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Home My WebLink AboutLANDSCAPE IRRIGATIONSCANNED �;- Sy =� talovv� STATE OF FLORIDA PE � i�Fj,�/Q�r) ONSTRUCT, REPAIR, �o MODIFY, OR A L Southwest i 1 w, PLEASE FILL OU r ALL APPLICr.BLF FIFIDS Cl Northwest ('Denotes Required Fields Mfe Applicable) L1SL'Johns River • 7fm+ynca rdvrronnarrar nras(!rnAl7lr lora,ra hriin ❑ South Florida ;yrl hW s iGls !arras .+W 1Cn'ri:ruutq the pt'Irrnr npPL<or%air it, rase USuvrannee River J)r)(ppl:)r{'llrr jL,'rlltlJ:.hhFrr}WIWJ{'lp,T)rrcn;e• ❑DEP Cl Delegated Authority (If Applicable) 1. J Paul Mahfood 2807 Bent Pine Drive Fort Pierce! FL 34951' Legal 2. tdU? 5acicllebrook Drive Port St Lucie FL 34986 .Well Location - Address. Road Name or Number, City 3.3321-601-0009-000-6 'Parcel ID No. (PIN) or Alternate Key (Circle One) 4.21 36S 39E St Lucie 'Section or Land Grant 'Township 'Range County 5. American Drilling Services, Inc. 2411 'Water Well Contractor 'License Number 6.405 SW 2nd Street 'Water Well Contractor's Address Pemii: NO S9- Florida Unique ID Permit Shpuldbons Required (See Attached) Quad No. Delinesnon No Aripiicaucv, No 770-241-5488 'State ZIP Telephone Number 9 _ Lot Block Unit Sabal Creek Check if 62-5241:1 Yes ✓❑ No Subdivision 863-763-3221 3.krboys@gmall.com Telephone Number E-marl Address Okeechobee Florida 34974 City State 71P 7. 'Type of Work Q Construction ❑ Repair ❑ Modification❑ Abandonrr ent 8. Number of Proposed Wells IT_ 'Rcal—m IV Repa' 6trj. •• 9. 'Specify Intended Use(s) of Weil(s)- Domestic (� Bottled Water Supply n Landscape Irrigation ❑ Recreation Area Irrigation ❑ Agricultural Irrigation H Site Investigations Lrtii ❑ Public Water ❑ Livestock Monitoring Supply (Limited Use/DOH) ❑ Public Water Supply (Community or Non-Community/DEP)❑ ❑ Nursery Irrigation Commerciallindustrial ❑ Test Earth Geothermal ❑ Class I Injection ❑ Golf -Coupled Course Irrgatior HVAC Supply Class V Injection: ❑ Recharge ❑ Commercial/Industrial Disposal ❑ AquiferStotage HVAC Return and Recovery ❑ Drainage Remediation: ❑ Recovery ❑ AIr Sparge ❑ Other (Describe$ ❑ Other mosenbe) 10: Distance from Septic System if <_ 200 ft, 11. Facility nescripllon 13.'Eslimated Well Depth LIX—ft. 'Estimated Casing Depth ft. Primary 14. Estimated Screen Interval- From/ZD To i 4,c) ft. 15.'Primary Casing Material: Black Steel Galvanized L PVC/ Not Cased Other: Diameter Stainless Steel 16. Secondary Casing: Telescope Casing Liner Surface Casing Diameter - in. AUG 2 8 20 hi St lode 12. Estimated Start Date Nov 2017 _ . Open Hole- From To ft. 17. Secondary Casing Material: Black Steel Galvanized PVC Stainless Steel Other 18.'Melhod of Construction, Repair, or Abandonment Auger . Cable Too] Jetted ((Rotary Sonic Combination (Two or More Methods) Hand Driven (Well Point, Sa(1d Point) Hydraclk ijol�Direct Push) Horizontal Drilling Plugged by Approved Method Other ,'vllescrber_ _ 19. Proposed Grouting interval for Inc Primary. Secondary, and Add tiorlaI Casing From To Seal tvlaterial ( Bentonite Neat Cement `Other at Ce .i ) From To Seal Material ( Bentoni(e Neal Cement I Other ) From _ To Seal Material i Bentonite Neat Cement Other ) From To Seal Material ( Bentonite Neat Cement Other ) 20. Indicate total number of existing wells on site 0•0 List number of existing unused wells on site 0.0 21.'Is this well