maintain or properly abandon this well: or, I certify that I am
the agent for the comer, that the infonnmien provided is ac hale, and that I have Informed the mmer of their
responsibilities as stated above. ovine consents to allowing pemonnel of this WhID or Ueletated Authority access
to the-11 att9durino he construction, repair. moditeutian, or ebandennherrt outro4zed by this permit.
Y
'Sign4tidre of Owner or Agent 'Date
issue Date W. Expiration Date
Check No.
Hydrologist Approval
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.
ID
in 62-532.300(1), F.A.C. Effective Date: October 7, 2010 Page 1
MAP OF SURVEY
BOUNDARY & TOPOGRAPHIC SURVEY
OF
LOT 27, BLOCK 5, LAKEWOOD PARK UNIT NO. 1, according to the plat thereof as recorded in Plat Book 10,
Page(s) 51, of the Public Records of St. Lucie County, Florida. (Contains 0.24 acres)
20.22 WELL ACROSS STREET OUT OF RANGE 20.09
_ MIRAMAR AVENUE 20.19
7BM D1 (70' PUBLIC R/W) SNkD
BM-2
EL=20.2§
20.07 0
20 f ASPHALT ROA
18.84
M
WARP
SCALE SWALE SCALE
INVERT
WARP 9.3'i
o
EL=19.42
INVERT
,9.2,
EL.=19.24J\�
19.51 -.
S 89*43'10" E 7
NE CORNER
CONC S 89'43'10' E
FIR 5/8'
o �
LOT 30, BLOCK 5
DRIVE 225.00'(P)(C)
o c 19.21
3.6'
/ PROPOSED PLASTIC
X 20.58 K 1 70 TUBING INDUSTRY
FENCE SYSTEM-
0.85' W.
'w m 25'
T
[�Tol SEPTIC
LOT 28
BLOCK 5
RESIDENCE
FF EL=22.23
UNABLE TO
LOCATE WELL Lu
LO
N
M
M
O
Z 1119.58
X 19.47
20.05
19.56
FENCE
3.55'W.
20.00
L=20.21
1
15'CMP
19.05
INVERT INVERT
ALA- s
AL
135.6't
EL=18.83 EL=18.85
0T T
SCALE
)0,
SIRC 1/2-
_
N 89'43'10' W
19.22
LB 8006
BEARING BASIS
75.00'(P)
PROPOSED
74.91'(M)
16'
CONC
x 19 9!
DRIVE
25' B.S.L
GAL
`YROP SED
Ivi
a
S/T
CONC
ENTRY W/ WALK
00
Cp
J
u�
^
U-)
•-
V1
cd
/
I,:
X 20.79
c
n
/
PROPOSED
c
v
"'
Ma
/
RESIDENCE
N
1612-B
c
a$
x
.56
�7.67'
8.00'
3
L 15' B
10'
-D 3x. X 19N
.2
PAD A��o d: 'Koj
LOT 27 \0 0- o
BLOCK 5
(VACANT)
PROPOSED
WELL
�0.6' 19.65
vi
UTILITY do DRAINAGE
X 20.44
X 20.77
LOT 26
LOT 25
BLOCK 5
BLOCK 5
VACANT
RESIDENCE
NO WELLS
FF EL=23.59
X 19.49
FlR 5/8-
AT NE CORNER
LOT 26, BLOCK 5
4