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HomeMy WebLinkAboutD O H PAPERWORKSTATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM SCANNED BY evlucieft* CONSTRUCTION PERMIT FOR: OSTDS New APPLICANT: John Wiswell PROPERTY ADDRESS: TBD Dyer Rd Port Saint Lucie FL 34952 PERMIT #:56-SF-1985616 APPLICATION #:AP1430610 DATE PAID: FEE PAID: RECEIPT #: DOCUMENT #: PR1253366 LOT: 12 BLOCK: 2 SUBDIVISION: St. Lucie Gardens PROPERTY ID #: 3414-501-1412-150-2 [SECTION, TOWNSHIP, RANGE, PARCEL NUt4BER3 [OR TAR ID NUMBER] SYSTEM MUST BE CONSTRUCTED IN ACCORDANCE WITH SPECIFICATIONS AND STANDARDS OF SECTION 381.0065, F.S., AND CHAPTER 64E-6, F.A.C. DEPARTMENT APPROVAL OF SYSTEM DOES NOT GUARANTEE SATISFACTORY PERFORMANCE FOR ANY SPECIFIC PERIOD OF TIME. ANY CHANGE IN MATERIAL FACTS, WHICH SERVED AS A BASIS FOR ISSUANCE OF THIS PERMIT, REQUIRE THE APPLICANT TO MODIFY THE PERMIT APPLICATION. SUCH MODIFICATIONS MAY RESULT IN THIS PERMIT BEING MADE NULLAND VOID. ISSUANCE OF THIS PERMIT DOES NOT EXEMPT THE APPLICANT FROM COMPLIANCE WITH OTHER FEDERAL, STATE, OR LOCAL PERMITTING REQUIRED FOR DEVELOPMENT OF THIS PROPERTY. SYSTEM DESIGN AND SPECIFICATIONS T [ 900 ] GALLONS / GPD Septic new CAPACITY A I ] GALLONS / GPD N/A CAPACITY .N [ ] GALLONS GREASE INTERCEPTOR CAPACITY [MAXIMUM CAPACITY SINGLE TANK:1250 GALLONS] % [ ] GALLONS DOSING TANK CAPACITY [ ]GALLONS @[ ]DOSES PER 24 HRS #Pumps - D [ 334 ] SQUARE FEET Drainfield new SYSTEM R [ ] SQUARE FEET N/A SYSTEM A TYPE SYSTEM: [ ] STANDARD [ ] FILLED p:] MOUND I CONFIGURATION: [ ] TRENCH [X] BED [ ] N F LOCATION OF BENCHMARK: Yellow Capped IR in median near SW DroDerh I comer. I ELEVATION OF PROPOSED SYSTEM SITE [ 8.00 ][ INCHES FT ][ ABOVE BELOW] BENCHMARK/REFERENCE POINT E BOTTOM OF DRAINFIELD TO BE [ 13.001r INCHES FT IABOVE BELOW] BENCHMARK/REFERENCE POINT L D O T H E R a �y Uui u: [Z3.00] INCHES EXCAVATION REQUIRED: [ 59.001 INCHES The system is sized for 1 bedrooms with a maximum occupancy of 2 persons (2 per bedroom), for a total estimated flow of 100 gpd. SPECIFICATIONS BY: Brian J I am TITLE: Environmental Specialist II APPROVED BY: tn+ kw — TITLE: Environmental Specialist II St. Lucie CHD Brian J Ing DATE ISSUED: 09/20/2019 EXPIRATION DATE: 03/20/2021 Dri 4016, 08/09 (ObsOletes all previous editions which may not be used) Incorporated: 64E-6.003, FAC Page 1 of 3 v 1.1.4 AB1430610 SE1202363 NOTICE OF RIGHTS A party whose substantial interest is affected by this order may petition for an administrative hearing pursuant to sections 120.569 and 120.57, Florida Statutes. Such proceedings are governed by Rule 28-106, Florida Administrative Code. A petition for administrative hearing must be in writing and must be received by the Agency Clerk for the Department, within twenty-one (21) days from the receipt of this order. The address of the Agency Clerk is 4052 Bald Cypress Way, BIN A-02, Tallahassee, Florida 32399. The Agency Clerk's facsimile number