Permit Well 96 W Dutton Isl Rd 2012 C \ „'1� CITY OF ATLANTIC BEACH
j 800 SEMINOLE ROAD
=� ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
JF3
Application Number . . . . . 12- 00000347 Date 4/03/12
Property Address 96 W DUTTON ISLAND RD
Application type description WELL PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
NEW WELL
Owner Contractor
CITY OF ATLANTIC BEACH HULIHAN TERRITORY
716 OCEAN BLVD P.O. BOX 331268
ATLANTIC BEACH FL 322335428 ATLANTIC BEACH FL 32233
(904) 285 -8505
Permit WELL PERMIT
Additional desc .
Permit Fee . . . 75.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 0
Expiration Date . 9/30/12
Special Notes and Comments
Seperate permit required for electrical
connection /wiring to new pumps
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.
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.
f s`lf1(' City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
, ts 800 Seminole Road
,� r Atlantic Beach, Florida 32233 -5445 /
Phone (904) 247 -5826 • Fax (904) 247-5845
>e E-mail: building-dept@coab.us ®� I Date routed: = r
City web -site: http: / /www.coab.us /
APPLICATION REVIEW AND TRACKING FORM
Property Address: %�� ti ]7j-
41 Department review required Yes No
/)T Building
Applicant: /; /) Planning & Zoning
Lce (I Tree Administrator
Project: Public Works
_ lic_Util' ' i
u lic Safety
Fire Services
Review fee $ Dept Signature
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: Approved. ['Denied.
(Circle one.) Comments:
BUILDING
PLANNING & ZONING Reviewed b
Y Date: .3 - 7Z,
TREE AD IN. Second Review: A roved as revised.
❑ pp nDenied.
.S Co • ments:
''UBLI UTI TIE
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ['Approved as revised. ['Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10
PUBLIC UTILITIES PLAN REVIEW COMMENTS
Date: 3 /a (61/ z Initials:
Project Name / Address: U./. ¢ S Application Permit #: 1 Z '3
Check Box Check
Application Tracking Comments to Add Box to
Comment "Print"
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, sewer cleanouts and valve covers are set to grade and visible. ❑ ❑
A sewer cleanout must be installed at the property line. Cleanout must be covered with and ❑ ❑
RT1 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 tested by a certified ❑ ❑
tester and a copy of the results sent to Public Utilities.
Plans note the building will be unsprinkled. If plans change, any fire line installed must be
metered with a Sensus touch -read meter in a properly sized vault and an appropriate backflow ❑ ❑
preventer installed. Backflow preventer must be tested by a certified tester and a copy of the
results sent to Public Utilities.
If fire sprinkler system is provided, contact Malcolm Clemons at 247 -5839 for backflow ❑ ❑
requirements. At a minimum, will require a double check backflow 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.
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S 1sVJr
Sit NCE11 nn
v MAR 2720
B
CITY OF ATLANTIC BEACH y
WELL PERMIT APPLICATION
Date 2-1 2.9 1 Z
j a s h 6 k
Owner's Name: 611 0 � A+1 � 4 r11 Address: Mtf ' f
Well Address (if different than above): 4` 0 tk1 0 4 1 1
Well Location on Property (i.e. northeast corner, etc.)
Well Installation Contractor: SCVit tAl h Oth
e6v5
Contractor License No.: 1S 01 Phone: 904 ze 5 Fax: 40 y' 2 -7 0 z '✓
Contractor Address: (% 11 Aft 4,4h C � U IVO
Check Use of Well: Domestic Irrigation )4 Other
# of Wells to be installed: 1 # of Pumps to be installed: 1
Estimated- Well Depth: ( Casing Depth:OZ Screen Interval from 2OtoOd
Well Diameter: t 4' Casing Material f ✓
Is address currently connected to the City water system? Ail
Is address currently connected to the City sewer system? /✓y
Gerl'
Has a Well Permit been obtained from the City of Jacksonville? / Permit #
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).
If permit is required, note Permit Number and attach a copy.
NOTE: WHENA WELL IS INSTALLED ON YOUR PROPERTY, YOU MUST
INSTALL A REDUCED PRESSURE ZONE TYPE BACKFLOW PREVENTER ON
THE CITY WATER SERVICE, ON THE CUSTOMER'S SIDE OF THE METER.
THE BACKFLOW PREVENTER MUST BE TESTED BYA CERTIFIED TESTER
AND A COPY OF THE RESULTS SENT TO THE PUBLIC UTILITIES
DEPARTMENT.
Printed on 3/29/2012 at 2:05 PM
ENVIRONMENTAL QUALITY DIVISION
W here Fiori & Buis.
