---3..._ dan barra, s. _ yoda, k. for: l approval --.3. signature information please: review &...

FROM: Charley TO: _IMATA,R. _ MILLS, D _ UYENO, D. _ CHONG, R. _ CHENG, C. _ LAROUX, E. _ OHYE, M. _ FUJII, N. _ YOSHINAGA, M. _ SWANSON, S. _ KUNIMURA, I. _ ENGLAND, D.

COMMISSION ON WATER RESOURCE MANAGEMENT

DATE: 1..8 d~ {O INIT. TO: INIT.

---"3 KAWAHARA, K. LHARDY,R. ~ _ SAKODA, E. ~ _ NAKAMA, L. _ TORRES, R

~ HOAGBIN, S _ CHING, F. _ DAN BARRA, S. _ YODA, K.

FOR: L Approval --.3. Signature

Information

PLEASE: Review & Comment

_ Type Draft .2.. Type Final

File _ Copies: __

Take Action:

Please See Me

02Jul08

c LINDA LINGLE

GOVERNOR OF HAWAII LAURA H. THIELEN

CHAIRPERSON

STATE OF HAWAII DEPARTMENT OF LAND AND NATURAL RESOURCES

COMMISSION ON WATER RESOURCE MANAGEMENT po. BOX 621

HONOLULU, HAWAII 96809

July 1,2010

WILLIAM D. BALFOUR, JR. SUMNER ERDMAN NEAL S. FUJIWARA

CHIYOME L. FUKINO, M.D. DONNA FAY K. KIYOSAKI, P.E. LAWRENCE H. MilKE, M.D., J.D.

LENORE N. OHYE ACTING DEPUTY DIRECTOR

0321-03.ccwc

Dwain and Sue Hill 41-720 Kamanaoio Place Waimanalo, HI 96795

Dear Mr. and Mrs. Hill:

Certificate of Well Construction Completion for Well No. 0321-03 (TMK (4) 4-4-011:032-0001)

We are pleased to inform you that the Well Construction work permitted for the Flow Well (Well No. 0321-03) is complete and acceptable and welcome you as a new member to the community of well owners and ground water users in Hawaii.

To protect Hawaii's natural ground water resources for the benefit of all, the following requirements apply to the use of your well:

1. Before this well can be pumped on a regular basis, a certificate of pump installation completion must be obtained.

2. If the well is not in use it must be properly capped.

3. If the well is to be abandoned then the landowner must cause a licensed contractor to apply for a well abandonment permit in accordance with § 13-168-12(f), HAR, prior to any well sealing or plugging work.

4. In the event that the well operator and/or landowner changes, the Commission shall be notified prior to the change.

5. In the event the benchmark in the concrete base of the well is altered in any way, an updated version of the Well Elevation page of the Well Completion Report Part I shall be submItted to the Commission. If a licensed surveyor had estImated the original benchmark elevation then a licensed surveyor must establish the new benchmark elevation. The Well Elevation portion ofthe Well Completion Report Part I can be obtained by contacting Commission staff or at our website at www.hawaii.gov/dlnr/cwrmlresources--.permits.htm.

Because ground water in Hawaii is a public trust, and adverse effects at one well may affect other water resources, any violation of the above conditions or any other provision of the Hawaii AdminIstrative Rules may be subject to fines of up to $5,000 per day. The Commission needs your help and asks that you to do your part in utilizing this shared resource. We prefer to work with you in meeting the goal of protecting our ground water resources together.

If you have any questions, please contact Charley Ice of the Commission staff at 587-0218.

CI:ss

c: Kauai Department of Water Oasis Water Systems, Inc.

Sincerely,

~~b:-r LENORE N. OHYE Acting Deputy Director

LINDA LINGLE GOVERNOR OF HAWAII


COMMISSION ON WATER RESOURCE MANAGEMENT P.O. BOX 621


July 1,2010

Mr. Barry Simmons Oasis Water Systems, Inc. P.O. Box 507 Hanalei, HI 96714

Dear Mr. Simmons:

Well Completion Report Part I for Well No. 0321-03

LAURA H. THIELEN CHAIRPERSON


CHIYOME l. FUKINO, M.D. DONNA FAY K. KIYOSAKI, P.E.

LAWRENCE H. MilKE, M.D, J.D.

LENORE N. OHYE ACTING DEPUTY DIRECTOR

0321-03.wcrl.acc

We received your Well Completion Report Part I for the Flow Well (Well No. 0321-03) on April 5, 2010 and acknowledge that it is complete. We acknowledge an error on our part, flagging an unacceptable casing length, which has been corrected.

This completes your obligation under the well construction permit. A certificate of well construction completion will be issued to the well operator/landowner and you will receive a copy. This certificate transfers responsibility of specific aspects of well usage and maintenance from you to the well operator/landowner.

If you have any questions, please contact Charley Ice of the Commission staff at 587-0218 or toll-free at 274-3141 (Kauai), extension 70218.

CI:ss

c: Dwain and Sue Hill

Sincerely,

~~. ()~tf-LENORE N. OH~ Acting Deputy Director

•

Results

Well Depth Theoretical Thickness of Aquifer 1/4 Aquifer Thickness Q,pthof Well below Sea Level

Well Casing Minimum Wall Thickness

Material Minimum Thickness per standards . Wall Thickness Provided

Minimum Length of Solid Casing 90% of ground to top of aquifer Lenath of solid casing Provided

CiJsina Matenal . (fdt pvc only - check for 200' limit)

fAnnular Space Depth of Grouting

Calculated Depth of Grouting Del>th of GfOOtina provided

Minimum Annular Space required Thickness of Annular Space

yes no

steel stainless steel

1025 256.25

-40

steel #N/A

0.25

3.)8:5 ( 400

ASTMA53 '--

255.5 316 1.5 3.5

o

Okay Section 2.2

n08tandard Section 2.4(b)

Idkay Section 2.4 c ~n. compliance Section 2.4 d okay Section 2.4 d

okay Section 2.6(e)

okay Section 2.6(d)

~

~ k+r~ vve (( c.1u.k ~{D

pvc plastic abs plastic thermoset plastic other

steel ANSI/AVIJINA C200 API Spec. 5L ASTM A53 ASTM A139 ASTM A606 other

positive displacement other

steel public steel non public

steel ANSI/AVIJINA C200 API Spec. 5L ASTM A53 ASTM A139 ASTM A606 other

#N/A

0.28

stainless steel ASTM M09 other

pvc plastic Schedule 40 Schedule 80 other

Results

Well Depth Theoretical Thickness of Aquifer 1/4 Aquifer Thickness Depth of Well below Sea Level


Material Minimum Thickness per standards Wall Thickness Provided

Minimum Length of Solid Casing 90% of ground to top of aquifer Length of solid casing Provided

Casing Material (for pvc only - check for 200' limit)

Annular Space Depth of Grouting

Calculated Depth of Grouting Depth of Grouting provided.

Minimum Annular Space required Thickness of Annular Space

yes no


615 153.75

10 okay Section 2.2

steel #N/A

0.25 no standard Section 2.4(b) I ;, • I') 'A

() VoI;-;'" U. \ , 310.5" S\U \ L'

r "-+ ' 300 not enough casing .... "" SeCtion 2.4(c) ASTMA53 • ·H.~ •• lncOmplll"'nce ..

Section 2.4(d) okay Section 2.4(d)

241.5 225 not enough Section 2.6(c) 1.5 3.5 okay Section 2.6(d)

o

Results

Well Depth Theoretical Thickness of Aquifer --..J 14145 1/4 Aquifer Thickness 3536.25 Depth of Well below Sea Level 10 okay Section 2.2


Material steel Minimum Thickness per standards #N/A Wall Thickness Provided 0.25 no standard Section 2.4(b)

Minimum Length of Solid Casing 90% of ground to top of aquifer 13.5 Leng!h of solid casing Provided 300 okay Section 2.4(c)

Casing Material ASTMA53 in compliance Section 2.4(d) (for pvc only - check for 200' limit) okay Section 2.4(d)

Annular Space Depth of Grouting

Calculated Depth of Grouting 10.5 Depth of Grouting provided 225 okay Section 2.6(c)

Minimum Annular Space required 1.5 Thickness of Annular Space 3.5 okay Section 2.6(d)


Mr. Barty Simmons Oasis Water Systems, Inc. P.O. Box 507 Hanalei, HI 96714

Dear Mr. Simmons:




June 24, 2010

Well Completion Report Part I for Well No. 0321-03



CHIYOME L FUKINO, M.D. DONNA FAY K KIYOSAKI, PE. LAWRENCE H. MilKE, MD, J.D.

