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HomeMy WebLinkAboutSEPWELL-1STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM CONSTRUCTION PERMIT FOR: OSTDS New APPLICANT: William & Regina Skopelia PROPERTY ADDRESS: TBD Southwind Trl Fort Pierce, FL 34951 LOT: BLOCK: SUBDIVISION: PROPERTY ID #: 1418-241-0040-000-9 PERMIT #:56-SF-2315487 APPLICATION #: AP1683054 DATE PAID: FEE PAID: RECEIPT #: DOCUMENT #: PR1597340 [SECTION, TOWNSHIP, RANGE, PARCEL NUMBER] [OR TAX ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION 381.0065, F.S., AND CHAPTER 64E-6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS, WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULL AND VOID. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY. SYSTEM DESIGN AND SPECIFICATIONS T [ 900 ] GALLONS / GPD Seotic new CAPACITY A [ ] GALLONS / GPD N/A CAPACITY N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] K [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps D [ 500 ] SQUARE FEET Drainfield new SYSTEM R [ ] SQUARE FEET N/A SYSTEM A TYPE SYSTEM: [ ] STANDARD [ ] FILLED [X] I CONFIGURATION: [ ] TRENCH [X] BED [ ] N F LOCATION OF BENCHMARK: Site BM, Set MAG NAIL & DISK "LB 8360" in UP, ELEV 24.75' I ELEVATION OF PROPOSED SYSTEM SITE [ 41.00][ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 34.00][ INCHES FT ][ABOVE BELOW BENCHMARK/REFERENCE POINT L • RNn D FILL REQUIRED: [25.001 INCHES EXCAVATION REQUIRED: [ ] INCHES The system is sized for 1 bedr 0 300 gpd. ooms with a maximum occupancy of 2 persons (2 per bedroom), for a total estimated flow of T H E R SPECIFICATIONS BY: Brian J In am TITLE: Environmental Specialist III APPROVED BY: TITLE: Environmental Specialist III Brian J gram DATE ISSUED: 07/19/20 DH 4016, 08/09 (Obsoletes all previous editions which may not be used) Incorporated: 64E-6.003, FAC EXPIRATION DATE: v 1.1.4 AP1683054 SE1554061 St. Lucie CHD 01 /19/2023 Page 1 of 3 NOTICE OF RIGHTS A party whose substantial interest is affected by this order may petition for an administrative hearing pursuant to sections 120.569 and 120.57, Florida Statutes. Such proceedings are governed by Rule 28-106, Florida Administrative Code. A petition for administrative hearing must be in writing and must be received by the Agency Clerk for the Department, within twenty-one (21) days from the receipt of this order. The address of the Agency Clerk is 4052 Bald Cypress Way, BIN A-02, Tallahassee, Florida 32399. The Agency Clerk's facsimile number is 850-413-8743. Mediation is not available as an alternative remedy. Your failure to submit a petition for hearing within 21 days from receipt of this order will constitute a waiver of your right to an administrative hearing, and this order shall become a 'final order'. Should this order become a final order, a party who is adversely affected by it is entitled to judicial review pursuant to Section 120.68, Florida Statutes. Review proceedings are governed by the Florida Rules of Appellate Procedure. Such proceedings may be commenced by filing