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Home My WebLink AboutLANDSCAPE IRRIGATIONRECEIVED L II P !e Q t I'll A u G 13 20118 I at. �� °oul STATE OF FLORIDA PERMIT APPLICATION TO C uCT , REPAIR, MODIFY, OR ABANDON A WELL N� t-udk' C911n }serm_f W !itUn9. ❑ Southwest Florida Unique ID % Of tj �✓yo PLEASE FILL OJT ALL APPLICABLE FIELOS ❑ Northwest ("Denotes Regwred Fields Where Applicable) Permit Stipulations Required (See Attached) ElSt. Johns River GJSouth Florida The wrl•.erwell tonrractorL<reg:onslbk/nrromplertng thi;form told rorwardingthe perndtapptimtiontothe 62-524 Quad No. Delineation No. ❑Suwannee River dpproprldredelegateduu+horiiywherenpplit'able. ❑ DEP JCUPANUP Application No, 9 *' * ' �a* "c 1t2WhWAabVErTfl1 LONETOft0EF1ciAUusEebF14y,+FA,3[Y0WV 1, Williar�,' & Rita Swain 9086 107th Court, Vero Beach, FL 32967-3141 b ?o 'Owne , Legal Name if Corporation *Address `City *State 'ZIP Telephone Number 2. TBD 1� Carlton Adams Road Fort Pierce FL *Well 46cal'on -Address, Road Name or Number, City 3.2236400-0009-000-3 9 *Parse ID No. (PIN) or Alternate Key (Circle One) Lot Block Unit 4, 36 35S 38E St. Lucie Luke's Lots Check if 62-524:❑ Yes ❑ No *Secti h or Land Grant *Township *Range *County Subdivision 5, Scottl Drilling, Inc. 11213 772-489-6117 scottsdriiling@beilsouth.net *Wate Well Contractor 'License Number *Telephone Number E-mail Address 6, 5014 Paim Drive Fort Pierce FL 34982 *Wale', Well Contractor's Address City State ZIP 7. *Type' 11 iWork: ❑J Construction ❑ Repair ❑ Modification❑ Abandonment 8. 'Numb ar of Proposed Wells ONE 'Reason ter Repair, Media n 9. *Speri y Intended Uses) Lfft r Domeells Landscape Ini ❑ Agricultural Irrigation ❑ Site Investigations Bottle Water Supply ion Area Irrigation ❑ Livestock ❑ Monitoring Public water Supply (Limited USeIDOH) ❑ Nursery Inigation Test JUL 1 6 201E PubliWater Supply (Community or Non-Community/DEP)❑ ComrnerciaUlnduslrial Earth -Coupled Geothermal Class I� Injection Golf Course Irrigation HVAC Supply FIVAC Return :lass V Inj ction: ❑ Recharge ❑ Commercial/Industrial Disposal ❑ Aquifer Storage and Recovery ❑ Drainage DOH In St LUdA Col 2emediatin: ❑. Recovery ❑ Alr Sparge ❑ Other (Deselib) E VIRQ � HE 10. IT 14. 15. 16. 17. 18.' 19. -20. Indic 21 'Is th or CI 22. Latil, 23. Data I hereby cant use permit or cmcsdc0ou, necessary apt eompledou rel Approval Fee Rea THIS PEI PERMIT i from Septic System,lf 5 200 ft. /00 r"' 11. Facility Description51ngit: i 8mily KeS10enCt? 12. Estimated Start Date td Well Depth 120 ft, *Estimated Casing Depth 100 ft. Primary Casing Diameter 2 in. Open Hole: From To ft. d Screen interval: From 100 To 120 fL Casing Material: Black Steel Galvanized ` / PVC Stainless Steel Not Cased Other. ry Casing: Telescope Casing Liner Surface Casing Diameter in, ry Casing Material: Black Steel Galvanized PVC Stainless Steel Other )f Construction, Repair, or Abandonment: Auger Cable Tool • Jetted ./ Rotary Sonic ombination (Two or More Methods) Hand Driven (Well Point, Sand Point) Hydraulic Point (Direct Push) orizontal Drilling Plugged by Approved Method Other (oascrbe) 1 Grouting Interval for the Primary, Secondary, and Additi -j1 0 0 To goo Seal Material ( Bentonite eat Ce Other ) _ To Seal Material ( Bentonite—iVeWCe'm`eht Other } _ To Seal Material ( Bentonite Neat Cement Other } _ To Seal Material ( Benlonite ' Neat Cement Other ) total number