KEN C. KAWAHARA, P.E. DEPUTY DIRECTOR

0321-03.wcrl.ack

We have received your Well Completion Report Part I for the Flow Well (Well No. 0321-03). However, matters which must be addressed before we can accept your report as complete are as follows:

1. Please explain why the length of solid casing was less than the required standard. We understand that the final profile of the well may change during the construction process, but our expectation is that adjustments would be made to follow the standards, or alternatively that a variance would be requested by phone, to be confirmed during the review of the completion report.

Until this matter is addressed, we cannot issue the certificate(s) of well construction completion and/or pump installation completion that transfer(s) responsibility of all aspects of well usage and maintenance to the well operator/landowner. Please remember that the well may not be pumped for purposes other than well and aquifer testing until the certificates of 1) well construction completion and 2) pump installation completion have been issued, otherwise such pump age would constitute a violation of the permit conditions. Since the permit is issued to the contractor, the contractor will be responsible for any non-testing pumpage violations when the certificates of completion have not been issued (where pumping tests are as defined in the Hawaii Well Construction and Pump Installation Standards). Please respond to the above item(s) within thirty (30) days of this letter's date. Failure to do so may result in fines of up to $5,000 per day.

If you have any questions, please contact Charley Ice of the Commission staff at 587-0218 or toll-free at 274-3141 (Kauai), extension 70218.

Sincerely,

W'f1M ~KEN C. KAWAHARA, P.E. Deputy Director

CI:ss

c: Dwain and Sue Hill

c

Results

Well Depth Theoretical Thickness of Aquifer 1/4 Aquifer Thickness DeptIJ Of Well below Sea Level


Material Minimum Thickness per standards Wall ThIckness Provided

Minimum Length of Solid Casing 90% of ground to top of aquifer Length of solid casing Provided

CssingMaterlal (for PVC only - check for 200' limit)

fAnnular Space Depth of Grouting

Calculated Depth of Grouting Def}th of Grouting f}rovided

Minimum Annular Space required Thickness of Annular Sf}ace

yes no


steel

ASTMA53

o

615 153.75

10 okay Section 2.2

#N/A 0.25 noslandarel Section 2.4(b)

'J 310.5 :t> '\ U ,~\...

;,,' 300 not enough casing:::"·wi',,~,~, Section 2.4(c) eli"~ Section 2.4(d)

okay Section 2.4(d)

241.5 225 not enough Section 2.6(c) 1.5 3.5 okay Section 2.B(d)

pvc plastic abs plastic thermoset plastic other

steel ANSI/AVW,JA C200 API Spec. 5L ASTM A53 ASTM A139 ASTM A606 other

positive displacement other

steel public steel non public

steel ANSI/AVW,JA C200 API Spec. 5L ASTM A53 ASTM A139 ASTM A606 other

#N/A

0.28

stainless steel ASTM M09 other

pvc plastic Schedule 40 Schedule 80 other

o 0 MEMO and ROUTE SLIP (ver. 02/17/10) 04/08/10

LI W:..:....::C:.:.R~1 :;;C;;;h;;;e~C~k~f:...:o:..:...r_w:....:....:e:..:.:II:.....::N...:...O~.~~O~3;;;2~1-~O~3 =--~(G:...:.w:...:r..::.:eg~u=la:..::tio:..:..:..n..:...:ro=ut~e)~_--LJR ~ 'Nd' (~~,t) 1. Fror(§harl~yan _----lCA~'.3o,;'"':_:__-(initial)

2. Well Log Check Geology Code forWelllndex1W\

3. Pump Tests Checlf. DialW- (initial)

Yes No

Step-Drawdown Test: followed WCPI Stds 0 0 ~ gpm no test required analysis attached 0 0

Constant Rate Test: followed WCPI Stds 0 0 ~ gpm no test required analysis attached 0 0

Potential Well Interference: 0 0

Potential Stream Impacts: 0 0 If yes, stream name(s):

Additional Testing or Data Required: 0 0

Pump Test Comments Attached: 0 0

Proposed Pump Capacity is OK.: 0 0

4. Construction Check_~:r (initial) Yes No NA If nOI describe deficiencll

( I : '

data complete 0 0 0 n.t.cd bdk~r ~\'(.f' N:.qv-fl-r,1 :~~Af'("

1'2. A t'''f ; 0 det IS. ~ t,i :.10 d.d:. ~V"lM:-Y' followed Special Cond & elevations 0 0 g( If; ~" M.w- IM-.~!I-e well database updated "'tiC 0 0 location unchanged from WCPIPA? R 0 0

(SMA, CD, TMK)

5. <&:harle~yan c.: (initial) take action based on above analysis

""" ATTACHMENTS FOR PUMP INSTALLATION PERMIT (72X)"

1 COVER LETTER

2 COUNTY COMMENTS (DWS/SMA)

3 DOH COMMENTS

4 DLNR COMMENTS (LD/OCCUDHP)

5 WCR 1 Accept

6 WELL CONST. COMPLETION CERTIFICATE --;r--

7 USGS MAPUPDATEt) 7' 8 PARCEL ~CJ( 9 WELL DAT~EINPUT CHECK

10 PUMP TEST WORKSHEET 11 WELt As-Bullt CHECK PRINT

__ not necessary - only WCP or BOTH.

} To be sent to driller/pump installer

<------ To Landowner

} Staff internal checks

6. ROy~nitial) check (Entered WCR 1IWCCC accept date into database) 7. Susan H. (initial) finalize 8. Ken al) signature 9. <£!larle~yan File & Enter PIP issue date if attached/required

, \

o 0 State of Hawaii COMMISSION ON WATER RESOURCE MANAGEMENT Department of Land and Natural Resources

WELL COMPLETION REPORT - PART I Well Construction

Instructions: Please print in ink or type and send completed report (with attachments, if applicable) to the Commission on Water Resource Management, P.o. Box 621, Honolulu, Hawaii 96809. The Commission may not accept incomplete reports. This form shall be submitted within 60 days of the completion of work. For assistance, please consult the Hawaii Well Construction and Pump Installation Standards or call the Regulation Branch at 587-0225. For updates to this form or additional information, please visit our website at http://www.state.hi.us/dlnr/cwrml

2010 APR -5 AM": S3

1. State Well No.: 03J\-D3 Well Name: flow WeA\ ( ) 2. Address: ~ d.O Mooed\) Rc\ (MU Ildd .If(,J () Tax Map Key:L

Island: ~ ueU 4 - 4 -0\\:- 63;2-DW\

O~'S W*C ~*-ro7\ ::tJ1e.. Jring construction: j)( Rotary 0 Percussio D, Other (describe)

(drilled,cased,grouted) completed: _--'"-r.-~-"l-,,O~ Attach Completed Driller's Log

Ired? 0 Yes 1X No

ompleted? liJ No 0 Yes

~N DY

Attach Step-Drawdown Test form (12117197 SDPTD Fonn)

r ltd? est comple e . 0 es Attach Constant Rate Ac uifer Test form (12117197 CRPTD Fonn) Water Level

- Depth to = ft. al;>ove mean Reference point water sea level (see Dateltime of

Water Level Data: elevation (feet) note below) measurement 9. Initial encountered during drilling

~= est .3~S .~~ -25 1';).- ~-D_9 (this should also be filled in on the driller's 1Qg) ft. msl

10. Just prior to casing installation ~= ft.~ 3bS e'? .a5 /;2- ID-oq If this reference i~}

••••••• 11. After casing installation point is not the (this information should be before any pump tests are benchmark, the

~ %5 ; .. a-5 /,4-/0 performed with casing installed) difference between

Chloride: ~. pm, Temperature: 7~ ~ OF the benchmark and. ;'. this.l0int is: ~.; 1: ft.

note. for aI/ elevations referenced to mean sea level, take the ground elevation (surveyed or estimated if survey not reqUired at thiS time) and subtract the depth to the water level.

12. As-built section filled in completely A 13. Photograph of well and concrete pad showing benchmark on concrete pad attached ~

14. GPS coordinates provided in degrees, minutes, seconds k1 15. If a pump is not planned to be installed, please describe (below in the remarks section) how well is secured to prevent unauthorized access (example: lockable cover, threaded coupling, etc.)