is 850-413-8743. Mediation is not available as an alternative remedy. Your failure to submit a petition for hearing within 21 days from receipt of this order will constitute a waiver of your right to an -administrative hearing, and this order shall become a 'final order'. Should this order become a final order, a party who is adversely affected by it is entitled to judicial review pursuant to Section 120.68, Florida Statutes. Review proceedings are governed by the Florida Rules of Appellate Procedure. Such proceedings may be commenced by filing one copy of a Notice of Appeal with the Agency Clerk of the Department of Health and a second copy, accompanied by the filing fees required by law, with the Court of Appeal in the appropriate District Court. The notice must be filed within 30 days of rendition of the final order. St. Lucie County Health Department 5150 NW Milner Dr Port Saint Lucie, FL 34983 PAYING ON: n:56-SF-1985616 BILL DOC m56-BID-4372106 CONSTRUCTION APPLICATIONk:AP1430610 RECEIVED FROM: John Wiswell AMOUNT PAID: $ 660.00 PAYMENT FORM: CREDIT CARD 83028E PAYMENT DATE: 08/26/2019 MAIL TO: John Wiswell FACILITY NAME: PROPERTY LOCATION: TBD Dyer Rd Port Saint Lucie, FL 34952 Lott Property ID: EXPLANATION or DESCRIPTION: Block: 128 - OSTDS Construction System Inspection Research Fee -1 - Surcharge (All) -1 - OSTDS New Permit Surcharge -1 - OSTDS Construction Application and Plan Review,New 123 - OSTDS Construction Site Evaluation 126 - OSTDS Construction Permit (New or Mod, Amendment) 127 - OSTDS Construction System Inspection 133 - OSTDS Construction Reinspection -1 - Well Construction QUANTITY FEE 1 $ 5.00 1 $ 45.00 1 $ 100.00 1 $ 100.00 1 $ 115.00 1 $ 55.00 1 $ 75.00 1 $ 50.00 1 $ 115.00 RECEIVED BY: MontanezNM AUDIT CONTROL NO. 56-PID-4076104 STATE OF FLORIDA 2 DEPARTMENT OF HEALTH Q ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM APPLICATION FOR CONSTRUCTION PERMIT APPLICATION FOR: [ ] New System [ ] Existing System [ ] Holding Tank [ ] Repair [ ] Abandonment [ ] Temporary APPLICANT: ©�� ]� Wl,ekAll I1 AGENT: MAILING ADDRESS: WELL No. 5q-aAaoa PERMIT NO. SIP-SF-]99961W DATE PAID: 512ulkCI FEE PAID: RECEIPT #: orA [ l Innovative [ 7 TELEPHONE, ;? Y96-// 7 1 TO BE COMPLETED By APPLICANT BY A PERSON LICENSED PURSUANT OR APPLICANT'S AUTHORIZED AGENT. SYSTEMS MUST BE CONSTRUCTED TO 489.105(3)(in) OR 489.552, FLORIDA STATUTES. IT IS APPLICANT'S RESPONSIBILITY TO PLATTED- (MM/DD/YY) IF REQUESTING THE PROVIDE DOCUMENTATION OF THE DATE THE LOT WAS CREATED OR CONSIDERATION OF STATUTORY GRANDFATHER PROVISIONS. PROPERTY INFORMATION LOT: _1 BLOCK: SUBDIVISION: 5+ L[iu� %a d n 5 PLATTED: PROPERTY ID #: 3q1 L/, -0I I q1 z 15-0 7 ZONING: Rey •5 I/M OR EQUIVALENT: [ Y/N ] PROPERTY SIZE: _1.39 ACRES WATER SUPPLY: [v PRIVATE PUBLIC [ ]<=2000GPD [ 1>2000GPD ' IS SEWER AVAILABLE AS PER 381..0065, FS? [ Y/0] DISTANCE TO SEWER: T PROPERTY ADDRESS: �'u eB d ' 1 DIRECTIIOONS TO PROPERTY: L1c� '1-�-� ,Q