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Permit 1 Fleet Land Blvd WELL 2011 IC BEACH CITY OF ATLANT 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5826 Application Number . . . . . � 11-00001664 Date 2/11/11 Property Address . . . . . . 1 FLEET LANDING BLVD MAIN Application type description WELL PERMIT Property Zoning . . . . . . . PLANNED UNIT DEVELOPMENT Application valuation . . . . 0 ---------------------------------------------------------------------------- Application desc USE OF WELL-OTHER ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ NAVAL CONTINUING CARE PARTRIDGE WELL DRILLING CO. FLEET LANDING Q/A:DONAL PARTRIDGE JR. 1 FLEET LANDING BOULEVARD 4744 COLLINS RD. ATLANTIC BEACH FL 32233 ORANGE PARK FL 32073 (904) 269-1333 ---------------------------------------------------------------------------- Permit . . . . . . WELL PERMIT Additional desc . . Permit Fee . . . . 75 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 8/10/11 ---------------------------------------------------------------------------- Special Notes and Comments Seperate permit required for electrical connection/wiring to new pumps Provide copies of COJ & SJRWMD Permits before beginning work. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00 STATE DBPR SURCHARGE 2 . 00 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 75 . 00 75 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Other Fee Total 4 . 00 4 . 00 . 00 . 00 Grand Total 79 . 00 79 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDASCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5826 Application Number . . . . . 11-00001665 Date 2/11/11 Property Address . . . . . . 1 FLEET LANDING BLVD MAIN Application type description WELL PERMIT Property Zoning . . . . . . . PLANNED UNIT DEVELOPMENT Application valuation . . . . 0 ---------------------------------------------------------------------------- Application desc WELL FOR IRRIGATION ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ NAVAL CONTINUING CARE PARTRIDGE WELL DRILLING CO. FLEET LANDING Q/A:DONAL PARTRIDGE JR. 1 FLEET LANDING BOULEVARD 4744 COLLINS RD. ATLANTIC BEACH FL 32233 ORANGE PARK FL 32073 (904) 269-1333 ---------------------------------------------------------------------------- Permit . . . . . . WELL PERMIT Additional desc . . Permit Fee . . . . 75 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 8/10/11 ---------------------------------------------------------------------------- Special Notes and Comments Seperate permit required for electrical connection/wiring to new pumps Provide the City of Atlantic Beach with a copies of reports submitted to COJ/SJRWMD. ---------------------------------------------------------------------------- Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00 STATE DBPR SURCHARGE 2 . 00 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 75 . 00 75 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Other Fee Total 4 . 00 4 . 00 . 00 . 00 Grand Total 79 . 00 79 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. �m:Partridge Well Drilling Co.,Inc. (19042475845) 09:04 0211 Oil I GMT-05 Pg 01-03 ---------- —----------- Company Name: PARTRIDGE WELL DRILLING Phone: 904-269-1333 EXT 105 FAX: 1-888-703-3167 Address: 4744 COLLINS ROAD -------------- ----------------- ------ TO: Donna or Shirley FROM: Debra Giddens I FAX# FAX 904-247-5845 1-888-703-3167 OF PAGES: 2 FOLLOWING COVER MESSAGE: Please find attached copy of Abandonment Permit from Duval for Naval Continuing Care Retirement. Please let me know when you have issued your permit, we need to abandon as soon as possible. Thank You, Debra Giddens (Partridge Well Co,. Inc.) :m:Partridge Well Drilling Co.,Inc. (19042475845) 09:04 02110111GMT-05 Pg 02-03 uu:tL3:.1t$a.M- ule-lu-duli Id LKNI Wey KUUfVl Printed on 2Mt2O 11 at 11:09 AM ENVIRONMENTAL QUALITY DIVISION VwAk6effl F6Ada Beoft Well Permit 2011-0064 Granted To: Naval Continuing Care Retirement Well Type: Abandoned I Plugged Well co Josh Ratrield I Fleet Landing Boulevard Permit 2011-0064 Atlantic Beach,FL 32233 4599 Well#- 7013 Well Location: I Fleet Landing Boulevard Contractor: Donal M.Partridge,Jr. Atlantic Beach,32233 License#- 1927 Authorization is hereby granted to construct.repair,alter or abandon well(s)at the above location in accordance with information supplied on the application for permit form according to the following provisions,and with the authority ofChapter 366,City oflacksonville Ordinance Code(OC).The Peffnittee and any future property owners hereby hold the Ciry ofJacksonville harmless from responsibility to comply with or obtain permits pursuant to any other federal,state,or local law.All permitted work most be accomplished by a well contractor