16. Remarks:

C-S7 Lic. No. --=~-.:'-:--,1...;::S~]....I..-__ _ Date _''-1-'/ ~'-<...:. ,,'-+'/JO"-"'-"'V"---__

Licensed Driller (print)

Signature

WCR1 Form 611W7 Page 1 of 5

c 12. AS-BUILT WELL SECTION (Please attach as-built if different from diagram provided below)

Elevation at top of casing ft., msl* lj--r (to nearest 0.01 ft.) I ~ Minimum of 2' Radius & 4" Thick Concrete Pad

-.-.b.. ?.~ r Ground Elevation: '39D ft., msl 0 Surveyed >(Estimate Bench mark T:··.~.:;.

Hole Diameter· 13 in

d

elevation: /,/,1,«\\ ... '\>., /1""" /1""'"

'. " ,.I.., >- Please refer to the .:t1.b.S., msl*

.0 •

~.: ...

315 ...

dl HAWAII WELL CONSTRUCTION AND Cement Grout: ft. ':.'~'. :~ :: o (Surveyed to (min. 70% of distance from ';,. .:.

~'.': 1 P,=!MP INSTALLATION STANDARDS nearest 0.01 ft.) ground elevation to top of .:.::: .:t>' CD to ensure that your as-built is in compliance .; . ~.

.~ :;:: ...J

}r(Estimated) water surface or SOO ft., ::.:~:. S with applicable standards. whichever is less.) ...

I---< :',,:.' ,1>,. ~ ~.: ;.: :.1- ::~'.

, Annular space between :~.:.: ;. ': . :> ~ Solid Casing: (~90% x (Ground Elev.-Water Level Elev»)

Grouting method: ..9! hole and casing (1.S" for -.:1>" :-:;. w '"/00 ,)(.positive

';.~ . ~:;:: Length: ft.

positive displacement, 3" r:f -0 C h displacement (if for other methods): V~·.:::·

'\>.- ~ Nominal ~iameter: in. annular space is

,lJ.._ !: .250 ~

;.: ... ; .... '" Q. Wall Thickness: in. less than two in. i----' ':,:-', :. ~. x inches, attach

>- ~ ... -lQ "'.,' ~ Bottom Elevation: ft., msl

photo oftremie) - ~ 0

Rock or Gravel Packing: a> o Other ~~

AI

~ft. h I ~ Mate al: Open Casing: I) Perforated o Screen

o Crushed Basalt ~p Length: ~() ft.

D~ V & o Rounded Gravel ~~ Nominal Diameter: in.

,JSO Water Level Elevation:

_L- ~ 1-Wall Thickness: in.

J..5 Bottom Elevation: --30 ft., msl ft. msl* Total Depth f--

430 ft. (item 11 from page 1)

Open Hole:

Length: to ft.

Diameter: ;3 in.

'----- --'-- Bottom Elevation: -40 ft., msl *msl = mean sea level

Solid Casing Material: Carbon Steel: compliant with (check one or more): 0 ANSI/AWWA C200 0 API Spec. SL J:iilASTM AS3 0 ASTM A139

And compliant with (check one or more): 0 ASTM A242 or A606 }t Type E 0 Type S )( Grade B 0 Other

Stainless Stael: (check one): 0 ASTM M09 (production wells) 0 ASTM A312 (monitor wells)

ABS Plastic conforming to ASTM F480 and ASTM 01527: (check one) 0 Schedule 40 0 Schedule 80

PVC Plastic conforming to ASTM F480 and (ASTM 01785 or ASTM 02241): (check one): 0 Schedule 40 0 Schedule 80 0 Schedule 120

Thermoset Plastic: (check one) 0 Filament Wound Resin Pipe conforming to ASTM 02996

o Centrifugally Cast Resin Pipe conforming to ASTM 02997

o Reinforced Plastic Mortar Pressure Pipe conforming to ASTM 03517

o Glass Fiber Reinforced Resin Pressure Pipe conforming to AWWA C9S0

o PTFE Fluorocarbon Tubing conforming to ASTM 03296

o FEP Fluorocarbon Tubing conforming to ASTM 03296

Open Casing Material: Carbon Steel: compliant with (check one or more): 0 ANSIIAWWA C200 0 API Spec. 5L 0 ASTM A53 ~ ASTM A139

And compliant with (check one or more): 0 ASTM A242 or A606 Ps Type E 0 Type S "Grade B 0 Other

Stainless Steel: (check one): 0 ASTM A409 (production wells) 0 ASTM A312 (monitor wells)


PVC Plastic conforming to ASTM F480 and (ASTM 0178S or ASTM 02241): (check one): 0 Schedule 40 0 Schedule 80 0 Schedule 120

Thermoset Plastic: (check one) o Filament Wound Resin Pipe conforming to ASTM 02996



o Glass Fiber Reinforced Resin Pressure Pipe conforming to AWWA C950



WCR1 Form 6112107 Page 2 of 5

C State of Hawaii COMMISSION ON WATER RESOURCE MANAGEMENT Department of Land and Natural Resources DRILLER'S LOG

For Official Use Only:

Well Number: 0321-03 ~~~------------

Depths (ft.) Rock description, Water level, etc. Dates Depths (ft.) Rock description, Water level, etc. Dates

0 to 25 Mud 11/10109 260 to 270 Hard blue rock 11/25/09

25 to 50 Brwn mud 11/11/09 270 to 285 Hard blue rock 11127109

50 to 65 soft 11/12109 285 to 315 Blue rock 11/30/09

65 to 80 Red mud 11/12109 315 to 345 Blue rock 12/1109

80 to 90 Clay, brwn mud 11/12109 345 to 355 Blue rock 1212109

90 to 100 Soft 11/12109 355 to 365 Blue rock 1217109

100 to 110 Soft, weathered 11/12109 365 to 385 Blue rock 12/8/09

110 to 115 Firmer 11/12109 385 to 395 llOI ' ? Hard cinders 1218109 '.1; • .

115 to 120 Weathered rock 11/12109 ,,' , ~ Hard cinders

395 to 415 bctt, wI- 365 12/9/09

120 to 125 Grey weathered 11/12109 415 to 430 Hard blue rock 12110/09

125 to 130 Firm 11/12109 to

130 to 135 Hard 11/12109 to water @365' below top of conductor 12110/09

135 to 140 Blue rock 11112109 to

140 to 165 Hard blue rock 11/13109 to

165 to 210 Hard blue rock 11/18/09 to



245 to 260 Hrd blue rock 11/24/09 to

Remarks:

DL Form 0612412004

EXAMPLE

NAD83: 5~,8 Latitude: Zl.. degrees Jl1 min 947 sec Longitude: ~ degrees 2L- min ~ I 0 sec *

SKETCH OF WELL LOCATION

PROPERlY UNE

Lat: 19"36'45"

(Referenced to permanent landmark, i.e. building, road, fence, etc.) Provide Latitude and Longitude of well referenced to NAD83 to nearest second

WCR1 Form 6/12107 Page 4 of 5

o o

1'# it

o Oasis Water Systems <[email protected]>

11/02/200909:03 AM

Hi Charley-

To Charley F Ice <[email protected]>

cc roy hardy <[email protected]>

bcc

Subject Well 0321-03 - 2 week notice to begin drilling

By this note we are giving our two week notice of intent to begin drilling the Flow Well- State No. 0321-03. I know you are out of the office. Aloha, Betsy Lis Oasis Water Systems, Inc. 826-1854

o WELL CONSTRUCTION PERMI'P

Flow Well, Well No. 0321-03 Note: This permit shall be prominently displayed at the construction site until the work

In accordance with Department of Land and Natural Resources, Commission on Water Resource Manage Section 13-168, entitled "Water Use, Wells, and Stream Diversion Works", this document permits the con Well (Well No. 0321-03) at TMK (4) 4-4-011:032, Kauai, subject to the Hawaii Well Construction & (HWCPIS - February 2004) which include but are not limited to the following conditions:

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

II.

12.

13.

14.

15.

16.

17.

The ChaiTP-erson of the Commission on Water Resource Management (Commission), P.O. Box 621, Honolulu, HI 96809, ,uau U~ IIUllll~U, m wrmng, at least two (2) weeks before any work authorized by this permit commences and staff shall be aJlowed to inspect instaJlation activities in accordance with § 13-168-15, Hawaii Administrative Rules (HAR).

