HomeMy WebLinkAboutWELL PERMIT APPLICATION5kR -SF- �9q 03"19
STATE OF FLORIDA PERMIT APPLICATION TO CONSTRUCT,
REPAIR, MODIFY OR ABANDON A WELL
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❑Southwest PLEASE FILL OUTALLAPPLICABLE FIELDS
Fields Where Applicable;
..:
❑ Northwest ('Denotes Required
❑ St. Johns River ris la o rig
The
Lhe penonsib/e
ann an fenvalraG
❑ South Florida ti to th
this loran and forwarding fie permft appGeagan to the
_❑.
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Cl Suwannee River appmpnate delegated authority where applicable.
1001
❑DEP
❑ Delegated Authority (If Applicable)
Unique ID_
Stipulations Required (See Attached)
Quad No. Delineation No.
3yy83 joI- €1fI
'State 'ZIP 'Telephone Number
2 L.Q D - 1 K VI VN
'We Location -Address, ad Name or Number, City aw s
3. 43a9 - So�,000�s _ o00 _Q 3+�Qc
'Parcel ID No. (PIN) or Alternate Key (Circle One) yL Block Unit
Check'd62-524:_Yes No
'Sec' n �or .L.a`nd'G1rant 'Township 'Range 'County Subdiivvisiiopr ,. ,�
5. t I qA I I\j �S 11 ��'-t•�(t`t-z*[CA� G-U -aI tr��i / QLAI�T%Q�
wat.rrWPI%a%0'Ilontractor 'License Number ',Telephone Number E-mall Address r�
7.'Type of Work:X4 Construction _Repair _Modification
I
Abandonment
-Reason for Repair, Modifiration, orAbandonment
B.•Number of Proposed Wells
9.'Sgecify Intended Use(s) of Well(s):
Q
p�OVI
Irrigation
Investigation
Domestic Landscape Irrigation _Agricultural
_Site
Bottled Water Supply Area Irrigation _Livestock
_Monitoring
_Recreation
_Nursery
Public Water Supply (Limited Use/DOH)
Irrigation
Commercial/Industrial—Earth-Coupled
_Test
Geothermal
-
S E P 2 5 2019
_Public Water Supply (Community or Non-Community/DEP)—Golf
Course Irrigation
_HVAC Supply
_Class I Injection
_HVAC Return
Class V Injection: _Recharge _Commerctalllndusbial Disposal _Aquifer Storage and Recovery _Drainage MOM
In St Lucie Cot
Remediation: _Recovery Air Sparge _Other (Desoibe)
_Other (Desrn'be) (Note: Not all types or we are Tito by a given penniWng authority)
10.•Distance from Septic System if 1200 ft.k 11. Facility Description (.t �Q, Tito
12. Estimated Start Dale
13.'Estimated Well Depth 12U ft. 'Estimated Casing Depth 100t. 'Primary Casing Diameter —1ZP—Lm. Open Hole: From To_ft.
14. Estimated Screen Interval: Fromo IZ. bft.
ts'Primary Casing Material: _Black Steel _Galvanized _PVC _Stainless Steel
_Not Cased _Other.
Secondary Casing: _Telescope Casing _ Uner —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 —1,-RDTary _Sonic
_Combination (Two or More Methods) _Hand Driven (Well Point, Sand Point) _Hydraulic Point (Direct Push)
_Horizontal Drilling. _Plugged by Approved Method —other (Describe)
• 19. Proposed Grouting Interval for the Primary, Secondary, and Additional Casing: - f SCANNED
From To Seal Material tBentonite_Neat Cement_Other )
From To Seal Material (_Bentonite_Neat Cement Other ) BY
From To Seal Material (_Bentonite_Neal Cement Other ) St. Linde Countv
• From To Seal Material (_Bentonite—Neat Cement Other )
• 20. Indicate total numberof existing wells on site V List number of existing unused wells on site
21.'Is this well or any existing well orwalerwihd wal an the owners contiguous property covered under a Consumptive/Water Use Permit(CUP/WUP)
{ or CUPIWUP Application? _Yes No If yes, complete the following: CUP/WUP No. District Well ID No.