one copy of a Notice of Appeal with the Agency Clerk of the Department of Health and a second copy, accompanied by the filing fees required by law, with the Court of Appeal in the appropriate District Court. The notice must be filed within 30 days of rendition of the final order. --- �-- St. Lucie County Health Department H5150 NW Milner Dr Port Saint Lucie, FL 34983 PAYING ON: #: 56-SF-2315487 BILL DOC #:56-BID-5375277 CONSTRUCTION APPLICATION #: AP16 RECEIVED FROM: G.M. Worley 83054 PAYMENT FORM: CHECK 18555 AMOUNT PAID: $ 545.00 PAYMENT DATE: 06/24/2021 MAIL TO: William & Regina Skopelja FACILITY NAME: PROPERTY LOCATION: TBD Southwind TO Fort Pierce, FL 34951 Lot: Block: Property ID: 1418-241-0040-000-9 EXPLANATION or DESCRIPTION: 128 - OSTDS Construction System Inspection Research Fee QUANTITY FEE -1 - Surcharge (All) 1 $ 5.00 -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 RECEIVED BY: AdamsC.• �2- 1 $ 45.00 1 $ 100.00 1 $ 100.00 1 $ 115.00 1 $ 55.00 1 $ 75.00 1 $ 50.00 AUDIT CONTROL NO. 56-PID-5060192 'Yi1L•„S'1��,w STATE OF FLORIDA ' 3 DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM APPLICATION FOR C0I4STRUCTION PERMIT APPLICATION FOR: PERMIT NO. DATE PAID: FEE PAID: RECEIPT #: [✓] New System [ ] Existing System [ ] Holding Tank [ ] Innovative [ ] Repair [ ] Abandonment [ ] Temporary APPLICANT: William G. & Regina G. Skopell'a AGENT: G.M. Worley, Inc. TELEPHONE: 863-467-2541 MAILING ADDRESS: 110 NW 5th Street Okeechobee, FL 34972 TO BE COMPLETED BY APPLICANT OR APPLICANT'S AUTHORIZED AGENT. SYSTEMS MUST BE CONSTRUCTED BY A PERSON LICENSED PURSUANT TO 489.105(3)(m) OR 489.552, FLORIDA STATUTES. IT IS THE APPLICANT'S RESPONSIBILITY TO PROVIDE DOCUMENTATION OF THE DATE THE LOT WAS CREATED OR PLATTED (MM/DD/YY) IF REQUESTING CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS. PROPERTY INFORMATION LOT: BLOCK: SUBDIVISION: PROPERTY ID # : 1418-241-0040-000-9 ZONING: AR-1 PLATTED: I/M OR EQUIVALENT: [ No C1] PROPERTY SIZE: 1.16 ACRES WATER SUPPLY: [o/] PRIVATE PUBLIC [ ]<=2000GPD [ ]>2000GPD IS SEWER AVAILABLE AS PER 381.0065, FS? [ No [] ] DISTANCE TO SEWER: FT PROPERTY ADDRESS: TBD Southwind Trail, Fort Pierce, FL 34951 DIRECTIONS TO PROPERTY: Head East in Indrio Road - Take left onto Southwind Trail at 4900 Indrio Road - Property is the lost -pawl ea the-4irst-i 11, S t0-' i " A i 2 i 0Qe(' �� ;Y\ BUILDING INFORMATION [ ] RESIDENTIAL [ ] COMMERCIAL Unit Type of No. of No Establishment Bedrooms 1 Single Family 1 2 3 4 _ [ ] Floor/Equipment Dra S IGNATURE : Building Commercial/Institutional System Design Area Sgft Table 1, Chapter 64E-6, FAC 1677 [ ] Other (Specify) N DATE: t DH 4015, 08/09 (Obsoletes previoig editions which may not be used) Incorporated 64E-6.001, FAC Page 1 of 4 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SITE EVALUATION AND SYSTEM SYSTEM SPECIFICATION APPLICANT: William & Regina CONTRACTOR / AGENT: G.M. LOT: APPLICATION # AP.)