HomeMy WebLinkAboutFDOHSCANNED
_��. ASTAT11OFFLORMI APIl1M�ITAONTO CONSTRUCT, S� l85t�y
_ A` REPAIR, MODIFY, OR ABANDON A WELL Permlt Na.
r OSOuthwest PLEASE FILL OUT ALL APPLICABLE FIELDS PIt rids UnIgU(r ID
❑ Northwest (*Denotes Required Fields Where Applicable) Permit Sllpulallons Required (See Attached)
GSt. Johns River
Tltdwuterwelfeontraetaristasponedr srbjrfor,tpfetlny
�60Ufh Florida
tltfrformornitimaw1ripthepermltappBrntlanfufhr: 62-524 OUnd NO. Dellnoatl/hNo.
OSuwannee River oppalprfatddelegatedauthority where appltulblu,
QDEP CUPiWUPApplication No,�
II' ❑ Delegated Authority (If Applicable)
1 DR.r' Construction of the Treasure roar LI G PO BOX 4343 Ft. Pierce FI 3494E (772) 216-8�900
Pon 'Address *dWate 'ZIP Telephone Number
2..5�412 KillarneyAvenue Ft. Pierce, FI 34951
3 1�1i+Vell Location - Address, Aoad Name or Number, City
'301-614-0013-000-6 _ _. 13 157
'Parcel ID No. (PIN) or Alternate Key (Circle One) Lot Block Unit
4, 12 34S 39E St Luole Lakewood Park Check if 02-624:❑ Yes ❑✓ No
`Section or Land Grant "Township 'Range *County Subdivislon
5, James P Tyson' 11352 954-818-4269 downthehole@att.net
"Water Well Contractor *License Number "Telephone Number E-mall Address
t3. P,6 BOX 881496 Port St Lucie FI 34988
Tater Well Contra toes Address City State ZIP
k7'pe of Work: Constructlol,�I❑ Repair ❑ Modification[] Abandonment
mber of Proposed Wells F 'Reason for Repalr, M II ri it r t D
eclfy Intended Uses) of Well(s):
omestle n Landscape irrigation ❑ Agricultural Irrigation ❑ Site Investigations
tlled Water Supply ❑ Recreation Area Irrigation ❑ Livestock ❑ Monitoringqq �9(�bllc Water Supply (Limited Use/DOH) Nursery Irrigation Test J U L 1 1 2018
❑Qublic Water Supply (Community or Non-Community/DEP)❑ Commerclal/Industrial Earth -Coupled Geothermal
Class I injection ❑ Golf Course Irrigation HVAC Supply
HVAC Return F OH to St' Lucie CotMyClas V Infection-, ❑ Recharge ❑ commercial/Industrial Disposal ❑ Aquifer Storage and Recovery ❑ Drainag� IR®NfU9Ef�TAL Oi LTH
Reml diallon: ❑ Recovery ❑ Alr Sparga ❑ Other (Dasvlbe) OfOolell Use Only
❑ Other (Describe) w
10.'Cistance from Septic System If 5 200 ft. 11. Facility Description Proposed Re5rdence 12, Estimated Start Dace
ASAP
13.*E'sllmated Well Depth 120 ft. *Estimated Casing Depth 100 ft, Primary Casing Diameter 2 !n, Open Hole: From �-To
' I '
14. Estimated Screen Interval: From _1 00 To „ 120 ft.
15,"Plf lmary Casing Material; Black Steel ._ Galvanized Stainless Steel
�I Not Cased Other:
16. Secondary Casing: Telescope Casing Liner Surface Casing Diameter in.
17, Seoondary Casing Material: BI9ck Steel Galvanized PVC Stainless Steel Other
18.* l elhod of Construction, Repair, or Abandonment: Auger Cable Tool Jelled Sonic
Combination (Two or More Methods) Hand Driven (Well Point, Sand Point) Hydrae c olnt (Direct Push)
Horizontal Drilling Plugged by Approved Method Other (oaacriba)
19, Proposed Grouting Interval for the Primary, Secondary, and A d tlon
From 0 To as , Seal Material ( Bentonite ' Other 1
�F rim To Seal Material ( Bentonite Neat Cement Other
1 rom_ To Seal Material ( Bentonite Neal Cement Other )
i�rom ^ To Sea( Material ( Senlonlle Neat Cement Other i
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 withdrawal on the owner's contiguous propertyy covered under a Consumplive/Water Use Permlt (CUP/WUP)
ct � CUPIWUP Application? Yes No If yes, complete the following: CUPIWUP No, District Well ID No.
