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HomeMy WebLinkAboutWell Permit'ftk�ltr STATE OFFLORIDA PERMIT APPLICATION ToCC1AfMUCT, �f ,2 REPAlk MODIFY. pit ABANDON A WELL Farm=; 4a. 59-31037 "" l '-_ Southrtast Florida Urtigoe ID �'I.EMaf1 fitLrLDUrALLFCiarrLlC/+BLcF'IELr3S ZY nl Northwest {"Danotea Required Fields Where Applicable) Pertn�t 5tiptla6ons Required (Sea attached) s At Johns RiVer outh Florida riffesponplbofor eampGef;ry rhfsrafmadrurm dilg¢hep rrne rp Dot WF`4"R :1 Suwannee RiverrtP9rvyrinto4kkimadaafftariryart� "#mbfe rlf• 62-624 AuOd No- 1)er"ication No. El DEP Delegated AuthorityIf CUF;NIUP Applicagon No, i Applicable) 1-Juan & Jessica Quinteras 4652 SW Wade Drive Pflrt St Lucie, FI 34953 Owner, Legal Name if Corporation Address City 2. 4537 S. Header Canal Road Ft Pierce F134945 State 21P Telephone Number Well Location -Address, Road Name or Number, City 3. 3202-504-0007-000-3 -Parcel ID No. (PIN) or Aflemate Key (Circte one) 4.02 365 38E St Lucie Persnicke Farms Let Black Unit Check if B2-5%t:� Yes Q No Section or Land Grant `Township "Range i~pu,tiy SUbdivisEon 5_ James Paul Tyson 11352 954-81114269 Water W6I1 Contractor downtheholeRu att.Ret iicdnse Number °Tad hone Numhar 6. PO BOX B81496 p E-mail Address Water Wglt Ccsntractnr s Address PAC# St. L ucle Fl 34988 City 7, 'Type of Work: Vi Canstrur;tion ❑ Repair n Modihcatfen[] Abandonment `Number State ZIP 8. of Proposed Wells_ 9. SpOWY intended Use{s) of Well(s): ❑omestiC Landscape irrlgahnn Raszuit rya rrav, rNnriricat at, arAltaaxtarmv r Agricd Irrigation Battled Water Su Livestock PPtY � Recreation Area trr€gation Q Livestock � Site Investigations Public Water supply (Limited UsefDOH) tSursery intgation ^] Mon Mgnitortng l'ttblit Water Supply {ComtnLln€!y or Atntt trtxnmunityft}EP) Cnnimercialilttdustrlal Class I Injection Earlh-Cnuplad Geother€nal S �Q� Goff Course Irrigation IiVAC Su t pp Y Class V Injection: ❑ Recharge [I COrrmerctateindtrstrial 17isposal 0 Aquifer Storage and Re overy M Drainage Remediation: ❑ p-COvety [] A€r Sparge Other ttSb�cr 6a) [l Other iiksmbei CO 10.'Distance from Septic System if S 200 11. Facility Description r©pose`51 f iECB 13, `l=stirrsaled Well Depth 12D ft. -Estimated Casing Dep;h 1 OD tr. Primary Casing Diameter 2 In, 2 open Hole: From ate To =fl. 14. Estimated Screen interval: Fr= 100 To 120 % 15. Primary Casing Material: slack Steel Galvanized Not Casett Other, <09 Stainless Steel :16. Secondary Casing; Telescope Casing Liner Surface Casing diameter in. 17. Secondary Casing Material: Black Steel Galvanized PVC Stainless Sleet 'a'' 0thod.afConstruetiors,Repair,orAbandonMy nt: Other Auger Gahis Tool Jetted � � Combination (Two or More Methods 1 Sonic Hand Driven (U!#elt Point: Sand Point) Hydraulic Point (Direct Push) Horizontal Dtflling Plugged by Approved Method Other roascaanl 19. Proposed Grouting Interval for the Primary, Secondary, From tl t fg oral adSeEiar(-4ment To 95 Seat Material ( From Toother Bentonttra 3 } Seal Material ( From To l3entanite Other Seal Material ( From To Bentolilte Neat Cement Other Seal Material ( Bemonite Neat Cement Other 20, Indicate total ruunber of existing yetis on site Q Q List number of existi un d 21.-is this well or any existing wall of tfrater will ixr� an Shea d u&e wMim on site er CUPNVUF Applicatiorl7 �'ss n ltyes. complete thieItao Awfroppa overed4 nder a C0I1$Ump#lueiWater Use Permit (CUp1VWp) 22. Latitude �; U ._ _ District Well ID No. L6itg€tlldf; 23, Data Obtained From: GPS Map Survey Datum' (i,ckaa, 91cNAD 23 NAD 83 __WGS 84 e"ukx �nBx [hn aae1�.5� ,.A:.y arida c feat-'arrn�ae dee..s,e h33d a wnu< ss-aCn+nm�arL6e'alrw(imge permi3:8rwedad �aa bean ar wt b..b'd-dWb: la ca:-rrxrer rantMwrn teenifr ^�uti nt lfearvnarerasn ivapa�ef.r�.uoc-,mm+acxr q,arekdbnccw In.rwtl Y�nlam elvers ofm wAa4r'aEIIatl. Iavmef ierfify la941f ntetFpa prpyj;,pa tlt Yale rpi%�S '9a Rar:CT13td 0.Rd �iffi iw:7 wt_ rnSFGRFG�!