HomeMy WebLinkAboutLETTER-CONDITION FOR ISSUANCE OF WATER-WELL PERMITSMission:
Ron DeSantis
To protect, promote & Improve the health
of all people in Florida through integrated
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state, county & community efforts.
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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 aaFLHEALTH.GOV
b. -Proviub 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(a)FLHEALTH.GOV
• Submit revisions to permit and/or site map and associated fee within 48 hours of well
construction or abandonment.
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Florida Department of Health
SL Lucie County • Division of Disease Control and Health Protection
Bureau of Environmental Health
5150 NW Milner Drive
Port St. Lucie, FL 34983
PHONE: 772/873-4931 - FAX: 772/595-1306
FloridaHealth.gov
Accredited Health Department
Public Health Accreditation Board
Sell(C, (AL)• LP-SF-1S4-1q )
STATE OF FLORIDA PERMIT APPLICATION TO CONSTRUCT, 59-29288
REPAIR, MODIFY, ORABANDON A WELL Permit No.
Florida Unique ID
Y. ' DSDuthwest PLEASE FILL OUTALLAPPLICABLE FIELDS
/ 7 Northwest ('Denotes Required Fields Where Applicable) Permit 5lipulagons Required (Sea Attached)
El St. Johns River
f"?4 Tire Wafer vied contractor is rt?sponsib7a for tompleling
ii'3n" ' h . ]South Florida this form and forwarding the permit apPlfcali0n 10 Ula 62-524 Quad No. DelineaCion No.
7Suwannee River appmpriatodclagafad authority where aPPllcabl0.
El DEP CUPNJUPApplication No.
on
Cl Delegated Authority (If Applicable)
�..-{y d 1 / {� da PI p
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1 • ' ` ' State . ZIP "Telene Number
aO rrter, Legal Name if I brrpo/ration ddres CiIY
2. Cvx .1►i' al. Y iy t=Yi �>°r 12
1
W II Location. -Address, Road Name or Number, City
`Porte ID No. (PIN) o�A4emate Key (Circle no)
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Lot Bieck Unit
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A.�__ ��— Checkif62-524:_Yes _No
'Saclinn n[''ll end Grant Township 'Range ;t ,, `.goupty_ �,,,.�� , ySubdivisionn r >1 )( , ; It _ i" -. r /" rin
6.
7.'Type of Work: Construction! _Repair _Modification Abandonment
'Reason for Repair, Modirtwlion, orAba Q n e
8. 'Number of'Pr used Wells U
9. "Specify Intended Use(s) of Well(s):
�mestic Landscape Irrigation _Agricultural Irrigation Site Investigation
Bottled Water Supply _Recreation Area Irrigation _Livestock _Monitoring
_Nursery Irrigation Test MAR _ 7 2099
_Public Water Supply (Limited Use/DOH) Commercialllndustrial _Earth -Coupled Geothermal
_Public Water Supply (Community or Non-Community/DEP)_Golf Course Irrigation _HVAC Supply
_Cfass I Injection _HVAC Return
Coui
Class V Injection: _Recharge _CommerciaUindustdal Disposal _Aquifer Storage and Recovery ___Drainage IR N St NTALLucie HEA
E IRONMENTAI MEA
Remediation: Recovery _AirSparge _Other(Doscn'he) Official Use Only
_Other (Desctiba) (Note: Not Nl,typos or 41e115 Ira permitted by a givon permitting oulbodly)
rI'�.0 12.EstimatedStart Date
10.'Distance from Septic S stem if 9200 ft. 11. Facilit Description + tt C'`
13.`Estimated Well Depth t. 'Estimated Casing Depth (�.6 ft. 'Primary Casing Diameterin. Open Hole: From To tL
14. Estimated Screen Interval: Fromj._(Jf0
15,"Primary Casing Material: _Black Steel _Galvanized 1 ` 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: Method of Construction, Repair, or Abandonment Auger _Cable Tool Jetted otary _Sonic
_Combination (Two or More Methods) Hand Driven (Weil Paint, Sand Point) _Hydraulic Point (Direct Push)
_Horizontal Drilling _Plugged by Approved Method ,_Other (Descibe)
19. Proposed Grouting Interval for the Primary, Secondary, and Additional Casing:
From To Seal Material C_Bentonite Neat Cement Other 1
From To Seal Material (_Bentenite_Neat Cement_Other )
From To Seal Material (_Bentonite_Neat Cement_Olher )
From TI Seat Material (Bentonite Neat Cement_Olher )
20, Indicate total numberof existing wells on site (D.- List number ofexistingunused wells onsite
21.'isthis well orany existing well orwalerwithd wwalontheowner'scontiguouspropertycoveredunderaConsumptive/WaterUsePermit(CUPNVUP)
or CUPNWP Application? _Yes a ltN If yes, complete the following: CUP/WUP No. District Well ID No.