This permit shall be prominently displayed, or made available, at the site of construction work until work is completed.

The weJl construction permit shall be for construction and testing of the weJl only. The permittee shall coordinate with the Chairperson and conduct a pumping test in accordance with the HWCPIS (the latest pump test worksheet can be obtained by contacting Commission staff or at www.hawaii.gov/dlnr/cwrmlresourcesJlermits.htm). The permittee shall submit to the Chairperson the test results as a basis for supporting an application to install a permanent pump. No permanent pump may be installed until a pump installation permit is approved and issued by the Chairperson. No withdrawal of water shall be made for purposes other than testing without a Certificate of Pump Installation Completion. The permitted pump capacity described on the pump instaJlation permit may be reduced in the event that the pump test does not support the capacity.

In basal ground water, the depth of the weJl may not exceed one-fourth (114) of the theoretical thickness (41 times initial head) of the basal ground water unless otherwise authorized by the Chairperson. If it can be shown that the weJl does not tap basal ground water then this condition may be waived after consultation with and acceptance by Commission staff However, in no instance can the weJl be driJled deeper than one-half (112) of the theoretical thickness without Commission approval.

The permittee shall incorporate mitigation measures to prevent construction debris from entering the aquatic environment, to schedule work to avoid periods of high rainfall, and to revegetate any cleared areas as soon as possible.

In the event that historically significant remains such as artifacts, burials or concentrations of sheJls or charcoal are encountered during construction, the permittee shall stoJl work and immediately contact the Department of Land and Natural Resources' State Historic Preservation DiVision. Work may recommence only after written concurrence by the State Histonc Preservation Division.

The proposed well construction shall not adversely affect existing or future legal uses of water in the area, including any surface water or established instream flow standards. This permit or the authorization to construct the well shaJl not constitute a determination of correlative water rights.

The WeJl Completion Report Part I shall be submitted to the Chairperson within sixty (60) days after completion of work (please contact staff or visit www.hawaii.gov/dlnr/cwrm/resources_permits.htm for current form).

The permittee shaJl comply with all applicable laws, rules, and ordinances; non-compliance may be grounds for revocation of this permit.

The weJl construction permit application and, if relevant, any related staff submittal approved by the Commission are incorporated into this permit by reference.

If the HWCPIS are not foJlowed and as a consequence water is wasted or contaminated, a lien on the property may result.

Any variances from the HWCPIS shall be approved by the Chairperson prior to invoking the variance.

The work proposed in the weJl construction permit application shall be completed within two (2) years from the date of permit approval, unless otherwise specified. The permit may be extended by the Chairperson upon a showing of good cause and good-faith performance. A request to extend the permit shall be submitted to the Chairperson no later than the date the permit expires.

If the well is not to be used it must be proferly capped. If the well is to be abandoned during the course of the project then the permittee must apply for a well abandonment permit in accordance with § 3-168-12(1), HAR, prior to any well sealing or plugging work.

The permittee, its successors, and assigns shall indenmifY, defend, and hold the State of Hawaii harmless from and against any loss, liability, claim, or demand for property damage, personal injury, or death arising out of any act or omission of the applicant, assigns, officers, employees, contractors, .ag~er this permit or relating to or connected with the granting of this permit. !! (t)~,

This permit shall apply to the location shown on the application only. If the well is to be relocated, the permittee shall apply for a new wvns~'!rpump installation permit ill accordance with §I3-168-12(f), HAR. ~ ~U;::o

Special conditions in the attached cover transmitta1letter are incorporated herein by reference. _ f'Ii ~ ~ J _ ::x 0 ."

~L-- »Z::;::0<

Date of Approval: Juue 30, 2009 Expiration Date: June 30, 2011

aVLAU H. THIEL N, Chairp n ~:eO \ Com ission on W er Resource'IIan~ent

N 1'iPi I have read the conditions and terms ofthis permit and understand them. I accept and agree to meet these conditions as acrrere.;5ffi'e and underlying condition of my ability to proceed and understand that I shall not commence work until I have signed, dated, and returned the permit to the Commission. I understand that this permit is not to be transferred to any other entity. I also understand that non-compliance with any permit condition may be grounds for revocation and fines of up to $5,000 per day starting from the permit date of approval.

Driller's Signature: C-S7 License #: C-214S7 Date:

Printed Name: Barry Simmons Firm or Title: Oasis Water Systems, Inc.

Please sign both copies of this permit, return one copy to the Commission office, and retain the other for your records.

Attachment

~UMP INSTALLATION PERMITC Flow Well. Well No. 0321-03

Note: This permit shall be prominently displayed at the site until the work is completed

In accordance with Department of Land and Natural Resources, Commission on Water Resource Management's Administrative Rules, Section 13-168, entitled "Water Use, Wells, and Stream Diversion Works", this document permits the pump installation for Flow Well (Well No. 0321-03) at TMK (4)4-4-011:032, Kauai, subject to the Hawaii Well Construction & Pump Installation Standards (HWCPIS - February 2004) which include but are not limited to the following conditions:

l. The Chairperson to the Commission on Water Resource Management (Commission), P.O. Box 621, Honolulu, HI 96809, shall be notified, in writing, at least two (2) weeks before any work covered by this permit commences and staff shall be allowed to inspect installation activities in accordance with § 13-168-15, Hawaii Administrative Rules (HAR).

2. No withdrawal of water shall be made other than for testing until a Certificate of Pump Installation Completion has been issued by the Commission.

3. This permit shall be prominently displayed, or made available, at the site of construction work until work is completed.

4. The pump installation permit shall be for installation of a 50 gpm rated capacity, or less, pump in the well. This permanent capacity may be reduced in the event that the pump test data does not support the capacity.

5. A water-level measurement access shall be permanently installed, in a manner acceptable to the Chairperson, to accurately record water levels.

6. The permittee shall install an approved meter or other appropriate means for measuring and reporting withdrawals and appropriate devices or means for measuring chlorides and temperature at the well head.

7. Well Completion Report Part II shall be submitted to the Chairperson within sixty (60) days after completion of work (please contact staff or visit www.hawaii.gov/dlnr/cwrm/resources _permits.htm for current form).

8. The permittee, well operator, and/or well owner shall comply with all applicable laws, rules, and ordinances, and non-compliance may be grounds for revocation of this permit.

9. The pump installation permit application and, if relevant, any related staff submittal approved by the Commission are incorporated into this permit by reference.

10. If the HWCPIS are not followed and as a consequence water is wasted or contaminated, a lien on the property may result.

II. Any variances from the HWCPIS shall be approved by the Chairperson prior to invoking the variance.

12. The work proposed in the pump installation permit application shall be completed within two (2) years from the date of permit approval, unless otherwise specified. The permit may be extended by the Chairperson upon a showing of good cause and goodfaith performance. A request to extend the permit shall be submitted to the Chairperson no later than the date the permit expires.

13. The permittee, its successors, and assigns shall indemnify, defend, and hold the State of Hawaii harmless from and against any loss, liability, claim, or demand for property damage, personal injury, or death arising out of any act or omission of tWapPl:i:CJu1t, assigns, officers, employees, contractors, and agents under this permit or relating to or connected with the granting oft . . erng:g

03: Special conditions in the attached cover transmittal letter are incorporated herein by reference. I: §6:!

en n tIl:::J 14.

Date of Approval: Expiration Date:

June 30, 2009 June 30, 2011

---f"i.LAU Com

L-- 1'1 (I)"" -,.(3n ...... Z!!! :;z:o<

~ :;p.z~ ssion on ater Resource Management at ~.~

- ::3:-' N f'I11""1 I have read the conditions and terms of this permit and understand them. I accept and agree to meet these con.on~ prerequisite and underlying condition of my ability to proceed and understand that I shall not commence work until I and the pump installer have signed, dated, and returned the permit to the Commission. I understand that this permit is not to be transferred to any other entity. I also understand that non-compliance with any permit condition may be grounds for revocation and fines of up to $5,000 per day starting from the permit date of approval.

Installer's Signature: £1ila~ ~ C-57, C-57a, or A License #: C-214S7 Date:



Attachments

o Oasis Water Systems <[email protected]>

08/10/2009 01 :00 PM

o

To Charley F Ice <[email protected]>

cc

bcc

Subject Flow Well- 0321-03 - Executed permits

Hi Charley-Attached please find the executed permits for the Flow Well- State no. 0321-03 for your files. I will send the Denise always wanted me to snail-mail copies to her, do you require the same? Aloha - and stay dry! Betsy Lis Oasis Water Systems, Inc. 808-826-1854

D!:' ~' ~ ....