°Ffd15�n KClll(r:,sr 7id.F�a 3a 5ts /toy td lnv. Ndit a! rahy n,rpk-ary a�WaVatNrns adxrraesrrl,rbm. wktW 9err+rirns,{a,itb. �+s�5ta.4 r:a apa,trar Inc ante., hat rF*.e e,#urwLvn pnntdcE aAQ.�aratm,a tisati haac .Afbrmcdtfia ca�nF&gtanrunaritaae GlnuL n]!E eyed rap�ar�e atsw@ +.-rn�.c+aYenaasawr.asao.,,. avnnra.�,.r Old 7.e a9t�ta�a4a,d rr4u;au.x.rmw. maxr4xaaa.w In ena web nia6:nnptn�co-ukxKtnn-eenai'. racut:'s3ipn. uraan��eernts hADaad Pei nnan4yafity aec¢ix Ca?ndlaut�aAa1.M31�;+xrW'atca�s teal. Sr perair. of Con "sign11352 � 8/2512020 nfunt iractar _ ... ` License No. nature of at actor Agant Date Approval Granted By AIIL_-`� `�- assu[a Lf9l2 �fj (,- Fee Received S�"'— Expiration Daterlydroloe€st Approval R'zrtipl NQ. ChaCk Na. I1-Z THIS PERMIT IS NOT VALID UNTIL PROPERLY SIGNED 13Y AN AUT14ORIZED OPPICER QR RLPRESENTATIVE CF THE sVA413 OR DELEGATED AUTHORITY. THE PERMIT SHALT BE AVAILABLE AT THE V ELL SITE DURING ALL CONSTRUCTION. REPAIR, MC)DfFICATION, DR ABANDONMENT ACTIVITIES. DEP Perm: 82-532-fi0tl(1) Incctporataq tr, 82-832-drMtit car w._a..._ ._... _ . . Page 1 of 2 D 0 Z Q U W 0 C. 0 Of a *4 x eo X rk I I v°z I I� � � I � 8 s ssl � � x � so I �0 90 �X sf, �� OR - ! z �� 1 �� � -- Ico o I r I� 1 F'Qo o 1 1 1 �� x 9% i ice` x f r f x 00. f i HO240d C130A 0 Q3SOdOdd `�x ! I I 1 I I I I x I i N N I � I ., £. �.�°.�•� zz� .ems .09�� II � x c-I) 4o6' ui N N I f �•' 1 � X CT CL ` J c'x TS x L 0 � ! af W Q� � I La IL 0 ! x 0 t co � I—� t� i c3 ` � ¢ I E x 0 W Z �x I Of cr � 0 I 020 0 w ! Ul fC7 y- 0 t/> a II x ct. c5 cL I � x c�1 sa Property Card Page 1 of 1 Michelle Franklin, CFA -- Saint Lucie County Property Appraiser -- All rights reserved. Property Identification Site Address: 4637 S Parcel ID: 3202-500-0007- Account 4: 176161 Sec/Town/Range: HEADER CANAL RD 000-3 02/36S/38E Map ID: 32/01X Zoning: AG-5 Count Use Type: 6000 Jurisdiction: Saint Lucie County Ownership Legal Description Juan R Quinteros PERSNICKETY FARMS-(PB 66-40) LOT 7 Jessica Quinteros 4652 SW Wade DR Port Saint Lucie, FL 34953 Current Values Historical Values 3-year Just/Market: $154,500 Assessed: $8,000 Year Just/Market Assessed Exemptions Taxable Exemptions: $0 Taxable: $8,000 2020 $154,500 $8,000 $0 $8,000 2019 $131,325 $8,000 $0 $8,000 2018 $122,740 $8,000 $0 $8,000 Date 01-20-2020 04-12-2004 View: Year Built: NIA Primary Wall: Bedrooms: 0 Full Baths: 0 Half Baths: 0 Book/Page 4372 / 2993 1985 / 1946 Type Roof Cover: Frame: Story Height Sale History Sale Code Deed Grantor 0001 WD Butterfly Enterprises LLC XX60 SP Quex LLC Primary Building Information Finished Area of this building: 0 SF Gross Sketched Area: 0 SF Exterior Data Roof Structure: Grade: No. Units: 0 Interior Data Price $225,000 $600,000 Building Type: Effective Year: N/A Secondary Wall: A/C %: 0% Electric: Primary Int Wall: Pleated %: NIA% Heat Type: Avg 1 lgt/Floor: 0 Sprinkled %: 0% Heat Fuel: Primary Floors: Total Areas Finished/Under Air 0 (SF): Gross Sketched Area 0 (SF): Land Size (acres): 10 Land Size (SF): 435,600 Total Building Count: I Special Features and Yard Items Qty Units Year Blt All information is believed to be correct at this time, but is subject to change and is provided without any warranty. © Copyright 2020 Saint Lucie County Property Appraiser. All rights reserved. https://www.pasle.org/RF,Card/ 9/28/2020 St. Lucie County Health Department ` t LTH 5150 NW Milner Dr Port Saint Lucie, FL 34983 PAYING ON: #: 56-SF-2153829 BILL DOC -n:56-130-4967255 CONSTRUCTION APPLICATION #: AP1566127 RECEIVED FROM: Jessica Quinteros AMOUNT PAID: $ 660.00 PAYMENT FORM: CREDIT CARD 08701 G PAYMENT DATE: 09/03/2020 MAIL TO: Juan Quinteros FACILITY NAME: c�, PROPERTY LOCATION: 4637 5 Header Canal Rd Fort Pierce, FL 34945 7 Lot: Block: Property I D: 3202-500-0007-000-3 EXPLANATION or DESCRIPTION: QUANTITY FEE 128 - OSTDS Construction System Inspection Research Fee 1 $ 5_00 -1 - Surcharge (AI) 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 -1 - Well Construction 1 $ 115.00 RECEIVED BY: WhighamJL _ AUDIT CONTROL NO. 56-PID-4638015 A_._. ........... Note: 59-31037