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HomeMy WebLinkAboutAPPLICATION TO CONSTRUCT STATE OF FLORIDA PERMIT APPLICATION TO CONSTRUCT, REPAIR,MODIFY,OR ABANDON A WELL Permit No. ,... 59.32465 FY11Esp yo Irao t i Southwest PLEASE FILL OUI ALL APPLICABLE FIELDS Florida Unique 10 I Northwest ('Denotes Required Fields Where Applicable) Permit stipulations Required(Solt,Atlar:hcd) : ;:I St.Johns River —__._._�._.__.._._....-__......_..__. z The waier well rontraclot ix re;;pousibre fol coniptehrlo y, I 1 South Florida this torn)and brwaraing the permit applcuaur,to the 62.524 Quad No......_____Dolinr,:uldn Nu __,• _. _. .,Suwannee River apprhpnatr delegatedournonty where apparnato cob wz thou• ["I DEP CUPiWUP Application No.,, I-]Delegated Authority(If Applicable) IYI YCu'n,. t Id E t+CtcL abj Iridtclr� F><i1is •Dr FF�'i&c-e F� 3 YSa 873- l0?07 'Ow r.Legal Name if Corporation 'Address 'City 'Slate ZIP Telephone Number 2 713p .'D.-IC) "�, ►i 5f WiCle. TL 3ggsa 'Well Location-Address.Road Name or Number.City 3. 34)4- 15D1-I q)a--J DD- / Lot Block Urn) 'Parcel ID No.(PIN)or Alternate Key(Circle One) - # Lve�e C�< r�(Pl?S ..!•a •- Chec5cif 62-524: Yes No 'Section or Land Grant 'Townsh'p 'Ran 'County Subdivision 5.J'Witr�We•l.'��c�b•s�s �r1c.Lt.-. �Itt:,yts ��3�.� �.� ' br�•`�O� S�_�v.iC�,\ri_�Z,'a.� <<aWri�r'�.��1,.�:A`t`!` ll Contract r 'License Number 'Telephone Number E-mail Address --- _ _- — __._. .. �..__ .....__....._ _.�9?1 _.. 6 61'Water Well Contractor's Address Cit — State ZIP 7 'Type of Work. _Construction •___• Repair __ Modificalton _Abandonment ___�_•__-_______.__ 'Number of Proposed Wells 'Reason'or Repair,Modlflcahon of Abendonlnerlt 9,*Specify Intended Use(s)of Well(s). r!� W v Domestic -.—Landscape Irrigation _,Agricultural Irrigation investigation „ Bollled Water Supply ..—Recreation Area Irrigation _.._Livestock _Monitoring Public Water Supply(Limited UseIDOH) Nursery Irrigation Test NOV 2��� Commercial/lndustnal . Earth-Coupled Geothermal Public Water Supply(Community or Non-Community/DEP) Golf Course Irrigation HVAC Supply Class I Injection HVAC Reluril Class V Injection _Recharge Comrnercrat/industrial Disposal--Aquifer Storage and Recovery——_Drainage OH in St Lucie Coun Rennedlalwn. . Recovery AirSparge Other;ooscfnial . , . E VlROPQ14t AIhTAt'�HEA H Other toescnhel_ _ _iNniA Net ei,types n'wn Is ate permitted by a groan p,:hnilbn�i auiho(Ay) , 10 'Distance Irom Septic System it.200 It. '/ _. 11.Facility Description Sing fe f 1 N 12. Estimated Start Date 13'Estimated Well Deplh,00•ft. 'Estimated Casing Depth__...... h. 'Primary Casing Diameter .• in. Open Hole. From To. ft. 14 Estimated Screen Interval.From To ft. 15.'Primary Casing Material. _Black Steel _Galvanized w•_•,PVC ___,Stainless Steel Not Cased Olhe(. 