Well Permit 2012 -0337
Granted To: City of Atlantic Beach Well Type: Irrigation Well
800 Seminole Road Permit #: 2012 -0337
Atlantic Beach, FL 32233 Well #: 27807
Well Location: 96 Dutton Island Road West Contractor: Scott Hulihan
Atlantic Beach, 32233 License #: 7369
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 of Chapter 366, City of Jacksonville Ordinance Code (OC). The permittee
and any future property owners hereby hold the City of Jacksonville harmless from responsibility to comply
with or obtain permits pursuant to any other federal, state, or local law. All permitted work must be
accomplished by a well contractor with a valid EQD registration within one year of the issue date. This well
shall not be used for the purpose(s) other than that indicated via the following provisions.
Provisions
1. There may be a difference between the items requested in the application for the well and the
requirements issued by EQD.
2. This well must be constructed, abandoned, repaired or modified in accordance with Chapters 62 -532
and 40C -3 FAC.
3. This well shall not be constructed or located within 50 feet of pollution sources (i.e. onsite sewage
treatment and disposal systems).
4. A legible and completed copy of the State of Florida Well Completion Report shall be submitted to
the Groundwater Section (GS) within 30 days after completion of the permitted well activity.
5. A copy of this permit should be given to any future property owner when the property is sold.
6. Wells shall be located, constructed, cased, grouted, plugged, capped, or sealed to prevent
uncontrolled surface flow, uncontrolled movement of water from one aquifer or water bearing zone
to another, contamination of groundwater or surface water resources, or other adverse impacts.
7. If confining units are penetrated by a well, construction shall include a casing and grout seal to the
confining unit to protect underlying aquifers of differing quality groundwater.
Well Permit 2012 -0337 Page 1 of2
ENVIRONMENTAL AND COMPLIANCE DEPARTMENT
214 North Hogan Street, 7th Floor 1 Jacksonville, FL 32202 1 Phone: 904.255.7100 1 Fax: 904.588.0518 1 www.coj.net
Printed on 3/29/2012 at 2:13 PM
ENVIRONMENTAL QUALITY DIVISION
8. Bentonite grout shall not be used on well(s) constructed in any identified contamination site.
9. 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 8, Chapters 62 -532 and 40C-
3, Florida Administrative Code (FAC), or as otherwise noted in subsequent provisos.
10. Water from this well is subject to those standards or limitations as may be established by the
SJRWMD or the City of Jacksonville for water use(s).
11. Issuance of this permit does not relieve the applicant of the requirement to comply with Chapter 752
of the City Ordinance Code specifying the need to connect to reuse water.
12. This site may be included in a designated water reuse zone in the future. If such designation occurs
and a reuse line becomes available adjacent to the site, the owner must discontinue using the well for
irrigation purposes and connect to the reuse line.
13. This well shall not be connected to any existing well(s) or its distribution lines without first
installing, maintaining and operating an approved backflow prevention device between each
wellhead and its distribution lines and/or between any irrigation distribution system.
14. A City plumbing permit shall be obtained prior to connecting an irrigation distribution system to this
well.
15. Use of this well shall be subject to all applicable water shortage restrictions pursuant to a Water
Shortage Declaration issued by the SJRWMD.
16. This well shall be located on the applicant's property in a place that will not expose it to a potential
physical or traffic hazard.
17. The upper terminus of the well casing shall project at least 12 inches above finished grade in
accordance with Chapter 62 -532 FAC.
18. This well shall not be constructed directly on any property line.
19. An approved back flow device shall be installed, maintained and operated between the well head and
any irrigation distribution system.
20. No guarantee of adequate water quality or quantity is intended or implied through issuance of this
well permit.
21. The property /proposed well site is located within 500 feet of a private well(s) exhibiting a detectable
concentration of a regulated contaminant and/or a documented contamination site(s) regulated by the
Florida Department of Environmental Protection or the U.S. Environmental Protection Agency.
Please contact the Groundwater Resources Section at 904- 255 -7100 for additional information.
22. This permit allows for the construction of a 1,25 inch diameter well to be completed to an
estimated depth of 1 40 feet below land surface.
14Adtvi t - 3 /30/ao /a
Issued By C J Er p t i- /ll/ srt_ L QN) Date
ra
Well Permit 2012 -0337 Page 2 of 2
ENVIRONMENTAL AND COMPLIANCE DEPARTMENT
214 North Hogan Street, 7th Floor 1 Jacksonville, FL 32202 1 Phone: 904.255.7100 I Fax: 904.588.0518 1 www.coj.net