HomeMy WebLinkAboutCONDITIONS FOR ISSUANCE OF WATER WELL PERMITMission: Ron DeSantis
To protect, promote &improve the health _
Governor
of all people in Florida through integrated •� ji ;, state, county & community efforts. Scott A. Rivkees MD ��-4'r
EAIYfr� State Surgeon General
Vision: To be the Healthiest State in the Nation
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(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: 772/871-5360
StLucieCountyHealth.com
4 ter T STATE OF FLORIDA PERMIT APPLICATION TO CONSTRUCT,
° rya REPAIR, MODIFY, OR ABANDON A WELL
f ''•a' o Southwest
t- ❑Northwest FLEASf FILL OUT ALL, APPLICABLE FIELDS'.
} � J 5t. Johns River (Denotes Required Fields Where Applicable)
N
�r q'uth Florida TnearJtrrtvalimarrarrorirrnsyanr rJrforrnmp!ciry
�/ this lam nrrd lnnrgtiring thz)rennir a�pGrutinn ro rhr
COU.�YG�9•v% lSuwannee River argtrop»at[reklnrvlaulbm;lyeehaeapp;iroblr,
❑ DEP
❑ Delegated Authority (if Applicable)
No, 59-31710
Unique ID
Stipulations Required (Sea Attached)
02-524 Ouod No. Delineation No.
CUPNWP Application No.
1. Esteban & Mary Ramos 681 SW McCullough Avenue Port St Lucie, Fl 34953
'Owner, Legal Name if Carpo�ation 'Address City 'State "ZIP
2,1071 S Header Canal Road Ft Pierce F134945 Telephone Number
"Well Location - Address, Road Name or Number, City
3.2214-501-0004-000-9 4
'Parcel ID No. (PIN) or Alternate Key (Circle One)
4.14 35S 38E St Lucie Lot Block Unit "Section or Land Grant ship 'Range -Count Check If 62.524:❑ Yes Q No
"To>,vn
5• James P. Tyson y Sulldivlsiorl
11352 954-818-4269 downthehole@att.net
'Water Well Contractor "License Number
6. PO BOX 881496 Telephone Number E-mail Address
Water Well Contractor's Address Port St. Lucie FI 34988
7. "Type of Wark: ❑✓ Construction ❑ Repair ❑ Modification❑ Abandonment City State ZIP
8. 'Number of Proposed Wells 1
9. 'Specify Intended Use(s) of Well(s): ReosonrorRepav, mumn:a on,orfibardon eat
✓ Domestic ate to
❑ ® Landscape Irrigation ❑ Agricultural rat irrigation ® I u1 �M ❑ Booted Water Supply Recreation Area Irrigation ❑ Livestock g Site Investigations d L(_ lJ�j Q V
Public Water Supply (Limited Use/DOH Monitoring
❑ Nuraary Irrigation Test
Public Water Supply (Community or Non-Community/DEP)n Commerciat/industrial
Earth -Coupled Geothermal
Class 1 Injection ❑
Golf Course Irrigation HVAC Supply M AY 2 0 2021
Class V Injecgon: ❑ Recharge ❑ q g HVAC Return
9 ❑ Commercial/Industrial Disposal Aquifer Storage and Recovery ❑ Drainage
Remedialion: ❑ Recovery[] Air Sparge ❑ Other (DOWAli.)
❑ Other (De3-bo) i O
10.'Olstance from Septic System if 5 200 ft. + 11. Facility Description rOpDSe tat once HE
13.'Estimated Well Depth 120 ff. 'Estimated Casin De th 100 12. Estimated Start Date
g p h. Primary Casing Diameter 4 In, Open Hale: From �To 14. Estimated Screen Interval: From 100 To 120 R,
15."Primary Casing Material: Stock Steel Galvanized
Stainless Steel
Not Cased Olhec
16. Secondary Casing: Telescope Casing Liner Surface Casing Dlametor in,
17. Secondary Casing Material: Black Steel Galvanized PVC Stainless Steel
18.'Melhod of Construction, Repair, or Abandonment: Auger Other
9 Cable Tool Jetted _Br Sonic
Combination (Two or More Methods) Hand Driven
(Well Point Sand Point) Hydraulic Point (Direct Push)
Horizontal Drilling Plugged by Approved Method
Other tDescrtw)
10. Proposed Grouting Interval for the Primary, Secondary, and a
From 0 To 65 Seal Material ( Berttonit cp( 9•
Other
From To Seal Material ( Bontanite Neat Cement Other )
From To Seal Material ( Bentonite Neat Cement Other )
From To at Material ( Bentonttc Neat Cement Other )
20. Indicate total number of existing wells on site 0 1
List number of existing unused wells on site 0