16 Secondary Casing: __Telescope Casing •__`Ltner ,Surface Casing Diameter---—tn. 17 Secondary Casing Material: ._• Black Steel Galvanized PVC Stainless Steel Other 18-Method of Construction.Repair,or Abandonment. . Auger >� Cable Too) _ . •Jetted Rotary Some Combination(Two or More Methods) Hand Driven(Well Point,Sand Point) ..Hydraulic Point(Direct Push) Horizontal Drilling Plugged by Approved Method ..,Other 1g Proposed Grouting;Interval for the Primary,Secondary,and Additional Casing. From ___•_.._.To Sea!Material(_i Bentonite Neal Cement,_•_,,Other_•_•__�, ,_•___ .,_..,) From _ To Seat Material(__•_Bentonite Neal Cement Other_ __ ) From To Seal Material( • , Bentonite Neat Cement Other., • ) From To••_ Seat Material(• ••_ _Bentonite Neat Cement. . Other ) 20 Indicate total number of existing wells on site__Q List number of existing unused wells on site. 21 'Is this well or any existing well or water withdrawal on the owner's contiguous properly covered under a Consumptive/Water Use Permit(CUP/WUP) of CUPIWUP Application? Yes X No If yes.complete the following.CUPIWUP No. District Well ID No 22 Latitude ._.._._.___._...._._..___.__...... Longitude---......... 23 Oata Obtained From:__GPS _-Map _Survey Datum __NAD27 • NAQ 83 ____,,WGS 84 I l,ara:r.:.dr Was 1..a-At w•A,Ula anUl,Wotn fl :s ul roue 4o nundaAC111 n,atral'vv Gunn.m:G W.1t.i nnlrt 1,v41y! J••1 YIL p'x1,Y.t AI WG i,1JW:ny.IhUI 11,v MIJM1AJItW,UlthtWld•++•N.t..In:v.—, a'.0 my .+nh••n:,+Jrpl r.,l farJ,nrAA P.-a.11,M.nnd..'A.11AG,t W A+G na uhl.,..n rl•nr 41 LMI,mP.n gmnn!At vAn MNnf! •,1.h. fMaf CMn1ar 7r.1 aMM1On$IAI,tiAtl In n,Ainlprl d ill l{1M+y.In l,nlAn rM1A.Mtl,M•1.,Anay—1.1,•, •••.W1f• {IW{hW"Mly Ih0I nit MIWmN'An ry&wwl m Uuy atfn" ,,J 13:'FC fine J.'n is-a,1 wa unln.n a'u.Ig n;l f l d. 1.1.G,lll i! .dGIrllvnM W Ilv,lte'i,3 JCturAll•JnA II,W 1lt.lv.:,••ly,nrm111,1+nwn,:r:r Ihn 1 .7t11nN.11 rl Mt a1"A11W."AI,aIJIII.11f to1:11 pnvnnMlAnl.S,:•lplvv lhln 1 Jeinn In Ittnv�A„A,v.11! •n!-tin•Gh .1 ..11(1 tM Lh\nM•f�4t�nn!i In JIIMNIIA eFlRllnllfll lit,'1,1.1lA::I In IIC.'n!tAil':n nl,'nnr:t ir+n!•\ 1 rn 0,ew,fe 1 0,1Wn m1hM]G Gays&hat G—p,al,W of n,e rr.lsu.<un'•.•Ann"n�an.Ur AnM.a' to t+A a .4 .ru:t-,rein r As 4Ca1Mn.Ar]{fAnOn,in,nn:•1,0011:M•Gr P•i Oata,i n.� A,mv •+1 by In•n nnnw roe n,n pnrmd n,{pm{,,.,•.a•+nn.m nea+a r ra / I lure of Owner or Agent DJIIe 'Sig a of Contractor License No. S u 9 9 g C Approval Granted By issue OarExpiration Oate 3 �idZ3 F•Iydrolugisi AfKlruval nln,uy Foe Roceived $_. 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THIS PERMIT IS NOT VALID UNTIL PROPERLY SIGNED BY AN AUTHORIZED OFFICER OR REPRESENTATIVE OF THE WMD OR DELEGATED AUTHORITY THE — - _— •••... ,_._ .__.._..... . ..._�.............. nn.•r�-r.+..+-•rv\n, nrnnln urt.�nlCu�nTlnnl no nunnlnrinlnA�nt74r'TIvtTIFC D ;o ar o;��` (S Z m "N a QZ p Z '�'ldpPe; ;Nd ,. m C7 O N I G) p � '� SO'17'05"E 165.00' --I p SO'17'05"E SO'17' m Ln °+ S cQ 990.45' �, `S� x 15.8 e �L O POSSIBLE SW INGRESS/EGRESS AND UTILITY EASEMENT (n �• (NO RECORDING INFORMATION PROVIDED TO SURVEYOR) N 01 �6 O - < DIRT ROAD VARIES 1 N -o �„ SLYER ROAD 9 D O � CQ �S6Al 15 OQ 1s _ l�.j(.-CL SWALE-' 90 S� rn Sao 0 6.00 0 r*T to m o m m u cn o U m\ �y� z 6� v Zo N 16.00 V 0 Z {� tr accnv rn O a m(Av U' 22.33' 0.00' (n 9 E 00 59.46' 00 5',o� CAcmm - ' � Ww O N \ rD b 9 mCAI c oi �D D AU , N w \oz C� as m r; o f Oo �! w "czi v m \ o' 000 22.83'OXO i o A 025.67 I 2 00 � rn 9.46' 0.00' LA N 0 Cn n i - A CA>_ / Do D 4 J O)w N Z 0 OpOO �t;0Np —O'p0 p�O O(T� O� / uN+�`? � C rn =I o v 0 0 0 D N � � CA \ r N N I / Z �m0 ;;0N � x6 � x6 r c< O Cn 1p Ln ZZ ,6 O O) m NORTH 330 F OF LOT 12, BL( SOUTH 165' O x O � SO'17'05"E 6.3 990.45 x `So Q& SO'17'05"E 16: so SO"17'05"E 165.00 sg xo TOE \ m Ut o ►� y c 00 m Z r O N\ zZ (p Iv cn m Z n Cl1 p O z ado C — o 0 m rn o CD CD n o Dv r ;0 Do rn N O co Po �I 91 U) W N! n mmmmma` P r Z!