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Home My WebLink AboutWELL CONSTRUCTIONSTATE OF FLORIDA PERMIT APPLICATION TO CONSTRUCT, ;"F"r�, REPAIR, MODIFY, OR ABANDON A WELL iW Southwest PLEASE FILL OUT ALL APPUCA8IF FIELDS Applicable] (-Denotes Required Fields Where A CNorthwest x > � "._ • St. Johns River outh Florida The warermll contractor it responsible forcompleting fhirform ordfomarding the Permit appfico6onro'be tic nSuwanneeRiver appropriatedelegaredauthoriryrohereopphwble. r4i„ G DEP 2Delegated Authority (If Applicable) - No. ID Stipuledony Required (SeeAttmhed) Quad No. Delineation No. UP Application No. Well Location -*Address, Road Name ortvurrtucl, v y 3. 3 ! �{ - O - IZ -15g -''t Lot Block Unit Parcel ID No. (PIN) or Attemate Key (Circle One) Check if 8Y-624:❑ Yes a• 25 No 0 L 4 (,(�ti Subdivision _ '°�'�"— —�--- 'Section or Land Grant 'Township 'Range 11247 County772-878-6698 abs olutewate^�er�,yarr�emaU Com 5• Tim water Well -Water wWell contractor is — License Number Telephone Number E-mail Address t St. Lucie Florida 349883 Port s, 258 SE Volkerts Terrace city State ZIP Water Well Contractors Address 7. Type of Work: Construction ❑ Repair ❑ Modification[] Abandonment Reason for Repair. ModRiralian.arAbendonfftM 8. 'Number of Proposed Wells �_ a amp 9. Specify Intended Use(s) of Well(s): Domestic 8 Landscape Irrigation ® Agricultural Irrigation ® Site Investigations Bottled Water Supply , Recreation Area Irrigation Nur stock Monitoring Public Water Supply (Limited Use1DOH) P NurseryIrrigation Test Public Water Supply (Community or Non-CommwigrlDEP)Commerefalllndustriai. F r&Coupled Geothermal Class I Injection Golf Course Irrigation F VAr Supply HVAC Return lass V Injection: ❑ Recharge ❑ CommerdaUlndusbial Disposal ❑ Aquifer Storage and Recovery ❑ Drainage Remedlation: ❑ Recovery ❑ Air sparge ❑ Other to---) official Lice Onl (l Other IDesaibe) d St o Into 'Distance from Septic System if 5 200 ft. Ill. Foal Desc 1 9o"—rt"t�-o—J C ' Estimated Well Depth 1- it. -Estimated Casing Depth iL Primary Casing Diameter Estimated Screen Interval: From To — it. 'Primary Casing Material: Blade Steel x Galvanized PVC Stainless Steel Not Cased Other Secondary Casing. Telescope Casing Liner Surface Casing Diameter In. 17. Secondary Casing Material: Black Steel Galvanized PVC Stainless Steel Other 18.•MethodofConstruction, Repair. orAbandonment Auger x Cable Tool Jetted Rotary Sonic Combination (Two or More Methods) Hand Driven (Well Point, Sand Point) Hydraulic Point (Direct Push) Horizontal Drilling Plugged by Approved Method Other (aewbe) 19. Proposed Grouting Interval for the Primary. Secondary, and Additional Casing: From To Seal Material ( Bentonhe Neat Cement Other 1 From To Seal Material ( Bentonite Neat Cement Other t From To Seat Material ( Bentonite Neat Cement . Other l . From To Seal Material ( Bentonfte Neat Cement Other 1 20. Indicate total number of existing wells on site r) _ List number of existing unused wells an site 21.'Is this well or any existing well or water wrawal on the owners contiguous proper�tyy covered under a Consumptive/Water Use Permit (CUPAANP) or CUPANUP Application-? Yes No If yes, complete the following: CUPAMJP No. District Well ID No. 22. Latitude Longitude 23. Data Obtained From: GPS Map Surrey Datum: MAD 27 NAD e3 WGS 84 Irerep)cemryLtY.lvq cel-rnm �e uN�•rGa•'.dnUirle �a, Fiarr_]PLfi:rNaP'e Cade ud:�a:abatet tClA?)tne:leee tie oAT.efUL�eF•ODIRJ.J`Y4'eL"1fY.w�jlO,nElC if iCN'Y:C. 9fJ1hT.l]T,.MirCCR/ ase cerm'iwarMSat reptarge neon: dneededtus eeen!rvslt Le etlSsed rCa•ta aalcmen;emen: etweR raxmtilxea uraar Caeeter]71 �nsia 5!atus-gni*.!am vrrr�el, abandendiQ,aef a.tcG.?1 Matt sin :Chet^.r i!YI- ifaMO.