HomeMy WebLinkAboutWater Well PermitsMission:
4^'•.":,.,
Ron DeSantis
To protect, promote & improve the health
' 4 _
"=r
i'larning & �'2,aiopmem
Governor
all people in Florida through integrated
state, 8 community efforts. �
state, county
, •
Services
Scott A. RivkeesMD
;
HEALTHState
Surgeon General
MAR 22 2021
Vision: To be the Healthiest State in the Nation
Florida Department of Health in St. Lucie County
Conditions for.lssuance 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(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(a)_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: 772871-5360
StLucieCountyHealth.com
STATE OF FLORIDA PERMIT APPLICATION TO CONSTRUCT,
REPAIR, MODIFY, OR ABANDON A WELL Permit No. 59-3
Southwest PLEFlorida Unique ID
El Northwest MenotesLRe OUT
APPLICABLE
ields Where A s Applicable) Permit Stipulations
q pp } p Required (See Attached)
nSt. Johns River
RJSouth Florida fhe:vnrerwcllcnnrrncmrisresponsibleforcomplering
this form and forwording the perrnfr applicoffon (othy- 62-524 Quad No. Delineation No.
❑Suwannee River uppraprfalarlclegnledaarhattysvhrreupplirabJd. —
DEP
,::,Delegated Authority (If Applicable)
Application No.
.1 • Kylie & Christopher Fasnacht 8932 Carlton Road, Fort Pierce, FL 34987 772-216-4456
`Owner, Legal Name if Corporation "Address 'City 'State "ZIP Telephone Number
2. _ I �>J Carlton Road Fort Pierce, FL 34987
"Well Location - Address, Road Name or Number, City
3.3234-231-0001-000-5
"Parcel ID No. (PIN) or Alternate Key (Circle One) Lot Block Unit
4,34 36S 38e St Lucie Check if 62-524:❑ Yes ❑ No
`Section or Land Grant "Township -Range 'County Subdivision
5. Scott's Drilling, Inc, 11213 772-489-6117 scottsdriliing@belisouth.net
'Water Well Contractor 'License Number "Telephone Number E-mail Address
Is. 5014 Palm Drive Fort Pierce FL 34982
"Water Well Contractors Address City State ZIP
7. `Type of Work: Q Construction ❑ Repair ❑ ivlodification❑ Abandonment
8. "Number of Proposed Wells ONE 'Reason for Repair. R1odirication, or Abandonment
9. "Specify Intended Use(s) of Well(s): S
Domestic Landscape irrigation L�=L! l.f` V
❑ Agricultural Irrigation Site Investigations
❑ Bottled Water Supply 0 Recreation Area irrigation ❑ Livestock H Monitoring
❑ Public Water Supply (Limited Use/DOH) ❑ Nursery irrigation ❑ Test
H
Public Water Supply (Community or Non-Community/DEP)H
Commercial/Industrial Earth -Coupled Geothermal F E B 1 6 2021
Class i Injection Golf Course Irrigation HVAC Supply
9 HVAC Retum
Class V Injection: ❑ Recharge ❑ Commercial/Industrial Disposal ❑ Aquifer Storage and Recovery ❑ Drainage
Remediation: Recover Air 5 are DOH in St Lucie Coun
Y ❑ p g ❑Other (Describe)A111IRMEW62❑ Other (Describe) yly
10.'Distance from Septic System if <_ 200 it. _✓�0 f" 1-1. Facility Description >` �' j _ iif l -s 12. Estimated Start Date
11"Estimated Well Depth IL1Ift. 'estimated Casing Depth l(A-- ft. Primary Casing Diameter in. Open Hole: From To ft.
14, Estimated Screen Interval: From W0 To i �'�' ft.
15,"Primary Casing 19aterial: Black Steel Galvanized ,/ PVC, Stainless Steel
Not Cased Other: ^-
•16. Secondary Casing: Telescope Casing Liner Surface Casing Diameter in.
