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HomeMy WebLinkAboutPermit Construction ( Well )STATE OF FLORIDA PERMIT APPLICATiON TO CONSTRUCT, REPAIR, MODIFY, OR ABANDON A WELL 0 Southwest I Northwest PLEASE FILL OUT ALL APPLICABLE FIELDS (-Denotes Required Fields Where Applicable) 0 St Johns River FiSouth Florida rne;vutrrwnllrnnrractwisrecpamiblero:completing ❑Suwannee River rhls /ormard /onrarding dm pennfrappUwdon rorhr nppaprnrede(rgnr.xtmnhary«hrreappGuibfe LIDEP 7 Delegated Authority (if Applicable) No. 59-31538 Unique ID Stipulations Required (See Attached) e2-524 Quad No. Delineation No. CUP/WUP Application No. 1 Jomilton Jovani Loza Andra(fi 4194 Happiness Street, West Palm Beach, FL 33406 G.vller; L eaal Name if Corporation `Address `City 'State •ZIP elephop, Number , , 6607 Deland Avenue Fort Pierce FL 34951 `i°leli Location - Address, Road Name or Number, City <.1301-612-0336-000-0 20 132 10 _ "P?rcei ID No. (Pill) or Alternate Key (Circle One) Lot Block Unit 4. 01 34S 39E St Lucie Lakewood Park -Section or Land Grant `Township 'Range 'County Subdivision Check if 62-524 ❑ Yes 0 No Scott's Drilling, Inc. 11213 772480-6117 scottsdrilling@belisouth.net Water'Afell Contractor `License Number -Telephone Number E-mail Address t, 5014 Palm Drive Fort Pierce FL 34982 .,Vaer VYeil Contractor's Address City State ZIP I. -Type of kNork: ❑ Construction ❑ Repair ❑ Modification❑ Abandonment -Niumber of Proposed Wells ONE a 'Speci4, Intended Use(s) of Well(s); `Reason for Repair, Mod = 91 tf'1 rl ✓� Domestic 1 Landscape Irrigation [� Agricultural Irrigation J Bottled Water Supply Recreation Area Irrigation ❑ 8 Site Investigations Livestock Monitoring Public Water Supply (Limited Use/DOH) ❑ Nursery irrigation I H Test p p rtnrt q I t G' LVC I APR Public Watcr Supply (Community or Non-CommunityJDEP)C Commercial/industrial Earth -Coupled Geothermal H i Class I Injection ❑ Goff Course Irrigation 8 HVAC Supply HVAC Return ,1,:ss V Injection: ❑ Recharge ❑ Commercial/industrial Disposal ❑ Aquifer Storage and Recovery ❑ Drainage DOH in St Lucie Cot 2emadlation: L7 Recovery ❑ Air Sparge ❑ Other (N-dbe) F VIRQN&J4JLT,4 HE l Other toe ewe) 1 r(;)Islance from Septic System Ir 5 200 fi. 11. Facility Description in9 a am y 2SI once 12. Estimated Start Date t:;. °f et)rtlaleri Vvull Depth 120 ft. "Estimated Casing Depth 100 ft. Primary Casing Diameter 2 in. Open Hole: From To ft. lrtated St:reen Int�rvai: Frain 100 To 120 ft. „.'P%ifnafy Casing taterial: Black Steel Galvanized ,/ PVC Stainless Sleet Not Cased Other._ ?i . Snr ndsry Casing' Telescope Casing Liner Surface Casing Diameter in. 1 Secondary Casing Material: Black Steel Galvanized PVC Stainless Steel Other 1 F° 'N'lelhod of Construction, Repair, or Abandonment: Auger Cable Tool Jetted Rotary Sonic Combination (Two or More Methods) Hand Driven (Well Point, Sand Point) root Push) Horizontal Drilling Plugged by Approved Method Other mesaibo) FTopo ed Grouting Interval for the Primary, Secondary, and Ad ' l 6aSff g