- 683054 PERMIT # 56-SF-2315487 DOCUMENT # SE1554061 SUBDIVISION: BLOCK: TO BE COMPLETED BY ENGINEER, ID#: 1418-241-0040-000-9 REGISTRATION NUMBER AND SIGN AND HEALTH DEPARTMENT EMPLOYEE, OR OR OTHER QUALIFIED SEAL EACH PAGE PROPERTY SIZE CONFORMS TO SITE OF SUBMITTAL. PERSON. ENGINEERS MUST PROVIDE ALL ITEMS. TOTAL ESTIMATED SEWAGE FLOW; PLAN: (X]YES [ ]NO NET USABLE AREA AVAILABLE: AUTHORIZED SEWAGE FLOW: � 30-- GALLONS PER DAY [ RESIDENCES-TABLEI 116 ACRES UNOBSTRUCTED AREA AVAILABLE: / OTHER -TABLE 2 ] 1740.01— _ GALLONS PER DAY [ 1500 GPD/ACRE 10OR 2500 GPD SQFT /ACRE BENCHMARK/REFERENCE POINT LOCATION: ] UNOBSTRUCTED AREA REQUIRED; 1000.00 SQFT ELEVATION OF PROPOSED SYSTEM SITE Site BM, Set MAG NAIL & DISK "LB 8360" in UP, ELEV 24 75, 4� 1•00 [ INCHES THE MINIMUM SETBACK WHICH CAN BE / FT ] [ABOVE / BELOW ] BENCHMARK/REFERENCE POINT SURFACE WATER: FT MAINTAINED FROM THE PROPOSED SYSTEM WELLS: PUBLIC: TO THE FOLLOWING FEATURES DITCHES/SWALES: 98 BUILDING FOUNDATION FT FT LIMITED USE: FT —�— NORMALLY WET: [ ]YES [X]NO A5 PRIVATE: FT 82 FT PROPERTY LINES: NON -POTABLE: FT 33 FT —_ SITE SUBJECT TO FREQUENT FLOODING? POTABLE WATER LINES; 49 FT 10 YEAR F [ ]YES LOOD ELEVATION FOR SITE: USDA SOIL SERIES: Munsell #/C [X]NO 10 YEAR FLOODING? � FT [ MSL /NGVD ] SITE ELEVATION: ( ]YES (}{ ]Ng ___ FT [ MSL /NGVD SOIL PROFILE INFORMATION SITE 2 olor 10YR 3/1 Texture Depth 10YR 5/1 Sand 0 To 14 10YR 6/1 Sand 9 To 28 10YR 7/1 Sand 17 To 37 10YR 3/1 Sand 37 To 40 Spodic Material 10YR 211 Spodic Material 40 To 51 51 To 72 USDA SOIL SERIES: Munsell #/Color Texture 10YR 3/1 Depth Loamy Sand 10YR 5/1 0 To 10 10YR 6/1 Sand 10 To 31 10YR 7/1 Sand 2 0 To 32 7.5YR 3/1 Sand 32 To 41 Spodic Material 7.5YR 3/3 Spodic Material 41 To 52 -- -- 10YR 4/3 61 Sand _ 61 To 72 I OBSERVED WATER TABLE: 4_ 7� INCHES [ ABOVE / BELOW ESTIMATED WET SEASON WATER TABLE ELEVATION: ] EXISTING GRADE TYPE: [ PERCHED / APPARENT ] HIGH WATER TABLE VEGETATION: � INCHES [ X ]YES ( ] NO [X]YES [ABOVE / BELOW ] SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING; MOTTLING: EXISTING GRADE DRAINFIELD CONFIGURATION: [ ]NO DEPTH: ] TRENCH IX BED DEPTH OF EXCAVATION: Sand/0,60 1"�� INCHES REMARKS/ADDITIONAL CRITERIA ( ] OTHER (SPECIFY) INCHES WSWT determined using USDA WSS and soil borings. 10YR6/1 stripping in 10YR5/1 matrix >10% with diffuse boundaries starting at 17" In SB1. S61 41" below BM. SB2 40" b am. SITE EVALUATED BY: r DH 4015, 08/09 Ingram, Brian (Obsoletes previous editions A W a nay-peclalist III) (ENVIRONMENTAL- HEATH) may not be used) Incorporated: 64E-6.001, FAC DATE: 07/16/2021 Page 3 of 4 AP1683054 E102315487 V 1.0.2 Michelle Franklin, CFA -- Saint Lucie County Property Appraiser -- All rights reserved. Property Identification Site Address: Southwind TRL Parcel ID: 1418-241-0040- Account #: 7990 Sec/Town/Range: 18/34S/40E 000-9 Map ID: 14/18N Zoning: AR-1 Count Use Type: 0000 Jurisdiction: Saint Lucie County Ownership Legal Description William G Skopelja 18 34 40 S 1/2 OF SE 1/4 OF NE 1/4 OF SE 1/4 OF NW 1/4- Regina G Skopelja LESS E 30 FT- (1.16 AC) (OR 4125-1988) 2181 Harwick Cir SW Vero Beach, FL 32968 