17. Secondary Casing Material: Black Steel Galvanized PVC Stainless Steel Other
•I B.`Method of Construction, Repair, or Abandonment: Auger Cable Tool Jetted Rotaryy Sonic
Combination (Two or More Methods) Hand Driven (Well Point, Sand Point) i`f?y1�•i-gi]tiCT-oint (Direct Push)
Horizontal Drilling Plugged by Approved Maihod Other (oescom)
19. Proposed Grouting Interval for the Primary, Secondary, and AAddiGlaaal eaciryq:
From o To 100
Seal Material {
Bentonite ,/ Neat Cernent
Other
FromTo —
Seal Material (
Bentonite � eaT merit
,}
Other j
From To _
Seal Material(
Bentonite Neat Cement
Other )
From To
Seal Nlaterial (
Bentonite Neal 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 wit , No Bt`er•�the owner's contiguous propert�yy covered under a Consumptive/Water Use Permit (CUPIWUP)
or CUPIWUP Application"? Yes ,/ yes, complete the following: CUI'/UWUP No. District Well ID No.
22. Latitude _ Longitude '
23. Data Obtained From: GPS Map Survey
I he,wiry rwmly !Itrd 1 rd; rangay'ralh Am a nc,abla rule•, at T,*l ,10, A)rida Adm],ilslia-,vo ende, aral tha19 water
use. nonii nr arlilicial "Ldla:ao fHaa !t, it shaded. has been of rr+li bit oldmred piiar to ceimrwicein-fit of viklf
conslnepm:. I lurthr:r ceniry that all a6mmlinn f+rovided to Ilds anWIntion is accutoho and that I VAR nUnIn
uoressary aprynval (tom odlet Icdcial. stale. or local pove,nntcutx it apd:c++b!�. I ape., ha pm•Adi% a an
r:ampICHM ropml to the• CIffiilfl rAlh!n 3a day-t title., mmp;nli l of tits r aslrtvYion. repXt. rnadlfcallan, or
nbra+rronntunl talliActl by Ills pm6t. critic peniEl exP!P�l+en, w!drimvrr occurs raw.
11213
Sgh
'License No.
Approval Granted By
Fee P,r--ceived $
Receipt No
Datum: _NAD 27 NAD 83 WGS &I
I ce0i that I am Ilia a:mef of Ilm tnopedY. that this InrommFou tymided+s acciarm. aria I", I ain mVae ul inl'
respausib!ntiee ender Chapter 373. Flomda stalutes, to mnintaln at rropeily abandon Ih!s waft: or. I C,,flry Ih:al I mu
Ilia ailanl roe Ilia avatar, mall ate infculnalioll nwil:fed is aecuroto. and Iitat I haria Inlolmed tho avmer of titair
responsi&hllea as sWtcd nbe•:a. rhmnr tonsenlsm;alm:irg pasunnel or tl:Lv+fJtdO nr UslefJPted.auowiily ;+apss
lu ilia vrvll sihi dluica tie :nusln , rnfrnii, imnhrtrdi9%,x obandanntant aumonmd by Ihis permit.
i
or Agent
issue Date-f Expiration Date_ 21 "f Hydrologist Approval
Check No.
Ifflitillif
TH15 PERMIT IS NOT VALID UNTIL PROPERLY SIGNED BY AN AUTHORIZED OFFICER OR REPRESENTATIVE OF THE VVMD OR DELEGATED AUTHORITY. THE
PERMIT SI-IALL BE AVAILABLE AT THE WELL SITE DURING ALL CONSTRUCTION, REPAIR, MODIFICATION, OR ABANDONMENT ACTIVITIES.
D
62-532.900(1) Incorporated in
Efrecfive Date. October 7. 2010
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LEGAL DESCRIPTION
THENORTH 342.89 FEET OF THE SOUTH 376825 FEET OF THE WE
ON&HALF OF SECTION 34, TOWNSHIP 36 SOUTH, RANGE 38 EAST,,
LESS THE WEST 000 FEET THEREOF, SAID LAND LYING IN = LUCIE
COUNfY FLORIOX
PARGEL#3234-23:I-Q001-000-5 '
SURVEY NOTES:
I. SURVEY OF DESCRIPTION AS FURNISHED BY CLIENT. LANDS SHOWN HEREON WERE
COT ABSTRACTED FOR EASEMENTS AND/OR RIGHT-OF-WAYS OF RECORD.
2. THIS SURVEY DOES NOT MAKE ANY ATTEMPT To DELINEATE OR DEFINE AREAS OF
ENVIRONMENTAL CONCERN OTHER THAN PROVIDED AND SHOWN HEREON. THERE
NAY BE AREAS OF ENVIRONMENTAL CONCERN ON THIS SITE NOT NOTED OR MAPPED
ON THIS SURVEY.
