HomeMy WebLinkAboutWell PermitMission:
To protect, promote & improve the health
of all people in Florida through integrated
state, county & community efforts.
Vision: To be the Healthiest State in the Nation
Ron DeSantis
Governor
Joseph A. Ladapo, MD, PhD
State Surgeon General
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 SLCDOH-WELLS(�D-FLHEALTH.GOV
• Submit revisions to permit and/or site map within 48 hours of well construction or
abandonment.
Florida Department of Health -St Lucie County
Division of Disease Control and Health Protection
Bureau of Environmental Health
Location: 3855 S US Highway1, Fort Pierce, FL 34982
Mailing: 5150 NW Milner Drive, Port St. Lucie, FL 34983
Phone 772-873-4931
Fax 772-595-1306
Accredited Health Department
• Public Health Accreditation Board
FloridaHealth.gov
STATE OF FLORIDA PERMIT APPLICATION TO CONSTRUCT,
REPAIR, MODiF'f, OR ABANDON A WELL
D Southwest PLEAS= FLLL OUT ALL A?PUCAaLE FIELDS
O Northwest (-Derirues RegWred Feids tNhere Applicable)
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Penrik No. 59-32821
Ftatda Unique 10
Permii Stlp:ieuons Requ:red (Sae nrecneo)
Cued No. Delineaboo No,
UP Aordreallo,, No.
Talephone Number
({7 � OT moor, /"� - — 3 _
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nzuela 1135 56171811si welldrilling@gmail.corr
m beach bry�e Number wesityaim Beach ��11 4ddres¢ 33411
KNater Well Contractor's Address City St(a�te ZtF
7_ 'Type of Work: Zonstructir ❑ Repair ❑ Modification❑ Abandonment
8. `Number of Proposed Wells ' I rte> a! n« 3euat. r [AEN"6
S. 'Speary intended Use(s) of Well($):
Domestic Landscape Irrigation (�-'�- {1 Agricultural Irrigation Site Investigations
Bottled Water Supply B Recrea:tlon Area Irrigation L__J Livestock H Monitoring
Public Water Supply (Limited UselD?H) F� Nursery Irrigation Test J A N 5 20Zi
Public Water Supply (Community or Non-CommunitylDEP) Commer2g ndustrial Earth -Coupled Geothermal
Class I Injection Golf Course irrigation HVAC Supply
HVAC Return
Class V Injection: ❑ Recharge ❑ Commercial/industrial Disposal ❑ Aquifer Storage and Recovery ❑ Drainag+ OH In St Lucie Cc
Remedlauon: ❑ Recovery ❑ Air Spar3e ❑ Other it7escnDel CN jRM UTa, H
❑ Other cNe . e)
10'Distance from SeptlC S s'lJt 1' 5-200 tl. 11. Facility Description 12. Estimated Start Date _ _
13.«Estimated Well Depth I ft. -Estimated Casino Depth /�'Clt. Primary Casing Dia rotor in. OP �.
14. Estimated Screen intervaE From lb-6 To ff.
15.'Pnmary Casing Material: Bled. Steel Galvanized Stainless Steel
Not Cased Other.
W."Sec ndary Casino: Telescope Casing Liner Surface Casing Diameter in.
. Secondary Casing Material: Blade Steel Galvanzed PVC Stainless Steel Other
f 8.'Method of Construction. Repair, or Abandonment: Auger Cable Tool Jetted gta SoriC
Combination (Two or More Methods) Hand Driven (Nell Point, Sand Point) Hydraulic Point (Direct Push)
Horizontal DnllirLo Plugged by Approved Method Other (Caxsce!