Current Values Historical Values 3-year Just/Market: $36,400 Assessed: $36,400 Year Just/Market Assessed Exemptions Taxable Exemptions: $0 Taxable: $36,400 2020 $36,400 $36,400 $0 $0 $36,400 $36,400 2019 $36,400 $36,400 2018 $30,400 $30,400 $0 $30,400 Sale History Date Book/Page Sale Code Deed Grantor Price 04-19-2018 4125 / 1988 0001 WD McMurtray Bill $36,500 $31,500 03-29-2017 3981 / 1380 0001 WD Dipersio Teresa Y $0 04-01-1988 0601 / 1458 XX01 CV Primary Building Information Finished Area of this building: 0 SF Gross Sketched Area: 0 SF Exterior Data View: Roof Cover: Roof Structure: Building Type: Year Built: N/A Frame: Grade: Effective Year: N/A Primary Wall: Story Height: No. Units: 0 Secondary Wall: Interior Data Bedrooms: 0 A/C %: 0% Electric: Primary Int Wall: Full Baths: 0 Heated %: N/A% Heat Type: Avg Hgt/Floor: 0 Half Baths: 0 Sprinkled %: 0% Heat Fuel: Primary Floors: Total Areas Finished/Under Air 0 (SF): Gross Sketched Area 0 (SF): Land Size (acres): 1.16 Land Size (SF): 50,530 Total Building Count: 1 Special Features and Yard Items Type Qty Units Year Bit All infonnation 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. r� Custom Soil Resource Report St. Lucie County, Florida 21—Lawnwood and Myakka sands Map Unit Setting National map unit symbol: 1jpvg Elevation: 0 to 200 feet Mean annual precipitation: 49 to 58 inches Mean annual air temperature: 70 to 77 degrees F Frost -free period: 350 to 365 days Farmland classification: Farmland of unique importance Map Unit Composition Lawnwood and similar soils: 41 percent Myakka and similar soils: 39 percent Minor components: 20 percent Estimates are based on observations, descriptions, and transects of the mapunit. Description of Lawnwood Setting Landform.• Marine terraces on flatwoods Landform position (three-dimensional): Talf Down -slope shape: Linear Across -slope shape: Linear Parent material: Sandy marine deposits Typical profile A - 0 to 8 inches: sand E - 8 to 28 inches: sand Bh 1 - 28 to 52 inches: sand Bh2 - 52 to 58 inches: sand C - 58 to 80 inches: sand Properties and qualities Slope: 0 to 2 percent Depth to restrictive feature: 10 to 31 inches to ortstein Drainage class: Poorly drained Runoff class: High Capacity of the most limiting layer to transmit water (Ksat): Moderately low to moderately high (0.06 to 0.20 in/hr) Depth to water table: About 6 to 18 inches Frequency of flooding: None Frequency of ponding: None Maximum salinity: Nonsaline to very slightly saline (0.0 to 2.0 mmhos/cm) Sodium adsorption ratio, maximum: 4.0 Available water capacity: Very low (about 0.9 inches) Interpretive groups Land capability classification (irrigated): None specified Land capability classification (nonirrigated): 4w Hydrologic Soil Group: A/D Forage suitability group: Sandy soils on flats of mesic or hydric lowlands (G156BC141FL) 10 Custom Soil Resource Report Other vegetative classification: (G156BC141FL) Hydrcc soil rating: No Description of Myakka Sandy soils on flats of mesic or hydric lowlands Setting Landform: