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HomeMy WebLinkAboutWater Well PermitsMission: To protect, promote &, improve the health of all people in Florida through integrated state, county & community efforts. HEALTH — Vision: To be the Healthi4st State in Ron DeSantis Governor Scott A. Rivkees, MD RECEIVED I State Surgeon General ST. Lucie 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 SLC DOH -WELLS (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(QFLHEALTH.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: 3866 S US Highway1, Fort Pierce, FL 34982 Mailing: 6160 NW Milner Drive, Port St. Lucie, FL 34983 Phone 772-873-4931 Fax 772-595-1306 Accredited Health Department Public Health Accreditation Board FloridaHealth.gov STATE OF FLORIDA PERMIT APFLICATiONi TO CoNSTitUCT, REPAIR, MODIFY, OR ABANDON A WELL 0 Southwest _. yp PLFASEFILLOUTALLAP I.1 qgLEFIELDS , ❑Northwest eq Villtere Applicable) ("Denotes R wired Hauls MouthhF'loridaer mdrvoc�lY�sco�rr�rorrsaspar:n,!rhrr[omjrhKtng ... P.Suwannee River 1111crannandfimtam!iolydiayannunppri'nrlanrnrlm LI DEP apprupdnredrleyrtrcdnedlorlWtvMerrappniab!e rlDelegated Authority (IrAppliczble) 1. Cherrie LaFond & John Murta 5268 NW West Lovett Circle Port St Lucie, FI 34986 "Oweer, Legal Name if Co oration Unique 10 59-30857 Stipulations Required (See Attached) Quad No. Delineation UP Application No. tP Address City •State "ZIP Telephone Number 2.11690 Palomino Drive Ft Pierce Fl 'Well Location - Address, Road Name or Number, City 3.3309-605-0037-000-2 34 'Parcel ID No. (PIN) orARemate Key (Circle One) 4.09 36S 39E Lot Block unit — St Lune Check if 62-5240 Yes 0 No 'Section to Land Grant -Township 'Range 'County Subdivision s. James Paul T son 11352 954-818-4269 downthehole(Mattnet "Water Well Contractor ^License Number 'Telephone Number 6. PO BOX 881496 E-mail Address Water Well Contractor's Address Port St. Lucie FI 34988 7. Type of Work: Dreonstruction Q Repair ❑ Modification❑ Abandonment City state . ZIP 8. -Number of Proposed Wells 1 ---•— Rea at rcr �ewrr. 01otIIGcaean a .Hbertriennrens 9._ -Specify Intended Use(s) of Weil(s): omestic Landscape Irrigation Q In, tliedWater8 i Agricuifural irrigation [� Site InvestigationsuPP y Recreation Area Irrigation Lf LivestockMonitoring ublic Water Supply (Limited Use/DOH) ❑ Nursery tmgation Test Earth Public tWer Supply (Community or Non-Cotnmunitylt7i_P) Commerciailindustr(at I JUL ,� 2 02I Class 1 Injection -Coupled Geothermal Golf Course Irrigation HVAC Supply . Class V Injection: ❑ Recharge Commerciallindustrial Disposal HVAC Return Remedlation: Recovery P ❑ AquKer, Storage and Recovery [I Drainage ❑ ry ❑ Air Sparge El (uescrlbe) ❑ Other (oesalbe) DO Co �''" 10.`Distance from Septic ,tam If 5 200 fr { . �:' 11. Facititsy.pescription esi ence 11"Estimated Weil De th .:: L 12. Estimated Stan Date P ft. . �C-st(matcd Casing Depth + (-iex ft. Primary rasing Diameter_, in Op©n Hale: From To =-1t 14. Estimated Screen.lntenrat: From (' t To:•.�+ ft. 16:'Prirnary Casing Material: Black Steel Galvanized P Stainless Steel Not Cased Other; 16. Secondary Casing: Telescope Casing Liner Surface Casing Diameter 17. Secondary Casing Material: Black Steel Galvanized PVC Stainless Steel 18'Method of Construction, Repair, or Abandonment: Auger Cable Tool Jetted -Other Combination (rVlo or More Methods) Hand Driven PA Point. Sand Pain 'O"ry Sonic Horizontal Dn'Ign Plugged b Approved hlethoa 1-14rrauiic Point (Direct Push) 9 99 y P Other !Cesenbr,} 19. Proposetroutlnq '` 'f for the Primary, Secondary, and A,dditionai•Easing: Seal Material ( Sentcnite Z` ea ' =dM Other ) From To SealNlatedaE ( .Bentonite Neat Cement Other Frog_ To Seat Material ( Bentanite Neat Cement Other From To Seal Material ( Be-Monite Neat Cement Other 