22. Latitude Longitude
23. Data Obtained From: _PPS _Map TSurvey Datum: NAD 27 NAD 83 WGS 84
I bomb., _mfy Bull w4 mmpiywiNaptiruU, muc fTra 40, Flar:da AdmWbmfim Cma. and Nat awa:er I fy eullam Na am,er el am riepeny,dut NC lnf0.1u6on p.AW it actura!o. am mat l a ma' m-f my
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eanslrvclron. IlurNet eadNY NatmNfomfation�mMGQh NiS apy:2tGal lsaxunleam tlUll WiE oblafn UW agent rw Nao+rmCy Nal Na Nfamnalpn paYideQ[SaWlmlq old Wtt Alvo YlWr:1:CQ Nabtmeroly+e(t
rwcassary appro•altr�mroNor loderol, slate. ar baatgwcm nta. it oppEe+Ma. lagroa WproNCaawei rcsponsfbrues as sLneQ abo+a. Pnner�arwmtrro'a'�a.4 parwn�t otausWAlb�ae:ery leQAUNaQtyacwss
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LtcenseNo.
31� gzii
'Date
Approval Granted By /—t�ls.�. Issue Dato �9 Exptration DaleAVILIIydrologistApproval In:,Qxs
Fee Received S V Receipt No. Check No.
THIS PERMIT IS NOT VALID UNTIL PROPERLY SIGNED BYAN AUTHORIZED OFFICER OR REPRESENTATIVE OF THE WMD OR DELEGATED AUTHORITY. THE
ONSTRUCTION REPAIR MODIFICATION OR ABANDONMENT ACTIVITIES.
PERMIT SHALL BE AVAILABLE AT THE WELL SITE DURING ALL C
DEP Form:62-532.900(1) Incorporated.in62-532.400(1),FA.C. Effective Data: October 7,2010 PagNo[VVl
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.PROPOSED WELL 75.00',
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J CB 8098 ) I 72.00'
1113686.89
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PROPOSED SEPAC
AND UNOBSTRUCTED AREA
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SET 5/8` IR&C
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WITNESS
STAMPED L6 5098
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PROPOSED 20'
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UNNUMBERED
NORTH UNE OF THE (NORTH 1/4 CORNER)
NW 1/4 OF SECTION 33,
TOWNSHIP 35 SOUTH,
RANGE 39 EAST
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Michelle Franklin, CFA — Saint Lucie County Property Appraiser -- All rights reserved.
Property Identification
Site Address:3755 Parcel ID:2328-343-0000- Account#:14401 Sec/Town/Range:
ELEVEN MILE RD 000-7 28/35S/39E
Map ID: 23/28S Zoning: AG-2,5 - C Use Type: 6000 Jurisdiction: Saint Lucie
County
Ownership Legal Description
Lynda Lloyd 28 35 39 E 30 AC OF SE 1/4 OF SW1/4-LESS N 840 FT- AND
David Lloyd S 4 AC OF W 10 AC OF SE 1/4 OF SW 1/4-LESS E15, FT-
3803 Eleven Mile Rd (16.13 AC) (OR 3376-25711)
Fort Pierce, FL 3,1987
Current Values Historical Values 3-year
Just/Market: $151,910 Assessed: $18,901 Year Just/Market Assessed Exemptions Taxable
Exemptions: $0 Taxable: $18,901 2018 $151,910 $18,901 $0 $18,901
2017 $149,310 $17,561 $0 $17,561
2016 S181,930 S19,661 $0 $19,661
Date
03-30-2012
09-14-2006
01-30-2004
View:
Year Built: 1967
Primary Wall: Conc Block
Bedrooms: 0
Full Baths: I
Half Baths: 0
Sale History
Book/Page
Sale Code Deed Grantor Price
3376 /2571
0002 WD Carlton Sidney $150,000
2934 / 1213
XX02 QC Remmerswaal (TR) (CST) $100
Jacqueline!-! Carlton
1908 / 0005
XX02 QC Remmerswaal Jacqueline 1-1 $100
Carlton
Primary Building Information
Finished Area of this building: 234 SF
Gross Sketched Area: 234 SF
Exterior Data
Roof Cover:
Roll Comp Roof Structure: Gable Building Type: 14D-
Frame:
Grade: D- Effective Year: 1977
Story Height: 1 Story No. Units: I Secondary Wall:
Tyl
This inforn
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31WO19 2:43 Ptvl Sales Receipt t121323
Store: 'I
St Lucie County Health Department
5150 NW Milner Drive
Port St Lucie, rL 34983
Environmental Heath Division
772-873.4931
Itern N City Price Exl Prlco
GQ..... . ,
1 61'15.00 $115.00 T
Wall Constnac(im
Subtotal: 8115,00
Local Sales Tar. 0 1/, Tax. * so,00
RECEIPT TOTAL: $115.00
Check: S l'15,00 1362
5J 29288
3803 Eleven Mile Rd
11ranlc YOU S Have a G=1 Dayl
111N III V 1111111111111
21323
Primary Int Wall:
Avg Ngt/Floor: 0
Primary Floors: A TL/CON
I
�I Areas
finished/Under Air 234
(SF):
loss Sketched Area 234
(SF):
Land Size (acres): 16.13
Land Size (SF): 702,622.8
fal Building Count: I
Is
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x,Blt
:hange and is not warranted.
I rights reserved.
3/6/2019