22, LI(Iatitude Longitude
23. I,ata Obtained From: GPS Map Survey Datum: NAD 27 NAD 83 _ WGS 84
t I11o11 willcomply Wml the ollptldar<e rulev 0111tie 40, Floana Arhn'rJebalNn ooae, enn Ibal a WFuu I lovely th,tl mn mu esahv et Ihx pailmly, that Or lilloran0a loovldnl lc nr,,Mule, 40,1 llud I om owae it Tsy
ww penl'lantlacld»chweE pnlriIt"l ed,Ina numi or wis le abtalned iFtor tatotumm�cem*nl ufwcll naponslU'pnen under Chephu a'r0. pl0dd*stnnrtnc, to nwinl%hl or prnpnly xhmdanlleo��dl; W,I aelNly lttrlrm
coal,lo ddlllan. I nlllim cedy that ell lImmlll m rovItledln lilt P!$oatlnn k%MWtle ,And that brat ah(rMt the a0enllol the olnuv, Iitnt Nw llKrealalloq ylueidalllh nmltoaty,trilltrip!!hnvn lntlmned the Utvne, nr U+nir
nenrot y tpprovei purl atber tad , t tolounr I edrnd arnmonb, ll nppb'eubtd, I Q19. to pravldn a well ItSQOPFIbIMIXII %7 AhNdi %heY1L amut oninanla to rolowihypenunnH of thMt WM0 ur DeIFDntedAoihmey oronFa
conWn n rspaa la tha 01,111 t Idtl 0 du a tar con IuQon of Or wnruuetlon, rsp,9, tnodl0oaltnb ul lu the WeU site lurinp the cmulrhetlole Ihpelr. mo lIPWlnn, n dllnndunaanl aulho&id by 09r porno.
ah s ryaoN audrml:od by this I in LoI p0aW10 r1, 501, wl0ohuvw...ole fro.
II l 'r 6/27/2018
ig atllra of Con clor 'Llcenee No. •Slgnattlre of Owner ent _ 'Date
Approval S val Granted By IseUe Data ! li C Expiration Date tl _VHydrologlet Approval
I 1 _ y Inidnbs
Fee RlIeoeived 5Receipt No, Check No.
THIS PERMiT IS NOT VALID UNTIL PROPERLY SIGNED BY AN AUTHORIZED OFFICER OR REPRESENTATIVE OF THE WM O OR DELEGATED AUTHORITY, THE
PERf1IIT SHALL BE AVAILABLE AT THE WELL SITE DURING ALL CONSTRUCTION, REPAIR, MODIFICATION, OR ABANDONMENT ACTIVITIES.
DEP Form: 62-632,0000) Incorporated in 62-632.400(1), F,A.C. Effective Dale: October7,201D Page •16
FDOH in St.. Lud6 County
Environftrftl Health
Site Plan Appr f.bt Construction
Supet-sedes All Previous Site Pans for
OSTDS#-%-,f,j (.1LO8 Well *51-?, ngy
W. It a 4
Pm mwm*
I
SITE
I/ ,e
GRAPHIC SCALE
I i
T
LOT 16
LOT 15
f
.(OCCUPIED)
F.F. EL-23,00'
(VACANT)
ST. LUCIE COUNTY, FLORIDA
VICINITY MAP
LEGEND NO SCALE
FRI 1-1—AT'
FD 2
-LB4 2
PLAT DATA T19 TWIN.
IREW DATA EL EUEVAMW
C CALCMAIM FROM I= UEASUREKDRS ewe CONCRERE
S1477'52'W 0.1
6' WOOD FENCE
EXISTING
WELL
MD. FDUND val WA10 METER
Pc.C. P001t OF CDUPOURID CURVE TOO TOP OF am
PAC fWa OF REVERSE CURVE RADIM- LIKE
PlAs PROFESSIONAL LAM SURVEYOR CASUE TREV61019 BOX
LICIMSED
89*5 VE09
Q4-0, 37.5.4� 1
IR/C
La. VJSRESS SAMMARY CLE OUT
IRc FW ROD &'CAP
A HAND RQUE
39.Cd
DELTA (CDnr.AL ANME) I IELSIHOKE Box
R RADOS .