22. Latitude Longitude
Obtained From:_GPS _Map _Survey
Approval Granted
Fee Received $_
Receipt No.
Datum:NAD 27_NAD 83 WGS 84
i 'Siggi
Issue Date Expiration Dale/GgL! HydrologistAppmval lei
Check No.
THIS PERMIT IS NOT VALID UNTIL PROPERLY SIGNED BYAN AUTHORIZED OFFICER OR REPRESENTATIVE OF THE
PERMIT SHALL BE AVAILABLE AT THE WELL SITE DURING ALL CONSTRUCTION, REPAIR MODIFICATION, ORABANL
DEP Fom:62-532.900(1) Incorporated In 62-53Z4C0(1), F.A.C. Effective Date: October 7, 2010
OR DELEGATED AUTHORITY. THE
Page 1 of 2 a
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PROPERTY
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PROPOSED
COVERED —
ENTRY
PROPOSED' SEPTIC SYSTEM
WITH 1,200 GALLON TANK,
I 667sq.ft DRAINFIELD
BENCHMARK MADE UP OF 56 QUICK4 INFILTRATORS
MAG NAIL 1,000sq.ft UNOBSTRUCTED AREA
TELEV=21.51
N.A.V.D. 1988 226.16'
PROPOSED
1 STORY CBS
RESIDENCE/
F.F.E.=T.B.U. 12.0
3 7.33'
/ .33
I
�`OX PROPOSED 91
BARSWIRE FENCE 0.5' 0° AC PAD ,�bhb
INSIDE PROPERTY -
-
— — --
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3
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o FND 5/8"IR&C
LB 4286
MCNEURLIN
30' RIGHT —OF —WA
10' D.U.E. — RIGHT_OF-
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PROPOSED
COVERED
PORCH
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p• 10' D.U.E.
10' D.U.E.
TRANSFORMER
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Property Card
SLo-SF-1110371 59- 21 ?q1
Michelle Franklin, CFA — Saint Lucie County Property Appraiser -- All rights reserved.
Property Identification
Site Address: Parcel ID:2329-502-0008- Account#:182598 Sec/Town/Range:
• BROCKSMITH RD 000-3 29/35S/39E
Map ID: 23/29N Zoning: Use Type: 0000 Jurisdiction: Saint Lucie
County
Ownership Legal Description
Amber Lynn Allen-Frade DRAWDY/BROCKSMITH ROAD SUBDIVISION (P13 75-23)
Carlos Jorge Leonardi Frade LOTS (5.55 AC-241-,758 SF) --- --
626 SE Damask AVE
Port St Lucie, FL 34983
Page 1 of 1
Current Values Historical Values 3-year
Just/Market: $116,600 Assessed: $116,600 Year Just/Market Assessed Exemptions Taxable
Exemptions: $0 Taxable: $116,600 2019 $116,600 $116,600 $0 $116,600
2018 $116,550 $1,526 $0 $1,526
Sale History
Date Book/Page Sale Code Deed Grantor
02-12-2019 4232 / 2912 0111 WD Allen Arthur H
10-24-2017 • 4062 / 0593 0001 WD Drawdy (TR)Troy W
Total Areas
Finished/Under Air
(SF):
Gross Sketched Area
(SF):
Land Size (acres):
Land Size (SF):
Total Building Count:
Price
$100
$140,000
0
0
5.55
241,758
Special Features and Yard Items
Type Qty Units Year Blt
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.
httvs://Paslc-dev.org/RECard/ 9/16/2019
�) Y•I .
Mission:,u Ron DeSantis
s,.;..
To protect, promote & improve the health "� "� �"'�=Governor
of all people in Florida through Integrated
state, county & community efforts. ON HEALTH
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-WELLSOFLHEALTH.GOV
b. Provide 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(&FLHEALTH.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 - Accredited Health Department
Port St Lucie, FL34983 Public Health Accreditation Board
PHONE: 77218734931 • FAX: 772/595-1306
FloridaHealth.gov