or any existing well or water withdrawal on the owners contiguous properly covered under a ConsumptiveNVater Use Permit (CUP/IA/UP) or CUPM/UP Application'? Yes ✓ No If yes complete the follovnnq- CUP/IJVUP No. District Well ID No. 22. Latitude Longitude 23. Data Obtained From r GPS ( Aap Survey Datum: NAD 27 NAD 83 WGS 84 t hLreGr ceinh UIM 1 siA ivRPlr,nN p•C at'H:rASt. (W4 Or I Jew �� Wncna,n't'rpAn l L�.,I a,w:ir i ce�4•y'.n]I t , R e - - , t 1 y ery rr.01 me �+'c•rnoT ( OrtF• A 1•. a4'ctnetr, nnAVul (•tin rerar,r of my J tte{ C,RUI pf ni(1(:Gifl feCi'A(e4' P4"'it r P4�i 1 i „ he a � r ' oGr}:rC Api�fn�eOMna'rrncc or twp M0U 0' �t U..t Che .'•r ] n'. i:lv Sa:u:es, N rn�:etea• w praLG N'ih3nU7r, nt] v:p, ta, r ([rt': rhJt 1 er•, ., +.vucwt hall er Lei• h L+m ep nhr pl. n p _A d h t n min 1 nil tm;,a ne a; en. tq C,0 ura.or • n ur trrmma^„n ❑p ACA ncr rive nnA •rim I hnrr mWme9lRt U::^.- u19•av n�us�,vv .,pMnrr? e f h +last. hi tat r Wo ln!s A ppr} tte. 1 nriiec Ip pmridr n —0 pun t L� c .tc Bunn .r.pn drnrr cnn' 4. w L n� prraum:f of nw ,htAD nr Or(r[rr�.•a .::r, n :r, �.as.w Lein, ktwn ,OPpn iq et. b;¢I i.t n�nin .0 ¢iys nre D"1(d :nn Af et C' 14•hpn, Inp:ttr, rtW}rx�,CIM Or StT Lhe ,sip :,n•rurtr..p Ih L a. x, rn}n rw tvdl'pGnn, e, nt9nAM,nnn1 nt ft+tTn f nY'1+;� ((tint uhnn+m merit nuS,ome-0 br ur. pamrL ut die P•+{'M e- e4.ryn, viurherer pcaus fist. 2411 _� 08/11/2 1 'Si 'atur of Contractor --- —' " -'—� -- — - -License No. Signature of . ner or Agent Dat v Approval Grarnled By Issu a S� _ Exp; •^n Date Z L Hydrologist Approval Fee Received s inp,h. 4 Receipt No. Chec No. _ THIS PERMIT IS NOT VALID UNTIL PROPERLY SIGNED BY AN AUTHORIZED OFFICER OP, RFPRESENTA, 4 AD OR ELEGATED AUTHORITY, rHE PERMIT SHALL BE AVAILABLE AT THE WELL SITE DURING ALL CONSTRUCTION REPAIR., h10DIF-ICATION OR ABANDONMEN ACTIVITIES DEP Form 62-532.9000) Date' October 7, 2010 ' 1 or 2 E J STATE OF FLORIDA PERMIT APPLICATION TO CONSTRUCT, �.otTxe�o REPAIR, MODIFY, OR ABANDON A WELL ❑Southwest zal ° w ❑Northwest PLEASE FILL OUT ALL APPLICABLE FIELDS ('Denotes Required Fields Where Applicable) V �° ❑St. Johns River rile water well Contractor is responsiblef'orcomplering OSoulh Florida r m ��[ IN; ondfarwording, Ihepermh oAvlrcotion ro rrle o❑Suwannee River oppropHate delegaledowhorfry where oppflcobfe O DEP l7 Delegated Authority (It Applicable) n I 1. 1 fi&Jk 02� �` �i rt.Q ay-, F-P. 'Own Legal Name if C r or lion 'Address ity 2. 1837_ Secdc VC., D-e YS 3yy 'Well Location - Address, Road Name or Number, City 3. 337-1--15701 e n 11,9-ooe-i -r� 5� -5F- / 7 Permit No. Florida Unique ID �� 5 Permit Stipulations Required (See Attached) I62-524 Quad No. Delineation No. I CUPMUP Application No. 'State 'ZIP Telephone Number 'Parcel ID o. (PIN) or Alternate Key (Circle One) Lot Block U 4. ZI 36 S_ 5%(4(I'-C Check if 62-524:0 Yes 0 'Section r Land Grant 'Township 'Range 'County Subdivision 5. /t wia- IJrt1f; nq .vcra -, s 7,qh kwf . 7(,,3 -3Z 2-1 3krb�ys �y1 a .f r 'Water Well Contractor 'License Number 'Telephone Number E-mail Address 6. 4l65J W Lnasr OKteGl�ohCe *Water Well Contr;ar's Address City State ZIP 7. 'Type of Work: IXI .,c%�Construction Repair Modification0 Abandonment 8. 