HomeMy WebLinkAboutWeel ConstructionSTATE OF FLORIDA PhiftlWITi PPLIC�4rloiv T.;r C :+P_S t FtUC% � o) �1ae�¢�
REPAIR, MODIFY, OR A13ANDON A WE t.L 59-3
Qp Cs ESrq Permit No., �.......-
205
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sr ('Denotes Required Fields Where Applicable) Pormit Stipulations Required (SooAttachud)
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❑Suwannee River u 1S form Ond ronvonikiQ tho pwm/t appl)ee0on to ihh e2.524 Quad Nn, --Delineation No.
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�= 0 Delegated Authority (If Appllcable CUPIWUP Application No:,-
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p "R2nge ,aunty Subdivision Check i( 62-54: Yes _DS•^Jo
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ti, tt Cleanse Number 'Telephone NL mbor Email Andress .�
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%• "typo of Work: 1NL Construction _ _Rnptair _.,, modirrootiorl Abandonment
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8. 'Number of Proposed Wells _ � _ _ _ `Rem)gli rl`rdWin1 Momncmiun, orncn - - -
f). "Specify Intended Use(s) of Well(s);
,.-Domestic LP 1
Landscape Irrigation ,__._.Agricultural irrigation _Site tnvesiigaliorl
ite In eat
—Bottled Water Supply Recreation Area irrigation
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_ __Livestock
�pltbllc ing
Water Supply (Limited Use/DOH) ... ._ .Nursery Irrigation Test
public Water Supply (Community or N(In-CornmunitylDEP) • --Commsrclalllndustrial "' Earth -Coupled Geothermal AUG 1 % 2021
_._Class i injection _._ Golf [,Ursa Irrigation--_^HVAC Supply
Class V Injection: —Recharge � e ,__- PIVAC Return
9 Commercial(Industrial Disposal_ Aquifer Storage and Recovery Drainage
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Rernediation: Recovery -Air Air Sparge -Other tocsctu a F OH In St Lucie Coun
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10.'Distance from Septic System its 20o ft, n g van pnmWllne pumaMy) d1 11. Facility Description-, 12. Estimated Start DateRS_ •13
°[:stimlatod Web pepih l.�,fl `'Cstimatvd Casing DepUt . S2.l,t...it. 'Primary casing Diameter fn. Open Wolla: From
14, Estimated Screen Interval: From Ta � tt.
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I6.'Primary Casing Material: Blacli Steel ---Galvanized VC Stainless Steel
Other.—_ -�"
Not Cased Other.—
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IS. Secondary Casing: _____Telescope Casing Liner —. Surface Casing D)arnator in.
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t7. Secondary Casing Material --- 81aok Steel Galvanized PVC __Stainless Steel
____._Other _
10 "Method of Construction. Repair, or Abandonment: Auger _ __ Cable Tool __ ,trotted �r ___
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,Rotary __sonic
combination (Two or More Methods S
Hand Driven (Wall point, wand Point) Hy raulio Point (Direct Kush)
_Horizontal DHIIII19 by Appraved Method
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_ _Plugged ,_, Other (uaacrlI1o)„.,",, _
19. Proposed tiling 1 rval for the Primary, Secondary, and Additional Casing:
From To Seal Material (�_�genton)te_�Neal Cement
From To
__ - _Other
Seat MatOrlal =8entonite -�__, Neat CGmont �- Other
From To Beat Material LBentcnite Nest Cement 01her�=y""""`
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Prom Tv Seal Material (_,8en1onile Neat Cement OUtor "-)
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20. Indicate total number axis ' Wolfson ode
� _ .._ List number unused wolfs on site
21.'Is this well or any existing well or water withdrawal on the owner's contiguous property covered under a Coneumptivalwater Use Permit (CUPIWUP)
or CLIPANUP Applieation7 '�'^
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Yes No If yes, eampleto the following: CUPIWUP No.
2.2. Latitude ._., District Well ID No.
- -- � longitude _
23. Data Obtained From: - _GP5 .�,!Cluap _._.__Survey Dalum: �_NAD 2% -_, _NAd $3
I MINI early llW lnal non T_W6S 84
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xlpiy 111 �(071
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Approval Granted 9y Issue Date i9 ( Expiration Dato4ro /A ?�1�i
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Fee Roceived _-- - Racell)t No. Ch
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THIS PERMIT Is NOT VALID UNTIL PROPERLY SIGNED BY AN AIJT140RIZED OFFICER OR REPRESENTATIVE OF THE WMD OR DELEGATED AUT! IORITY. THE
PERMIT SHALL, BE AVAILABLE ATTHE WELL SITE DURING ALL CONSTRUCTIAN, REPAIR, MtlDIFICATItlN, OR ABANbONMENTACTIVITiES.
DPP Farm: 62.632,000(l i (ncorporatau In 62-63?.40n(•I ), i .A.G. Efferavc pale: Ortohar 7, ?.D10
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UNPLAT
(VACAI
Ron DeSantis
Mission: Governor
To protect, promote & improve the health
of all people in Florida through integrated Scott A. Rivkees, MD
state, county & community efforts. Moro a
State Surgeon General
HEALTHVision: 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
S LC DO H-W E LLS Ca-) F LH 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 SLCDOH-WELLS(a)- 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 Mlner Drive • Port St Lude, FL 34983 Public Health Accreditation Board
PHONE: 772/462-3800 • FAX 77218715360
StLucieCountyHealth.com