Flatwoods on marine terraces Landform position (three-dimensional): Talf Down -slope shape: Convex Across -slope shape: Linear Parent material: Sandy marine deposits Typical profile A - 0 to 7 inches: sand E - 7 to 27 inches: sand Bh - 27 to 38 inches: sand C - 38 to 80 inches: sand Properties and qualities Slope: 0 to 2 percent Depth to restrictive feature: More than 80 inches Drainage class: Poorly drained Runoff class: High Capacity of the most limiting layer to transmit water (Ksat): Moderately high to high (0.57 to 5.95 in/hr) Depth to water table: About 6 to 18 inches Frequency of flooding: None Frequency of ponding: None Maximum salinity: Nonsaline to very slightly saline (0.0 to 2.0 mmhos/cm) Sodium adsorption ratio, maximum: 4.0 Available water capacity: Low (about 4.5 inches) Interpretive groups Land capability classification (irrigated): None specified Land capability classification (nonirrigated): 4w Hydrologic Soil Group: A/D Forage suitability group: Sandy soils on flats of mesic or hydric lowlands (G1566C141 FL) Other vegetative classification: Sandy soils on flats of mesic or hydric lowlands (G156BC141 FL) Hydric soil rating: No Minor Components Ankona Percent of map unit: 7 percent Landform: Flatwoods on marine terraces Landform position (three-dimensional): Talf Down -slope shape. Convex Across -slope shape: Linear on: Sandy soils on flats of mesic or hydric lowlands Other vegetative classificati (GI 56BC141 FL) Hydrcc soil rating: No Electra Percent of map unit: 7 percent 11 Custom Soil Resource Report Landform: Knolls on marine terraces, rises on marine terraces Landform position (three-dimensional): Interfluve Down -slope shape: Convex Across -slope shape: Linear Other vegetative classification: Sandy soils on rises and knolls of mesic uplands (G156BC131FL) Hydric soil rating: No Waveland Percent of map unit: 6 percent Landform: Flatwoods on marine terraces Landform position (three-dimensional): Talf Down -slope shape: Convex Across -slope shape: Linear Other vegetative classification: Sandy soils on flats of mesic or hydric lowlands (G156BC141 FL) Hydric soil rating: No 12 Mission: Ron DeSantis To protect, promote & improve the health Governor of all people in Florida through integrated state, county & community efforts. aScott A. Rivkees, MD HEALTHState 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-WELLSCa)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-WELLSRFLHEALTH 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 5150 NW Milner Drive • Port St. Lucie, FL 34983 Accredited Health Department PHONE: 772/462-3800 • FAX: 772/871-5360 ' = Public Health Accreditation Board StLucieCountyHealth.com STATE OFFLORIDA PERMITAPPLICATiONTOCONSTRUti, o`a' o•oanr�o' REPAIR, MODIFY, ORABANDONA WELL 17Southsvest Permit No. o Q ilOrthsfJBSt Lcv,SE FILL OUT ALL APPLICABLE FIELDS {1Fiorrd2 Unique ID 59-32202 St. Johns River (Denotes Required Fields Where Applicable) (i'ermil Stipulations Required (.See Attached} t ° South Floridancc..aterreticontrcctur; res➢an; ole