0321·03 . Executed Well Permit. pdf 0321·03· Executed Pump Permit. pdf

o o WELL CONSTRUCTION PERMIT

Flow Well, Well No. 0321-03 Note: This permit shall be prominently displayed at the construction site until the work is completed

In accordance with Department of Land and Natural Resources, Commission on Water Resource Management's Administrative Rules, Section 13-168, entitled "Water Use, Wells, and Stream Diversion Works", this document permits the construction and testing of Flow Well (Well No. 0321-03) at TMK (4) 4-4-011:032, Kauai, subject to the Hawaii Well Construction & Pump Installation Standards (HWCPIS - February 2004) which include but are not limited to the following conditions:

I.

2.

3.

4.

5.

6.

7.

8.

9.

10.

II.

12.

13.

14.

IS.

16.

17

The Chairperson of the Commission on Water Resource Management (Commission), P.O. Box 621, Honolulu, HI 96809, shall be notified, in writing. at least two (2) weeks before any work authorized by this permit commences and staff shall be allowed to inspect installation activities in accordance with § 13-168-15, Hawaii Administrative Rules (HAR).


The well construction permit shall be for construction and testing of the well only. The permittee shall coordinate with the Chairperson and conduct a pumping test in accordance with the HWCPIS (the latest pump test worksheet can be obtained by contactmg Commission staff or at www.bawaii.gov/dlnr/cwrmlresourcesJlermits.btm). The permittee shall submit to the Chairperson the test results as a basis for supporting an application to install a pennanent pump. No permanent pump may be installed until a pump installation permit is approved and issued by the Chairperson. No withdrawal of water shall be made for purposes other than testing without a Certificate of Pump installation Completion. The permitted pump capacity described on the pump installation permit may be reduced in the event that the pump test does not support the capacity.

In basal ground water, the depth of the well may not exceed one-fourth (1/4) ofthe theoretical thickness (41 times initial head) of the basal ground water unless otherwise authorized by the Chairperson. If it can be shown that the well does not tap basal ground water then this condition may be waived after consultation with and acceptance by Commission staff. However, in no instance can the well De drilled deeper than one-half (112) ofthe theoretical thickness without Conunission approval.

The permittee shall incorporate mitigation measures to prevent construction debris from entering the aquatic environment, to schedule work to avoid periods of high rainfall, and to revegetate any cleared lIfeas as soon as possible.

In the event that historically significant remains such as artifacts, burials or concentrations of shells or charcoal are encountered during construction, the permittee shall stop work and immediately contact the Depal:!ment of Land and Natural Resources' State Historic Preservation DiVIsion. Work may recommence only after written concurrence by the State HistorIC Preservation Division.

The proposed well construction shall not adversely affect existing or future legal uses of water in the area, including any surface water or established instream tlow standards. This permit or the authorization to construct the well shall not constitute a detennmation of correlative water rights.

Thc Well Completion Report Part I shall be submitted to the Chaifllerson within sixty (60) days after completion of work (please contact staff or visit www.bawaii.gov/dlnr/cwrm/resourtt8_permits.htm for current form).

The permittee shall comply with all applicable laws, rules, and ordinances; non-compliance may be grounds for revocation of this pemlit.

The well construction permit application and, if relevant, any related staff submittal approved by the Commission are incorporated into this permit by reference.

If the HWCPIS are not followed and as a consequence water is wasted or contaminated, a lien on the property may result.


The work proposed in the well construction permit application shall be completed within two (2) years from the date of permit approval, unless otherwise specified. The permit may be extended by the Chairperson .upon. a showing of good cause and good-faith performance. A request to extend the pennit shall be submItted to the Charrperson no later than the date the pen1llt expires

If the well is not to be used it must be properly capped. If the well is to be abandoned during the course of the project then the permittee must apply for a well abandonment permit in accordance with § 13-168-12(f). HAR, prior to any well sealing or plugging work.

The permittee, its successors, and assigns shall indenmify, defend, and hold the State of Hawaii harmless from and against any loss, liability, claim, or demand for property damage, personal injury, or death arising out of any act or omission of the applicant, assigns, officers, employees, contractors, and agents under this permit or relating to or connected with the granting of this permit.

This pennit shall apply to the location shown on the application only. lfthe well is to be relocated, the permittee shall apply for a new well construction/pump installation permit m accordance with §13-168-12(f), f1AR

Special conditions in the attached cover transmittal Jetter are incorporated herein by reference.

Date of Approval: June 30, 2009 Expiration Date: June 30, 2011.

I have read the conditions and terms of this permit and understand them. I accept and agree to meet these conditions as a prerequisite and underlying condition of my ability to proceed and understand that I shall not commence work until I have signed, dated, and returned the permit to the Commission. I understand that this permit is not to be transferred to any other entity. I also understand that non-compliance with any permit condition may be grounds for revocation and fines of up to $5,000 per day starting from the permit date of approval.

Driller's Signature: C-S7 License #: C-21457 Date:

Printed Name: Bany Simmons Finn or Title: Oasis Water Systems, Inc.

Please sign both copies oft";s permit, return one copy to the Commission office, and retain the other for your records.

Attachment

o o PUMP INSTALLATION PERMIT

Flow Well. Well No. 0321-03 Note: This permit shall be prominentlv displaved at the site until the work is completed


I. The Chairperson to the Commission on Water Resource Management (Commission), P.O. Box 621, Honolulu, HI 96809, shall be notified, in writing, at least two (2) weeks before any work covered by this permit commences and staff shall be allowed to inspect installation activities in accordance with §13-168-1S, Hawaii Administrative Rules (HAR).



4. The pump installation permit shall be for installation of a 50 gpm rated capacity, or less. pump in the well. This permanent capacity may be reduced in the event that the pump test data does not support the capacity.

5. A water-level measurement access shall be pennanently installed, in a manner acceptable to the Chairperson, to accurately record water levels.

6. 'Jbe permittee shall install an approved meter or other appropriate means for measuring and reporting withdrawals and appropriate devices or means for measuring chlorides and temperature at the well head.

7. Well Completion Report Part II shall be submitted to the Chairperson within sixty (60) days after completion of work (please contact staff or visit www.hawaii.gov/dlnr/cwrm/resources _permits.htm for current fonn).

8. The permittee, well operator, and/or well owner shall comply with all applicable laws, rules, and ordinances, and non-compliance may be grounds for revocation of this pennit.

9. The pump installation permit application and, ifrelevant, any related staff submittal approved by the Commission are incorporated into this permit by reference.


11. Any variances from the HWCPIS shall be approved by the Chairperson prior to invoking the variance.

12. The work proposed in the pump installation permit application shall be completed within two (2) years from the date of pennit approval, unless otherwise specified. The permit may be extended by the Chairperson upon a showing of good cause and goodfaith performance. A request to extend the permit shall be submitted to the Chairperson no later than the date the permit expires.

13. The pennittee. its successors, and assigns shall indemnify, defend, and hold the State of Hawaii harmless from and against any loss, liability, claim, or demand for property damage, personal injury, or death arising out of any act or omission of the applicant. assigns, officers. employees, contractors, and agents under this pennit or relating to or connected with the granting of this permit.

14. Special conditions in the attached cover transmittal letter are incorporated herein by reference.


June 30, 2009 June 30, 2011

j.,~LAU ~l vr ~om

ater Resource Management

I have read the conditions and terms of this permit and understand them. I accept and agree to meet these conditions as a prerequisite and underlying condition of my ability to proceed and understand that I shall not commence work until I and the pump installer have signed, dated, and returned the permit to the Commission, I understand that this permit is not to be transferred to any other entity. I also understand that non-compliance with any permit condition may be grounds for revocation and fines of up to $5,000 per day starting from the permit date of approval.

Installer's Signature: tli~ k C-57, C-57a, or A License #: C-214S7 ------ Date: ---=8+-1 $-t-='ID-l--9 _

Printed Name: Barry Simmons Firm or Title: Oasis Water Systems; Inc.

Please sign both copies of this permit, return one copy 10 the Commission office, and retain the other for your records.