3. UNLESS OTHERWISE STATED THE BASIS OF BEARINGS AND DISTANCES ARE IN
ACCORDANCE WITH THE RECORD PLAT AND HAVE BEEN VERIFIED BY FIELD
MEASUREMENTS.
4. ALL MEASUREMENTS SHOWN HEREON ARE IN FEET. '
& ALL ELEVATIONS SHOWN HEREON ARE BASED ON '
THE NORTH AMERICAN VERTICAL DATUM OF I am (NAVD98).
6. "-THIS SURVEY MEETS OR EXCEEDS APPLICABLE ACCURACY REQUIREMENTS AND IS
.PREPARED ACCORDING TOTHE STANDARDS OF PRACTICE SET FORTH BY THE _
FLORIDA ADMINISTRATIVE CHAPTER SJ-17 AS CODE, ADOPTED BY THE BOARD OF
PROFESSIONAL SURVEYOR AND MAPPERS.
7. VIRRTEN DIMENSIONS TARO: PRECEDENT OVER SCALED DIMENSIONS AND SYMBOLS
OF FEATURES ARE NOT TO SCALE ANDARE ONLY A REPRESENTATION OF LOCATION
IN THE FIELD.
B. THIS SURVEY IS NOT VAUDWRHOUTTHE ORIGINAL SIGNATURE AND EMBEDDED
SEAL OF THE SURVEYOR IN RESPONSIBLE CHARGE, THIS'SURVEY CANNOT BE '
TRANSFERRED OR ASSIGNED WTTHOUTTHE SPECIFIC WRITTEN PERMISSION OF THE
SURVEYOR HEREON, AND IT IS A VIOLATION OF CHARTER SJ•17, FLORIDA
ADMINISTRATIVE CODE TO ALTER THIS SURVEY WITHOUT THE EXPRESS PRIOR
WRITTEN CONSENT OF THE SURVEYOR ADDITIONS AND/OR DELETIONS MADE TO,
THIS SURVEY IN ANY FORM RENDERS THIS SURVEY INVALID.
9. NO UNDERGROUND IMPROVEMENTS HAVE BEEN LOCATED AS PART OFTHE SURVEY.
• - 10. BY ACCEPTING THIS SURVEY, ALL PARTIES AGREE THAT THE SIGNING SURVEYOR'S
LIABILITY IS LIMITED TO THE AMOUNT PAID FOR SAID SURVEY.
11. NO OWNERSHIP OF FENCE LINES HAS BEEN DETERMINED AS PART OF THIS SURVEY.
12. THIS SURVEY IS INCOMPLETE WHEN ALL SHEETS IN THE SET ARE NOT SHOWN IN
THEIR ENTIRETY.
13. THE LAST FIELD DATE OF THIS SURVEY WAS: 2I ? 1
14. FLOOD ZONE INFORMATION:. I .p V. f f�1'.' !W,r, HD LIeiL' 1 QC.
FLOOD ZONE: "7C,MAP. 12111CO250J �1G LOC,
DATED: 02/16/12 --I
• o
LEGEND
L -ARC LOOM CM-CONCILLIE MONUMENT E.av-c"xnCI • .
j, -ONW- -OVERHEAD WIRE a -am RID FIFE -rNUN FLOOR ELEYATMON CORNERSTONE SURVEYING
^ i 0--4MSIRNG PRE FENCE P -RON PPE BM-SECHMARlt
:'" �% /, •.., -:' -%--EOSTRM CHAwwc FENCE NAD NAL A OW Do -0FTIDAL RECORD BOOK LB# 7941
--EIOStiIO IR700 FENCE CM -VONC ETE MONUMENT PM -PLAT BOON
o--OOSIaG P Aa11C FENCE POO -PORT OF COMMENCEMENT 09 -ODD BOOK
-CHEER ENE PM -PONT RE T GINNINGREFERENCE
PO -FACE
R/11 -w LINE � -'ENT R�'Wx Mp °`mrt PND :Fa"n 325 SW SOUTH QUICK CIRCLE
` PCP-PEPMANENT CONTIML POINT TM WATER
r -,..s WF -Ham FRAME a
MEAsuaD psrANCE a eP�a+m WV -WAFER MEYER PORT ST. LUCIE, FLORIDA 34953
MARK' W::TEEPE PT 'rPaNT OF unGEEE CY -PLATTED
DISTANCE h IEMNO MN MuuaMc
PROFESSIONAL.,LAND.'§ RVEYOR PR -FONT aF ORVME C -CAMMATm p17ANCs s BEAANG LP ��aNT Po HYDRANT TEE: 772-018 2376
PRC -FONT OF RE4Qt5E CURVATIRE -OEMR pSTANCE G WARxU up 'TNTT Pas Coi2NERSTONESURVEYING@JFK7TMAlL.,COM
FLORIDA REGISTRATTION NUMBER # 4811 ON +ate PRp�vONAt SURVEYOR ANON MAPPER Ru _MSanERea ww S RKYOR
CB -CHORD BEARING RR-NCQL3D Wiffam
BOUNDARY SURVEY
PREPARED ON M C OM OR
scAHa ��E
DRAM
n /DATE.