J Let �f l / h, 4vrnf r BUILDING INFORMATION [x]RESIDENTIAL ` /[ ] COMMERCIAL Unit Type of No. of Building Commercial/Institutional System Design No Establishment Bedrooms Area S�g)ft Table 1, Chapter 64E-6 FAC 1 2 3 4 [ ] Floor/Equipment Drains [ ] Other (Specify) \//O� SIGNATURE: DATE: —C ` (l —4 DH 4015, 08/09 (Obsoletes previous editions which may not be used) Incorporated 4E-6.0.01, FAC Page 1 of 4 STATE OF FLORIDA DEPARTMENT OF HEALTH ONSITE SEWAGE TREATMENT AND DISPOSAL SYSTEM SITE EVALUATION AND SYSTEM SPECIFICATION APPLICANT: John Wiswell CONTRACTOR / AGENT: LOT: 12 BLOCK: 2 SUBDIVISION: St. Lucie Gardens ID#: 3414-501-1412-150-2 APPLICATION # AP1430610 PERMIT # 56-SF-1985616 DOCUMENT # SE1202363 TO BE COMPLETED By ENGINEER, HEALTH DEPARTMENT EMPLOYEE, OR OTHER QUALIFIED PERSON. ENGINEERS MUST PROVIDE. REGISTRATION NUMBER AND SIGN AND SEAL EACH PAGE OF SUBMITTAL. COMPLETE ALL ITEMS. PROPERTY SIZE CONFORMS TO SITE PLAN: [X]YES [ ]NO NET USABLE AREA AVAILABLE: 131 ACRES TOTAL ESTIMATED SEWAGE FLOW: 100 GALLONS PER DAY [ RESIDENCES -TABLET / OTHER -TABLE 2 ] AUTHORIZED SEWAGE FLOW: 1965.01 GALLONS PER DAY [ 1500 GPD/ACRE OR 2500 GPD/ACRE ] UNOBSTRUCTED AREA AVAILABLE: 2000.00 SQFT UNOBSTRUCTED AREA REQUIRED: 250.00 SQFT BENCHMARK/REFERENCE POINT LOCATION: Yellow ELEVATION OF PROPOSED SYSTEM SITE 8.00 Ilan near SW property comer. FT ] [ ABOVE / BELOW ] BENCHMARK/REFERENCE POINT THE MINIMUM SETBACK WHICH CAN BE MAINTAINED FROM THE PROPOSED SYSTEM TO THE FOLLOWING FEATURES SURFACE WATER: 100 FT DITCHES/SWALES: 40 FT NORMALLY WET: I ]YES [X]NO WELLS: PUBLIC: FT LIMITED USE: FT PRIVATE: 100 FT NON -POTABLE: FT BUILDING FOUNDATIONS: 5 FT PROPERTY LINES: 5 FT POTABLE WATER LINES: 59 FT SITE SUBJECT TO FREQUENT FLOODING? 10 YEAR FLOOD ELEVATION FOR SITE: SOIL PROPIT.P. TNPnnw hLm e [ ]YES EX ]NO 10 YEAR FLOODING? [ ]YES . [X]NO] _FT [ MSL / NGVD ] SITE ELEVATION: FT [ MSL / NGVD USDA SOIL SERIES:Wabasso fine sand Munseli WColor Texture Depth 10YR 512 Sand 0 To 5 1 OYR 6/2 Sand 5 To 30 10YR 7/2 Sand 20 To 33 10YR 22 Spodic Material 33 To 57 1 OYR 4/4 Sand ' 57 To 67 10YR 513 Loamy Fine Sand 67 To 72 SOIL PROPTT.R TN nRMam . c USDA SOIL SERIES:Wabasso fine sand Munsell #/Color Texture Depth 1 OYR 5/2 Fine Sand 0 To 6 1OYR 6/2 Sand 6 To 29 1 OYR 7/2 Sand 19 To 33 1 OYR 2/1 Spodic Material 33 To 59 10YR 4/3 Sand 59 To 66 1 OYR 52 Loamy Fine Sand 66 To 72 OBSERVED WATER TABLE: 31.00 INCHES [ ABOVE ESTIMATED WET SEASON WATER TABLE ELEVATION: / BELOW ] EXISTING GRADE TYPE: 19 INCHES [ ABOVE / BELOW ] [ PERCHED / APPARENT ] EXISTING GRADE HIGH WATER TABLE VEGETATION: [X]YES [ ]NO MOTTLING: [X]YES [ ]NO DEPTH: 19.00 INCHES SOIL TEXTURE/LOADING RATE FOR SYSTEM SIZING: DRAINFIELD CONFIGURATION: [XI TRENCH [ Sand/0.80 DEPTH OF EXCAVATION: 59 INCHES (SPECIFY) ] BED [ ] OTHER - REMARKS/ADDITIONAL CRITERIA WSWT determined using USDA WES and soil borings. 