or � I c•:mp;abrsq � �:'`"" c• ❑Swvannee River too the i32..524 t �•rttat pt� QDEP rs➢➢ro➢rintedeirgcrredembnriryvirereapp?ira5?e. Quari" a0' DBIineaLart No. Q Delegated Authority (If Applicable) CUPJV41JP Application No. ---- ot QWner, Legal am if Co ratio Lt �riV r 2. `JC` Address ' Cily(OX _ - r' � N�fl L CA- "State "ZIP Telephone Number "Well Location - Address, Road Name or t�lumbe , �� 3. _ q r City 4. -Farce! i _ I t , � - O �)� T `I ° 0 (PIN) or ]Alternate Key - 5 e ion or L and rant wnshi ---�` "' "� ` p • • t�— Lot S�—` Unit — ge 'lo County _ Check i; 62-524: 0 Yes [] No 5• Subdivision lAJater Well Contractor - �—t - F t-V ,, �l§50 t 3 ��, i�� Ltc?nse Number "Te{mot hone rl;mberfluU� 6. �TL, E-mail address Water vvell Contractor's Address 1 C� {_ a .1r� 7. 'Type oftlslork: q�Construction City` '-- State - 7-=-b� 'f''Q F?ee�air Q fv;Od iication Q 4bandenment 8. 'Number cf Proposed vvelis 9. ;,ypecify Intended Use _ s) of Wall(sy Ream" for F3Peir, i.:1^df »ricn, a tad-cpmSnt -- Domestic ❑Landscape Irrigation PC Q$ottled Water Su I ❑Livest {turai irrigation Q Site investigations L Supply Recreation Area Irrigation Q Livestock ❑Public Water Supply (Limited Ilse/DOH) Q Monitoring ❑ Nursery Irrigation ❑ Test ❑Public Water Supply (Community or Non-Community/DEP) ❑ Commercial/Industrial ❑Class I Injection ❑ Earth -Coupled Geothermal JU L 2 0 2021 ❑ Golf Course Irrigation Q HVAC Supply Class V injection: ©Recharge ©Commercial/lndustrial Disposal Q HVAC Return Remediatlon: ❑Recove P ©AquiferSto age and Recovery QDrainage is ry QAIr Sparge ©Other (Describe) DOH in St Lucie Cou QOther mesaibei 10.' Distance from Septic S item if < 200 ft. NN� �' t viRol NI'L, EAR H f 3. 'Estimated Well Ge th 1 i . Facility �G--�syc� iptior, P ft. 'Estimated CasingDe It G>� V 12. Estimated Start Date —_ Pt R. Primary Casino Diameter in. Open Hole: From 14. Estimated Screen Interval: From (i�i To�ft. ,Toi ft. 15, `Primary Casing Material: Q Black Steel ❑Galvanizeu VC ❑Stainle5s Sleet Q Not Cased ❑ Other: 16. Second-ry Casino: [Telescope Casing ❑Liner Q Surface Casin-• Diameter in 17. Secondary Casing iViateriai: Q Black Steel ���}} ©Galvanized ,�I<lC c tainless Steel [Other 18.>11pe CR ❑S thod Of Construction, Repair, or Abandonment: [Auger OiCable Tool Jetted �JIotar± [Sonic Q Combination (Ttvo or More Methods ti r Qliand Driven ;:tlei( Point, Sar;r! Point) trri _ r i o Q Horizontal Drilling Q Plugged by Approved Method Q H, drain c , pint (Direct Push) ©Other ±Oescrits)� i 9. Proposedf,2routing { terial for the Primary, Sec dary, and Additionai Casing: From (-,� To entonite Seal Material I=ron•I To ( Neat Cement ©Outer 1 Seal Material ( 8entonite ❑Meat Cement t ,- From To Seal Material (Q6entonile Q�deat Camera QO h r ) From ❑Other ) To Seal Material ( [Ben' nice ONeat Cement ❑pthef 20. Indicate total number of existing wells on site _ ) List number Of existing unused wells on site 21. °!S CU A311 or any existing I Will Or Y'Y! W tvithdt a Yd, ,11 tits airline, s cO"tiguous pro;�at iy Coverd under a C011SUMiptiVeNater Jse Permit (CUpnrVUi�} or CU�IINUP Application? Yes N If yes. eompie -a t r 22. Latitude l t tile ,e{lOe;ring: CUPrUVUP No. Longitude District Well iD hic. 23. Data Obtained From: QGPS ap []Survey i hembYurtiN that !