HomeMy WebLinkAboutApplication For Construction-° (qo(A-) "?10500CoZ
STATE OF FLORIDA PERNTI-1;`AFFiLI(;FIfiUN C "►7;S'j RUC7
•� ��
o�spesr47
REPAIR, MODIFY, OR ABANDON d WELL
Pernilt No., .. 59-32453
NN • :
0 Southwest
PLEASE FILL OUT ALLAPPLICABLE FIELDS
(.i Northwest (`Denotes Required Fields Where Applicable)
ESL Johns River
Flodds Unique ID _
laorrritt Stipulations Required (Soo Attached)
u $
�^
`South Florida 7714 wulur Wulf ronfracos is raaprmeltllu rot rnri plerblg
Ihly ramp and ranvertYlnplho pannif nppllcnl on ro lno
❑Suwannee River upp+updaladelaNarodpuawnlywprre apprleaalo.
�—
e2-S24 (.Quad No. Dollneation No.
'Ootw.1+�•
C1D[P
0Delegated Authority (If Applicable)
CUPANUP Application No.
'1 4 ,
'Owner, Legal Name d.rporatii-n, '
ss
Ity Slate `ZI '"t'al� ptho�to 2.
N�um__ tier •
Ws I LacaUon -tddr�ess, Road a^me r umber, CI /�� ( ` Q4 I L
O
"Farce I No. (PIN) orAltemate I< y (Cir a ne Low" Block Uni--'�—:--
'Section or Land Trani' 'Township 'Range 'County Subdivision ack if 82- 4: _Yes
' `Waiter Well Contractor ^Ulan.' Number—Tjejle�phon9e 1;uy"t ber E-mail Address
'Water Well Cop ctoc s Address QLL_-_
Laly
�pn of lStele —"f-
7 �MocCr Cenatn of t+ Repair [IP�Modlficotian __,• Abandonment
B""NUrl7bar of Proposed Weilb " •Raannn for Blip it , Motllllralinn, pr
°9pecify Intend d Use(s) o Well(s), r
oa L
otl�osfio _.,.Landscape Irrigation _Agricultural Irrigation _Site Investigation
ttlind Water Supply _Recreation Area Irrigation _Uvestock Monlioring
_Public Water Supply (Limited Use/DOH) _Nursery Irrigelicln Test r+ qq _Public Water Supply (Community or Non-Cornmunily/DEP) -- CammerclalAndustrial _Earth•Coupled Geothermal AUG — 2 20E1
____Class I Injection _._ Golf Course Irrigation _••.,__IFIVAC Supply
FIVAC Return
Class V Injection: Recharge _Cammercialllndusirial Disposal Aquifer Storage and Recovery - ...... Drainage
Remediation: Recovery Air Sparge Other (Ocs.1boh F H In St Lude Cou
_�olher(❑awriba) _ EM IRONMENT iaiHEA H
Not ICI twa ni wnYC an, por,1111bU IV o swan pormllilns aulhway)
Dfatance from 3opkc System IC s200 tt 11 Facill Descrlptlon _ 12. Gstlmeted Start Date
Estimated Well Dep)�_Qfki "Estimated Casing DopUi =1f 'Primary Casing Diamatec Open Hole: Fram_To_ n.
