HomeMy WebLinkAboutWELL PERMIT SepA-i G too: 2 2i r� 1
Ot tH �Jq! STATE OF FLORIDA PERMIT APPLICATION TO CON57R''(.i,
/ir~ fi REPAIR,MODIFY,OR ABANDON A WELL' Permit No. nQ
%i Southwest Flprida Unique IQ ti
J ~ f•!Northwest (*DenoFILL Required Fier sAfl One a Applicable) PerYA
mit Stipulatwna Requueu(See Attacneo)
'
:. the wear wart t otnrrlrror is An roi ivele far rem r�� LISt.Johns River
�LSOuth Florida l r!labo r —
1' 7LL.qloftnmtdlunvnrrhngdiepwudtnpplurd,unrnrin 62-524 QNnd No, Delineation No,
op 0 Suwannee River r+Ppropnntrdlvts7fla,7rrufhmrywiwnnppbraura ---
0 DEP L'UPNVUP Application No,
ODelegated Authority(If Applicable)
1. 1
" caner.Leg I Name if o pore Io ress "City S to ZIP Telephone NUrnber�
'0elIL,0cation:_A_d ea ,Road N le or umber,Ci
Parcel ID N (PIN)or Altar Key(Ci:c lie) t\i� t �r� _ Lot Block Unit
4' Check if 62-524:❑ Yes [tf No
ction L nd Gran Town ip ange 4 1 County Subdivision
"Water Vyalt Ontractor� r .. 'License Number l Telephone N mbe. � E-mail Address
6.
`Water Well Con actors Address City State
7. -Type of Work: Constru Lion ❑ Repair ❑ Modification❑ Abandonment
8. 'Number of Prop psed•Wells �� Ruosen ter Repair Modficalion.or Aoanuonrmont
g. "Specify Intended Use(s)of Well(s): rD ( o p
Domestic Landscape Irrigation Agricultural Irrigation Site Investigation
Bottled Water Supply 8 Recreation Area Irrigation 8 Livestock 8 Monitoring (�
Public Water Supply(Limited Use/DOH) ❑ Nursery lrrigatlon Test
PublicInjection
Water Supply(Community or Non-Community/DEP)(] Commercial,Indu,trial Earth-Coupled Geothermal J N 3 1 ��22
CIBSS i InJ2Cti0n ❑ Golf Course Irrigation HVAC Supply
pP Y
HVAC Return
Class V Injection:❑ Recharge ❑ Commercial/industrial Disposal 0 Aquifer Storage and Recovery❑ Draina,�gg�e
Remediation:❑ Recovery(] Air Sparge ❑ Other (Dobcobe) t 0 1 i in !_.)Ir"
❑ Other (Describe) E N V I Ottic ,Use Oftly
10.Distance from Septic Sys1pirn if 5 200 ft. 11.Facili Description _ 12.Estimated Start Date
1:3."F.stimaled Well Depth fl. stinrated Casing Depth ft. Primary Casing Diameter. f�n. Open HOW From To ft.
14.Estimated Screen Interval:From_Y To 42Q.ft.
15.`Primary Casing Material: Black Steel Galvanized (P)VC
Stainless Steel
Not Cased Other: _
16.Secondary Casing: Telescope Casing Liner Surface Casing Dlanleter in.
'17.Secondary Casing Material: Black Steel Galvanized PVC Stainless Steel Other
18.'Method of Construction,Repair.or Abandonment: Auger Cable Tool Jetted Sonic
Combination(Two or More Methods) Hand Driven(Well Point.Sand Point) Hyd Rota int(Direct Push)
Horizontal Drilling Plugged by Approved Method Other tcwso,w)
19.Proposed Uling 1 r I for the Primary.Secondary,and Additio J.st
From To Seal Material( Bentonite a Other I
From To Seat Material( Bentonite alit 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 witVwN
n the owner's contiguous roper covered under a Consumptive/Water Use Permit(CUP/WUP)
or CUPNVUIP Application? Yesf yes.complete the following:CU)''/WUP No. District Well ID No.22.Latitude
23.Data Obtained From: GPS Map Stirvey Daturn: t27NAD 83 WGS 84
I hemby cony Utal I Wb eeltpiy"0 We oRpkAbId fdosof TPie Ia,F A 1i,...1,At Cok,..J that a wnle. I em by null um the o I thot al. ".w Pmmt o' mk.11.0.ty.Pmnnt.11 n.rtWu,Ma Uscn w.4 be obbimod rywt m oomm.ncwml of w.0 mspon.m�Ibn.unUef .01 3aW1U..to mW.Wits 4f af.P"Iy.1—don A*WWI'w.I Nnify 1he11 on1
iWntnt.aminnnehan PravktuJn WunP1`rlfaWm ir,n—.1.n 4[haliw11 r.1P.n1 Il.e ngoulMme lh.l t. 1" PeeW aoWulo-d lh.l l barn u,W—tl a,a—or.I Ulm
d atnW.w l4wl tlaveuU,mnU,.dawilublo.I bprnn In W1rv1aP n x'o1 ISPNNOAU, as%1 RJt to allpwntg rMillom.l of PW t0JM0 a1 OPlee.t.A A%iihWny a"*%-In Uu,WN't W.l,,nnp..11.rrnmPlcb.,Aol Uriw.11n dun . a ttnluntml b.Mo.P.un[nr the Pnrnw uxpN' po W.r,hq t oebwa M.S.'S latur o Contra for Lloense No. •Sign y _ Date
ONLY 0"NOM11
Approves Gran d B Is Ie Dote �_ Expiration pate I Hydrologist Approval
I,Jt1�� In b.b
Fee Received S .00 Receipt No. heck^ heck No.