>•ra enmpfy r,it!, tUr a y Datum: hlAD 2% iV,4D 83 i use aM1TI{t ar artificial !erJ78r a Fl>�WIYd ru1.55 o/ Tyc• , F1Crlda n4rnirgyrTi%ve Bodo. nna that a,ra!a: �. VGS $4 t7 Pennd. i(nabdC•U, h�a Nun Of mli h3 at;ahlatt {=fa; A carrn_nceacr- ct0.6; 1 o^nbY tCat l a'O the Our»C: Cf rhY. ,R• ooCrly. ingt !ho fnram.;flM. prm•i�py is aCurratC. ann Mat err• a;rx r JPStR,C!iaa. IfuRliaf cnAih(Ntat as 0....U-1 prayid�,n IhG ax:tcaliCn is acc;,n!e arm I,, II1�. GOtatlt of nry fnSpCl]itl:RicS u^Act ChaUx jT3, FIUC:13 Siat11E5, N mi�niam of RrcpErty dba!N:UII 1hS 1'leil'. UT, ! Y,!#y tFal ! am necrssacy apP.-t 1 hom a=R , fetl.rat, state, or Ic.at aor.!rtmc:as.:t apaSctCe ! �7rec In grov a a:vaa the aJerJ roctF.e a:mat. t:lat the tnhanatibrt conpntmr. mpoa tonc� L1xr runm 3v c:ys arcr cam;rc:rcn c! 6:o con;::ur.:an. mpai:, mx++,!•a,im, or waiden is aca,al_, ^nd Ihat ! hour. infom,ad the o-.:nar o! L,oir ram.^cn::CiGtiea as sta!:II abate. o::•n_r consents to a!tT•.^r ; p nnv of this WivIr7 or CatctlotM A:tthottty ercess =C]ntlCiaf,anl3VlSaReCdtYth!SP' I,Lbt lrA fm�1 If en the:rali ape tll:anp in3 Cehl(u;1. a,'at elan. Vit1!rllaslYO `:IrS }yyi. a:I. rvpa:r, mco,n:::t�on o: ahanrr!nc:r, a;rM's-'Ycy ey VI 04 nr . 'Signature orcontractor "License No. �ignature cf O+nmer or Agent ` --—"`-" ----Date D82e S£LOWTHISUNE FOROFFICWLUS£ONLy Approval Granted By Fee ReceivEe $ issue Data 7,_ �apiration Date,( �Z Hydrologist Approval _ Receipt No, Check Flo. THIS PERRAIT iS NOT VALID UNTIL PROPEP.LY SIGNED 6l" AN AUTt IORIZED OFFICER OR REPRESENTATIVE OF TtlE WPJiD OR GELD PERMIT SHALL BE AVAILABLE AT THE WELL SITE DURING ALL CONSTRUCTION, REPAIR. MODIFICATION, OR ABANDONMENTACTtVtr7;Eg ArJ I FIOF2IT, t HE DEP Foun: 62-532.900(1) incorporaied in r2-532.409(i), F,A,C. Effective Date: Dctcher 7, 2Ls1J Pill 'I of 2 GlJ O — (x/G ,wr war IiBru le c'ol 'da.we IWQAinlu•i nos WIN vw� 5� x L.... 1 r rl rrmsus Nr 4. AVMrNq olmr.v!u •p\ P,+ {21 •atg F SP S K 4 _ INd A1'00t 3.01 9. 1 r Qi"rhPr d}f7.It n> r/, xq 811 JU bud jsvp �' '" ux o� r n� fi� I .j 1 l �1 t II ? h Od w .,I �I b I ^ 1 r 1 1 iU wv f 1u� .yi �•rSN;n rWuµss ,w�n,l ;v� 4_�L�y,M wNPpN I -16 'IQ 6123/2021 Image (13E).jpg Ow"er/Applicant Signature Authorization P-Ject Name;_ I�}Olf 01m anon I Application and/or Permit # Of available): _ I hereby designate%and authorize the agent listed below to act on my behalf, or on behalf of my corporation, as:the agent in the processing of this application for the permit and/or proprietary authodiation indicated above; and to furnish on request supplemental information in support of this application. In addition, I authorize the below -listed agent to bind me, or my corporation, to perform any requirement which may be necessary to the permit or authorization. procure I