21.`Is this watt or any existingg well or water tv"�+Qn �I)e owner's contiguous pro otr covered under aConsumptive/Water Use Permit (CUP/WUP)
or CUPMJUP Applfcal[on7 Yes f es. complete thfollowing rope covered
No. -__
22. Latitude Longitude Dlstdct Well ID No,
23. Data Obtained From: GP5
IRaspy twfy dta! I w.a wn.;�y.,.u,l;,, ,.... .Map Survey Datum: NAD 27 NAD 83 WGS 84
KP . `le rukc of L.:�O,rla:ka Adr.a,:ku:va CcJe,:md L',da caster I.ergty puilnm p•e carat c}xe rc r „t,lt l!r[•nd',rmvtien pme:dad B acoW end LAallemmc:e Arta
uce RurMa Ih1th ireduresn al 4,7n[eArd hat Man n: unL 6a apfrradprerw eamn.encerranlu!w;9
eau[ufinn.11+tp;zu;Ly tr�R a71^.!otlnuXvt µevcfeUrn the milcaG:n la wccu•a![endtnatlrty o6tm eeyp:n::A'.lka u;de:Cup: SiJ,FN;•dJS'slrte-f.lart,llrtanapq�d/ghynyn lA:a wcl. a.leer6rythatl sin
nOG�firy NODtrM1rl�l/MI O�,M rrAlh•1 AYK,C+If�lio tY[fnIIb11C:. iI i(:ti['.ttlp, IY;Y[010 o,e r�lrt lSJ d•cw+nir,ei,C Lis r,rq TJHvI pYy.dlJli t•:taYDIO,Y'1tl!h�:iblVC If14YRn1LA4YL;tr pf i•;[i
Senn{dclvl leputly pee 6,ahiel �N,:n 7a clots afire rnc,4i:n ot,i.v con nc Mw.Let.-p t[! ,nsa;.Utan a!aled aL•i�e 6v«:sr cunxcey:n n9wn
ttwm,l;,w:enl warNptrdby tAf pem:t,uttepv:nilo .ruton. v.�,ar;at w.vaNai�'m:.Al„Jolt. ar tp Cry wtDx:ln,�u 7W�,roIa1L /, L17Aa m❑,kp!4td Py9w:rnY nrcr"c
�j M:e<rAu<;en. epe.,nicyrcyyu „y Ox .1 ;,L••r.rnitrylUpy,.t,
11352
'Signature at Contractor 'License No. - - 3/22/21
"Signature of Ovtner or Agent Data
Approval Granted By //! \ '^„�`- Issue Dat �1 �i6a
ExgiroUon Daley.Hydroia0lsf Approval
Fee Received 5 Recnlpt No i r 4
Check No.
THIS PERMIT 15 NOT VALID UNTIL PROPERLY SIGNED BY AN AUTHORIZED OFFICER OR REPRESENTATIVE OF THE 1M I) OR DELEGATED AUTHORITY. THE
PERMIT SHALL BE AVAILABLE AT THE'NELL SITE DURING ALL CONSTRUCTION, REPAIR, MODIFICATION, OR ABANDONMENT ACTIVITIES.
DEP Form: 62-532,9000) Incorporated in 62-532.400(t), F-A.C, Elreetiva Date: Oclober7. 201D
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Michelle Franklin, CFA -- Saint Lucie County Property Appraiser -- All rights reserved.
Property Identification
Site Address: 1071 S Parcel ID: 2214-501-0004- Account #: 181577 See/Town/Range: 14/35S/38E
HEADER CANAL RD 000-9 Map ID: 22/13X Zoning: AG-5 Count
Use Type: 6000 Jurisdiction: Saint Lucie
County
Ownership Legal Description
Esteban A Ramos MELLEN GROVES (PB 74-4) LOT 4 (7.258 AC - 316,158 SF)
Mary F Ramos (OR 4121-2115)
681 SW McCullough AVE
Port St Lucie, FL 34953
Current Values
Historical Values 3-year
Just/Market: $135,307 Assessed:
$1,996 Year Just/Market
Assessed Exemptions
Taxable
Exemptions: $0 Taxable:
$1,996 2020 $135,307
$1,996
$0
$1,996
2019 $115,011
$1,996
$0
$1,996
2018 $109,688
$1,996
$0
$1,996
Sale History
Date Book/Page
Sale Code Deed Grantor
Price
04-17-2018 4121 / 2115
0001 WD Leonard Vito Mecca Farms Inc
$145,000
Total Areas
Finished/Under Air
0
(SF):
y —+
Gross Sketched Area
(1
l
-s6?
(SF):
Land Size (acres):
7.26
Land Size (SF):
316,158
Total Building Count:
Special Features and Yard Items
Type 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.
CO Copyright 2021 Saint Lucie County Property Appraiser. All rights reserved.
St. Lucie County Health Department
I Gnu<y-w 5150 NW Milner Dr Port Saint Lucie, FL 34983
HEALTH
PAYING ON: #: BILL DOC #:56-BID-5208640
RECEIVED FROM: Down the Hole 11352 AMOUNT PAID: $ 575.00
PAYMENT FORM: CREDIT CARD 082200 PAYMENT DATE: 03/23/2021
MAIL TO: Down the Hole 11352
PO Box 881496
Port Saint Lucie FL 34988
FACILITY NAME: Down the Hole 11352
PROPERTY LOCATION:
PO Box 881496
Port Saint Lucie FL 34988
Lot:
Property ID: _
-1 - Well Construction
EXPLANATION or DESCRIPTION:
Block:
61
QUANTITY FEE
$ 575.00
RECEIVED BY: AdamsC AUDIT CONTROL NO. 56-PID-4909420
Note: 59-31710 - 59-31714