1 5YR7/2 stripping in 1OYR6/2 matrix >10% with diffuse boundaries starting at 19" in SB2. S131 and S132 8" above SM. I SITE EVALUATED BY: _ _ - DATE: 09/16/2019 Ingram, Brian (Title: Envl nmental Specialist 11) (ENVIRONMENTAL HEALTH) DH 4015, 08/09 (Obsolete- Previous editions which not be used) Incorporated: 64E-6.001, FAC Page 3 of 4 AP1430610 EID1985616 v 1.0.2 e .. a .w r' ,r i �, x' �,+' � %_�• .SOIL- ..r - .1 w r �x. l - �'.it "�• t M Six i • . 2�NT u 4✓ . �p y'it f�{ U. f F. .: a O i N •• A 4 • 1 � (�/�G� � i r u �,1 Custom Soil Resource Report St. Lucie County, Florida SO—Waveland and Immokalee fine sands Map Unit Setting National map unit symbol: 1jpwd Elevation: 20 to 200 feet Mean annual precipitation: 49 to 58 inches Mean annual air temperature: 70 to,77 degrees F Frost -free period: 350 to 365 days Farmland classification: Not prime farmland Map Unit Composition Waveland and similar soils. 44 percent Immokalee and similar soils: 44 percent Minor components: 12 percent Estimates are based on observations, descriptions, and transects of the mapunit. Description of Waveland Setting Landform: Flatwoods on marine terraces Landform position (three-dimensional): Taff Down -slope shape: Convex Across -slope shape: Linear Parent material: Sandy marine deposits Typical profile A - 0 to 4 inches: fine sand Eg - 4 to 32 inches: sand Bh1 - 32 to 40 inches: loamy sand Bh2 - 40 to 53 inches. sand Cgi - 53 to 66 inches. sand C92 - 66 to 80 inches, sand Properties and qualities Slope: 0 to 2 percent Depth to restrictive feature: 31 to 50 inches to ortstein Natural drainage class: Poorly drained Runoff class: High Capacity of the most limiting layer to transmit water (Ksat): Moderately low to moderately high (0.06 to 0.20 in/hr) Depth to water table: About 6 to 18 inches Frequency of flooding: None Frequency of ponding: None Salinity, maximum in profile: Nonsaline to very slightly saline (0.0 to 2.0 mmhos/cm) Sodium adsorption ratio, maximum in profile: 4.0 Available water storage in profile: Very low (about 0.8 inches) Interpretive groups Land capability classification (irrigated): None specified Land capability classification'(nonirrigated): 4w Hydrologic Soil Group: CID 13 Custom Soil Resource Report Forage suitability group: Sandy soils on flats of mesic or hydric lowlands (G156BC141 FL) Hydric soil rating: No Description of Immokalee Setting Landform: Flatwoods on marine terraces Landform position (three-dimensional): Talf Down -slope shape: Convex Across -slope shape: Linear Parent material. Sandy marine deposits Typical profile A - 0 to 6 inches: fine sand E - 6 to 35 inches: fine sand Bh - 35 to 54 inches: fine sand Cg - 54 to 72 inches. fine sand Properties and qualities Slope: 0 to 2 percent Depth to restrictive feature: More than 80 inches Natural drainage class: Poorly drained Runoff class. High Capacity of the most limiting layer to transmit water (Ksat): Moderately high to high (0.57 to 1.98 in/hr) Depth to water table: About 6 to 18 inches Frequency