with a valid EQD registration within one year oftht issue date.This well shall not be used for the purpose(s)other then that indicated via the following provisions. Provisions I. There may be a difference between the items requested in the application for the well and the requirements issued by EQD- 2. This well musr be constructed,abandoned,repaired or modified in accordance with Chapters 62-532 and 40C-3 FAC. 3. A legible and completed copy ofthe St.Johns River Water Management District(SJRWMD)well completion report shall be filed with the Groundwater Section(GS)within 30 days after completion of1his well. 4. The well contractor and owner shall be responsible for notifying the GS at least 24 hours prior to starting work and receive an authorization number, 5� A copy of this permit should be given to any future property owner when the property is sold. 6. All wells shall be plugged by a state licensed well contractor within six(6)months after their use has been permanently discontinued,or when the well is determined to be in a state of disrepair and/or subject to abandonment pursuant to Chapter 366,OC,EPB Rule 0, Chapters 62-532 and 40C- 3.Florida Administrative Code(FAC),or as otherwise noted in subsequent provisos, 7. This well shall be plugged in a manner consistent with Chapter 40C-3, Florida Administrative Code (FAC). WO Permit 2011-0064 Page I ot`2 ENVIRONMENTAL AND COMPLIANCE DEPARTMENT 407 North Lauri Streci,�iailr 300 1 Jackimville,F 1.32202 ! Phone OW 255 7 100 1 Uax.Q04.5811.05 18 1 www cu)nei 09:04 02fl Oil 1GMT-05 Pg 03-03 :m:Partridge Well Drilling Co.,Inc. (19042475845) 08:53:55a.m. 02-10-2011 212 ERPIA COPY ROOM Prinied on 2,'912011 at 11:09 AM ENVIRONMENTAL QUALITY DIVISION 8. The well casing shall be cleared of al I internal obstructions to its original constnicted depth and r tounded for total depth prior to plugging. 9. Efforts shall be taken to ensure the well is plugged in a continuous manner by having adequate additional material on site or by obtaining a more accurate estimate of the wells volume.through sounding or logging before the work begins,The well contractor shall initially atiempt to fill thewell with a volume of cement equal to the calculated volume of the well and open hate plus twenty percent(20%). 10. This permit is not a sanction that the volume of material stated on the application will be adequate to satisfy the requirements of Chapter 366 of the City Ordinance Code or Chapter 40C-3.FAC. it, When the well contractor and owner shall be responsible for notifying the GS at least 24 hours prior to starting work and receive an authorization number,the well contractor shall provide cell phone number,pager number,or some other acceptable field to office communication notification arrangement for ft crew that will be constructing/plugging the well. If the crew contact person or work schedule changes occur after the work order number has been obtained the well contractor must notity the Groundwater Section and obtain their concurrence. djq Laoij k. Issued By Date Weli Permit 1011-0064 Page 2 of 2 FNVIRONMENTAL AND COMPLIANCE DEPARTMENT 407Nmh1jiuraSirect.SaiieJ00 i Jackson,11c,FL 32202 1 Phonc:(XU.255.7100 ! F&x,904.5A&051A i w%wcoinci Graham Shirley From: Kaluzniak, Donna Sent: Friday, February 11, 2011 7:47 AM To: White, Debbie; Graham Shirley Cc: Showman, Lisa Subject: Fleet Landing Well permits Debbie &Shirley, Fleet Landing well permits 11-1664 and 11-1665 approved. Will enter into AS400 now-Donna Donna Kaluzniak Utility Director City ofAtlantic Beach 902 Assisi Lane Atlantic Beach, FL 32233 PH. 904-270-2535 FAX. 904-242-3475 dkaluzniak(at-oab.us Pleasenote: Florida has a very broad public records law. Most written communications to or from city officials regarding city business are public records available to the public and media upon request. Your e-mail communications may be subject to public disclosure. Graham Shirley From: Kaluzniak, Donna Sent: Friday, February 11, 2011 9:45 AM To: Graham Shirley Cc: Showman, Lisa Subject: RE: Fleet Landing Well permits It's still in my office, I will bring over- Donna From: Graham Shirley Sent: Friday, February 11, 20119:44 AM To: Kaluzniak, Donna Subject: RE: Fleet Landing Well permits Will you have Lisa bring back the paperwork ASAP today? From: Kaluzniak, Donna Sent: Friday, February 11, 20119:42 AM To: Graham Shirley Subject: RE: Fleet Landing Well permits Shirley, no fee- Donna From: Graham Shirley Sent: Friday, February 11, 20119:41 AM To: Kaluzniak, Donna Subject: RE: Fleet Landing Well permits Are you charging a fee for review? .......... From: Kaluzniak, Donna Sent: Friday, February 11, 20117:47 AM To: White, Debbie; Graham Shirley Cc: Showman, Lisa Subject: Fleet Landing Well permits Debbie&Shirley, Fleet Landing well permits 11-1664 and 11-1665 approved.Will enter into AS400 now-Donna Donna Kaluzniak Utility Director City of Atlantic Beach 902 Assisi Lane Atlantic Beach, FL 32233 PH. 904-270-2535 FAX 904-242-34 75 dka1uzniakCa)coab.us Please note: Florida has a very broad public records law. Most written communications to or from city officials regarding city business are public records available to the public and media upon request. Your e-mail communications may be subject to public disclosure. City of Atlantic Beach -LxuCE1VED APPLICATION NUMBER Building Department FEB 10 2011 (To be assigned by the Building Department.) 