14, Estimated Screen Interval: From%0-7oLQ0 tL
f L#rimary Casing Materlal: -Black Steel ___Galvanized EyQ ` _Stainless Steel
NotCased Other._
16. Secondary Casing; Telescope Casing Liner Surface Casing Diameter __ in,
17. Secondary Casing Material: Blaolc Steel __Galvanized IoVC Stainless Steel Other _
;1&,i[itethod of Construction, Repair, or Abandonment: _Auger Cable Tool Jetted
Combination (Two or More Methods) .Hand Driven (Well Point, Sand Point) Hydraulic Point (Direct Push) S„
Horizontal Ddtling -__—Plugged byAnproved Method-�Othorraeacaaa)
19. Proposed feltout! ni rval for the Primary, Secondary, and Additional Caslnq:
From_ To Seal Material ( l3antonite~Moalernenf Other, _)
From To�__•_Seel Materiat(gentonile "� _Neat°Gbment _ - Other,
From To —Sea Material L_Bentoitite Neal Cement , Other_ — ) �,
Frorn To Seal Material L._.BentonIle Neat -Cement 'Other )
20. Indicate total number of exleGng wells on site List number of existing unused wells on site
-24110his well or any existing well or water withdrawal on the owner's contiguous properly covered under a Consumptive/Water Use Permit (CUPlWUP)
or CUPANUP Applicagon? Yes Meyif You, complete the following: CUP/WUP No.__.__ District Well ID No. co
22. Latitude Longitude.--
23. Date Obtained From: GPS Map Aulvey Dalum• NAD 27 NAD 83 WGS84
"A"m
I MnViY ea4iY heal I url amnply vnlir Wa amkubm rabla nr'rai 4n, Fin ndr MnW,lmlhn U,4..Ona mu a as W trarldr IaU I:tm an owlvrM lib ryvpM ,Obi IIt[,,f
.nn pnnlrlrrrarvav puma, aanodnl, Iron p 11 arndr tlaatmaw anariofilm„wnpmndaf„,Y arl,mlv4Ni„umUr �lNarp79 FtOMn Slawln4lo mA lnm 'Ip,y ly Naaama �1IC N�1 tONIY Ih Iloa1
canlUuraNl. Ita wComfy vim atl"Alm"I IUCYUIrrd hi 11m apWo_IM Ia OWOala as I Usti . bbu1 Yd0 ('(Hall IplprovdW,o aaGllab.ana.01104 mfaman thoQWA01
naiulwayvpalave faun athur rartma, ataW, oi I" ri mlmwnb, d upAlmliv, I aaou le umw61 o WaV r ao hl a t!°m nwnln W vtlawl panadal YI Yus WGta W
r�nutwun web b a„CUUid YAM do dOYa dwr rarVOLIwt of Ulu l:onuWalou rapw, lr01,40bwyw wY UyWU11n al ul,rbaa,r put. lnaUU• '���110i'Nawatu
abeluawnud wWaru ld by lwU panNl, Or alu ponmtugWWWI. wluataM alauua Gnat. nlNall.W UUu1UWrmamuuUianxaa hY VdJ pwatlt. >t
Approval Grdnleb4x A A—kA1-L0
Fen Received b - �tsceipt No. _
THIS PERMIT IS NOT VALID UNTIL PROPERLY SIGNED BY AN ALIT OR ZEI
PERMIT SHALL BE AVAILABLE AT THE WELL SITF_OLIPWr,AtI (in nT ur
DPP Form: e2-932.91ID(1) Incorporated In a2-s32,4on(•I ), F,A.C.
Exptradon Date
R tWat1'2`toL0 Check No. C&L
OFFICER OR REPRESENTATIVE OF TILE WMD OR
OctObOr 7, 2010
bwm,
AUTHORITY, THE
Pago 1 of 2
2to�a-bOc�2
LEGAL DESCRIPTION
LOT 18, BLOCK 152, 0 15 30
LAKEWOOD PARK, UNIT 11,
%SURVEY: AS RECORDED IN PLAT BOOK 11, PAGES 326, 1 INCH - 30 FEET
CONSULTANTS I PUBLIC RECORDS OF PORT SAINT LUCIE COUNTY, FLORIDA. I JOB NUMBER
r r r 1 I./
N 21-01-094-5701
` SHANNON
BOUNDARY SURVEY
LaPPG30�lC D �'
AUG - 2 2021
L
oroM.
FDOH M $t Ludo Cotmty ~ a
ENVIRONMENTAL HEALTH
N N Z n
132.54'(M) •! c
S89e58'00"E P&M
.-... I UNOBSTRRUUCT Fr.
'.