^m�a awo ily o —to w^mrty zo •* —lo am --1 (A C=-D < Dm ran ;uvv y—I m7 O SO m Z �m Q =0 S-«m m -w0 C > m —m o o o m CD 0 o a� `-+ OOOOOODOOO 000000000' Q 0�p rtQ m O O �p '*0 rtrt O � n � rtUl 7 0-0 '� "i am m m m m m m m mmmmmmmmmmm rn m m D < • Qrt m O m m 0 < o m m a—, " "- � zzzzzzzzzzzzzzzzzz Sm0 m Q.O-►a-� rtSa� 0 Qn 0 Q Q �p`< r+;0 f�ry�y 0000000000000000000, O C• N 0 j p•m FIAMi ��N 7.�m Z t0 < Q 0 0 rt C to O D r y fw/)fw/1 fw/1 N tm 0/I 0 W w w w m(n N N U)U)(A CI)I) r«O a vy`G Ort� 0 0 �m -nr+ C m 7 a O O =! E w a r" �vOCOVOZm�npOZ�Cmm'>L7=200' _rI 0 n W o M 0 D,n 7 0 y fD N N h tQ 7rt'O a CL n ,n fA f �0 0 0 0 '7 r !*) 0 2�*1 mokmmoo2zm x000 Michelle Franklin, CFA-- Saint Lucie County Property Appraiser--All rights reserved. Property Identification Site Address:Dyer RD Use Type:0000 Sec/Town/Range:25/36S/40E Account#:41201 Parcel ID:3414-501-1412-100-7 Map ID:34/25N Jurisdiction:Saint Lucie County Zoning:RM-5-Cou Ownership David Ingram Alicia Ingram r � + 201 Indian Hills DR M s• ° t - �. Fort Pierce,FL 34982 Legal Description �F ST LUCIE GARDENS 25 36 40 BLK 2 S 165 FT OF N 330 FT OF LOT 12 (1.31 AC)(MAP 34/25N) Current Values a�8s Just/Market Value: $70,400 Assessed Value: $35,271 s :a Exemptions: $0 •-,�u x' '�� �.� ,.. ,e..?. D �.-: �1 ._:.�.��e�:_� Taxable Value: $35,271 Total Areas Property taxes are subject to change upon Finished/Under Air(SF): 0 change of ownership. Gross Sketched Area(SF): 0 Land Size(acres): 1.31 • Past taxes are not a reliable projection of future taxes. 57,063.E The sale of a property will prompt the removal of all Land Size(SF): exemptions,assessment caps,and special classifications. Building Design Wind Taxes for this parcel: SLC Tax Collector's Office Download TRIM for this parcel:Download PDF© Speed Occupancy Category I II III&IV Speed 140 160 170 Sources/links: All hiformation 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. St. Lucie County Health Department 5150 NW Milner Dr Port Saint Lucie, FL 34983 PAYING ON: #:56-SF-2367576 BILL DOC#56-BID-5586092 CONSTRUCTION APPLICATION#:AP1728701 RECEIVED FROM: Homecrete Homes AMOUNT PAID: $ 660.00 PAYMENT FORM: CREDIT CARD 7836a _ PAYMENT DATE: 09/07/2021 MAIL TO: David and Alicia Ingram FACILITY NAME : PROPERTY LOCATION: TBD Dyer Rd Port Saint Lucie, FL 34952 Lot: 12 Block: 2 Property ID: 341450114121007 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 52 j (a 5 1 $ 115.00 RECEIVED BY: EvansJS AUDIT CONTROL NO. 56-PID-5224035 Ron DeSantis Mission: Governor To protect,promote&improve the health of all people in Florida through integrated -' it state,county&community efforts. HEALTH Joseph A. Ladapo,MD, PhD 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(c-D-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-WELLSCU)-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 Accredited Health Department Phone 772-873-4931 Public Health Accreditation Board Fax 772-595-1306 FloridaHealth.gov