Attachment_D_FINAL.pdf

Attachment D: Permits Attachment D Contents:

• Florida Administrative Code 62-555.365 Changes In Ownership of Public Water Systems

• Wastewater Facilities Permit

• SJRWMD Construction Permit for Well #3

The following Florida Administrative Code shall apply to the transfer of the water system:

62-555.365 Changes in Ownership of Public Water Systems.

At least 30 days before the proposed sale, or legal transfer of ownership, of a public water system, the current owner of the system and the proposed owner of the system shall jointly notify the Department in writing of the proposed change in ownership of the system. The notification shall be submitted to the appropriate Department of Environmental Protection District Office or Approved County Health Department and shall include the following information: the public water system name and identification number; the name of the current owner of the system;

the name of the proposed owner of the system and the name, title, mailing address, telephone number, fax number, and e-mail address of a designated responsible official of the proposed owner; and the proposed date for the change in ownership of the system.

Rulemaking Authority 403.861(9) FS. Law Implemented 403.861(14) FS. History–New 8-28-03.

September 12, 2016

Gainesville Regional Utilities PO Box 147117, Sta. A122+ Gainesville, FL 32614-7117

SUBJECT: Water Well Construction Permit 147437 located in Alachua County

Dear Sir/Madam:

Please find enclosed the permit for the above referenced project. Permit issuance does not relieve you from the responsibility of obtaining permits from any federal, state, and/or local agencies asserting concurrent jurisdiction for this work.

In the event you sell your property, the permit will be transferred to the new owner if we are notified by you within thirty (30) days of the recording of the sale. Please assist us in this matter so as to maintain a valid permit for the new property owner.

The permit enclosed is a legal document. Please read the permit carefully since you are responsible for compliance with any conditions which is a part of this permit. Compliance is a legal requirement and your assistance in this matter will be greatly appreciated.

If you have any questions concerning your permit, please do not hesitate to contact this office at

(386) 329-4401.

Thank you for your interest in our water resources.

Sincerely, Margaret Daniels, Office Director Office of Business and Administrative Services

Cc: District Permit File Contractor Wesley Curtis

STATE OF FLORIDA PERMIT APPLICATION TO CONSTRUCT,

REPAIR, MODIFY, OR ABANDON A WELL Permit No: 147437-1

Southwest PLEASE, FILL OUT ALL APPLICABLE FIELDS Florida Unique ID Northwest (*Denotes Required Fields Where Applicable) Permit Stipulations Required (See Attached) St. Johns River The water well contractor is responsible for completing this form and forwarding the permit application to the appropriate delegated authority where applicable.

South Florida 62-524 Quad No. Delineation No.

Suwannee River DEP CUP/WUP Application No.

Delegated Authority (If Applicable) ABOVE THIS LINE FOR OFFICIAL USE ONLY

1. City of Gainesville Po Box 490 Gainesville FL 32627-0490 3523931618 *Owner, Legal Name if Corporation *Address *City *State *Zip *Telephone Number

2. GRU Facility at Cross Creek MHP, Adjacent to 13910 SE 174TH PL, Cross Creek, FL *Well Location – Address, Road Name or Number, City

3. 18354-043-057 *Parcel ID No. (PIN) or Alternate Key (Circle One) Lot Block Unit

4. 36 0 11S 21E Alachua

*Section or Land Grant *Township *Range *County Subdivision Check if 62-524: Yes X No

5. Thomas Salter 3206 8505761271 tts@Rowedrilling.com *Water Well Contractor *License Number *Telephone Number E-mail Address

6. PO Box 1389 Tallahassee FL 32302-1389 *Water Well Contractor's Address City State ZIP

7. *Type of Work: X Construction Repair Modification Abandonment *Reason for Repair, Modification, or Abandonment

8. *Number of Proposed Wells 1

9. *Specify Intended Use(s) of Well(s):

Domestic Landscape Irrigation Agricultural Irrigation Livestock Nursery Irrigation Commercial/Industrial Golf Course Irrigation

Site Investigation Monitoring Test Earth-Coupled Geothermal HVAC Supply HVAC Return

Date Stamp

Bottled Water Supply Recreation Area Irrigation

Public Water Supply (Limited Use/DOH)

X Public Water Supply (Community or Non-Community/DEP)

Class I Injection

Class V Injection: Recharge Commercial/Industrial Disposal Aquifer Storage and Recovery Drainage

Remediation: Recovery Air Sparge Other (Describe)

Other (Describe) (Note: Not all types of wells are permitted by a given permitting authority) Official Use Only

10.*Distance from Septic System if ≤ 200 ft. 11. Facility Description Wellfield 12. Estimated Start Date 09/14/2016

13.*Estimated Well Depth 120 ft. *Estimated Casing Depth 100 ft. *Primary Casing Diameter 4 in. Open Hole: From 100 To 120 ft.

14.Estimated Screen Interval: From To ft.

15.*Primary Casing Material: X Black Steel Galvanized PVC Stainless Steel

Not Cased Other:

16.Secondary Casing: Telescope Casing Liner Surface Casing Diameter 10 in.