•Cela'yAal aOmrvratmn nrCWy mt? aSg dues, 9a: wa erd lost Iwo Ulm NeeQlm lT ter aN•IC.Mil'me'r'a?db:DpO%CS�AiLaB:e�WoLhY'I Nie Cltt l:!lea:^e GPILLK Y. tPN. rY:estwyaFpravil!!e*ea:e•fedmal tVute,a N:ataavetemer•.a. Racyknyree tle. ifop•evoeauNl •ena:imaIn AS Med aY.ve. ar.�er taroe'^sto aBan>73 cenc^nN o::ns 5�1ADm Ce!earte7 P��nry. artsa aaa'Atel'ao•CFod totae.D6tr.:wenin 7a dabsa'!e• ezrnlar:n tithe tonlru2m Two m066;� 'a• FONe'A +SM1edu•=jLheLWJ�..Jt repilme,:.fi3'A•l elf6MdefLTWLi4'.de tea E%Ch`G 98'•]:L aall!Sa ••naerar4wtymct-T.d C^-,d Krrt AP'LTon, whi�nMt:a:1:l �T: e 11247 Sxanature of cant License No. Signaturo of Owner it Agent 'Date APprovid Granted BY 12. Estimate a a Open Hole: From --To — ft- issue Date Expiration Date Hyde Approval kniab Fee Received $ Recdpt No. Check No. THIS PERMIT IS NOT VALID UNTIL PROPERLY SIGNED BY AN AUTHORIZED OFFICER OR REPRESENTATIVE OF THE WMW PERMIT SHALL BE AVAILABLE AT THE WELL SITE DURING ALL CONSTRUCTION, REPAIR, MODIFICATION, OR ABANDONlt 1 DEC 0 f A7- p-(', AI TiING St. Lucie County, FL Permit No. SpuTMVE5T FL0MA WAIMMAMAG�i1BiTDM"a 2379 BROAD STREET, BROOKSVILLE, FL 34604 PAVE: ( SfATE.FL US 423-1476 ST.jo MSMMWAMMAMAGBWffDISTRICT 4049 REID STREET, PALATKA, FL 32178-1429 PHONE: (385) 329-4500 VWWY.SJRWMD.COM MoRTHWESTFLOMDA WA79tMAMAGBMfrDMUCT 152 WATER MANAGEMENT DR., HAVANA, FL 32333-4712 (U.S. Highway 90,10 moss west of Tal ahassee) PHONE' ( ) 539.6999 W WV.N AD.STATE.FLUS SOM FLOMDA WAIM MANAGBIBNT DIM Ma P..O..BOX? 3301 GUN CLUB ROAD WEST PALM BEACH, FL 334164M PHONE: (561) ®Sti`M *M-SFWMD GOV SiUWANN)B OMWAYMMAM MUMDOTIM 9225 CR 49 LIVE OAK, FL 32060 226- PHONE: aM 362NEERIVER) - 1066 (Fbrida only) 417 V-) fe OPO--, bmn Waft Ww eta de0rf n ftM d .VMMpqkftarsftKbmg@6 gepbc a awM wwouyhuafft ad oonlsnhoft M appYw 3kL DEP Farts 826M9000) Itrapor0led rn G2-532ACgl)6FAQ Effac w o@W 7, 2010 , Papa 2 d 2 Michelle Franklin, CFA — Saint Lucie County Property Appraiser — All rights reserved. Property Identification' Site Address: Dyer RD Parcel 1D: 3414-501-1412 350-4 Sec/Town/Range: 2556S/40E Account #: 41206 Map ID: 34/25N Use Type: 0000 Zoning: RM 5 Jurisdiction: Saint. Lucie County Ownership Michael Peterson Ericka Fultz 673 SW Kayak AVE Port St Lucie, FL 34953-6425 Legal Description ST LUCIE GARDENS 25 36 40 BLK 2 S 165 FT OF N 1155 FT OF LOT 12 (1.31 AC) (MAP 3425N) (OR 3998-1793) Current Values Just/Market Value: $27,600 Assessed Value. $26,940 Exemptions: s0 Taxable Value: $26,840 Taxes for this parcel: SLC.Tax Collectors Office© Download TRIM for this parcel: Download PDF 19 Total Areas Finished/Under Air (SF): 0 Gross Area (SF): 0 Land Size (acres): 1.31 Land Size (SF): 57,063.6 This information is believed to be correct at this time but it is subject to change and is not warranted- 0 Copyright 2017 Saint Lucie County Property Appraiser. All rights reserved.