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HomeMy WebLinkAboutWater Well PermitsMission: Ron DeSantis To protect, promote & improve the health r Governor of all people in Florida through integrated 11MV a state, county & community efforts. Fr t1 U Scott A. Rivicees, mD RECEIVED HEALTH State Surgeor General Vision: To be the Healthiest State in the Nation 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 SLCDOH-WELLS(@.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 SLCD0'H-WELLSr7FLHEALTH GOV • Submit revisions to permit and/or site map and associated fee within 48 hours of well construction or abandonment. Florida Department of Health Lucie County 515 Accredited Health Department 5150 NW Milner Drive • Port St. Lucie, FL 34983 PHONE: 7721462-3800 • FAX: 772/871-5360 ' Public Health Accreditation Board StLucieCountyHealth.com Y STATEOF FLORIDA PERMITAPPLICATION TO CONSTRUCT, IN °epnRnn,."e REPAIR,MODIFY,ORABANDONAWELL ~ ECUP/WURAPPIlcaflon 59.32010 a i3SOuthwest PLEASE FILL OUT ALL APPLICABLE' FIELDSUnique ID ©NOrtllWest Florida©St..Johns River (•Denotes Required Fields' Whore Applicable)tions Requlrecl {See Attached) 0 South Florida 77ru wotorttr!lcontrnctorls responxiLluforcompletinp thisformandfonvarrlingflicpermita llcatlontothe ClSuwannee River PP N0. Delineall. No �onrN Pro DEP oPProprlotudMngoteilautlrodlywhereonP11ca01e. ,. 0 Delegated Authority (If Applicable) icatlon No, I. 5t. Lucie Habitat for Huma 702 S 6th st.Fort.Pierce Or Owner, Legal Name If Cprporation FL 34950 772-577-0008 2 _------- 1 m y I rf Address City 'State 'ZIP Well Location - Address, Road Name or Number, City Telephone Number 3. 3403.806 0046-000.1 3403.0050045-0004 4._ Parcel ID No. EI (PIN).orr C]Alternato / Key `j W 114--S _ 2 Lot 81- o— ok _gS Goon or Land Grant •Township Ra a Saint LUle --Coanfy RUHLMAN 5/D Unit 9 'County Check if 62-524: Oy- 0No 5' , t �� lid. S Subdivision 'Water Or ntractor • ---_ _� 7��'�t¢'�-� (c"i 'Gcc i fnJCt,��. �S`A,I w u� ( dk� � License Number 'Telephone Number Water Well Contractor'ss ddreiss l r(�� 01 e -. • E-mail Address�� 7. 'Type of Worl<:Construction [j Re air City r State — SIP P []Modification []Abandonment 8. 'Number of Proposed Wells 9, SCifyIntendedUse(s)of Well(s): 'Roason(or Ropaii, 140dinWIlon.orAbandon orleAl fp&m-ostic ❑ Landscape irrigation / pPIY ❑ Recreation Area Irrigation ❑Bottled Water Su ❑Agricultural Irrigation ❑ Site Investigations. &J-" ❑Livestock ❑Public Water Supply (Limited Use/DOH) ❑ Monitoring ❑Public Water Supply (Community or Non=Community/DEP) ❑ Com Nursery Irrigation vial 0 Test q 0Class I Injection ❑ Earth -Coupled GeothermalrJUL / 2�2 i d Golf Course Irrigation ❑ HVAC Supply rn Class V Injection: E] Recharge to y 9 OCommercial/Industrial Disposal DAquifer Storage. and Recovery E] Drainage Remedlation: C]Recovery i]AirSparge []Other 001her (Describe) (ooscrl°°) DOM St Lucie CO f IO.'Distance from Septic System if 5 200 ft E I 13.•Estimated Well Deplh -�s-1 i- Facilily Description r t2, Estimated Start Date if � ft, 'Estimated Casing Depth�_R. Prima 14. Estimated Screen Interval: From.