'Number of Proposed Wells i 'Reason for Repair. Modir"Son, or Abandonment 9. ;Specify Intended Use(s) of Wallis): ` D � ry0 Iu�(' Domestic 8 Landscape Irrigation ® Agricultural Irrigation Site Investigations a (' fw(JUJj(`(4/�� Bottled Water Supply Recreation Area Irrigation Livestock 8 Monitoring ❑ Public Water Supply (Limited Use/DOH) n Nursery Irri ®Class I Injection gation 0 Test Public Water Supply (Community or Non-Community/DEP) Commercialllnduslrial Earth -Coupled Geothermal i1 DEColf Course Irrigation HVAC Supply Cli �� HVAC Return' Class V Injection: [3 Recharge [] CommerciaUlndustrial Disposal 0 Aquifer Storage and Recovery [] Drainage Remedlation: 0 Recovery ❑ Air Sparge Q Other ioaseribs) "311taktom on 0 Other (oetscoo) E MRMWF- 10.-Distance from Septic S ste If < 200 fL 11, Facilit cription 12. Estimated Start Da e'ttc 13.'Eslimated Well Depth ft. 'Estimated Casing Depth s ft. Primary 'Casing Diameter in. Open Hole: From To It. 14. Estimated Screen Interval: From t � l To In it. 15.'Primary Casing Material: Black Steel Galvanized PVC Stainless Steel Not Cased Other: 16. Secondary Casing: Telescope Casing Liner Surface Casing Diameter in. 17. Secondary Casing Material: Black Steel Galvanized PVC Stainless Steel r 1 B.'Methad of Construction, Repair, or Abandonment: Auger Cable Tool Jetted Rotary Sonic Combination (Two or More Methods) Hand Driven(Well Point, Sand Point) Hydrau In (Direct Push) Horizontal Drilling Plugged by Approved Method Other jooxra:e) 19. Proposedf uting Int f r the Primary. Secondary, and Ad Re : From / To Seal Material ( Benton@e Neat Cement Other ) From To Seal Material ( Bentonite ea emen . Other ) From To Seal Material ( Bentonite Neat Cement Other ) From To Seal Material ( Bontonite 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 existingg ell or water witCN the owner's contiguous property covered under a Consumptive/Water Use Permit (CUPiWUP) or CUPANUP Appw licafion7 YesI es, complete the following: CUPANUP No. District Well ID No. 22. Latitude _ tuoe 23. Data:Obtained From: GPS _ Map Survey Datum: NAD 27 NAD 83 WGS B4 uselPe' Merlbellwlcargvy-ml. dllaa cabbrutit oram+alloe re ime ytl1 ej..1 aler Icsn:ty NaIIP.IneDM.Dr InD DDDc+Ir.IftW tb04110111�Iga gadded it OGGWPIa, icA lrHl rC(II ai1AeD}R.y ute pminf a anaµV reNffiav perm►, d naaaeq nD1 Ceul or ww bP omaiutl plat to cemmenromeal alrA rr-pvns�11ir1 uMur ChaplPr �; ), fbrida StabAvl, w rr�:nbin a propmiy abunavn do ndt m.I cmlyr lhM l em GOnllnrtlion. IIYMCIGN}/Ihe is blfYTi6WIDr0'/IOCa in I1ri01a7piiealiWlie DCCurAb affa lF-0I A»i1 Ga4tin Pp 49" In Ao awn., vW Ina We'. orAva isattvDle, vnv Wet l tun IWU"4 04 pwDerA llK'r neufeary aeymry bam dlw.iCOeraL able. arizrafcaemmene,l�n.,e-�n,w i,,,..n-,......•--..-.. by Mlc r¢1po yb10n w adrd obara. ewri. u to aaoeriMr peamnvl yr tN1 YJMe or D.tyarev APD�Iy te:sui to Ue cocoa lib Jvrina Pie [onSlNctgn, oaii. a,n[aaWl, of rlbenaonmvA DPUw¢x9 br ayl veix•,1. Stgneturo of Owner or, Approval Granted By. Issue Dale l Z Zz 10Ewf6tion Date D / Hydrologist Approval __\ 4 Fee Received S Receipt No. Check No. L� of THIS PERMIT IS NOT VALID UNTIL PROPERLY SIGNED BY AN AUTHORIZED OFFICER ORAEPRESEM1TATIVE OF THE WMD OR DELEGATED AUTHORITY, THE PERMIT SHALL BE AVAILABLE AT THE WELL SITE DURING ALL CONSTRUCTION, REPAIR, MODIFICATION, OR ABANDONMENT ACTIVITIES. DEP Form: 627532.900(1) Incorporated in 62-532.400(1), F.A.C. Effective Dale: October?, 2010 Page 1 c