of existing wells on site List number of existing unused wells on site A or any existing well or water wit icaaratorrk owner's contiguous property covered under a Consumptive/Water Use Permit (CUPMIUP) NUP Application? Ye ( No If complete the following: CUP/WUP No. District Well ID No. ongiEude atned From: GPS Map Survey Datum: NAD 27 NAD 83 WGS 84 vnl campy With [he app9:ablo Well o: TUe 40, Flohda Admleicbabve (;ode. and trot a water Ica0ly m,U am me owner afineproPOM/,MetmeNfamaloAprav7dod is acaiwte, and mat l am amn, of my I locha190 Permit. If headed, has been of wit be obtalaed piIor to wmmancoment of wen responalblatfes under Chapter 373, Honda 5la:utee, to mttnm'n or Wt,paly Wandon NO wen; or. I ealify drat f em , eably that nfl,nrorms0a, provided Ir. *4a Ppplicanon lc a,corala and that I1411 able. the agent Wthe owner Moore, lnf.r rbtn pravidod Is. —rate. and that I hava inlarfncd Ura ovmer of U,ed rom aU1er roderal, state, or local oovamments, If applicable. I agree to ptavhle a wen rcipoosibratiOs as stated abem ox v ppn m, to alaudng iiuuu w at in, WInD W Dduooled A.U.Wly accns he D15UICI w(Min30 days after eamplctipir of No eonsUmWob, repair, msdlUradon, or to 0rc wO11 el,a dmin9 0 wnsvuc9rn,, rnpui , mudigcali , w ebmdmeaera-U..A..d by this penes reed by this Pollan, Of the perndl eeplratial, v hlarever ocatfa first. N 11213 6 :;onlractor 'License No, Signet re of Owner or Agent 'Date By /O� Issue Date//W * 0 Expiration Date 1WJ v11v Hydrologist Approval i INualc 5 Receipt No. Check No. IS NOT VALID UNTIL PROPERLY SIGNED BY AN AUTHORIZED OFFICER OR REPRESENTATIVE OF THE WMD OR DELEGATED AUTHORITY. THE L BE AVAILABLE AT THE WELL SITE DURING ALL CONSTRUCTION, REPAIR, MODIFICATION, OR ABANDONMENT ACTIVITIES. PIED SEPTIC JT OF RANGE 24.8 STATE OF FLORIDA PERMIT APPLI REPAIR, MODIFY, OR ABANDON A ❑Southwest PLEASE Ft] ❑ Northwest (*Denote! ❑St Johns River RECEIVED AUG 2 3 2018 ILlM'CRbi'ftit<y, Pern G1South Florida The tywerwell contractor 1;responslbfefor completing thh form and forwarding the permir oppliw6on to the []Suwannee River approprlutodeleguted uuNmrity where applicable. ❑DEP . r ❑ Delegated Authority (If Applicable) Ra ide-Un Florida.Un ique-ID N/ Permit Stipulations Required (See Attached) ad No. Delineation No. I Application No. 1, William Rita Swain 9086 107th Court, Vero Beach, FL 32967-3141 '77;- 20 `Owner, legal Name if Corporation `Address "City 'State 'ZIP Telephone Number 2. TBD I', Cadton Adams Road Fort Pierce FL .Well LocoEdon -Address, Road Name or Number, City 3.2236-70-0009-000-3 9 *Parcel 10'No. (PIN) or Alternate Key (Circle One) Lot Block Unit 4.36 11 35S 38E St Lucie Luke's Lots Check if 62-5240 Yes ❑ No *Section 'r Land Grant *Township *Range `County Subdivision 5. Scott's q' illing, Inc. 11213 772-489-6117 scottsdrilling@bellsouth.net 'Water 1N6i11 Contractor `License Number *Telephone Number E-mail Address 6. 