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HomeMy WebLinkAboutCONDITIONS FOR ISSUANCE OF WATER WELL PERMITSy' *., s Rick Scott Mi sion: �';�'"<. ,,�^ Governor To otect, promote 8 improve the healthy q� I�R ',M +` d P p M3CANNED of all people in Florida through integrated Celeste Philip, MD, MPH state county 8 community efforts. BY State Surgeon General and Secretary St. Lucie Count, HEALTH 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(a),FLH EALTH. 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-WELLS(aD_FLHEALTH.GOV Submit revisions to permit and/or site map and associated fee within 48 hours of well construction or abandonment. Florida'Ipepartment of Health St. LuciQ1County • Division of Disease Control and Health Protection Bureau f Environmental Health 5150 (Milner Drive Port St I Cie, FL 34983 Accredited Health Department • : Public Health Accreditation Board • FAX: 772/595-1306 l STATE OF FLORIDA PERMIT APPUCATiON TO CONSTRUCT, REPAIR„ MODIFY, OR ABAND014 A WELL �QttiEaT,y. y 's, 13 Southwest PLEASE FILL OUTALLAPPUCABLEFiELDs O Northwest (Denotes Required Fields VVhereApplicable) O'St Johns River , ThecooterweNmntracrerkrusPonslbfcloriampleUng IJSouth Ftanda thfsfoiniarid(oiurrJdngthopenn/tapPlica6oatothe' �� :• + L7 Suwannee River 2pp.mpdatedelegatedauMado0emappiimbla rye' 0 DEP 0 Delegated Authority (iiApplicable) Florida Unique ID Permit Stipulations Required (See Attached) 62-524 Quad No. Detineeilon No. I��.,a i�/�.-1 •ia/ •� .f'-t'rs #29 2z & gxrs A-p-it PA P; �-ce Ft •OwneyLegal•NaMe'ifCorporaVoA"Address 'City •State "ZIP 2. •Parcel. ID No. (PIN).. Itemate Ke (Ci Cie One) Lot Block Unit !Sec norLarid`Grarrt ToVrnship *Range -county Subdivision Check if 62-524 Yes _ No *Water Weil Contractor icerise-Number *Telephone Number E-mail Address _ . *Type of Work Construclian ..Repair _Modification _Abandonment *Number of F7oposed mils _ I __ 'won for itapaV,14odlGwUon, or A ent "Speafy intended•Use(s) of V►411(s): A Domestic TLandscapeIrrigation Agricultural Irrigation 8ite.tnvessigation :]Bottled Watet'Supply TReoneation Area Irrigation _Livestock _,Monitoring _Publlc Water Supply (Limited Use/DON Nursery Irrigation Tom? PubtiWa a ter Supply (Community or Non-Community/DEP) �O erriaUtndustriai �i;arth-Coupled Geothermal OCT 1 5 2018 _Goff Course Imgalion _HVAC Supply Class I Injection _—_-Puff Return lass V lirjeclion: Recharge CommerciaUinaustriat Disposal Aquifer Storage and Recovery _,.,_Drainage errrediation: ----.�Rewvery AirSpaige •Other(Dawftj OH I y%Ol _,Other Ioascbbe) (Nola: Wall "oa of wa:lt me permiita i by a ylyan pormUQng we I *Distance from Septio System IfFacilityDesrxiptiorr!C,,AS f=4 n. l i 12. Estimated Start Date 1 w I't~stimated Well Depth 7 —'5_R 'Estimated Casijtg Depth 4o % •PrimaryCasing 131ameter.,,__2 in. Open Hole: From To it Estimated Screen Interval: FromAz'To 2 Lit. � /' 1'Primary Casing Material: „_ Black Steel _ILGelvanized PVC Stainless Steel NotCased Other. Secondary Casing: Telescope Casing _ Liner Surface Casing Diameter in. ..Secondary Casing Material: _ , TBlack Steel Galvanized ./ PVC Stainless Steel Other .*Method of Construction, Repair. orAbandonment Auger CabieTool Jetted . Rotary Sonic Combinallog.(Two Aar More.Methods) Hand Driven (Well Point, Sand Point) Hydraatic Point (DirecFPush) liorizorital pdiGng .Plugged bgApproved Method Other (oesulbe) Proposed Grouting,Intetval ipfthe Paritary, Secondary, and Additional Casing: From. - To Seal Material (Behton(te Neat -Cement Other From Tp' ' Seal Material (^_Benton'de Neat Cement Other From To Seal Material (­Bentonite Neat Cement other Frofr To'. ; seal Material L_ Sentonite ht8at cemenL_Other Indicatetolai numberofe)dstingwellson site List numberof existing unused wells on site nsthis well orany existing well orwat6rwMdrawa1on the owners $ contiguous property coveredurideraConsumptive/Water Use Permit (CGPAIUP) or CUPAVUP Application? Yes No Ifyes, complete the following: CUPNIVIJP No, District .Well ID No. Latitude: Longitude Data Obtained From-. GPS ,.,_,Map Survey. Datum: _NAD 27 NAD 83 WGS 84 a Sy Receipt No. v L. Cheek No. - 13YAN AUTHORIZED OFFICER (Via) This permit is valid for tr0 days from the data of Issue. THE - ar- ar-,}• .-- 2a->,}• :1,-61• .— ,a-,} ,c-o}• .- s-s}' .— v-,}• 16'-B'••oPEN BFA:1 61'-a•••ROM BEAM Zau t k 7 11'-1 ]//' Iq'-0 I/4' 114' Y-r 1e a _a.X m-r -It tr-r ar-e a N arar I -ar-r u-Tt tr-r E" }erg •.o1.. x a fry. -W I It n 0 m° It- N Fi W • o VA T I : Bodtoomm 93 $ S •• p .. ,rm��71 _ 1 • - r 1 . IQlrhan'.'. I;,,et) 1i rn •- o A = i i i i <y/ XFMAMI `LJ go o 0.4 DMI ow 0- � � - 'IT'r � - h N V ' OttJ , t7havr'•�� A _ sFIA �II_r ii FamMtoom oo ® 11 8 i Mmler Vedrev room �_ oam r I,n a t6ed tmra�n ir! 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