of flooding: None Frequency of ponding: None Salinity, maximum in profile: Nonsaline to very slightly saline (0.0 to 2.0 mmhos/cm) Sodium adsorption ratio, maximum in profile: 4.0 Available water storage in profile: Low (about 5.3 inches) Interpretive groups Land capability classification (irrigated): None specified Land capability classification (nonirrigated): 4w Hydrologic Soil Group: B/D Forage suitability group: Sandy soils on flats of mesic or hydric lowlands (G156BC141FL) Hydric soil rating: No Minor Components Jonathan Percent of map unit: 3 percent Landform: Knolls on marine terraces, ridges on marine terraces Landform position (three-dimensional): Interfluve Down -slope shape: Convex Across -slope shape: Linear Hydric soil rating: No Salerno Percent of map unit. 3 percent Landform: Flatwoods on marine terraces Landform position (three-dimensional): Talf Down -slope shape: Convex 14 Custom Soil Resource Report Across -slope shape: Linear Hydric soil rating: No Lawnwood Percent of map unit: 3 percent Landform: Marine terraces on flatwoods Landform position (three-dimensional): Talf Down -slope shape: Linear Across -slope shape: Linear Hydric soil rating: No Electra Percent of map unit: 3 percent Landform: Rises on marine terraces, knolls on marine terraces Landform position (three-dimensional): Interfluve Down -slope shape: Convex Across -slope shape: Linear Hydric soil rating: No 15 -� � _ ; .� _ ..-.. , _. ._ ,t - r • � 1'°�--�-+°v� -r�..o n, t ' I .i( Lam' . •4 • `�.--'-"�-'- _. -.. �_� ,.� � •' �,,.,� .•� sl (sill �, RX��� X� �R!X! y.Xg�.,' y!llpF N �N XX'ecp �� �! N� rcr I'� !_ .•� � _ q • - .f -�� _ r�s • � at S, F FrIfrF ..iRYf �.■ a r I..-._ �' sa a. r a O It .,. � I,a pep+ a � 1 ,� •.`,." _ Ft a I• his a add ' y i G'al I... �ir °r z'1:�O1 '.i$!TC $' 4�..D�/tk .. 7` 7a ..: j'."+• (((I , �c'in r1 rr: �qyy a ■ { t 1, j y ilk ,r JON ad,email f a 11 yi. d!� ♦ ! D�•w�F',or �6. .,� Ic , - rl , .� In :r a 1°n �' t � ..dIMP x7 h � � was 61r7 EFmel add a/ re°.i � .:rcw warp 7w�..f a p yY ` , . , _ � ysmm Amw i err am 37 IF sa h "z ., .. k :r as '� •� -. -r F 6 I IN y� �iziF?��'�i.+'� \• � ."�`;'c':'• sue- i�^� � 51 '-I �•� !ir I t :Xj 19 ��t ` A, \ i •. r _'—� . �. �. I —'-'— �---,.-- I� -• .� �:_.. 'L:I fl A H 8{_ I I r1.g' 17 1A Wr Mill, 71 ...i=...._....=�»_J.."�• .' 1 . ,.. i '��.~.� •I;= lit ! 'J 1 1. I " Fj-i rft i{ .y ..) r - r ♦I I Y' r c .} z I . ( ' lr Ili=--•�, ,, .,�hia '�•. 'T Na .f\ �, rey�< !hw ] �� +' Y r1 r •:,h I, +y i'a\ t�N. ] ® B j-+.-_ r--•�.r.,�.•�s !_�_y _.....__. \ f�('�Y'�[7��' r V � °"t ' :r• a ! - �'8 •. f{,ysp�;�) �] �`- Y--�_��`�. -r`-�----_•�.f a \+�NnrS �� .l�ufA t ar vi'. 1Y.. fY. t oil- d� �Yd fiJ . Tf. �.: t sJ h� a• _ F . _ 6C', ,�vr y T 4�•• T `. .I 1 `'` ! r f � ,a AV�!>r,s*�J YA 1 I €r s \ !! 'l '•i (i7 ' i• .,4� +. r >3 1 ✓�'' •� f�ri. t v�� . .