From 0 To 100 Seal Material { Bentonit V Neat Cement Other 3 Frcrri To Seal Material { Bentonite Other ) from To Seal Material { Bentonite Neat Cement Other ) From To Seal Material ! Bentonite Neat Cement Other ) 20. Indicate total number of existing wells on site List number of existing unused wells on site 21 -is this well or any existing well or water wl oral o the owner's contiguous properlycovered under a Consumptive/Water Use Permit (CUPANUP) (itCUPrVvUP Application? Yes ,/ `No yes, complete the following: CIJPRMUP No. District Well ID No. 22. Latitude �p etude 23. Data Obtained From; GIPS Map Survey . ,:;st*.• ,v:t;, !h ".: ra@ tulYLh'.v �� dIv c}ptk+•Uti lu'ac- YTB� rA, F bode Agm'cbte.:t Grasp. dal Umt n w+[n, DM,11.d(,W46,104 ben —in be cooaso tine la"M.P.. em rfnotl IretM:•tt'O!Ay11,41hu114mvliLhp ovuxt!ell this a*c4dee Is PAIR* Brat Ulat i\nD dblR,n .:: l• %r�.i's%Ycl loin adur nx�nM. areln,, a• Ie:+V doromrr2rYa.Irep�:�tie. I �pJes b mVatie a vrta 11213 h� � Y:.i. n ,spun JD We Cis:ls .Orin 30 dam ptltr arrgilnnnn of Ula [auUUCkn, mrair, ned3c:Dun, m . r ,>n:{Cllcnl n: JuUwri-Ge Dr tole p/mtL 4f IhE �nnM 9YFieoal, Whlttr�lr oaaum b,d. :..gnatore cf Contractor „ •Uoense No. pproval Grenied By :'r r Rr na.ved $ Receipi No. Issue Date Datum: NAD 27 NAD 83 WGS 84 1=lily UUA I and the ounor or Cperlr, Uwt rho ttdmmn%on pNZd0d Is D ,.I* ab !NT.! i— w n! ,ro =;M"Aullm mlda Chaps 31� F?edda etaaUn, to nvbddn I.trdltaM abrandon 0i*,Ak a.1 c 13y Wi % inn tho ecw for UW MW1. d!dt eYktxl is eCw2te: MW tha; I have A11o*mnd !n c ,es of if Oi rcap�r:stralana ea sdred obeve. rrmse-diffDCa opd�mWa ortdl,6'�'.10td by t-,4 p4 AI., ee:.e6e A the wcU Uladtclrg tie paw.rcedr,�aodiilcttai,mahxvla+nanl vsnal-ad by :-q tM:mt., djtlon Date Check No, f Approval ImtaS, r•IG PERMIT .S NOT VALID UNTIL PROPERLY SIGNED BY AN AUTHORIZED OFFICER OR REPRESENTATIVE OF THE WWI) OR DELEGATED AUTHORITY. THE !,E.4 41T SHALL. HE AVAILABLE AT THE (YELL SITE DURING ALL CONSTRUCTION, REPAIR. MODIFICATION, OR ABANDONMENT ACTIVITIES. CEO' Fomi: 62-532.900(t) trtmrporated in 62-537..4Q0(1 }, F.A.C. Effective Data: octobsr 7. 2010 Page 1 of 2 ID .'\�lql w North sr`q's, 70. EXrsnNG 12 "CUP Q �— swat£ - FN NOI11 D +: �/89 :5846 50.2 'PY P POSED 9O�GS ,,s %L 24 " N � A LOT 21 r j F.F.E. =51.7' W O O O Z LOT 6 OCCUPIED 1717a., �41m NAIL IN EDGE OF PAVEMENT=50.00(ASSUMED) 1 +tE9 Da EXlS77NG ,� SWAIE ----r,12 CMP RT 90.00 50.2 49.49 }�VEWA Y O 8 0. 0' ese 51.8E-F �d JlJ96 t;2 81 PROPOSED F.F.E.=52.3' 15.0 ' PA T O 51.8 0 51.3 LOT 20VACIAIT r0� N N h y061' ese 28 50.2 FND j"IR NO ID os, cP 50. 9 .42 18_ .. ILITY AND CHA�LINKlN FENCE LOT 7 OCCUPIED 4- IV89'58'46'E 90. G " /I xY n J j LOT 19 F.F.E.