19. Proposrcuting igt�v�i,for the Primary. Secondary. and Additional Casing:
From L�_ To !U� } Seal Material ( BentonRe Neat Cernent Other )
From To Seal Material ( Sentonite Neat Cement Other )
From To Seat Material ( Sentorltte Neat Cement Other }
From To Seal Material Neat Cement Other i
20. indicate total number of existing wells or. site List number of existing unused wells on site
21.'is this well or any existalg well or viater withdrawal on the oumer's contiguous property covered under a ConsumptiveNYater Use Pe".0 ?CUP.111YUP,1
or CUPMNP AppficaZ3 Yes No if yes, complete the following: CUP AIJP No. District Well ID No
22. Latitude Longitude
23. Data Obtained From: GPS Map 7,urvey Datum: NA.D 27 NAD 63 VJGS 84
Ihe.WyerMrf Pml �a car*r1r r+.aN'h•spprlr•b'w rsk <f:ey w.rwrs' an e.^.oue r.OnY.a e:r Iur..Ta.:iin ire pwls^lCwP.P—r. lhar Dieb:mn�R'art aanxa:a ae+nle.aM a-c;> a._�r.0 ro
tarmY a>citcY re;IwT xrr'ek. ¢rwadaet-hat Eec0at k Y. n > w a sG er.,<t r=sac+::e6`.a rAr Craw' 3?3. R +Aa EAanrr. m ,*cr1x, v rim• ar aamrcu. Ae r:eT. v. I ceYi �: C i r
:aslkueT+vit.pn«p..eysrar aP aeemfen Wnv lair -Iron has af..n_n•rI •«t rbvi en ap«,: qr meame.enrh•MarmxHaa vnwla a_n:e+ +naa••::1 ha.e ,.!.rm-e:he ewrexr+e.
evr+al•="d4'Un eGin2tlGal elr ,pbeal pe:Mtmers" .iF .l.�pes t•p.s,♦acawnil r•cpa�bµn•as:aYa eEwe.Q«nx ant.umw,arw^9P-YAa'rM er T.+.'fM1.Ca'J3-sC.raS•t:..:..re�
ea,pblan �aettb Lm tit r+Nlv+2^_2r,w •he p•ratr:Eor. ,.da�r•oae,.dka»+r, rr bkee.Ja4dcugrhr aanalrrler., repo m•cr!c•Lar. e[euaM .e.xrobYsY; trs•r.�
+bmWm-leeft�l!hMat46 M'••I,N��e VniYl rej�• � '. Yai:1'�bsl
_� _ 11358 _ Z
wgnaatreactor 'License No. iqn firer a Agent Oa
App-0-nied ByIssue Date i �r t piratiop a 7/ �� Nvdrologiat Aperrnpi
Fee Reor<tved S _ Receipt No, Check Ito.
THiS PERMIT IS NOT VALID U14TiL PROPERLY St NED BY .AN AUTHORIZE OFFICER OR REPRESENTATIVE OF THE 4Vn40 OR DELEGATED AU7HCF':TY. Tic
PERMIT SHALL BE AVAILABLE AT THE VVE-L SITE DURING ALL CONSTRUCTION. REPAIR, MODIFICATION, OR ABANDONMENT AC ilViTt=_S.
DEP Form: 62-532.900(1) Incetpoadad in S2-532.400(1). FA.C. Effective Detn October 7. 2010 Pegs 1 of 2
D
LOT is
GRAPHIC SCALE
0 '5 0
BLOCK 34
U14T 04
(OCCUPIED)
F F =20AG
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p
INTERNATIONAL SURVEY FErr
I Wh 30 IL
LOT 14
BLOCK 34
UNIT 04
z
(VACANT)
LOT 13
X
En
U4111T 04
(OCCUPIED)
FP X-17.09
NO WELL. POND OR D.F.
WITH N 1W FROM
NO WELL. OR POND
PROPERTY UNE
MTH*d 1w FROM
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PROPERTY LNE
to ws
LOTIS
SLOCK34
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UNIT 04
(OCCUPIED)
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PHOTOCOPYING PROHIBITED 0=1
MDTVMMWM#01H7MMQMTUF1EAWUC0MMMk
CONSTRUCTION LAYOUT SURVEY IMOFARMWALIMmAMWoR��
LEGAL DESCRIPTION (As (umWW by client) LEGF14D-,
M" RWER MATES MET 4, BLOCK 34. LOT 14AS REMR000IN PLAT 90M 11X PAWS 46, AA v RECORDS OF &WJT LUME COtOfff FLOM&
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Digitally signed by
=4
Robeit D Robert D
2tT21
Whitehead
Whitehead Date:2021.08.04
12:58:54 -04'00'
K IRV* Fffl. IN b if OR[) a MRINI iml ME
Owner/Applicant Signature Authorization
Project Name: 704 E. Midway Road, Fort Pierce, FL
Application and/or Permit # (if 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 authorization 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 procure the permit or authorization.