-c.. N � 1'-� +sR'.e �. pi�. Y v�Iii •�i �,1.I Mission: To prated, promote 8 improve the health of all people in Florida through integrated state, county 8 community efforts. Vision: To be the Healthiest State in the Nation Ron DeSantis Governor SCANNED sf. Lucie Cone, 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-WELLSaFLHEALTH GOV Provide the following information: is Permit number ii. Driller name iii. Address iv. Date and rtime 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-WELLSaFLHEALTH GOV • Submit revisions to permit and/or site map and associated fee within 48 hours of well construction or abandonment. Florida Department of Health St 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 STATE OF FLORIDA PERMIT APPLICATION TO CONSTRUCT, REPAIR, MODIFY, OR ABANDON A WELL ❑Southwest PLEASE FILL OUT ALL APPLICABLE FIELDS ❑ Northwest ('Denotes Required Fields Where Applicable) 0 $l, Johns River Duth Florida fiewpturvePmnnpaor4rerypmbfe lorcmnpktlng th7proan ❑Suwannee River opproprlpateddelEgateddmagmrhhoedprye whereaRptpagdmoeWlep the D DEP ❑ Delegated Authority (If Applicable) nb . 5u-5F- No. Unique ID itipulations Required (See Attached) Quad No. Dellneation No. UP Application No. 1. John & Lisa Wswell 77 NE South Wamer Drive Jensen Beach, R 34957 772-486-1149 'Owner, Legal Name if Corporation 'Address -City 'Slate '7JP Telephone Number 2. Dyer Road/Parcel Id #3414-501-1412-150-2 'Well Location- Address, Road Name or Number, City 3.3414-501-1412-150-2 12 'Parcel ID No. (PIN) or Alternate Key (Circle One) Lot Block Unit 4.25 36S 40E St Lucie St Lucie Gardens Check if 62-5240 Yes ✓❑ No `Section or Land Grant *Township 'Range 'County Subdivision 5. James Paul Tyson - 11352 954-818-4269 downthehole@att.net - 'Water Well Contractor 'License Number 'Telephone Number E-mall Address B. PO BOX 881496 Port St. Lucie FI 34988 'Water Well Contractor's Address City State ZIP 7. 'Type of Work: ✓❑ Construction ❑ Repair ❑ Modification❑ Abandonment 8. `Number of Proposed Wells 1 9. 'Specify Intended Use(s) of Well(s): •ReawnWRepay. Madi tdor.orAbendurmant e p Domestic Bottled Water Supply B Recreation Area irrigation Livestock Ilydgation ❑ Siteitminggations Monitoring �� OW Public Water Supply (Limited Use/DOH) ❑ Nursery Irrigation ❑ Test Public Water5upply(Community or Non-Community/DEP)❑, CommemialAndustdal Earth-Coupled Geothermal SEP 2 0 2019 Class I Injection ❑ Golf Course Irrigation HVAC Supply LI HVAC Return 'lass V Injection: ❑ Recharge ❑ CommerciaUlndustrial Disposal ❑ Aquifer Storage and Recovery ❑ "mina" iemediation: ❑ Recovery ❑ Air Sparge ❑ Other (Dw albe) OH In St Lude COD n Other (Deemba) 'Cistance from Septic System if 5 200 ft, r 0� 11. Facility Description r-roposeu mesleence 12. Estimated Start Date H0rv' 'Estimated Well Depth 120 ft. 