800 Seminole Road // — s Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 - Fax(904) E-mail: building-dept@coab.us Date routed: City web-site: hftp://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: rr'-1 Department review required Yes No Building Applicant: .46 Planning &Zoning Tree Administrator Project: 4 I'q d, Public Works CPublic Utilftt_ies�> Public Safety Fire Services 15`ii "M &g 0 Other Agency Review or Permit Required Review or Receipt Date of Permit Verified By Florida Dept.of Environmental Protection Florida Dept. of Transportation St.Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: gApproved. F�Denied. (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by:_a, Date: TREE ADMIN. Second Review: []Approved as revised. DDenied. 0 ' P - 4 ents: o m TILITIE 12L10--f Q9 5FETY Reviewed by: Date: FIRE SERVICES Third Review: []Approved as revised. []Denied. Comments: Reviewed by: Date: Revised 05/14/09 Public Utilities Plan Review Comments Date: ;1101 11 Initials: 0" Project Name/Address: �-Leee(CAPI>ik?l Application Permit -heek.-Box Application Tracking Comments to A—dd -.Comment Avoid damage to underground water/sewer utilities, Verify vertical and horizontal location of utilities. Hand dig if necessary. If field coordination is needed, call 247-5834. Ensure all meter boxes, sower cleanouts and valve covers are set to grade and visible. 13 A sewer cleanout must be installed at the property line. Cleanout must be covered 11 -with an RTI concrete box with metal lid. Cleanout to be set to grade and visible. A reduced pressure zone backflow preventer must be installed if irrigation will be provided or if there is a private well on the property. Backflow preventer must be 13 tested by a certified tester and a copy of the results sent to Public Utilities. Plans note the building will be unsprial-led. lf plans change, any fire line installed must be metered with a Sensus touch-read meter in a properly sized vault and an El appropriate baciffiow preventer installed. Bazlcflow preventer must be tested by a certified tester and a copy of the results sent to Public Utilities. If fire sprinl-de.Tsystem is provided, contact Malcolm Clemons at 247-5839 for backflow requirements. At a minimum,will require double check-bacl-flow 12 preventer. Fire lines must be metered with a Sensus touch-read meter. Meters larger than 2" must be installed in a vault as noted in JEA specifications. ri CITy OF ATLANTIC BEACH WELL PERMIT APPLICATION Date MftupftY 6,2011 Cjj,n 32233 Owner's Name:"KIAL COFMUMC�CMM ftn"W�IT FoeNDAMN Address: I hl'z'*TLAmc BE* . SM&E AS ABOVE Well Address(if different than above). Well Location on Property(i.e. northeast comer, etc.) --T""IST FLEFT LALNDINC.EAST NEARTHE TWO TR"SFORUM Well Installation Contractor: DONAL M.pARTRID6E Contractor License No.: 1927 Phone:904-269-1333 Fax: I-M6-703-3167 Contractor Address: 4744 COLLINS ROAD ORANGE pAR&FLORIDA 32073 Check Use of Well: Domestic_ Irrigation— Other AMODOWEff"EMSTM ALL # of Wells to be installed: 0 # of Pumps to be installed: Estimated-Well Depth: 540 IT Casing Depth: 390FT Screen Interval fromNl*to Well Diameter: 8X4 Casing Material— Is address currently connected to the City water system? Is address currently connected to the City sewer system? YES Has a Well Permit been obtained from the City of Jacksonville?YEs Permit# PENDING Does the well require a permit from the St. Johns River Water Management District? (Not required for wells under 2-inches diameter installed by resident or wells under 6- inches diameter if installed by licensed well contractor). NO If permit is required,note Permit Number"ENDING and attach a copy. copY YALL BE susmrrm As soon As aTY OF jAcKsowu.La wuEs NOTE: WHENA WELL IS INSTALLED ON YOUR PROPERTY, FOUMUST INSTALL A RED UCED PRESSURE ZONE TYPE BA CKFLO W PRE VENTEF THE CITY KA TER SER VICE,-ON THE CUSTOMER'S SIDE OF THE ME THE BACKFLOWPREVENTER MUSTBE TESTED BYA CERTIFIED TE AND A COPY OF THE RESULTS SENT TO THE PUBLIC UTILITIES DEPARTMENT. 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