-
. I AREA
b I _ no
8 o o -iD - ., x
y G y zM1tig N 52p
n fyR{��II O
.`I', p I ... - .. w.-• A 4 THICK a b I co
.. I ..-N CONC DROVE v
DO
Do
S89.58'00"E(P) 132.50'(-)
m N
S89959'20"E(M) 132.38'(M) Lop I m n
�oa1N ym f' ZN
aI C4
F- y
IrGs:?l0 h ARRREVIATONc 0 %23.•4 . GROUND ElEVA71ON
PSM WP m& SURVEYOR h 1650-B-LH 10,600 SO. FT. PROPOSED DRAINAGE
U3 . UCQRSED BUSNFSS BOUNDARY SURVEY CERTIFIED TO: PROPERTY ADDRESS- ARROW
FEND F(%I�ND� svR`rEYOR CENTURY COMPLETE 5701 SHANNON DRIVE ' - PROPOSED ELEVATION
sET sET'RVF&' FT PIERCE, FL 34951 . PRcpmm inner
�- PSE" �.�� ] CORITIICATEO UFTAL PIPF
DRIVEWAY
!Y
,
1. BASIS K' BEARING -THE NORTHERLY UNE OF LOT 1gg,, fRLOtlC 182, LAKEYA00
PAPIf, UNR 11,A5 RECORDED N PLAT BOON it, PAGES 320, PUBUC RECORDS OF
TRUE µ0 CORRECT TO-TIE5T (F
MY NNOMLFDCE, AND THAT THIS SURVEY
.
PORT SAINT LUdE COUNTY. FLORIDA, AS BF3R0 588�8'00'E PER PLAT.
ME'Ei5 THE STANDARDS OF PRACTICE AS
RIGHT-GOMOF-WAY
. RTOHT-OT•--�WpANYQ� ( PRO)
0
2 DATE OF FIELD SURVEY- 0/12/2021.
REQUIRED BY CHAPTER SU-17 FLORIDA
BOARD OF LAND SURVEYORS PURSUANT
TO SECTION 472.027 FLORIDA
EAtiF11ENiS'x3.5'
& ADORIONS OR OElETI0N5 10 SURSEY MAPS OR RFPORIS BY OTHFR THAN THE
STATURS.
. UtTIwUnTY��,F2�{SFAIFNT
. TlOOD BOARD FENCE
9CNING PNt1Y Oif PAR7ES IS PROHIBITED YAIF{OUT WO77Q7 OOHSEN7 OF RiE
SIgUWC SURVEYOR.
CWUN UNKK FENCE
VUIri FENCE
4. PROPERTY LINES SHOULD NOT,BE fSTA1TUSHED USINO FENCE OR BIALDINO TES
T1de Re" hw hew re�iraJml7
-.dW y Iv M. I. P91
PLAT
.MEASURED
GLFIWOIIT
S. NO UNDER&IOLIND INSTALLATIONS OR IMPROYF307115, WCLUDWO BUT NOT
Ui07Ep TO. BURIED UTIUM3. FOUNOATONS AND FOVE Nt:RE
, m
IOed/fYne nw,>. Yi°.n] ur,p a 4i(/ly
ea4h++e.� ca .�•t
• WATER MUFTI
CABLE RIgR
LOCATm.
UPON My q�EW aF NSUftAN� RATE MAP" Ppp� yJNT
PANEL R0.1'2p1p1ICT70EJ. E�CIiVE VAX
old. repo �t
ey.otu. mW'tir � a,-u,7 �ewir
. ELECTRICTELEPHOR RISER
ELECTRIC RISER
�W/pgE/��C�W�N1�Yj�iLpOpRplpOAp.�yCOMNUtOIY
ARE 'AS OETQWWh Tf BE OUT�9D� � THE 0.� ANNUAL CHI�IHCE RIIWP�LAR' AS
. PONER POLE
�T AS NOIEO.
. WELL
FRONDED. NOR OID 1H1OSVRVE7'OR ABS`7RACT E� lAN05
SANITARY SENOR MANHOLE
e• `SURVEY FILE NUMBER: 21-01-004-0701 SHANNON
FAUN , H(FEIF,�(t�;p
OSS2
4EA0 ELECTRIC WATER PIPE
8. E3EYATGNS SHOWN HgEON ARE BASED ON THE NORTH AMERICAN VERTICAL
OATUY OF 1088..INAVOe81 AND MORE SPEdRCALLY TO THE FLORIDA PERMANENT
"M SUAYEY CINSL . C L13 7W
CABLE CE NE•ILYORK ( AN) CWFiWUOUSLY OPERATING REIRDIENCE STATIONS °�FPW-IV'"�
(o�oRs sTEw FIn FLFII Faun Hoffineier,,l,,,,,.,,..,,,,
e,oa
31 W Bro0dw0y. SuTte 1001. Ovfed% FL 32765 ww.hnhvimycOm 407.5424977