'Estimated Casing Depth 100 ft. Primary Casing Diameter 2 in. Open Hole: From=To=R Estimated Screen Interval: From 100 To 120 ft, 'Primary Casing Material: . Black Steel Galvanized ��2 Stainless Steel Not Cased Other. Secondary Casing: Telescope Casing Liner Surface Casing Diameter in. Secondary Casing Material: Black Steel Galvanized PVC Stainless Steel I8.'Method of ConsWction. Repair, or Abandonment: Auger Cable Tool Jetted to Sonic Combination (Two or More Methods) Hand Driven (Well Point, Sand Point) Hydraulic Point (Direct Push) Horizontal Drilling Plugged by Approved Method Other (Desalbe} 19. Propo"sed Grouting Interval for the Primary, Secondary, and Add ' d ee%gg:, - From 0 To 95 Seal Material ( Bentonite �t�' Other 1 From To Seal Material ( Bentonile Neat Cement Other 1 From To Seal Material ( Bentonhe Neat Cement Other 1 From To Seal Material ( Bentonite Neal Cement Other 1 20. Indicate total number of existing wells an site 0 List number of existing unused wells on site 0 21.1s this well or any existing well orwaterwith n the owner's contiguous proper�ftwy covered under a Consumptive/Water Use Permit (CUPANUP) or CUPIWUP Application? Yes fyes, complete the following: CUPAAIUP No. District Well ID No. 22. Latitude Longitude 23. Data Obtained From: GPS Map Survey Datum: NAD 27 NAD 83 WGS 84 I hceby aNry Nvll�parnrtrytyx+A by NpOmbleNwalTitleaa, Fimide adlimtlfeadve dedl, IlW matawamr Icatlt/tl,all embepxnralba poperty.mrtmae,rombamprMMdbeaweb, old mml ern mare elmy usepemila Wlclb Herat'' pamJLnne,dad.Mebemarabe alltinedpdabmmmeaemW elW ImpMWltieaak,eWp4,a1]. FbMaShOtlne.bme6deNprprppe,ryalpedp abwpe; a,ICWnaWlam mmWWm.IfaPar ceRtrmmaa bimnutlmptnvldedmatla appllnamhewreleaMdutlWaabin NeaRNrpr Qa om,er. tlutba Fbrmadanpmid.d hemaab.aMdutlMm Woemadga aw,erdlpm necvaaryapprmdeammM ledp,W.pbb.alOW ae+mmeaa,Ilepppnbk.IgmbamaaaaN ncpu,vaSEmMeWdabwe.Ow,ermaeMbaGOMnppenmlW eltldcYeAla DabpabdAumMe ectm mmpktlm rePaM1bme WaiQp 4�b Jedeya aderw�le9m alma [abEYdlm,fppa4.modiE4am.a bmevellaie da6pihe NlabUmen.rapenrmd�r[aam,v WMmmeNa,dlMiadby NpPem T. 11352�/ / 'License Na. •Si Lure of Owner or Agent Approval Granted By p Issue Dale 7 lu f7 Expiation Date Foe Received S / Receipt No. Check No. $- /i-- I °l 'Date bmm THIS PERMIT IS NOT VALID UNTIL PROPERLY SIGNED BY AN AUTHORIZED OFFICER OR REPRESENTATIVE OF THE WMD OR DELEGATED AUTHORITY. THE PERMIT SHALL BE AVAILABLE AT THE WELL SITE DURING ALL CONSTRUCTION, REPAIR, MODIFICATION, OR ABANDONMENT ACTIVITIES. SHEET 1 OF 2 SURVEY SKETCH ------------ SURVEY NOT COMPLETE WITHOUT ALL SHEETS MAP OF BOUNDARY SURVEY PREPARED FOR JOHN D. WISWELL AND LIST A. WISWELL • I I a2 30' R.U.&D.E.,1y I a3 FIR 1/2' a DIRT ROADWAY BEARING (NO ID) ya DYER ROAD tiyp� BASIS FIR N °18'21'W ,y 165.00' FlR.1 2• S0018'21'E 30' R.U.