�—To U 0 � Primary Casing Oiarneter In. Open Hole: From To fL 15.'Primary Casing Material: ©Black Steel ' DGaivanized I! PVC El Stainless Steel 0 Not Cased 0 Other: 16. Secondary Casing: E]Telescope Casing 0 Uner 0 Surface Casing Diameter' 17. Secondary Casing Material: 13Black Steel OGalvanized ©PVC E7Stainless Step E]Other 1'8. `Method of Construction, Repair, or Abandonment: E]Auger DCable Tool Jetted Mi o7 Lary 138onic )l Combination (Two or more Methods) ❑ Hand Driven Well Point Sand Point L7 Horizontal Drilling E] Plugged by Approved Method ( ) ©HYdreulic Point (Direct Push) 19. Proposed Grouting Interval for the Primary, Secondary, and Addillonal �On9 r (Dancrtna) From To Seal Material (Mentanite ClNeat Cement DOlher From To Seal Material From To .(08entonite E]Neat Cegtent From E]Other ) Seal Material (08entonite E7Neat Cement 00ther ) Seal Materia To l .DBenfonite ) 20. Indicate total number of existing wells on site ,� DNeal Cement C101her ) ofe List number ing unused 21, 1s this well or any existing well or water with rawal� owner's contiguous property tcovared underiasCansumptive/Waler Use Pe or CUP/WUP Application? Yes an site X , No If yes, complete the following; CUPM/UP No. 22. Latitude 1 on District Well iD No(CUPNV JP) ongitude 23. Date Obtained From; E3GpS Olvia IhenWyCanty OmlIWit com nhhera P E]SUrvey Datum: NAD27 NAD83 irl,Wr anGl¢otdonUuaalTdlhJf1,hnunrlaAHndnisvmWbCodo.nmlthotumtor WGS84 wn prmnh or i noth rechnr°u porma, II naoW d, the been ar vtd bo ntaakwd Wra la p°nniana>fttaN or wdl ! cediry Ihnr I um the wmm et the rnnslrucllnn. ttrnat rcanf(ytl,nl ny lniomloaon prarldod mlhlkn prupurty, thgl lhuinrumlaeonrxvMco is extada, and Ulnllron aaaro n,ny !rocusssty np Ir olhcrl' npBpalon is t+x+gala and that luel obulm 1e' riftpUcs wear ChapIM 373, FIadda Slatulae; to mYnml rnmMaoon nderpl atota, at 1 povamin m N , expo n nplelnGt,nlfnt as dnyn al' crrm npnnMlbo cuonl�i,�Cb IrewVp orndao n+ws Ira cowl Far nar lltat lha lh'anmuan n orproaedy abandon eto Wart. or, Inanly that, am nbarMnmiont'• h ad IhIC respanetm5l! prwltletl y nteuraa, and Aran Irmo tnlamiiil Ulo oxnar of Inplr nanuit or w a4 ! madillcollon, or co as nnlae abtvn. 0wnMr tonnanta to tIk+R7pe porwnnd a rlaa IPMn or 1>cl,ytnetl h{ttltanl / tin/d7 roam. Nlicl,nrM euar, amt. In the"ll Wm dorms rho construcllon. repair moddypl�an. at,ea dwnard arrowAlod by dyrpenml. Yarcyai SicUl� lON of COnlraCtor / `-- -- ._.t- License No. �1i.1 � signn ature of Owner or Agent i" —"- — - 'Date BEIUWTHISUNH FOROFrItlAIUSCONIy tAPProval Granted By Received S IBSUO Dalo 2�'ti Expiration Dale Hydrologist ApprovalReceipt No. PER IS NOT AI LIO UNTIL Pf;O RLY SIGNED 81' qN AUTFIORIZHD OFFICER OR REPRESENTATIVE OF THi WMD QR DELEChe0 NO. GATED AUTI IORITY, TI IE inhlaw PERMIT SHALL 8E AVAILABLE AT 71•IE WELL SITE DURING ALL CON,9TRUCTION, REPAIR, MODiFICATIOPL.OR ABAN40ONMENT ACTIVITIES. DEP Form: 62.532,900(1) Incorporated in 62.532.400(1), F,A.C. Effective Date: October 7, 2010 .4Y 1 or 2 a 0 N N 0 N 3 Ln m w O Z a 3 N ca :° w ' E 1 CD 0 2, Z 3, 4. a 2 5. rN 8. 7. 0 8. d w° 9. N 10 <n w F tx m 1N� 0 fol.y� cn xf IHT—OF- 0 0 FND 1/2" IRC (LB7025) 1.03' N 75.00' LOT 4 (OCCUPIED) FFE:15.76' SEPTIC IN BACK (BEARING B S89'53'3 50.04'(C) 50.0 \(P)cn n) 0 , 36.40' d O 0 0 0 o CONC PAD LOTLo 0 (VACANT) (O " 36.78' O V) I ,IS 1 x 0.00(H__1610 ' ���. 