20. indicate total number of existing wells on site ) —"+ "" ) 1 List number of existing unused evells on site 1 21:'IOr s this well or any existin wait orwatcrrdtlf .ilyn the owner's coati uous Coro arrttyy covered under a ConsumptivelWater Use Permit (CUf�/WUP) 2Z Latitude P Application? Yes 1`l No, If yes, complete the faliow�ig pCtIPPMP No.District Well ID No. Longitude 23. Data Obtained From: GPS Map Survey Datum: NAD 27 =e0d GrryttWfCwmFymt meted'Tuber,�t-aulret242.F1,,0asamcrm co�ca.,atrat�pr�r f�tAD83 WGS84 WepmteR4ar8Aildtadrmpa pumR,.iroeeded.lxahcoamtmitn et+n,a rrcw nermtttrt.to!vCl Icarey tnAtamQ;. wawrnf6re ptcpt.eeth.irJxnidunpmr:dW lsicurdt,aN Wdimnuwanr array matbuol'on.lfwt6acm6firSMt_ Y�AitibiYztnproid.tltzWx paGr ClrJ bretlpllNrespsnsD:rtlasaMr:CIr.�Ig3TJ.Pa+ka.Ohr..a5dsnerpnWmllrurdndon&JapeY a[Cd770tYapAmY,t Glyn tihYr�DrlGL'tll ie asw�Mrn t•'a! :GBtCIC 71hrRSkCa •a'.Ientfyptatlatn t►r041,QtaR1 vetn7ertp,:I9Mrvyu. IxtE'aCto deatwa aFM't hfrbp pnc7ur. prny!d;dq accun!<. �ndt6iTlhsveinWnredlho myyrortlulr s,:mphrran mFwi^`o Dhh iW_ ar,�. otnwwuhrrras. repar.m4laftmpm to tli. am mtrdabnrn Caaerera:rztaroCal ap+xdeaefott=fawuowDalete7ed Futter aceea -,,.,"""r"" �'—�e:;rekat. nor+cc,n:tnrcLa,rcpw.mx:.ufvr,wnbcnEdrrna � m uu'karad tY r)dp pa+w�t r' 11352 slgnaturaofcontracror — �,,`�� 06/30/2020 'License Igo. ' 'Signatur$IorculnararAgent . � 'Date Approval Granted By Fee ReceiveIssue Date 7 �N 1440 Ezp(rationDate i/!Y 24 n d y�ctcgistA2proval S Receipt N(L,_ _ twrta Check No. THIS PERMIT IS NOTVALID UNTIL PROPERLY SIGNED BY AN AUTHORIZED OFFICeR OR REPRESENTATIVE OF THE vVMD OR DELEGATED AUTHORITY. THE PERMIT SHALL BE AVAILABLE AT THE WELL SITE DURING ALL CONSTRUCT ION. REPAIR, MODIFICATION. OR ABANDONMENT ACTIVITIES. DEP Faint: 62-532,0060) Incorporated in 62-5n,400(1), F.A.C. Effective Date: October 7, 2t110 _IEtJ SHEET 1 OF 2 SURVEY SKETCH ------------ SURVEY NOT COMPLETE WITHOUT ALL SHEETS MAP OF BOUNDARY SURVEY PREPARED FOR JOHN MURTAGH AND CHERRIE LAFOND uNo��ci MARE LAKE TRACT "C" LOT 35 OT 3f CANTT FIR tl�r z �i`) (NO i0) 4 23.1 iN010) / ry` f, CV 'pO* Rol �� /cP'��Gr / • ri � �i��0'J ai 60 f' � / 4� / 14 tr) 10 e o �4ex r N / 0 R 50.00' i / RR (N m) IVY MR R tl/tl' O. NB9.3 'S5•V b (xo w) 37.04, 49' SITE BENCHMARK B1 SITE BENCHMARK #2 ELEVATION a ELEVATION - 21.30 (NAVO '88) 21.20 (NAVD '08) NOTES: ALL BEARINGS AND DISTANCES SHORN ARE RECORD AND MEASURED, UNLESS OTHERWISE SHOWN. ELEVATION NOTES: ALL ELEVATIONS SHOWN ARE BASED UPON NORTH AMERICAN NORTH ARROW & GRAPHIC SCALE BEARINGS ARE BASED UPON THE SM'NG PUBLIC UTILITY UPO ANDTHE RECORDDRAINAGE EASEMENT. FOR BEARING FOR THE VERRCAL DATUM OF 19B8 (NAVO'88). PROPOSED FINISHED FLOOR ELEVATION IS SUBJECT TO CHANCE 'PER HEALTH DEPARTMENT. IGH NORTHWESTERLY RIGHT OF WAY LINE OF PALOMINO DRIVE. LINE 1" = 60- 60' PERMIT NUMBER AND CONTACT N/A O atvAZM- PRVOM EILYAM-� OAI MIX AM* -- JOB j - 2008-017 REN90N - KNOW IT NOW, INC, PROFESSIONAL SURVEYING AND MAPPING 5220 US HIGHWAY 1, �11( VERO BEACH, FL 32967 PHONE — (888) 396-7770 1 WWW.KINSURVEYORS.COM FIELD DATE -W/12/Z ° gym- REVISION - PROPOSE METAL BULUG 0.10.2D mum — PIV90" FtMS=" REVISION _ REVISION " REVISION _ 0N — FLORIDA BUSINESS CERTIFlCATE OF AUTHORIZATION NUMBER LB 5912 { St. Lucie County Health Department HEALTH 5150 NW Milner Dr Port Saint Lucie, FL 34983 PAYING ON: #: BILL Doc#:56-BID-4773815 RECEIVED FROM: Down the Hole AMOUNT PAID: $ 1265.00 PAYMENT FORM: CREDIT CARD 031526 PAYMENT DATE: 07/14/2020 MAIL TO: Down the Hole Fort Pierce FL 34945 FACILITY NAME: Down the Hole PROPERTY LOCATION: Fort Pierce FL 34945 Lot: Property ID: _ -1 - Well Construction EXPLANATION or DESCRIPTION: Block: QUANTITY 11 FEE $ 1265.00 RECEIVED BY: VanceMH AUDIT CONTROL NO. 56-PID-4501284 Note: 59-30856-59-30866