THIS PERMIT IS NOT VALID UNTIL PROPERLY SIGNED BY.4N 1.1T1 ORIXED OFFICER OR REPRESENTATIVE OF THE WMO OR DELEGA•rED AUTHORITY. THE
PERMIT SHALL BE AVAILABLE AT THE WELL SITE DURING AI_l. NSTRUCTION.REPAIR.MODIFICATION,OR ABANDONMENT ACTIVITIES.
DEP Form.62-532.900(1) incorporated In 02-532.400(1).F.A.C. Erfartive Date•Oclober 7,2010 Page 1 of 2
�r7twvu�t+JfUvbT79o+3'wt7mNum VOIUO-U 3OU31d'li
o+.anouae:s�vn�n,.w7 "••.• OVOU HOIUIn
S D •ONi`saaavne vrzoao
A3A8ns OIHdVtlOOd01 ONV AUVONnos
jig
.y _fl 61
Vill
0 a e Y b g 5 5' b� � Rgga � Y e F- � h' Z ¢'
e
y yYII _gg 5' a
yvyyy gQp p� yet s5 q � t <o '15i
Z Q 1p ? Y
111
lift I
J •�8o�tl�:�'3�•�e�o6�.go o_C' � _ yg U LL is �tA'dttpzll
7nN3nv 0— € > < W- I $
2
PA
_ 0Q
o U =
@ = Z
zcr I
cq
CIO
y 4
a ° -
'/ LL Z
I � a 6 ens
lit
Ilk
iF .aar 791.DL9$ I 8
I I I
I I I p
I
bD
'I`��1_��-_- -- ___ -_ ,bt r4• .e,r,t �_m a•DD�s— wL
e
-- --.—....--1--. — -- --..— ��— -.'— �w-
-. ..-- -- -- -- -- —_
� $ au<.n urnmr aD a v.u,.sr c r"ua •.Y I
g d 4 I
4
�g I
s�
� n °5
ellI
Michelle Franklin, CFA-- Saint Lucie County Property Appraiser --All rights reserved.
Property Identification
Site Address: 545 ULRICH Parcel ID:3410-243-0001- Account#:40352 Sec/Town/Range: 10/36S/40E
RD 020-8 Map ID:34/1 ON Zoning:RS-2-Cou
Use Type: 0000 Jurisdiction: Saint Lucie
County
Ownership Legal Description
William Gee Roe III 10 36 40 W 1/2 OF SW 1/4 OF SE 1/4 OF NW 1/4-LESS N
Nadine T Roe 206.25 FT AND LESS RD R/W-(3.32 AC)
1836 SE Fallon DR
Port Saint Lucie,FL 34983
Current Values Historical Values 3-year
Just/Market: $119,100 Assessed: $119,100 Year Just/Market Assessed Exemptions Taxable
Exemptions: $0 Taxable: $119,100 2021 $119,100 $119,100 $0 $119,100
2020 $83,900 $83,900 $0 $83,900
2019 $83,900 $83,900 $O $83,900
Sale History
Date Book/Page Sale Code Deed Grantor Price
08-28-2020 4477/2644 0001 WD Gamboa Crisanto $137,500
09-27-2018 4187/1273 0001 WD McClary(TR)Charline P $107,000
05-10-2010 3198/0082 0311 WD McClary Charline P $100
Primary Building Information
Finished Area of this building:0 SF
Gross Sketched Area:0 SF
Exterior Data
View: Roof Cover: Roof Structure: Building Type:
Year Built:N/A Frame: Grade: Effective Year:N/A
Primary Wall: Story Height: No.Units:0 Secondary Wall:
Interior Data
Bedrooms:0 A/C%:0% Electric: Primary Int Wall:
Full Baths:0 Heated%:N/A% Heat Type: Avg Hgt/Floor:0
Half Baths:0 Sprinkled%:0% Heat Fuel: Primary Floors:
Total Areas
Finished/Under Air 0
(SF):
Gross Sketched Area 0
(SF):
Land Size(acres): 3.32
Land Size(SF): 144,619.2
Total Building Count: 1
Special Features and Yard Items
Type 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.
0 Copyright 2022 Saint Lucie County Property Appraiser.All rights reserved.
St. Lucie County Health Department
1 5150 NW Milner Dr Port Saint Lucie, FL 34983
HMTH
'AYING ON: #: 13ILL Doc#:56-BID-5741950
RECEIVED FROM: American Drillinq 2411 AMOUNT PAID: $ 115.00
'AYMENT FORM: CREDIT CARD 073907 PAYMENT DATE: 12/22/2021
MAIL TO: American Drilling 2411
Okeechobee FL 34974
::AGILITY NAME : American Drilling 2411
'ROPERTY LOCATION:
Okeechobee FL 34974
Lot: Block:
Property ID:
EXPLANATION or DESCRIPTION: QUANTITY FEE
-1 -Well Construction 1 $ 115.00
RECEIVED BY: AdamsC AUDIT CONTROL NO. 56-PID-5413977
Note: 59-32799- 1 0"ne-y c or-\L-e
01"C A-