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: %en Z
Signature of Authorized Agent:
Date: 10/19/21
Typed/Printed Name of Owner/Applicant:
Corporate Title if Applicable: d e L L-e -
Signature of Owner Application: -- -
Date: i A-,—_
SignatureAuthonzationTemptate krm20130206
Michelle Franklin, CFA -- Saint Lucie County Property Appraiser -- All rights reserved.
Site Address: 704 E MIDWAY RD
Sec/Town/Range: 02136SI40E
Parcel ID: 3402-605-0037-000-8
Jurisdiction: Saint Lucie County
Ownership
Daniesky Vega Garcia
Daumaris Rodriguez
900 SW 27th AVE 203
Miami, FL 33135
Property identification
Use Type: 0000
Account ti: 36798
Map ID: 34/02N
Zoning: RS-2 - Con
Legal Description
INDIAN RIVER ESTATFS-UNIT-04- BLK 3410T 14 (MAP 34/02N)
Current Values
JusdMarket Value: $35,700
Assessed Value: $23 691
Exemptions: S0
Taxable Value: $23,691
Property taxes are subject to change upon
change of ownership.
• Past taxes are not a reliable projection of future taxes.
• The sale of a property will prompt the removal of all
exemptions, assessment caps, and special classitlentions.
Taxes for this parcel: SLC Tax Collector's Office 92
Download TRIM for this parcel: Download PDFI2
Total Areas
Finished/Under Air (SF): 0
Gross Sketched Area (SF): 0
Land Size (acres): 0S3
Land Size (SF): 23�320
Building Design Wind
Speed
Occupancy Category I ❑ 111 & IV
Speed 140 160 170
Sources/links:
Sale History
Date
Book/Page
Sale Deed Grantor
Code
Feb 25, 2021
4567 / 0288
0001 WD DeCambre David
Mar 3, 2017
3970 / 1651
0001 WD Reyes Apolinar
Mar 13.2014
3613 / 1344
0001 WD Ramsarran Lorraine
Oct 5, 2007
2890 / 2902
XX03 QC Ramsarran Harold
Jun 8.2004
2007 / 2608
XX02 WD Miller Steven J
Nov 20, 2003
1848 / 2586
XX00 WD Fiore Catherine
Sep 17,19%
1036 / 1599
XX01 PR Autenrieth Vita N
Building Information (1 of 1)
Finished Area: 0 SF
Gross Sketched Area: 0 SF
Exterior Data
View:
Roof Cover.
Building Type:
Year Built: NIA
Roof Structure:
Frame:
Price
$50,000
$20,500
$13500
$100
$90.000
$29,500
$0
HEALTH
PAYING ON:
RECEIVED FROM
PAYMENT FORM:
St. Lucie County Health Department
5150 NW Milner Dr Port Saint Lucie, FL 34983
#: aILL Doc #:56-BID-5747485
PB Well Drillinq / 11358 AMOUNT PAID: $ 115.00
CREDIT CARD 006306 PAYMENT DATE: 01/05/2022
MAIL TO: PB Well Drilling / 11358
West Palm Beach FL 33411
FACILITY NAME : PB Well Drilling / 11358
PROPERTY LOCATION:
West Palm Beach FL 33411
Lot:
Property ID: _
-1 - Well Construction
EXPLANATION or DESCRIPTION:
RECEIVED BY: WhighamJL
Note: 59-32821 - 704 E Midway
Block:
1
QUANTITY FEE
$ 115.00
AUDIT CONTROL NO. 56-PID-5419551