L AFM ft NUMBER LENTIN
PC POW OF CURVE
ca CHORD j3E#jwm PT POINT OF TANCINCY
ff.Avm "mm AVER mm VEITIVAL DATUM CEPUERUNE
41 ,.95
in a
-06 d
'LOT
of c)
NOTES
DO 01 ri 13 -
— =- -I
19.33'
10-1 14
L NOT VAUD BXTHDU�T THE SIGNATURE AND THE ORIGINAL RAISED SEAL OF A FLORIDA
LICENSED SURVEYOR AND MAPPER.
3UH11-
24-1
Zr, (VACANT)
2, ADDITIONS OF DELETIONS TO SURVEY MAPS OR REPORTS. BY OTHER THAN THE.MGN!NG
I
SURVEYOR IS PROHIBITED, WITHOUT CONSENT OF THE SIGNING SURVEYOR.
iq
0
-q-
SHOWN
3, DESCRIPTION SHO HEREON PROVIDED BY CLIENT AND/OR MR AGENT.
4. OVERALL PARCEL CONTAINS 10.890 SQUARE FIEET, LESS.
CON )R
BRAIN
FIELD
R
oD
S. THE LASTDATE WORK WAS MAY 3, 20111.
OF FIELDWORK
D. THE CENTER LINE PLAT BEARING OF KILLARNEY AVENUE IS NOTED AS NOO'04'4WE; THE
Z
43.OW. 1
21.33'
u
_oSQI_
In In
E)IISONG FOUND FIELD CONTROL DEARS V001457E. ALL OTHER BEARINGS SHOWN ARE
17.50
RELATIVE THERETO. ALL BEARINGS AND DISTANCES SHOWN ARE PER RECORD PLAT (P) AND
89-jB-WW
121.00-(C)
r.
MEASURED ESS SHOWN OMRVflSE.
W
LL.LL_118 9'19*36"W
111.00'(P:
7. H
EWESSHOWNINTERSECTING A CURVE ARE RADIAL TO THAT CURVE UNLESS DESIGNATED
AS NON -RADIAL (MR).
L
IL LANDS SHOWN HEREON WERE NOT ABSTRACTED BY THIS OFFICE FOR RIGHT -OF -RAM
_R7EO8
T
kT I. -A/C
5
RESERVATIONS, AGREEMENTS. AND/ EASEMENTS OF RECORD. SUCH INFORMATION SHOULD
E
;i
r
/ASSUMED
Aill
.8
0 �48" tR/C
IS
P
BE OBTAINED AND CONFIRMED oy TMMR APPROPRIATE TITLE VERIFICATION.
ERS THROUGH
9. UNDERGROQXD UTILITIES. UTILITY SERVICES. FOUNDATIONS AND IMPROVEMENTS WERE NOT
LOCATION
S I
LOCATED AS A PART OF THIS SURVEY.
10. DESCRIBED PROPERTY IS LOCATED WITHIN AN AREA HAVING A FLOOD DESIGNATIONS 'X"
kRj OFJ
ICTfO SPACE
>o
0019'33"W 0.63'
BY
THE FEDERAL EMERGENCY MANAGEMENT AGENCY (FEMA). 0.4 FLOOD INSURANCE RATE MAP
DRAIN
NO.12111CD070J ST. LUCIE COUNTY, FLORIDA. IMTH AN EFFECTIVE DATE OF FEBRUARY 16,
Iwo
IEU4' CHAIN LINK FENCE-
201Z
SET 548- IR/C
U-m!) LOT 12
LOT 11
LEGAL DESCRIPTYON
LB49 2' R/C (OCCUPIED) I
'S6O*.3Er56"W 0.81, F.F. EL.24.23'
I (OCCUPED)
F.F. EL: 23.00'
LOT 13, BLOCK 157 OF LAKEWOOD PARK UNIT NO 12, ACCORDING TO THE PLAT
THEREOF AS RECORDED IN PLAT BOOK 11, PAGES-26. 26A AND 269 OF THE PUBLIC
C. W�Ewki--
RECORDS OF ST. LUCIE COUNTY, FLORIDA.
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