Backup Documents 07/11/2023 Item #16C 5 ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIP TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO 1 6 C 5
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. The completed routing slip and original documents are to be forwarded to the County Attorney Office
at the time the item is placed on the agenda. All completed routing slips and original documents must be received in the County Attorney Office no later
than Monday preceding the Board meeting.
** ROUTING SLIP**
Complete routing lines#1 through#2 as appropriate for additional signatures,dates,and/or information needed. If the document is already complete with the
exception of the Chairman's signature,draw a line through routing lines#1 through#2,complete the checklist,and forward to the County Attorney Office.
Route to Addressee(s) (List in routing order) Office Initials Date
1. N/A
2. N/A
3. County Attorney Office County Attorney Office
r � �7/(z )3
4. BCC Office Board of County
Commissioners r(L 77l?/3
5. Minutes and Records Clerk of Court's Office -'//
PRIMARY CONTACT INFORMATION
Normally the primary contact is the person who created/prepared the Executive Summary. Primary contact information is needed in the event one of the
addressees above may need to contact staff for additional or missing information.
Name of Primary Staff Peter Schalt,PU Sub-Regional Utilities Div. Phone Number 239.269.4938
Contact/Department CC: C L ..J;ei V j-oo j S
Agenda Date Item was 07/11/2023 Agenda Item Number 16.C.5
Approved by the BCC
Type of Document(s) Certification of Financial Responsibility for Number of Original One
Attached Local Government Documents Attached
PO number or account N/A
number if document is
to be recorded
INSTRUCTIONS & CHECKLIST
Initial the Yes column or mark"N/A"in the Not Applicable column,whichever is Yes N/A(Not
appropriate.
(Initial) Applicable)
1. Does the document require the chairman's original signature(instead of stamp)? Yes PS
2. Does the document need to be sent to another agency for additional signatures? If yes, N/A
provide the Contact Information(Name;Agency;Address;Phone)on an attached sheet.
3. Original document has been signed/initialed for legality. (All documents to be signed by Yes PS
the Chairman,with the exception of most letters,must be reviewed and signed by the
Office of the County Attorney.)
4. All handwritten strike-through and revisions have been initialed by the County Attorney Yes PS
Office and all other parties except the BCC Chairman and the Clerk to the Board.
5. The Chairman's signature line date has been entered as the date of BCC approval of the Yes PS
document or the final negotiated contract date whichever is applicable.
6. "Sign here"tabs are placed on the appropriate pages indicating where the Chairman's Please
signature and initials are required. do PS
7. In most cases(some contracts are an exception),the original document and this routing slip Yes PS
should be provided to the County Attorney Office at the time the item is uploaded to the
agenda. Some documents are time sensitive and require forwarding to Tallahassee within a
certain time frame or the BCC's actions are nullified. Be aware of your deadlines!
8. The document was approved by the BCC on_07/11/2023 and all changes made Yes PS N/A is not
during the meeting have been incorporated in the attached document. The County an option for
Attorney Office has reviewed the changes,if applicable. this line,
9. Initials of attorney verifying that the attached document is the version approved by the Yes PS N/A is not
BCC,all changes directed by the BCC have been made,and the document is ready for the an option for
Chairman's signature. this line.
I:Forms/County Forms/BCC Forms/Original Documents Routing Slip WWS Original 9.03.04;Revised 1.26.05;2.24.05;11/30/12;4/22/16;9/10/21
1 6 C '5
CERTIFICATION OF FINANCIAL RESPONSIBILITY FOR LOCAL GOVERNMENT
Collier County Public Utilities Department ,a unit of local government of
the State of Florida,hereby certifies that it has unconditionally obligated itself to have the
financial resources necessary to close, plug,and abandon its underground injection well(s)
and related monitoring wells,as required by Chapter 62-528,Florida Administrative Code. It
is further understood that the cost estimate to conduct plugging and abandonment,
established on dune 6,2023 , shall be updated thirty(30)months after the date
of permit issuance and this obligation shall incorporate accumulated inflation costs.An
increase exceeding 10 percent compared with the amount stated below shall require submission
of an updated certification form.
Injection Wells and Monitoring Wells Covered By This Agreement:
(attach additional sheet if necessary)
FacilityName; Golden Gate WWTP Injection Well System
Facility Address; 4931 32nd Avenue SW Golden Gate, FL 34116
Facility Contact: Julian DeLeon
Phone Number: (239) 920-3929
Latitude/Longitude of Injection Well(s): 260 10' 13.2" 81° 42' 09.5++
Current Permit Number: 0263889-004-U0/11
940
Current Plugging and Abandonment Cost Estimate: $368'
(total for all injection and monitoring wells)
It is hereby understood that the cancellation of this certification may not take place without
the prior written consent of the Secretary of the Florida Department of Environmental
eoteet2c7
NOTARY: See Next Page
(Signature)
Rick Locastrp, Chairman
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ate)
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I,^rye;iai K.tint 1,Orr'.-'C, its in and fnr Collier Cnunty
ci +x;rclv r pr+iru+i'-1 tha atMvp instncment is a true and correct
c A i ti in Collier Cougttr,Florida ^�
1✓C. • Deputy Clerk
4
6 C 5
Notary Form
State of Florida
County of: Co I ( ;e-r
Sworn to(or affirmed)and subscribed before me this I I day of J U , 20 .5
by \c,ie-, L.
(Name of person making statement)
aft ersonally known to me
OR
Produced the following identification
L1auii*R** MJ.CAP
ju
-:s MY COMMISSION#HH 144329
EXPIRES:October 4,2025
Bonded Thou Notary Public Undenstliers
Print,Type,or Stamp Commissioned Name of Notary Public
1
Apply Seal of Notary Public below-State of Florida
;,. AIXA J.CAPIZZI
MY COMMISSION#HH 144329
,-7.if71 EXPIRES:October 4,2025
••O/V
. .0 Bonded Thru Notary Public Underwriters
tOrl fjz,nd 1 1,v0;y
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A sis.tunt County Attorney
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IV.REVIEW OF OBSOLESCENCE PLUG AND ABANDONMENT COSTS
is
The last update of the obsolescence plugging and abandonment plan and estimated costs for the
Golden Gate WWTP injection well system(i.e. injection well 1W-1 and the dual zone monitoring
well) was provided to the Department in 2017 (WadeTrim, 2017) during the UIC renewal. An
update to the estimate of the obsolescence plugging and abandonment costs for the Golden Gate
WWTP injection well system is included herein (Table 4-1). The previous plugging and
abandonment cost estimate was $290,241. The current plugging and abandonment cost estimate is
$368,940.Since the current cost estimate increase for the plugging and abandonment of the Golden
Gate WWTP injection well system is more than 10% of the last cost estimate, an updated
Certificate of financial responsibility is being provided in a subsequent page of this section.
The FDEP approved obsolescence plugging and abandonment plan for the injection well included
unseating and removing the 13.75-inch OD FRP tubing, installing a cement bridge 15 feet below
the base of the 18-inch OD steel casing at 2,487 feet below land surface, and cementing the well to
land surface, The approved obsolescence plugging and abandonment plan for the dual zone
monitoring well (DZMW) consists of grouting to land surface both monitoring zones with neat
cement.No changes to the FDEP approved obsolescence plugging and abandonment plan for IW-1
and the DZMW are requested herein. Schematic diagrams showing the proposed Golden Gate
WWTP injection well and monitoring well obsolescence plugging and abandonment details are
provided in Figures 4-1.
As previously indicated, a new Certificate of Financial Responsibility for the Golden Gate
WWTP injection well system is provided herein.
22-351A.OR.0423 36
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