HomeMy WebLinkAboutFL WELL PERMIT APPLICATIONSTATE OF FLORIDA PERMIT APPLICATION To CONSTRUCT,
REPAIR; MODIFY, OR ABANDON A WELL
❑Southwest .PLEASE FILL OUT ALL APPLICABLE FIELDS
11StJohnst(°DenotesRequiredFieldsWhereApplicable
St Johns River
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❑Suwannee River hiakmaMfervmrdngdapzmimPPProtionrethe
❑DEP Pulov;rmta anmaumr�,rryvmu Pu��ra
❑ Delegated Authority (If Applicable)
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ID
Quad No.. Defineallon
UP Application No.. -
•even Location -Address, Road Name or Number, City
3.2321-802-0028-000-6
26
2
'Parcel ID No. (PIN) or Alternate Key (Chris One}
Lot
-
Block Unit
4:?1 35S 39E St Lucie _ Pine Hollow _
'Seclion:orLand --county Subdivision
Grant `Township °Range
check if ock Yes O' No
_
5, SCOWS Drilling; Inc. 11213 772-489-6177
scottsdrilling@bellsoLlttt.net
"_
Water Well - License Number "telephone Number
s: 6014 Palm Drive
E-mail-Address -
Water Well Contractor's Address -- Fort Pierce
City
FL - 34982
State ZIP
7, 'Type of Work: Q Construction 0 Repair Modification[] AbandonmentB.
'Number of Proposed Wells ONE.
•ReasonrmRapalS a
a
S. -Specify Intended Use(s) of Well($):
!p
Domestic Landscape Irrigation Agdrdrl(uralirrigation
Bottled Water Supply 8 Recreation Area Irrigation ®l Livestock
Site Investigations
® Monitoring
Public Water Supply (Limited UsaIDOH) f��--.-iIII Nursery Irrigation
Public Watersuppy(Community orNon-CommtmitylDEP)I_.:.I CommerdaWridustriai,�
'Class IInjaon
W
Test SEP 2 O 20191�(
Earth -Coupled Geothermal
❑u Golf Course Irrigation
14VACSupply
HVAC Return _ (ill Lllt;ie Curet Classdlidlo Ilion: Redlsrge OommerdaVindusidal Disposal Aquifer Storage and Recovery Draina�F—C
ltl�i11TIQt.PIFAL
Remediationi0 Reodvery0 Alr Sparge 0 Other feasaibeJ0 Other Ibeembel - Omualdlssonty.
I M'Distance from Septic. System if 5 200 ft. - - �11. Facility Dasalp8onsin9 8 familyre3 ence _ 12,. Estimated Start Data -
13:'Estimated Well Depth 120 fL -Estimated Casing Depth. 1. 90 . Primary Casing Diameter 7 in. Open Hole: From.__ To=iC
14. Estimated Screen, Interval: 100. To 120 {(,
16,°Primary'Casing Materiel: Black Steel Galvanized - ✓ PVC Stainless Steel=I`' I • -
Not Cased Other._ _ _ - _ r7
96. Secondary Casing: Telescope Casing Liner SurfaceCasing Diameter - - in: Ok'
17. Secondary Casing Material. Black Steel Galvanized .PVC Stainless. Steel ry her -
;IS.•Method of Construction, Repair, crAbandonmenti Auger Cable Tool Jetted _ bI Sonic
Combination (Two or More Methods) Hand Driven (Well Point, Sand Point) Hy rainRotairecFPush)
HorizontalDrining Plugged by Approved Method Othermescncey.
- _ __
19. ProposedGrdugng Interval for the Primary, Secondary, and n as -
From a,_ To - 100 Seal Materiel( Benton' y NeatCeme Other __ )
.Pram To Seal Material,( Bentom— - n Other _ I
from - - To Seal Material ( Senton'de. Neat Cement Other }
'From - To Sear Material ( Bentorilts Neat Cement Other 1
20. Indicate total number of existing wells on site _ List number of existing unused wells on site
27 *Is this well or arty eAsting well or water rawal o the owner's contiguous PProperrttyy covered under a Consumptive(WaterUse Permit:(CUPPNUP)
or CUPIWUP Application? Y No as, complete the follow lli - c IWUP No. _
22. Latitude._ g' District Well ID No.
23. Data Obtained From; CPS Map Survey Datum:
.=_NAD 27 _NAD 83 _VUGS 84
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IDate
Approve( Granted By - 4 __
Issue Data 1.0 Expimtian Dale 3 'LO 11 Hydrologist Approval
Fee Received $. _ Receipt No. _
- Check No. THIS PERMIT IS NOT VALID UNTIL PROPERLY SIGNED BY AN AUTHORD:ED OFFICER OR REPRESENTATIVE OF THE WMD OR DELEGATED AUTHORITY, THE
PERMITSHALL BE AVAILABLE AT THE WELL SrTr DURING ALL CONSTRUCTION. REPAIR. nnnrncinenner as