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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. 7.rl.,,,,��t x' On HEALTH Vision: To be the Healthiest State in the Nation Ron DeSantis Governor Scott JL Rivkees, MD State Surgeon General 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)-FLH EALTH. 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 S LC DOH-WELLS(cb_FLH EALTH. 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: 7721462-3800 - FAX: 772/871-5360 StLucieCountyHealth.com �f: — STATEOFFLORIDA PERMiTAPPLICATIONTOCONSTRUCT, DPP1f, REPAIR, MODIFY, OR ABANDONAWELL Permit No. 59-32011 ❑ Southwest PLEASE FILL OUT ALL APPLICABLE FIELDS ❑ Northwest ('Denotes Required Fields Where Florida Unique ID r,. Applicable) ❑St. Johns River Permit Stipulations Required (See Attached) k �zg []South Florida rhrWorenYeAcontroctorisresponsibleforcvmpledrw ''°neat ddsformondfonvardingthepermJtopplirnuontothe []Suwannee Suwannee River approp6retedelegotedoudrorirywhereappficahte. 62-5240uadNo. _Delineation No. - 0 DEP ❑ Delegated Authority (if Applicable) CUPIWUP Application No 1. St. Lucie Habitat for Huma 702 S 6th st.Fort Pierce 'Owner, FL 34950 772-577-0008 Legal Name if Corporation , Address City 2. 1 - "N 11i r-)4 r P_ vim( lc� . `State ZIP Telephone Number 'Well Location - Address, Road Name or Number, City n 3, 3403-005-0047-000-8 3403-805-004li.000-5 'Parcel ID No. ❑ (PIN) or I Alternate Key Lot 4, - _ �� Saint Lucie County RUHLMAN SID 'Section or Land Grant 'Township 'Range County 57'�cr-�f. t>,�,�J►'(licrPAS' (is4 Subdivision -TYZ-�lc��- q�7 Wa� ter Well ntractor , f�� "License Number 6. `7 !S U.S va p4 01l bi-e iL.It�Y C�.4 'Telephone Number Water Well Contractor's Address I U City 7. 'Type of Work: Egii,onstruclior ❑ Repair ❑ Modification ❑ Abandonment 8. 'Number of Proposed Wells _ 'Reason for Repair; I W— Block Unit Check if 62-524: ❑Yes []No No,. -re ✓ b e � , �. 4E-mail Address Ls State ZIP 9. 'Specify Intended Use(s) of Well(s): n p tEmp MDomestic El Landscape Irrigation ❑ Agricultural Irrigation ❑ Site Investigations Mottled Water Supply ❑ Recreation Area Irrigation ❑ Livestock ❑ Monitoring []Public Water Supply (Limited Use/DOH) ❑ Nursery Irrigation ❑ Test ❑Public Water Supply (Community or Non-Community/DEP) ❑ CommerciaUlndustrial ❑ Earth -Coupled Geothermal J U N 1 7 2021 []Class I Injection ❑ Golf Course Irrigation ❑ HVAC Supply ❑ HVAC Return :lass V Injection: ❑ Recharge ❑Commercial/Industrial Disposal ❑Aquifer Storage and Recovery ❑Drainage temediatton: ❑Recovery ❑A)rSparge ❑Other (Dasedbo) F OH in StLueielCot ❑Other (D-criba) EN 10.'Distance from Septic System if 5 200 E- 11. Facility Description C 7 ` I o -(- 12. Estimated Start Date 13.'Eslimated Well Depth f 0 O ft. 'Estimated Casing Depth 00 ft. Primary Casing Diameter_ . n. Open Hole: From To ft. 14. Estimated Screen Interval: From 0 r (0 0 tt 15.