Attachments

o o LINDA LINGLE

GOVERNOR OF HAWAII

RECEIVED HISTORIC PRES. Dry. DEPT. OF LAND & •

MATURAl RESOURCES

LAURA H THIELEN CHAIRPERSON

MEREDITH J. CHING NEAL S. FUJIWARA

CHIYOME L. FUKINO, M.D. DONNA FAY K. KIYOSAKI, PE

LAWRENCE H. MilKE, M.D., J.D.

STATE OF HAWAII KEN C. KAWAHARA, PE.

DepUTY DIRECTOR

TO:

FROM:

SUBJECT:

DEPARTMENT OF LAND AND NATURAL RESOURCES



May 29,2009

Dr. Puaalaokalani Aiu, Administrator Historic Preservation

Ken C. Kawahara, P.E., Deputy Director Commission on Water Resource Management

Well Construction/Pump Installation Permit plication Flow Well (Well No. 0321-03), TMK: (4) 4-4-011:032

I »-S , U1

• \Ct -<If" ....,

Transmitted for your review and comment is a copy of the captioned Well ConstructionlPump Installation permit application. The maps attached to the permit application show the proposed well location.

We would appreciate your comments on the captioned application with regard to the programs, plans, and objectives specific to your division. Please respond by returning this cover memo form by June 30, 2009. Ifwe do not receive comments or a request for additional review time by this date, we will assume you have no comments.

If you have any questions about this permit application or request additional review time, please contact Denise Mills of the Commission staff at 587-0251. If you require additional information regarding specific information that can be provided by the applicant, please contact the applicant directly at the contact information provided on the application form.

dem:ss Attachment(s)

RESPONSE:

[ ] This is a [ ] public (county or state) project [ ] private project and [ ] will [ ] may disturb historic sites.

~("') rr'1Q ~:J: C:3: ::0-t'')(J)~ M(I)f"'I -.. 5("') -""z'" J> < xc." »zc ~J. ~ ... '""'" z::a -t

~]

[ ]

~e. concur that the 'York described under this permit will not disturb historic sites. ~(()ft'\~ VJ>ed.. Qo fa5:>~ I tJb tIvUWvt ~~ 1V'l ~

We do not concur that the work described under this permit will not disturb historic sites. We require the following for our concurrence:

\----+"::'I-----,."'I----=--A--'m,----· c._~~~ Phone: (jQ.-"6 DJ 5 Signed:~_+-.u."h...~_':::::::::::::::~ ______ _ Date: 7fO/stJ

..... c::::> .... c.:>

~ (~:;. , r~..,)

-< :011...

". -... L-

c .," ..

.~ o ,. ~


Mr. Barry Simmons Oasis Water Systems, Inc. P.O. Box 507 Hanalei, ill 96714

Dear Mr. Simmons:




July 9, 2009

Pump Installation Permit Flow Well (Well No. 0321-03)


SUMNER ERDMAN NEAL S. FUJIWARA

CHIYOME L. FUKINO, M.D. DONNA FAY K. KIYOSAKI, P.E. LAWRENCE H. MilKE, M.D., J.D.

KEN C. KAWAHARA P.E. DEPUTY DIRECTOR

Ref: 0321-03 pip. doc

Enclosed are two (2) originals of your approved Pump Installation Permit for the captioned welles) that authorize permanent pump installation work for your welles). As part of the Chairperson's approval, the following special conditions were added and are part of your permit under Permit Condition 14:

Special Conditions

1. If the elevation benchmark needs to be altered, the permittee, well operator, and/or well owner shall ensure that the benchmark is transferred (or the well resurveyed) and documentation of the new benchmark shall be submitted to the Commission within sixty (60) days after the pump is installed.

2. Attached for your information are copies of the Department of Health's (DOH's) review comments. Please note DOH's requirements related to discharge of effluent from well drilling and testing activities. Also, please contact the Noise Radiation and Indoor Air Quality Branch at 586-4700 for information on construction noise restrictions and permit requirements for this project.

The permittee is responsible for all conditions of the permit. This includes ensuring the submission of a completed Well Completion Report Part II form within sixty (60) days after the pump installation work is completed. Be advised that you may be subject to tines of up to $5,000 per day for any violations of your permit conditions starting from the permit approval date.

Please sign both permit originals and return one copy to the Commission office for our files.

IMPORTANT - Pump installation shall not commence until a fully signed permit is returned to the Commission.

If you have any questions, please call Charley Ice of the Commission staff at 587-0218 or toll-free from Kauai at 274-3141, extension 70218.

c: Dwain & Sue Hill (with applicable DOH comments) USGS KauaiDWS

/

JIIP'''',

V PUMP INSTALLATION PERMIT o

Flow Well, Well No. 0321-03 Note: This permit shall be prominently displayed at the site until the work is completed


l. The Chairperson to the Commission on Water Resource Management (Commission), P.O. Box 621, Honolulu, HI 96809, shall be notified, in writing, at least two (2) weeks before any work covered by this permit commences and staff shall be allowed to inspect installation activities in accordance with § 13-168-15, Hawaii Administrative Rules (HAR).



4. The pump installation permit shall be for installation of a 50 gpm rated capacity, or less, pump in the well. This permanent capacity may be reduced in the event that the pump test data does not support the capacity.

5. A water-level measurement access shall be permanently installed, in a manner acceptable to the Chairperson, to accurately record water levels.

6. The permittee shall install an approved meter or other appropriate means for measuring and reporting withdrawals and appropriate devices or means for measuring chlorides and temperature at the well head.

7. Well Completion Report Part II shall be submitted to the Chairperson within sixty (60) days after completion of work (please contact staff or visit www.hawaii.gov/dlnr/cwrm/resources _permits.htm for current form).

8. The permittee, well operator, and/or well owner shall comply with all applicable laws, rules, and ordinances, and non-compliance may be grounds for revocation ofthis permit.

9. The pump installation permit application and, if relevant, any related staff submittal approved by the Commission are incorporated into this permit by reference.


11. Any variances from the HWCPIS shall be approved by the Chairperson prior to invoking the variance.

12. The work proposed in the pump installation permit application shall be completed within two (2) years from the date of permit approval, unless otherwise specified. The permit may be extended by the Chairperson upon a showing of good cause and goodfaith performance. A request to extend the permit shall be submitted to the Chairperson no later than the date the permit expires.

13. The permittee, its successors, and assigns shall indemnify, defend, and hold the State of Hawaii harmless from and against any loss, liability, claim, or demand for property damage, personal injury, or death arising out of any act or omission of the applicant, assigns, officers, employees, contractors, and agents under this permit or relating to or connected with the granting of this permit.

14. Special conditions in the attached cover transmittal letter are incorporated herein by reference.


June 30, 2009 June 30, 2011

~LAU Com

EN, Chairperson ater Resource Management

I have read the conditions and terms of this permit and understand them. I accept and agree to meet these conditions as a prerequisite and underlying condition of my ability to proceed and understand that I shall not commence work until I and the pump installer have signed, dated, and returned the permit to the Commission. I understand that this permit is not to be transferred to any other entity. I also understand that non-compliance with any permit condition may be grounds for revocation and fines of up to $5,000 per day starting from the permit date of approval.

Installer'S Signature: C-57, C-57a, or A License #: C-214S7 Date:



Attachments

/

......... LINDA LINGLE

GOVERNOR OF HAWAII


Dear Mr. Simmons:

,If'-"",

o




July 9, 2009

Well Construction Permit Flow Well (Well No. 0321-03)

LAURA H. THIELEN I CHAIRPERSON

SUMNER ERDMAN NEAL S. FUJIWARA

CHIYOME L FUKINO, M.D. DONNA FAY K. KIYOSAKI, P.E. LAWRENCE H MilKE, M.D., J.D.

KEN C. KAWAHARA, PE. OEPUTY DIRECTOR

Ref: 0321-03 wcp.doc

Enclosed are two (2) copies of your approved Well Construction Permit for the captioned welles) that authorize well construction activities but excludes installation work for a permanent pump. As part of the Chairperson's approval, the following special conditions were added and are part of your permit under Permit Condition 17:

Special Conditions

1. Attached for your information are copies of the Department of Health's (DOH's) review comments. Please note DOH's requirements related to discharge of effluent from well drilling and testing activities. Also, please contact the Noise Radiation and Indoor Air Quality Branch at 586-4700 for information on construction noise restrictions and permit requirements for this project.

Please refer to the Permit Processes Worksheet (transmitted with your acknowledgement letter) for further information regarding the process of drilling a well and installing a pump.