understand that knowingly making any false statement or representation in this application is a violation of Section 373.430, F.S. and 18 U.S.0 Section 1001. Printed Name of Authorized Agent: NO 1 ! Signature of Authorized Agent: Date: I 4 t Typed/Printed Na/�r1e of Owner/Applicant. �, !l V Corporate Title if Applicable: Signowle Of OYdner/Applicant: Date: : c J 4� I SignatureAuthorizadi onTemplate CM20140403 https:/IMail.gnogle.comfmail/ofO/7odbi::inboxfFMfcgzGkXwFWr2Dl•IgfrR�itjTbr'dKf XxG9?projeciorI9MGSS1g0Pcrt1d=0.I 1/� Michelle Franklin, CFA -- Saint Lucie County Property Appraiser -- All rights reserved. Site Address: Southwind TRL SccrfowEIRange: 18/34S/40E Parcel ID:1418-241-0040-000-9 Jurisdiction: Saint Lucie County Ownership William G Skopelja Regina G Skopclja 2181 Harwick Cir SW Vero Beach, FL 32968 Property identification Use Type: 0000 Account 1f: 7990 Map ID: 14/18N Zoning: AR -I Count Legal Description 18 34 40 S 1/2 OF SE 1/4 OF NE 114 01' SF. 114 OF NW 1/4-LESS E 30 Fr- 0.16 AC) (OR 4125-1998) Current Values Just/Market Value: $36,400 Assessed Value: $36,400 Exemptions: 50 Taxable Value: $30400 Property taxes are subject to change upon change of ownership. • Past taxes are not a reliable projection or rulure taxes. • The sale of a properly will prompt the removal of all exemptions, assessment caps, and special classdicaiioas. Taxes for this parcel: SLC Tax Collector's of ice Q Download TRIM for this parcel: Download PDF 19 m Appr 19.2018 Mrr 29. 2017 Apr I, 1988 Nov I, 1974 View: Building Type: Grade: Story Height: Book/Page 4125 / 1958 3981 / 1380 0601/1458 0235/1439 Sale Code 0001 0001 XX01 XX00 Total Areas Finished/Undur Air (SF): 0 Gross Sketched Area (,Sr.). 0 Land Size (acres): 1.16 Land Size (SF): 50,530 Building Design Wind Speed Occupancy Category I H III & IV Speed 140 150 160 Soutcrslliaks: Sale History Deed Grantor WD McMurtry Hitt WD Dipersio 'Icresa Y CV Cv Building Information (1 of 1) Finixlwd Aroma: 0 SF (boss Sketched Area: 0 SF GXtenor Data Roof Cover. Year Built: WA Effective Year: NIA No. Units: 0 Interior Data Iicdrooms: 0 lilccaric: Full Baths: 0 Wcat Type: Half Baths: o Heat Fuel- A/C %: 0% Heated a/o: N/A% Rool' Structure: Frame: Primary Wall: Secondary Wall: Primary tut Wall: Avg HgM- oor: 0 Primary Floors: Sprinkled %: 046 Price tS3I,SP.O SU 6.01)0 a= cro C.co �j c E Z a a 2 N W W M,6 W Ir x Z 'C N aw m L Y r N c C7 (p U c Lo T CR ,- W W cr N W d N a U f U �, � F1 V N PAYING ON: RECEIVED FROM PAYMENT FORM: St. Lucie County Health Department 5150 NW Milner Dr Port Saint Lucie, FL 34983 Ed's Wells & Pumps - advance Water 1 CREDIT CARD 001607� MAIL TO: Ed's Wells & Pumps -Advance Water 11182 Loxahatchee FL 33470 FACILITY NAME: Ed's Wells & Pum s - PROPERTY LOCATION: Loxahatchee FL 33470 Lot: Property ID: _ -1 - Well Construction EXPLANATION or DESCRIPTION: RECEIVED BY: AdamsC Note: 59-32202 - TBD Southwind Trl - SF-2315487 Block: AMOUNT PAID: $ 115.00 PAYMENT DATE: 06/24/2021 1 QUANTITY FEE $ 115.00 AUDIT CONTROL NO. 56-PID-5060301 __y�^