HomeMy WebLinkAboutAPPROVED well permitRon DeSantis
Mission: Governor
To protect, promote & improve the health
of all people in Florida through integrated FlbYia
state, county & community efforts. Scott A. Rivkees, MD
HEALTH
1 TH 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
STATE OF FLORIDA PERMIT APPLICATION TO CONSTRUCT, I —11
REPAIR, MODIFY, OR ABANDON A WELL Permit No.
L Southwest For da Unique I❑ 59'31918
C Northwest PLEAS[ FILL OUT ALL(1PP�ICgBLE FIEL Pp )
("Denotes RequireaD Fie ds Where A licable Permit Stipulations Required (See Attached)
i•%SL Johns River
ig*oath Florida Ihervaterweficontractorisrespaal6rdforcompfeting
this form cod forwarding ihr permit appitcatlon to the
Suwannee River opproprrere ddegaredobthority where oppllrofrfe.
I.- DEP
C Delegated Authority (if Applicable)
Quad No, Delineation No.
Application No.
'-Sally Donovan 16085E Duran Blvd Loxahatchee FI 33470 _
"Owner, Legal Name if Corporation 'Address 'City "State ZIP Telephone Number
2.11770 Palomino Drive Port St Lucie FI 34987
"Well Location ^Address, Road Name or Number, City
3.
'Parcel ID No. (PIN) or Alternate Key (Circle One)
4. 09 3611; 39E St Lucie
33 A
Lot Block Unit
Check if 62-524:❑ Yes QJ No
'Section or Land Grant 'Township 'Range 'County Subdivision
5, James Paul Tyson 11352 954-818-4269 downthehole@att.net
`Water Well Contractor "License Number "Telephone Number E-mail Address
6. PO BOX 881496 Port St. Lucie FI 34988
`Water Well Contractor's Address City State ZIP
7. "Type of Work: WConstruction [] Repair MatliricationE] Abandonment
8. 'Number of Proposed Vuells 1-- -- "Reason for Ropir, modificauan, or Abandonment
Sg `Specify Intended Use(s) of Well(s): /--t tprti�n n
,;'Domestic Landscape Irrigation ® Agricultural irrigation Site Investigations L/rnil\ p t f�"J1) \VV/
0 Bottled Water Supply ® Recreation Area Irrigation Livestock ® Monitoring
Public Water Supply (Limited Use1DOH) [] Nursery irrigation Test Public Water Supply (Community or Non-Community/DEP)o CommereiaUindustrial Earth -Coupled Geothermal J U L 6 2021qq
Class I Injection [� Golf Course irrigation HVAC Supply
HVAC Return
Class V Injection: Recharge ❑ Commercial/Industrial Disposal ❑ Aquifer Storage and Recovery ❑ Drainage
Remediation: ❑ Recovery ❑ Air sparge r_1 Other (Describe) tOH ' t �l COL
Other (Describe)
10.'Distanee from Septic System if S 200 ft. 11. Facility Description Residence 12. Estimated Start Date
13.°Estimated Well Depth 12Q_ft. "Estimated Casing Depth( _ft. Primary Casing Diameter 2_in. Open Hole: From =To ft.
14. Estimated Screen Interval: Fram100 To120 ft.
15."Primary Casing Material: Black Steel Galvanized V Stainless Steel
Not Cased Other:
6. 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 Toot Jetted ; ot;iy Sonic
Combination (Two or More Methods) Hand Driven (Well Point, Sand Point) Hydrae trPo{nt (Direct Push)
Horizontal Drilling Plugged by Approved Method Other (Descnba)
19. Proposed Grouting Interval for the Primary, Secondary, and 14M i al ' Ing:
From 0 To 9.5 Seal Material ( Bentonile 4Z a rrre tt Other 1
From To Sea( Material ( Bentonile a Ctafttent Other
m }
FroTO Seal Material ( Bentonite Neat Cement Other )
From To Seal Material ( Bentonite Neat Cement Other )
20, Indicate total number of existing wells on site 0 List number of existing unused wells on site 0
21.1t; this well or any existingg well or water withdran n the owner's contiguous property covered under a ConsumptivelWater Use Permit (CUPIWUP)
or CUPANUP Applicatlo3 Yes No if yes, complete the follaty ng: CIJP/WUP No. District Well ID No.
22. Latitude Longitude
23. Data Obtained From: GPS Map Survey
'hereby wrafi Nat t mil comptysnth dw APPlleatde rules at Tr3d 40. Ftonda Adn0191100 Coda, and that a water
ute permit u ubbdal recharpe penriL it needed, has been ar a41 be dblaWtd tenu W wmmenasax�nt otrrcA
"nsWGaOn, lelrerer eerbly dlBl aG Glfarnsaian Plmeded In bra dppbeaEart lcaKdria and ihal t.Wl Ohtin
necaccay apF vsf from defier kdsral, stab, wtdcd pavommerdc,:l aPplicabh,. I aWee to prov.da a .a
wrpfatian reportto the e:sbid rydh:n 30 deys Alan wrrplclio Na ed^ahuMan. repak, moddication, or
abAnd n�yyi,ayatal:ad by M. permit, am. pu! td P� a ,vk,<hmve ocsaxy£J.
end
11352
`Signature of Contractor , _ `License No.