No withdrawal of water if allowed for other than for testing purposes until a certificate of pump installation completion has been issued by the Commission.

Please sign both permit originals and return one copy to the Commission office for our files. For copies of the aquifer pump test worksheet, please call staff or visit www.state.hi.us/dlnr/cwrm/forms.htm.

IMPORTANT - Drilling work shall not commence until a fully signed permit is returned to the Commission. The permit shall be prominently displayed or made available at the construction site during construction. Be advised that you may be subject to fines of up to $5,000 per day for any violations of your permit conditions starting from the permit approval date.

If you have any questions, please call Charley Ice of the Commission staff at 587-0218 or toll-free from Kauai at 274-3141, extension 70218.

Sincere ,

URA~~~ lrperson r1IEL

Enclosures

c: Dwain & Sue Hill (with applicable DOH comments USGS KauaiDWS

- ..... c o WELL CONSTRUCTION PERMIT

Flow Well, Well No. 0321-03 Note: This permit shall be prominently displayed at the construction site until the work is completed

In accordance with Department of Land and Natural Resources, Commission on Water Resource Management's Administrative Rules, Section 13-168, entitled "Water Use, Wells, and Stream Diversion Works", this document permits the construction and testing of Flow Well (Well No. 0321-03) at TMK (4) 4-4-011:032, Kauai, subject to the Hawaii Well Construction & Pump Installation Standards (HWCPIS - February 2004) which include but are not limited to the following conditions:

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

The ChaifEerson of the Commission on Water Resource Management (Commission), P.O. Box 621, Honolulu, HI 96809, shall be notified, in writing, at least two (2) weeks before any work authorized by this permit commences and staff shall be allowed to inspect installation activities in accordance with § 13-168-15, Hawaii Administrative Rules (HAR).


The well construction permit shall be for construction and testing of the well only. The permittee shall coordinate with the Chairperson and conduct a pumping test in accordance with the HWCPIS (the latest pump test worksheet can be obtained by contacting Commission staff or at www.hawaiLgov/dlnr/cwrmlresources_permits.htm). The permittee shall submit to the Chairperson the test results as a basis for supporting an application to install a permanent pump. No permanent pump may be installed until a pump installation permit is approved and issued by the Chairperson. No withdrawal of water shall be made for purposes other than testing without a Certificate of Pump Installation Completion. The permitted pump capacity described on the pump installation permit may be reduced in the event that the pump test does not support the capacity.

In basal ground water, the depth of the well may not exceed one-fourth (1/4) of the theoretical thickness (41 times initial head) of the basal ground water unless otherwise authorized by the Chairperson. If it can be shown that the well does not tap basal ground water then this condition may be waived after consultation with and acceptance by Commission staff. However, in no instance can the well be drilled deeper than one-half (112) of the theoretical thickness without Commission approval.

The permittee shall incorporate mitigation measures to prevent construction debris from entering the aquatic environment, to schedule work to avoid periods of high rainfall, and to revegetate any cleared areas as soon as possible.

In the event that historically significant remains such as artifacts, burials or concentrations of shells or charcoal are encountered during construction, the permittee shall stOll work and immediately contact the Department of Land and Natural Resources' State Historic Preservation DiVision. Work may recommence only after written concurrence by the State Histonc Preservation Division.

The proposed well construction shall not adversely affect existing or future legal uses of water in the area, including any surface water or established instream flow standards. This permit or the authorization to construct the well shall not constitute a determination of correlative water rights.

The Well Completion Report Part I shall be submitted to the Chairperson within sixty (60) days after completion of work (please contact staff or visit www.hawaii.gov/dlnr/cwrmlresources_permits.htm for current form).

The permittee shall comply with all applicable laws, rules, and ordinances; non-compliance may be grounds for revocation ofthis permit.

The well construction permit application and, if relevant, any related staff submittal approved by the Commission are incorporated into this permit by reference.

If the HWCPIS are not followed and as a consequence water is wasted or contaminated, a lien on the property may result.


The work proposed in the well construction permit application shall be completed within two (2) years from the date of permit approval, unless otherwise specified. The permit may be extended by the Chairperson upon a showing of good cause and good-faith performance. A request to extend the permit shall be submitted to the Chairperson no later than the date the permit expires.

If the well is not to be used it must be prorerly capped. If the well is to be abandoned during the course of the project then the permittee must apply for a well abandonment permit in accordance with § 3-168-12(f), HAR, prior to any well sealing or plugging work.

The permittee, its successors, and assigns shall indemnify, defend, and hold the State of Hawaii harmless from and against any loss, liability, claim, or demand for property damage, personal injury, or death arising out of any act or omission of the applicant, assigns, officers, employees, contractors, and agents under this permit or relating to or connected with the granting of this permit.

This permit shall apply to the location shown on the application only. If the well is to be relocated, the permittee shall apply for a new well construction/pump installation permit m accordance with §13-168-12(f), HAR.

Special conditions in the attached cover transmittal letter are incorporated herein by reference.

!tiL-Date of Approval: June 30, 2009 Expiration Date: June 30, 2011

I have read the conditions and terms of this permit and understand them. I accept and agree to meet these conditions as a prerequisite and underlying condition of my ability to proceed and understand that I shall not commence work until I have signed, dated, and returned the permit to the Commission. I understand that this permit is not to be transferred to any other entity. I also understand that non-compliance with any permit condition may be grounds for revocation and fines of up to $5,000 per day starting from the permit date of approval.

I

Driller's Signature: C-S7 License #: C-21457 Date: -------



Attachment

WqH"ponstruction/Pump Permit Applicati,\n Review Tracking

Well No.: 061-1- 03 Well Name: Row --~----------------

Review start date: --,{j+-{Z=t:l~f_Gq-=----____ _ Comment deadline: f/~CI()q

Reviewer

DLNR

Land Division, Morris Atta

Historic Preservation Division

Comments Received (YIN)

y

Date

~9\(Dan Davidson) A /\ ~ /\ /"1\ 1\ /*"' /\ ~

D HL\Qion\rJicah 'Wane,v \ / \l v V V V \I DOH (Hon. C~l. Fukino)

Attach Comments to Permit (YIN)

N

/\ /\ / \ / \

v \

WWB - Thomas See y C, 14-/ "q N SDWB - Stuart Yamada V rdz-itr1 ~ N CWB - Alec Wong Y t-L'iJt"'! y,o;; HEER - Kawaoka V C} t~ I t'1 N

~&C~f Hqnplulu /".. /\ /""""0./'\ ~ f\.. /" /\ /' /\ /\ ~O~Olllu I\W~(Wa\ne ~asti(ro) / \ / \ / \ / \ I \ I \ / \ I \ / \ pept\o Pla~nfng & P~rrpitting\(r(enry En~ / \ I \ / \ I \ I \ / \ I \ / \

K~ai, ~ pt of );llanning '(Jcosta)\} \j V \J V V V v \ J \

t

,un.16. 2009 11: 16AM DOH:HEER OFFICE 208-536-7537 ~o, 2735 P. 1

P, (J, IelOX JHI

HONOWLU. H,o\W.l.U !I;(.~l

STATE OF HAWAII DEPARTMENT OF HEALTH

HAZARD EVALUATION AND EMERGENCY RESPONSE OFFICE

NO. OF PAGES:_~/"--<r-,-I __ _

COMPANY: ____ ~c~w~g~~ ________________________ ----

TELEPHONE: ____ ~1_-=O~~~~_5 __ __ FAX: t -02/ 9

FROM:_.....--:.g~C'"'-"'~Q""'-'v-'-'"'d'-'---'Pc--"""Q...,"'-'-'l~~ ____ ~ _____ _

TELEPHONE: (808) 586-4249 FAX: (808) 586~7537.

COMMENTS:

o 1< uk H fE. f2..

JUi'l-16-2009 11:16AM FAX:808 586 7537 ID:DLi'lR (WRM PAGE: 001 R=95%

,un.16. 200911:16AM DOH-HEER OFFICE 208-536-7537 ~o. 2735 P. 2

LINDA LINGLE r.):O..."fimol\ or' ptAW.'JJ r,EC[lYED

lAUAAlt THIELEN CM.\IRPE.Re:ON

TO:

Rl HUH OF HEALTH

lOO' JUN ... 2 AIQ: I 0

STATE OF HAWAII HEER OFfiCE OEPARTMI':NT OF LAND AND NATURAL RESOURCE:S

COMMISSION ON WATER RESOURCE MANAGEMENT P.O.1I0X621

HONOLULU. HAWAII 96809

May 29,2009

Honorable Chiyome L. Fukino, M.D., Director Department of Health Attention: Tomas See, Chief, Wastewatel' Branch

Stuart Yamada, Chief, Safe Drinking Water Branch Alec Wong, Chief, Clean Water Branch

vDr. Keith Kawaoka, Office of Ha rd Evaluat'

ME~EOIIH J. CHING NI;AL S. FUJIWAM

CHIVOMEL FUKINQ, "to. DONNA FAY K KIYOS"K1. P.I>. LAWRENC~ H. MilKE. M.D .• JD.