-Primary Casing Material: ❑ Black Steel ❑Galvanized VC ❑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 18.'Method of Construction, Repair, or Abandonment: ❑Auger ❑Cable Tool Jetted igRotary ❑Sonic i] Combination (Two or More Methods) ❑Hand Driven (Weil Point, Sand Point) E3 Hydraulic Point (Direct Push) Horizontal Drilling ❑ Plugged by Approved Method ❑Other wesrnbo) 19. Proposed Grouting Interval for the Primary, Secondary, and Additional Casing: From To Seal Material (❑Bentonite ❑Neat Cement ❑Other ) From To Seal Material (❑Bentonite ❑Neat Cement ❑Other ) From To Seal Material(❑Bentonite ❑Neat Cement ❑Other 1 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. Is this well or any existing well or water withdrawal on the owner's contiguous property covered under a ConsumptiveMater Use Permit (CUPMUP) or CUPANUP Application? Yes /A No If yes, complete the following: CUP/WUP No. District Well ID No. 22. Latitude Longitude 23. Data Obtained From: ❑GPS ❑Map ❑Survey Datum: NAD 27 NAD 83 WGS 84 1 bomby c 0-fuwl I1r41 woo o-1loth Iho n eeed. b: s be at 7tra dQ Fbdrlo d rAwtoraL'w Cato, aad Thal o xater I rA111Y teal 1 rcn eta —of ft. Wnpony. that the iNormaaon prorlddl is mm�vo, nM1 awl l anti iM M a my um aamV a nr he rttf lythpramlb d motion, nis been a %is a o oftradoned ploy to w4 ti rrccmoN orm+'I MlDenslbiWaos underClwgM 373. FlodJa SIabAP to mdraaia W papacy rl mdon Ms vtllt o61 cadllythat I ml Mnsantaan. Irvnhw heat J7lnfotmaaon prarldcd in this aptirradon is aaerirato m+d lfultw•1 ebLim tho agent rotas ofala, that Ino irdpmatien;mWded is awxzb. midi llwll Mro Wmwdanoe=rathev mtagar/ appro ul l ,dtlx.lajaral, stela, or Weil aaranmdds, l7 a, pticaCa I agran to prol.W a rnh rosPonsb'bCas as stared a4wa Oarac mnnaus M dloM opa Y oamhkaonrcPoa ytrrct wdHn 30 mJ Pwronmd dens W61rI or Oat IM Amltodl aces days ana cnn Nabors d Ihn rdosarrclm, repnv modJlGdm, nr la are rtil mle riot Uq mnstnrean, tepee, mall/wuuion. w abmrloreoenl orGhonml vby nd— N a d is Ihih penni of the mGi or d eroccros aryl '� ay has Pam P" Signature Contract �� 'Ltcens 6. %'S nature of OwnororAgent Date Z� aELOWTHBUNE FOROFFt ALUSE LY Approval Granted By Issue Da Fee Received $ Expirolion Date Z 17 ydrologisl Approval Receipt No. Check No. InNNs THIS PERMIT IS NOT VALID UNTIL PROF SIGf IED 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. DEP Form: 62-532.900(1) Incorporated in 62-632.400(1), F.A C. Effective Date: October 7, 2010 Page 1 of 2 D s N 0 J E a� 0 z , m m x N Ln N 0 0 w iQ / / /� As tK �6 1�/' LIMITS OF PLAT (50.00'� I.G� T'/l F WAA%Y,}�� b^� cn x x'�°c* SET 5/8" IR (BE IN G BASIS)105.50'(D) _ _ (LB8098) 5d N8 °53'37"E 105.58'(0 50.04'(6) 50.04'(C) 50.04'(C) 50. 4'(C) 50.00'(P) �50.00'(P) 50.00'(P) x 50. 