Approval Granted By
Fee Received S
Rccojpt No,
Datum: NAD 27 NAD 83 WGS 84
1 cenify Mat I am the miner of he propany, ,let the Intcana on pfawied'a aectraft, and that I an ewite of my
resf»neattkn under Chapter 3Ia, Fbdda SfaOae£, to mainsail ar prapeN abandon Ous we0; ar,1 aMry Ihet I am
the spent for Ms owacr 15r-fot(prv}ded Is acmraa, eni that I have Intarrid the "ller of they
rosponat toes ac dabovo, owner c ..wnfa ed ardn4 PUAon'eldt lhls VvyAO rA eNepated Au;.oNty access
I.0--flea I," the anebucFsn.r yr,/ndd4/rt:aCm,-q ubaa�cnment eJharlaed by inls pena!t
" Ignature of Owner or Agent `Date
losue Date !L!/Z fffZ Expiration Date
Check No.
Hydrologlot Approyal
lnhfasa
THIS PERMIT IS NOT VALID UNTIL PROPERLY SIGNED BY AN AUTHORIZED OFFICER OR REPRESENTA:rIVE OF THE w1Y1D OR DELEGATED AUTHORITY, THE
PERMIT SHALL BE AVAILABLE AT THE WELL SITE DURING ALL CONSTRUCTION, REPAIR, MODIFICATION, OR ABANDONMENT ACTIVITIES.
DEP Form: 62-632.900(1) Incorporated in 62-532.400(1), F.A.C. Effective Date: October 7, 2010 Page 1 or 2
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Michelle Franklin, CFA -- Saint Lucie County Property Appraiser -- All rights reserved.
Property Identification
Site Address: 11770 Parcel ID: 3309-605-0036- Account #: 35536 Sec/Town/Range: 09/36S/39E
PALOMINO DR 000-5 Map ID: 33/09S Zoning: AG-2.5 - C
Use Type: 0000 Jurisdiction: Saint Lucie
County
Ownership Legal Description
Sally Donovan PONY PINES -UNIT ONE BLK A LOT 33(1.34 AC)
16085 E Duran BLVD
Loxahatchee, FL 33470
Current Values Historical Values 3-year
Just/Market: $69,300 Assessed: $56,700 Year
Just/Market
Assessed
Exemptions
Taxable
Exemptions: $0 Taxable: $56,700 2020
$69,300
$56,700
$0
$56,700
2019
$58,600
$51,546
$0
$51,546
2018
$49,200
$46,860
$0
$46,860
Date Book/Page
I 1-02-2020 4502 / 2925
02-14-2006 2763/2003
09-30-1994 0922/2108
View: Roof Cover:
Year Built: N/A Frame:
Primary Wall: Story Height:
Sale History
Sale Code Deed Grantor
0001 WD Knowles Donald B
XX01 QC Knowles Clorene M
XX00 WD Paul J Rondeau
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
Bedrooms: 0 A/C %: 0% Electric:
Full Baths: 0 Heated %: N/A% Heat Type:
Half Baths: 0 Sprinkled %: 0% Heat Fuel:
;e
,� ',� �S " ..,rah Qr•
Total Areas
Price
$103,000
$100
$30,000
Building Type:
Effective Year: N/A
Secondary Wall:
Primary Int Wall:
Avg Hgt/Floor: 0
Primary Floors:
Finished/Under Air
(SF):
Gross Sketched Area
(SF):
Land Size (acres):
Land Size (SF):
Total Building Count:
Special Features and Yard Items
Type Qty Units Year Bit
0
0
1.34
58,370.4
1
All information is believed to be correct at this time, but is subject to change and is provided without any warranty.
O Copyright 2021 Saint Lucie County Property Appraiser. All rights reserved.
St. Lucie County Health Department
5150 NW Milner Dr Port Saint Lucie, FL 34983
PAYING ON: #: BILLooc#:56-BID-5273798
RECEIVED FROM: Down the Hole 11352 AMOUNT PAID: $ 115.00
PAYMENT FORM: CREDIT CARD 045059 PAYMENT DATE: 04/30/2021
MAIL TO: Down the Hole 11352
Port Saint Lucie FL 34988
FACILITY NAME: Down the Hole 11352
PROPERTY LOCATION:
Port Saint Lucie FL 34988
Lot:
Property ID: _
-1 - Well Construction
EXPLANATION or DESCRIPTION:
Block:
1
QUANTITY FEE
$ 115.00
RECEIVED BY: AdamsC AUDIT CONTROL NO. 56-PID-4959281
Note: 59-31918 - 11770 Palomino Dr