17.Secondary Casing Material: X Black Steel Galvanized PVC Stainless Steel Other

18.*Method of Construction, Repair, or Abandonment: Auger Cable Tool Jetted X Rotary 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:

From 0 To 100 Seal Material ( Bentonite X Neat Cement Other ) From To Seal Material ( Bentonite Neat Cement Other ) From To Seal Material ( Bentonite Neat Cement Other ) From To Seal Material ( Bentonite Neat Cement Other )

20. Indicate total number of existing wells on site 2 List number of existing unused wells on site 1

21. *Is this well or any existing well or water withdrawal on the owner's contiguous property covered under a Consumptive/Water Use Permit (CUP/WUP) or CUP/WUP Application? Yes X No If Yes, complete the following: CUP/WUP No. District Well ID No.460159

22. Latitude 292937.2516 Longitude 821015.7656

23.Data Obtained From: GPS X Map Survey Datum: NAD 27 X NAD 83 WGS 84

I hereby certify that I will comply with the applicable rules of Title 40, Florida Administration Code, and that a water use permit or artificial recharge permit, if needed, has been or will be obtained prior to commencement of well construction. I further certify that information provided in this application is accurate and that I will obtain necessary approval from other federal, state, or local governments, if applicable. I agree to provide a well completion report to the District within 30 days after completion of the construction, repair, modification, or abandonment authorized by this permit, or the permit expiration, whichever occurs first.

I certify that I am the owner of the property, that the information provided is accurate, and that I am aware of my responsibilities under Chapter 373, Florida Statutes, to maintain or properly abandon this well; or, I certify that I am the agent for the owner, that the information provided is accurate, and that I have informed the owner of his responsibilities as stated above. Owner consents to allowing personnel of this WMD or Delegated Authority access to the well site during the construction, repair, modification, or abandonment authorized by this permit.

Thomas Salter 3206 City of Gainesville 09/09/2016 *Signature of Contractor *License No. *Signature of Owner or Agent *Date

BELOW THIS LINE – FOR OFFICIAL USE ONLY

Approval Granted By Issue Date 09/12/2016 Expiration Date 09/12/2017 Hydrologist Approval

Initials Fee Received $ 250 Receipt No. 64853 Check No. OnLine-304497929-357141

THIS PERMIT IS NOT VALID UNTIL PROPERLY SIGNED BY AUTHORIZED OFFICER OR REPRESENTATIVE OF THE WMD OR DELEGATED AUTHORITY. THE PERMIT SHALL BE AVAILABLE AT THE WELL SITE DURING ALL CONSTRUCTION, MODIFICATION, OR ABANDONMENT ACTIVITIES.

DEP Form: 62-532.900(1) Incorporated in 62-532.400(1), F.A.C. Effective Date: October 7, 2010 Page 1 of 2

*Permit No.________________________

SOUTHWEST FLORIDA WATER MANAGEMENT DISTRICT

2379 BROAD STREET, BROOKSVILLE, FL 34604-6899

PHONE: (352) 796-7211 or (800) 423-1476

WWW.SWFWMD.STATE.FL.US

ST. JOHNS RIVER WATER MANAGEMENT DISTRICT

4049 REID STREET, PALATKA, FL 32178-1429

PHONE: (386) 329-4500

WWW.SJRWMD.COM

NORTHWEST FLORIDA WATER MANAGEMENT DISTRICT

152 WATER MANAGEMENT DR., HAVANA, FL 32333-4712

(U.S. Highway 90, 10 miles west of Tallahassee)

PHONE: (850) 539-5999

WWW.NWFWMD.STATE.FL.US

SOUTH FLORIDA WATER MANAGEMENT DISTRICT

P.O. BOX 24680

3301 GUN CLUB ROAD

WEST PLAM BEACH, FL 33416-4680

PHONE: (561) 686-8800

WWW.SFWMD.GOV

SUWANNEE RIVER WATER MANAGEMENT DISTRICT

9225 CR 49

LIVE OAK, FL 32060

PHONE: (386) 362-1001 or (800) 226-1066 (Florida only)

WWW.MYSUWANNEERIVER.COM

Comments:

*General Site Map of Proposed Well Location

N .

Identify known roads and landmarks. Give distances from all reference points or structures, septic systems, sanitary hazards, and contamination sources, if applicable.

DEP Form 62-532.900(1) Incorporated in 62-532.400(1), F.A.C. Effective Date: October 7, 2010 Page 2 of 2

"EXHIBIT A"

CONDITIONS FOR ISSUANCE OF PERMIT NUMBER 147437-1

GRU Cross Creek MHP FDEP Community PSW Well 2R - 4 inch Replacement Well DATE ISSUED September 12, 2016

1.

The water well contractor shall notify a District field representative no less than 24 hours prior to initiating construction or grouting operations. The District field representative for this water well construction permit is Wesley Curtis, phone number (386) 329-4252, or cell number (386) 937-0600.

2. The well contractor shall collect drill-cutting samples (labeled with depth interval) at 10-feet intervals and at formation changes, and store the samples on site for District inspection and retrieval. Changes to the sampling interval are not authorized unless approved in advance by the District.

3. The well contractor shall disinfect and then purge/develop the well of disinfectant residuals pursuant to Subsection 40C-3.512(1), F.A.C., and disinfect all well components prior to installation. The well contractor shall complete all development and disinfection activities prior to scheduling a final well inspection by District staff.

4. The well contractor shall install a concrete slab measuring 6 feet by 6 feet by a nominal 4 inches thick, centered on the well casing.

5. The well contractor shall submit to the District a Well Completion Report in a District-approved format within 30 days of the completion of the construction, repair, or abandonment authorized by this permit.