=52.3 / " 51.3 50.8 z r kw 31.00' 00 / It � $ O / ol I " I +� �r ALL R4 00 !us 50.2 FNO rlRC _-t. _ I PStM 2931 x 49. /6• LOT 8 OCCUPIED Property, Card Page 1 of 1 Michelle Franklin, CFA -- Saint Lucie County Property Appraiser -- All rights reserved. Property Identification Site Address: 6607 Parcel ID: 1301-612-0336- Account #: 3047 Sec/Town/Range: DELAND AVE 000-0 01/34S/39E Map ID: 13/01 S Zoning: RS-4 Count Use Type: 0000 Jurisdiction: Saint Lucie County Ownership Legal Description Jomilton Jovany Loza Andrade LAKEWOOD PARK -UNIT 10- BLK 132 LOT 20 (MAP 4194 Happiness ST 13/01S) West Palm Beach, FL 33406 Current Values Historical Values 3-year Just/Market: $11,100 Assessed: $11,100 Year Just/Market Assessed Exemptions Taxable Exemptions: $0 Taxable: $11,100 2020 $11,100 $11,100 $0 $11,100 2019 $9,800 $8,147 $0 $8,147 2018 $9,300 $7,407 $0 $7,407 Date 01-10-2019 10-12-1988 View: Year Built: N/A Primary Wall: Bedrooms: 0 Full Baths: 0 Half Baths: 0 Sale History Book/Page Sale Code Deed Grantor 4222 / 1117 0001 WD Lang Raymond 0608 / 2888 XX05 WD Burns Shirley J Primary Building Information Finished Area of this building: 0 SF Gross Sketched Area: 0 SF Exterior Data Type Price $14,500 $7,500 Roof Cover: Roof Structure: Building Type: Frame: Grade: Effective Year: N/A Story Height: No. Units: 0 Secondary Wall: Interior Data A/C %: 0% Electric: Primary Int Wall: Heated %: N/A% Heat Type: Avg Hgt/Floor: 0 Sprinkled %: 0% Heat Fuel: Primary Floors: Total Areas Finished/Under Air 0 (SF): Gross Sketched Area 0 (SF): r' .. Land Size (acres): 0.27 Land Size (SF): 11,790 Total Building Count: 1 Special Features and Yard Items Qty Units Year Blt All information 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. https://www.paslc.org/RECard/ 4/8/2021 St. Lucie County Health Department t' 5150 NW Milner Dr Port Saint Lucie, FL 34983 HEALTH PAYING ON: #: 56-SF-2240461 BILL Doc #:56-BID-5181164 CONSTRUCTION APPLICATION #: AP1629926 RECEIVED FROM: Javier Lopez AMOUNT PAID: $ 660.00 PAYMENT FORM: CHECK 1187 PAYMENT DATE: 02/11/2021 MAIL TO: (Agio Construction Services, LLC) FACILITY NAME: PROPERTY LOCATION: 6607 Deland Ave Fort Pierce, FL 34951 Lot: 20 Block: 132 Property ID: 1301-612-0336-000-0 EXPLANATION or DESCRIPTION: QUANTITY FEE 128 - OSTDS Construction System Inspection Research Fee 1 $ 5.00 -1 - Surcharge (All) 1 $ 45.00 -1 - OSTDS New Permit Surcharge 1 $ 100.00 -1 - OSTDS Construction Application and Plan Review,New 1 $ 100.00 123 - OSTDS Construction Site Evaluation 1 $ 115.00 126 - OSTDS Construction Permit (New or Mod, Amendment) 1 $ 55.00 127 - OSTDS Construction System Inspection 1 $ 75.00 133 - OSTDS Construction Reinspection 1 $ 50.00 -1 - Well Construction 1 $ 115.00 RECEIVED BY: WhighamJL AUDIT CONTROL NO. 56-PID-4884667 Mission: To protect, promote & improve the health of all people in Florida through integrated state, county & community efforts. a Yiy HLT11' Vision: To be the Healthiest State in the Nation Ron DeSantis Governor Scott A. Rivkees, MD 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(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 S LCDOH-WELLSCa)-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 Milner Drive - Port St. Lucie, FL 34983 :Public Health Accreditation Board PHONE: 772/462-3800 • FAX: 772/871-5360 StLucieCountyHea Ith.com