00.0SET 5/8' IRC 3' 1.30 C VV (LB8098)y0'x 3'1.00'(P) PROP 50.04 (50.04'(C) S89'53'37�'W(C16' 5 00't50.00'(P) x D� I ' I 35.68' 1 1 /� ^. ) > 00 / �] � V I AC PAD o PROPOSED RESIDENCE LOT 6 FIFE: * (VACANT) cn rn N w 35.30' 00' � PROP WATER rn LINE w %� I50.04:(C) �!�. I 0.04 50.00 (P) 0 00' PROPOSED 500 SQ. FT. DRAINFIELD . 850 SQ. FT. " U .. UNOBSTRUCTED I AREA O b 00 00 •x w LOT 7 Lf) (VACANT) O (O O O z B L O C K P) xl 50.04 3 rSET5g/8;U'IUR 0 fir) SET 5/87IRIRCN89'53'3 "E 100.08'(C) IRC (LB8 100.00'(P) Qw I ' LOTS 19 & 20 LOTS 17 18 (OC UPIED) (OCCI.PI D) 3URVLYORS NOTEPORT: FFE. 21.05 WELL IN BACK FFE: 20. 4' NOT VALID WITHOUT THE SIGNATURE AND THE ORIGINAL RAISED SEAL OF A FLORIDA LICENSED SURVEYOR AND MAPPER. ADDITIONS OR DELETIONS I 0 SURVEY MAF OTHER THAN THE SIGNING SURVEYOR IS PROHIBITED, WITHOUT CONSENT OF THE SIGNING SURVEYOR. THE LAST DATE OF FIELD WORK WAS FEBRUARY 25, 2021. PARCEL CONTAINS 0.34 ACRES, MORE OR LESS. CURRENT DESCRIPTIONS SHOWN HEREON PROVIDED BY THE CLIENT AND/OR THEIR AGENTS. LANDS SHOWN HEREON WERE NOT ABSTRACTED BY THIS OFFICE FOR R RESERVATIONS, AGREEMENTS, AND/OR EASEMENTS OF RECORD. SUCH INFORMATION SHOULD BE OBTAINED AND CONFIRMED BY OTHERS THROUGH APPROPRIATE III UNDERGROUND UTILITIES, UTILITY SERVICES, FOUNDATIONS AND IMPROVEMENTS WERE NOT LOCATED AS A PART OF THIS SURVEY. BEARINGS SHOWN HEREON ARE BASED UPON THE CENTERLINE OF NOTLEM DRIVE, PER THE LINE LABELED HERON AS (BEARING BASIS) AND ALL OTHER BEARINGS THERETO. DISTANCES ARE IN U.S. SURVEY FEET AND DECIMAL PARTS THEREOF. ELEVATIONS SHOWN HEREON ARE BASED UPON THE NORTH AMERICAN VERTICAL DATUM OF 1988 (NAVD'88). ELEVATIONS ARE RELATIVE TO A NiGS BENCHMARK "X ELEVATION OF 12.71 FEET NAVD 1988. FOR SITE BENCHMARK SEE SURVEY PREPARED BY THIS OFFICE FOR LOTS 7 AND B. IN SOME INSTANCES, GRAPHIC REPRESENTATIONS AND SYMBOLS SHOWN HAVE BEEN EXAGGERATED TO MORE CLEARLY ILLUSTRATE THE RELATIONSHIP BETWEEN PH IMPROVEMENTS AND/OR LOT LINES. THE DIMENSIONS SHOWN SHALL CONTROL THE LOCATION, OF THE IMPROVEMENTS, OVER THE SCALED POSITIONS. THIS PROPERTY LIES IN FLOOD -ZONE "X," ACCORDING TO FEMA FLOOD INSURANCE RATE MAP 12111CO277K, EFFECTIVE FEBRUARY 19, 2021. REVISIONS SHOWN HEREON DO NOT REPRESENT A "FIELD SURVEY UPDATE" UNLESS OTHERWISE NOTED. St. Lucie County Health Department a 5150 NW Milner Dr Port Saint Lucie FL 3 H��YI� 4983 PAYING ON: . #: 56-SF-2275637 BILL DoC #:56-BID-5266035 CONSTRUCTION APPLICATION #: AP1658598 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 5-6 Lot: s Block: Property ID: 3403-805-0045-000-4 EXPLANATION or DESCRIPTION: QUANTITY FEE 128 - OSTDS Construction System Inspection Research Fee 1 $ 5.00 -1 - Surcharge (All) 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 $ 115.00 RECEIVED BY: AdamsC AUDIT CONTROL NO. 56-PID-4954516 Note: Well App being sent in separately , jg_-sZj ( O n Page 1 of Michelle Franklin, CFA -- Saint Lucie County Property Appraiser -- All rights reserved. Property Identification Site Address: TBD Parcel ID: 3403-805-0045- Account #: 39542 Sec/Town/Range: Map ID: 34/03S 000-4 03/36S/40E Zoning: RS-4 Count Use Type: 0000 Jurisdiction: Saint Lucie County Ownership Legal Description St Lucie Habitat For Humanity Inc RUHLMAN S/D BLK 3 LOT 5 (0.16 AC). (OR 4534-1012) 702 S 6th ST Fort Pierce, FL 34950 Current Values I Historical Values 3-year Just/Market: $9,600 Assessed: $2,634 Year Just/Market Assessed Exemptions: $0 Taxable: $2,634 2020 $9,600 Exemptions Taxable 2019 $9,600 $2,634 $0 $2,634 2018 $9,600 $2,395 $0 $2,395 $2,178 $0 $2,178 Date Book/Page 05-22-2020 4426 / 1320 04-30-2010 3194 / 0761 06-07-2007 2831 / 0734 View: Roof Cover: Year Built: N/A Frame: Primary Wall: Story Height: Bedrooms: 0 Full Baths: 0 Half Baths: 0 Sale History Sale Code Deed Grantor 0117 WD Helgran [any C 0112 QC GV Financial Corp XX01 QC Matos Herbert 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 A/C %: 0% Electric: Heated %: N/A% Heat Type: Sprinkled %: 0% Heat Fuel: Building Type: Effective Year: N/A Secondary Wall: Primary Int Wall: Avg Hgt/Floor: 0 Primary Floors: Total Areas Finished/Under Air 0 (SF): Area p Gross Sketched r (SF): Land Size (acres): 0.16 Land Size (SF): 6,969.6 Total Building Count: I Special Features and Yard Items Type Qty Units Year Bit All information is believed to be correct at this time, but is subject to change and is provided without any warranty. © Copyright 2021 Saint Lucie County Property Appraiser. All rights reserved. Price $6,000 $100 $100 Ittps://Www.paslc.org/RECard/ 4/26/2021 Page 1 of Michelle Franklin, CFA -- Saint'Lucie County Property Appraiser -- All rights reserved. Property Identification Site Address: TBD Parcel ID: 3403-805-0046- Account #: 39543 Sec/Town/Range: Map 1D: 34/03S 000-1 03/36S/40E Zoning: RS-4 Count Use Type: 0000 Jurisdiction: Saint Lucie County Ownership Legal Description St Lucie Habitat for Humanity 702 S 6th ST RUHLMAN S/D BLK 3 LOT 6 (0.16 AC) (OR 4534-1012) Fort Pierce, FL 34950 Current Values Historical Values 3-yepr Just/Market: $9,600 Assessed: $2,634 Year Just/Market Assessed Exemptions: $p Exemptions Taxable Taxable: $2,634 2020 $9,600 $2,634 2019 $9,600 $2,395 $0 $2,634 2018 $7,700 $2,178 $0 $2,395 $0 $2,178 Sale History Date OS-20-2020 Book/Page Sale Code Deed Grantor 04-30-2010 4426 / 1270 3194 / 0759 0117 WD Helgran [any C 0112 06-07-2007 2831 / 0736 QC GV Financial Corp XXOI QC Matos Herbert Primary Building Information Finished Area of this building: 0 SF Gross Sketched Area: 0 SF View: Year Built: N/A Primary Wall: Bedrooms: 0 Full Baths: 0 Half Baths: 0 Type Exterior Data Roof Cover: Roof Structure: Building Type: Frame: Story Height: Grade: Effective Year: N/A No. Units: 0 Secondary Wall: Interior Data A/C %: 0% Electric: Primary Int Wall: Heated %: N/A% Heat Type: Avg Hgt/Floor: 0 Sprinkled %: 0% Heat Fuel: Primary Floors: Total Areas Finished/Under Air 0 (SF): Gross Sketched Area - 0 (SF): Land Size (acres): 0.16 Land Size (SF): 6,969.6 Total Building Count: I Special Features and Yard Items Qty Units Year Bit All information is believed to be correct at this time, but is subject to change and is provided without any warranty. © Copyright 2021 Saint Lucie County Property Appraiser. All rights reserved. Price $6,000 $100 $100 ile:///C:/Users/VAJANY—I/AppData/Local/Temp/Low/HTIANBT28.htm 6/11 /2021