0'(P) x� PROP. CONC. •�' o DRIVE a x 41•3 ' 36.36' 27.89' 4.C6 a,14.08 - - -� x I 0 El1 S 3' -4 x AC PAD A PROPO EDDX x��' O W RESIDENCE I o O c,+ FFE: w w r LOT 5 W 28.16 41.33 \ 36.09' VACANT) LOT 6 .. LnT 7 12.85' 20.48' LOT I (VACANT) Q (VA_Jj ANT) CONC. (VACAN ) PORCH 8.00 CO PROP I O WATER O LINE I I I zcn rn W I B L O C K 3 I I73�I ro ' I FND 58" IRCI 50.04'(C) �. 50.04'(C) x-h 50.04'(C) 50. 4'(C)(PSM6330) 50.00'(P) x'�6• 50.00'(P) 50.00'(P) 50. O'(P) 0.45' E SET 5/8" IRCS89'53' 7"V A'b5.58'(C) E A (I c c C a c C V S (I (LB8098) "• 0 I 105.50'(D)@ LOTS 19 & 20 LOTS 17 18 (OCCUPIED) (I Cc UPI ) FFE.21.05' FFE 20 4 SURVEYORS (VOTES AND REPORT: 1. NOT VALID WITHOUT THE SIGNATURE AND THE ORIGINAL RAISED SEAL OF A FLORIDA LICENSED SURVEYOR AND MAPPER. ADDITIONS OR DELETIONS OTHER THAN THE SIGNING SURVEYOR IS PROHIBITED, WITHOUT CONSENT OF THE SIGNING SURVEYOR. 2. THE LAST DATE OF FIELD WORK WAS JUNE 9, 2020. 3. PARCEL CONTAINS 0.32 ACRES, MORE OR LESS. 4. CURRENT DESCRIPTIONS SHOWN HEREON PROVIDED BY THE CLIENT AND/OR THEIR AGENTS. LANDS SHOWN HEREON WERE NOT ABSTRACTED BY THI! RESERVATIONS, AGREEMENTS, AND/OR EASEMENTS OF RECORD. SUCH INFORMATION SHOULD BE OBTAINED AND CONFIRMED BY OTHERS THROUGH Al 5. SOME OF THE INFORMATION USED TO RESOLVE THE BOUNDARY SURVEY IS BASED ON HISTORICAL DATA AND/OR INFORMATION FROM OTHER SURVE' 6. UNDERGROUND UTILITIES, UTILITY SERVICES, FOUNDATIONS AND IMPROVEMENTS WERE NOT LOCATED AS A PART OF THIS SURVEY. 7. BEARINGS SHOWN HERON ARE BASED UPON THE CENTERLINE OF NOTLEM DRIVE, PER THE LINE LABELED HERON AS (BEARING BASIS) AND ALL OTH THERETO. DISTANCES ARE IN U.S. SURVEY FEET AND DECIMAL PARTS THEREOF. B. ELEVATIONS SHOWN HEREON ARE BASED UPON THE NORTH AMERICAN VERTICAL DATUM OF 1988 (NAVD'BB). ELEVATIONS ARE RELATIVE TO A NGS ELEVATION OF 12.71 FEET NAVD 1988. 9. IN SOME INSTANCES, GRAPHIC REPRESENTATIONS AND SYMBOLS SHOWN HAVE BEEN EXAGGERATED TO MORE CLEARLY ILLUSTRATE THE RELATIONSHI IMPROVEMENTS AND/OR LOT LINES. THE DIMENSIONS SHOWN SHALL CONTROL THE LOCATION, OF THE IMPROVEMENTS, OVER THE SCALED POSITIONS, 10. THIS PROPERTY LIES IN FLOOD -ZONE "X," ACCORDING TO FEMA FLOOD INSURANCE RATE MAP 12111CO277K, EFFECTIVE FEBRUARY 19, 2021. 11. REVISIONS SHOWN HEREON DO NOT REPRESENT A "FIELD SURVEY UPDATE" UNLESS OTHERWISE NOTED. St. Lucie County Health Department Vvda 5150 NW Milner Dr Port Saint Lucie, FL 34983 HEALTH PAYING ON: #:56-SF-2275662 BILL DOC #:56-BID-5266081 CONSTRUCTION APPLICATION #: AP1658615 RECEIVED FROM: Meeks Plumbing, Inc. AMOUNT PAID: $ 660.00 PAYMENT FORM: CREDIT CARD 026630 PAYMENT DATE: 04/26/2021 MAIL TO: (St. Lucie County Habitat for Humanity) FACILITY NAME: PROPERTY LOCATION: TBD Notlem Dr Fort Pierce, FL 34982 Lot: 7/8 Property ID: 3403-8050047-000-8 EXPLANATION or DESCRIPTION: 3 Block: 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 RECEIVED BY: WhighamJL 5f, 3zoc f 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 AUDIT CONTROL NO. 56-PID-4954576