&D.E. +`°� 00 1,654,70' P C C VERT { Ir/ A � N Lo U N O 6,0' Z m O 9,3 g 13.6' w I- 9.7' , to O m b� %.0 LL OO Ld S�o Z LLJ aw6„ 6 D Z GOPHER TORTOISE ' i a a ,jh f=— 2 • BUFFER x 111,5' O0 � ZZO Ld cv I`J 00 N p o o hX CD 00 co1y. ._.. __ 00 CO z o �,� ��4 GO � 1P THE SOUTH 165' OF THE NORTH 495 FEET OF LO 12, BLOCK 2 FIR 1/2 (NO ID) y� �y�n' Fl(NO ID) y�y Michelle Franklin, CFA-- Saint Lucie County Property Appraiser — All rights reserved. Property Identification Site Address: DyerRD Parcel ID:3414-501-1412- Account #: 41202 Scclrown/Range:25/36S/40E I50-2 Map ID: 34/25N Zoning: RM-5 PSL Use Type:0000 Jurisdiction: Saint Lucie County Ownership Legal Description John DWsll Lisa AWiswewell ST LUCIE GARDENS 2536 40 BLK 2 S 165 FT OF N 495 FT OF LOT 12 (1.31 AC) (MAP 34/25N) 77 NE South Warner DR Jensen Beach, FL 34957 Current Values Historical Values 3-year Just/Market: $36,900 Assessed: $26,500 Year Just/Market Assessed Exemptions Taxable Exemptions: $0 Taxable: $26,500 2018 $36,900 $26:500 $0 $26,500 2017 $27,600 $24,091 $0 $24,091 Sale History Date Book/Page Sale Code Deed Grantor 04-18-2019 12-06-2000 4259 / 1900 1348 / 2936 0001 WD Camarotti Juan 06-12-2000 1308 / 1118 XX00 WD Jacob Aaron Corp XX03 WD Lake Lucie Estates Inc Primary Building Information Finished Area of this building: 0 SF Gross Sketched Area: 0 SF Exterior Data View: Roof Cover Roof Structure: Year Built NIA Frame: Grade: Primary Wall: Story Height: No. Units: 0 Interior Data Bedrooms: 0 A/C %: 0% Electric: Full Baths: 0 Heated %: N/A% Heat Type: ' Half Baths: 0 Sprinkled %: 0% Heat Fuel: Type Total Areas Building Type: Effective Year: N/A Secondary Wall: Primary Int Wall: Avg Hgt/Floor. 0 Primary Floors: Finished/UnderAir (SF): Gross Sketched Area (SF): Land Size (acres): Land Size (SF): Total Building Count: Special Features and Yard Items Qty Units Year Bit Price $47,500 S14,000 $7,400 0 0 1.31 57,063.6 1 All information is believed to be correct at this time, but is subject to change and is provided without any warranty. 0 Copyright 2019 Saint Lucie County Property Appraiser. All rights reserved. ID TYPE UNRSIZE HEADHT. REMARKS A WYAae XiAgI1I MY r •mdl+�INa e winpXxuylT 38.T r •39114N8ero p wAp•NWIT J-0*3' r •JHldl•N p WAaINup131 J'I•.Y T •SNZE e WYiW Nup131 TJI/1••hP T Nf1/W.J9 1 wAWXW131 T31mrr r •111IN.J9 ST. LUCIE County Building Department Product Approval Pmjed Afton: coNraadw.. MANIELLRedderco nemea Fad St. Wele. Fladda aF Ploducf ManN. nwaaP Reauef ID arm, Moden Pmfe RagWed ANUNOWti _ 9NaewNo w191s100 Non .mnlN SEE eaAa.1nX• ffNa 11 3 03 PLAN LOV wN WN VIA]. JSm ae ANm. EE 9S»lea Sca—ad Nan Me14) CNFo yylnn.T/IC a VNm.a1 Sa saem ODP°wOjny! ia• Llw swwooapa neRAW"M 3eepepaqa,d a OSIM fa®CU,511ae9 I,�i(m-dM3Da'. I1158.1 Sa eala cuasXaonl 'Mtic. FJJodaMafadde Rd m Aba Ala t, OM 13mm2 wens almaaxec«. Jigs 2;OMMI- .,4 an mn Shang Smrm mum Mae mpaamrx.m •!•nn So191 mean ,.Was. meanxp�vqpW ISMS 3aMaX�LT W[t« m•rze FDOH in St. Lucie County Environmental Health Site Plan Approved for Construction Supersedes All Previous Site Plans for OSTDS #66-SF- SG/robe Well #52,1, oZ• Date, /9 Reviewer: 4 X dt ©M�1 • o o_ t.�....,,....._iE! .S • yi 1X ii ;• I■I • `3 fi '1 4 t N ft J 1 1 RR 0 Floor Plan f231F t I•.A• I am §442' m U J n w W O 9N: P C 7 V n d p d So& 0d 009 C m h C O Z; 01 0 0 N W CIS Joao — WE J/=' SHEET A2 4