uCIE
or `aG Saint Lucie County Property Appraiser
s�4 = Michelle Franklin CFA
Report generated: Thursday, December 3, 2020
Parcel Report
Parcel
T
PARCELNO:
3234-231.0001-000-5
Property ID:
150608
Ownerl:
Kylie M Fasnacht
SiteAddress:
TBD
Owner
Overview
Ownerl:
Kylie M Fasnacht
PrimaryLandUse:
6000 - GRZNG SLD CP
Owner2:
Christopher C Fasnacht
DistrlctGroup:
0001 -,Saint Lucie County
Owner3:
Subdivision:
Metes and Bounds
MailingAddress:
8932 Carlton RD Fort Pierce, FL
Just/Market Value:
S160,240
34987-3225
FinishedArea:
Acres:
20.03
TotalArea:
872,507
Legal Description
LegaiDescription:
34 36 38 N 342.29 FT OF S 3768:25
FT OF W 1/2-LESS W 100 FT- (20.03
AC)
Value History
Just/Market
Building Land SFYI
Assessed
Exemption County
Save Our Home OR 10%
Ag
Year Value
Value Value Value
Value
Amount Taxable '
Cap Differential
Credit
2020 $160,240
$0 $160,240 $0
$67,308
$0 S67,308
SO
$92,932
2019 $192.300
SO $192,300 $0
$192,300
$0 $192,300
$0
SO
2018 $160,240
$0 $160,240 $0
$16,024
s0 $16,024
$0
$144.216
Tax Links
Improvements
S1_.;: Ta�Collsi_tnr's_f] iirc 4z�xu:-. for this n;�rcc i
Building Sequence:
1
f7otivii9naal "rRlty! c,otir._r.�or_this.i�;�rr <:I
Bedrooms:
0
Bathrooms:
0
Building Type:
-
Story Height:
No of Living Units:
Total Finished Area:
0
Gross Sketched Area:
0
Year Built:
Effective Year:
Primary Roof Cover:
Primary Roof Structure:
Primary Wall:
A/C %:
0
Land Lines
Line Number
Units Unit Type
1
12.03 MACR
2
12.03 CACR
3
8 Acre
St. Lucie County Health Department
HEALTH9 5150 NW Milner Dr Port Saint Lucie, FL 34983
PAYING ON: #: 56-SF-2211896 BILL HOC #:56-BID-5123436 CONSTRUCTION APPLICATION #: AP1606194
RECEIVED FROM: Kvlie Fasnacht AMOUNT PAID: $ 660.00
PAYMENT FORM: CREDIT CARD 06808D PAYMENT DATE: 12/09/2020
MAIL TO: Kylie Fasnacht
FACILITY NAME:
PROPERTY LOCATION:
TBD Carlton Rd
Port Saint Lucie, FL 34987
Lot:
Block:
Property ID: 3234-231-0001-000-5
EXPLANATION or DESCRIPTION:
128 - OSTDS Construction System Inspection Research Fee
-1 - Surcharge (All)
-1 - OSTDS New Permit Surcharge
-1 - OSTDS Construction Application and Plan Review,New
123 - OSTDS Construction Site Evaluation
126 - OSTDS Construction Permit (New or Mod, Amendment)
127 - OSTDS Construction System Inspection
133 - OSTDS Construction Reinspection
-1 - Well Construction 5C - 319q i
QUANTITY
FEE
1
$
5.00
1
$
45.00
1
$
100.00
1
$
100.00
1
$
115.00
1
$
55.00
1
$
75.00
1
$
50.00
1
$
115.00
RECEIVED BY: WhighamJL AUDIT CONTROL NO. 56-PID-4825916
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