5014 Pdfm Drive Fort Pierce FL 34982 'Water Well Contractor's Address City State ZIP 7. *Type of Mork: ❑✓ Construction ❑ Repair ❑ Modification[] Abandonment 8. *Number of Proposed Wells ONE 'Reason for Repair, ModdI of b� 9. er_ify II nded Uses)II( PIP lJ Domesti' an scP ia Agricultural Irrigation ❑ Site Investigations d ater Supply ea lmgation g Livestock ❑ Monitoring ] Public W l� ter Supply (Limited Use/DOH) Nursery Irrigation ❑ Test J U L 1 6 2019 ] Public Water Supply (Community or Non-Community/DEP) Commercial/Industrial Earth -Coupled Geothermal ] Class I Infection ❑ Golf Course Irrigation HVAC Supply HVAC Return ;lass V InjecReturnI n: ❑ Recharge ❑ Commercial/Industrial Disposal ❑ Aquifer Storage and Recovery ❑ Drainage DOH in St Lucie Cou Zemediation: ED Recovery ❑ Air Sparge ❑ Other (Descfibd) F VIRONMEUYAlu HEf 'N10.' fslance f�°in Septic System if S 200 ft. /Oa P 11. Facility Description Inge aml y eSl ence 12. Estimated Start Date i-Estimated (Well Depth 120 ft. 'Estimated Casing Depth 100 ft. Primary Casing Diameter 2 in. Open Hole: From To ft.' 14. Estimated Screen Interval: From 100 To 120 ft, 15.'Prirnary C8)sing 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 Other 18.1Method of ionstruction, Repair, or Abandonment: Auger Cable Tool Jetted ✓ Rotary Sonic Cot jbination (Two or More Methods) Hand Driven (Well Point, Sand Point) Hydraulic Point (Direct Push) Ho ziontal Drilling Plugged by Approved Method Other (Descrbe) 19. Proposed Grouting Interval for the Primary, Secondary, and Additi From 0111 To 100 Seal Material ( Bentonite .. • Neat Ce Other ) From To Seal Material ( Bentonite a eTnelit Other ) From II To Seal Material ( `Bentonite Neat Cement Other ) From Il To Seal Material ( Bentonite Neat Cement Other ) 20. Indicate to al number of existing wells on site List number of existing unused wells on site 21.'Is this well or any existing well or water wit owner's contiguous property covered under a Consumptive/Water Use Permit (CUPMIUP) or CUPMNP Application? Ye No 1 complete the following: CUP/WUP No. District Well ID No. 22. Lalilude ongitude 23. Data Obtaiied From: GPS Map Survey Datum: NAD 27 NAD 83 WGS 84 1 hereby Cattry Nal I31ILmply vnUl The applcabla rules of 71Uo 40. h7unda Adair.12traWo Coda. and bnn: a water I cuUty that are No mmer of a propem/• oral Ilia Infarma-Im rpovldod Is aeslnate, and 41a11 am xw,ro of my uwpmm: w atiWal red acoa perms• 0 noodod, has been or wal be oUtain d pnta td cummencomMt of well tdrpCn9btlltlea dndet rlmptet 374. Flollda Stowtes, to nmlMoh or pmpmly ab.nd., Oda 1 ugy Na t 1 um eonsoucUan. I furNer cyNly.Omi n0lnftumadcn provided It. Nla appEcallao Is aewra:a Md NN at 11N1 obtaln a aofor the the omaf fhaltha Infotmatlan provided 1: a=ralo, aid Ulal I have infmu,cd Wava e m, ul Nelr necacsaly approval Tm 10"t lodetal, state, or local povemmenls, If applicable. I aof's to prodda a w 11 ruponslblatles as staled elil o. Ovna cau N 1u ofuwbsg pa,srvmel of eda WI.ID inDdndafeJ AuNud:y acwas eonipldian lepolt to Ups Suit! Niwo Jo days after enmpleden of old =VnIiUon, repair, m24111co ldn, at to Ne weU Gha durbre 0m acunobucU/u/],//�ni, nmdiGcaOvb w aWnd,nanu�cl.-l�ujuWodccd b/y Die. pemnl. hando autbo I yUns pause, of me pwmlt esp6atlon, aMldiavuoccurs ptsl. �/�� / I ✓ 11213 {/'X` `Signature of C6Pactor 'License No. 'Signature of Owner or Agent 'Date I Approval GrantetBy Issue Date Expiration Date ( f0 26 Hydrologist Approval InWals Fee Received $ 1 Receipt No. Check No. THIS PERMIT IS-,", OT VALID UNTIL PROPERLY SIGNED BY AN AUTHORIZED OFFICER OR REPRESENTATIVE OF THE WMD OR DELEGATED AUTHORITY. THE PERMIT SHALL E AVAILABLE AT THE WELL SITE DURING ALL CONSTRUCTION, REPAIR, MODIFICATION, OR ABANDONMENT ACTIVITIES. 77Form: 62-532.1900(1) Incorporated in 62-532.400(1), F.A.C. Effective Dale: October7. 2010 Page 1 of 2 IDS T SEPTIC LIT X 23.8 FF-1