KEN C. KAWAHARA. P.E. DrJ'UTY D P."~TORi

FROM: !2rLaura H. Thielen, Chairperson fr Commission on Water Resource Managem t

SUBJECT: Well Construction/Pump Installation Pc t Applicati n Flow Well (Well No. 0321·03), TMK (4) 1J.~4-011 :032

Transmined for your review and comment is a copy ofrhe captioned Well Construction/Pump Installation permit applicatioll_ The maps attached to the permit application show the proposed well location.

We would appreciate your comments on the captioned application for any conflicts or inconsistencies with the programs, plans, and objectives specific to your department. Please respond bI ret~~ninr this cov~r memo. form by Ju~e 30, 2009. rf we do not receive comments or a request for adchhona reVlew time by thIs date, we Will assume that you have no comments.

If you have any questions about this permit application, request additional information, or request additional review time, please contact Denise Mills of the Commission staff at 587-025l.


RESPONSE: ( ) This well qualifies ~s il SOUrce which will serve as a SOurCe Qfpot~bJe water to a public Wliter system (dofined as serving 2S or morc

people at Ieil..lt 60 days pc;r year or has 15 Or mOre $ecYice connectioJls) aJld must receive Pi rector ofliealrll approval prior 10 its use to comply with. Hawaii Adminidrallvc Rules (HAR), Title II, ChaptedO. Rl.des Relating to Potable Water Systems, §1I-20-29.

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This well does not qulllity as l\ sour~ serving a public water system (mns les~ than 25 people or more people at least 60 days per year 0( 15 £er'\lice connections) md if the well water is med for drlnking. the plivate OWner .houiillest for bacteriological and chemical prescnce before initiating such use and rO\III~ly monitor dle waler qulllity Ihmafter. However, if future planned use from this source increases to meet the public water system definition then Director of Health approvill is reqoired priorto implementa[ion.

[fthe well is us~d to ~\lpply bOLh potable and non-pot~bl~ purpose~ in a single system. the user sllall elimint'1te CrOU-comltCllons and b~ckflow connections oy physically separating potable and nOIl-potable systems by an air gap Of all apprDved backflow preventer, and by clearly labeling all n!ln-potable spigolS with warning signs to prevent inadverte!lt consumption of non·Jlotable water. B~ckt1ow prevention devices sllould be rOlilineiy inspected and tested. It does no! appear that this well Will be used for CIlmumptive purposes and is not Subject to Safe Drinking Water Regulations.

For the applicant's information, a sourCe of possible waslewater contamination [ )i$/ ( )Is not located near (he pr<:lposed well site . (information attached).

An NPDES permit IS required.

Other reJevallt DOH r'Ules!rcg\ll~tions. infomlaLion, Or re(;l)mm~tlda!ions life ahlched. In the ~vent that tile location of the well changes bUI is still within the parcel described 0(1 this IIppiication, our division considers the tomlllents to still be applicable. and we do not need to r~yjew Ihe new location. No comments/objections

Contact Person: k?ch a.-If'd. R..l"", QC Phone: 5"8 b '-o~!;-7

Signed: Zf;.A.:u.d ~. Date: 6)t/;"cro 't

JUN-16-2009 11:16RM FRX:808 586 7537 ID:OLNR CWRM PRGE:002 R=95%

06-04-Z~09 09:19am From-DEPT OF HEALTH ENVIRONMENTAL MNGMT 9085864352 T-167 P.003/003 F-169 ., -LINOA LINGLE

&ovERNO;c .oF 1'i4wAli

C V

~AA' '""",. .~ GnAltb'~&ON

STATE OF HAWAII DE;PARTh'lENT OF LAND AND NATURAL RESOURCES

COMMISSION ON WATER RESOURCE MANAGEMENT po. eOX!l2'

HONOW~I.l. HAWAII 96609

MERfOI'rH J. CHING NEAL S. FI.lJIWAAA

CHIYOM" L. FIJKlNO, M.D. DONNA FAY K.I<lYOSAKI. P.E. I-AWRENCE H. MIII<E, M.[l. J.D.

K~N c. KAWAHARA. ".~ CEPuT\t }JRECTOR

May 29, 2009 •..

. ~.~..:. ~ : .

TO; Honorable Chiyome 1. Fukino, M.D., Director Department of Health Attention: Tomas See, Chief, Wastewater Branch

Stuart Yamada. Chief, Safe Drinking Water Branch -Alec Wong, Chief, Clean Water Branch

FROM: ~Laura H. Thielen, Chairperson . ~ Dr. Keith Kawaoka, Office of Ha d EVfluaf n ani Emergency Response

-[" Commission on Water Resource Managem t

SUBJECT: Well Construction/Pump Installation Pe t Applicaf n Flow Well (Well No. 0321-03), TMK (4) ~-4-011:032

Transmitted for yO·ur review and comment is a copy of the captioned Well ConstructionlPump Installation permit application. The maps attached to the pennit application show the proposed well location.

We would appreciate your COmments on the captioned application for any conflicts or inconsistencies with the programs, plans, and objectives specific to your department. Please respond by returning this cover memo form by June 30,2009. Ifwe do not receive comments or a request for additional review time by this CJare, we will assume that you have no comments. .

lfyou have any questions about this permit application, request additional information, Or request additional review time, please contact Denise Mills ofthe Commission staff at 587-0251.


RESPONSE: L I This well quahfies as a source which will serve as II w\lrce of potable watQ[" to a pulJli~ water system (detineq:as seIVinl;l25 or more

people lit le<l,[ 60 days per year or has 15 or mort SCJVicQ connci:tion,) Il.nd mu~t rc:cdvt Pirc:ctor of HOlllth approval pr.OT to 11.~ lise to camply with Hawaii Administrative Rules (HAR). Title 11, Chapter ;20. ~1I1~1' R~ll>.tlns ~o Potable Wl>.,er Sy.lems, § 11-;2()-Z9,

[ ] This well docs not qualify ~~ II ~Ol~ra: serving a public wiittr symm (scnes less mall 25 people or more people at least 60 days per ytar or ) 5 Sl:'I"Yice connection!.) and if the well water .s used for drinking. the pr:vatc: owner shoulct teS~ for bacteriological and chemical presence bef()~ initiatin~ l'uch us~ Wld rontindy monitor !he W!1t"r Ciualiry rh~eaft,)r. However, iffuturil plaM"d use from !hi. Souyc. increases to meet Ihe public wateT 'Y$tem ddlnitiOlilhen Director of Heallh approval is required prior to implementation.

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!fehe well is u."d to supply both PQlable ilnd non-potable purposes in a singl= system. tile \lser shall eliminate cross"collllcctions and bacldlow connections by pby~ically separating porable and non-p()uble systems by ,\.1 air gap or an approvad bacldJow preventer. and by clearly label ins al1l1on-potl\bl~ spigol!i with WlIn'lillg signs to pr~\'ent inadvenent consumption of non-potable walei'. Backflow prevention devices should be TO\ltin.:l) ln5p~Ctl;(! IUld t"~te4.

It does not appeal' ella. this wdl will be used for con~umptive purposes ~nd il; not subjed: to S~f~ Dunking Watllr Regulalions.

For thc appliclmt'~ infonnation, a source of possible wasrewater c()l1tamina.ion l lis I[ I is not located near tile proposcd well Sl1e (infolTl1ation IIttachtd).

An NPDES pennil is requited.

~l1er rel~wmt DOH rilles/regulations. infonnation. (If r!;Commendations arc alW:he4 111 ehe event that the location of \he well changes but is ~i11 witbill the pared d~~o;:ribc4 on this application, our divisiQn conSIders the coml!1(:nt~ to still be IIpplicable, and we do lIor need 10 review the /lew location. No commcntslob$C1:iol1~

Contact Person: ~~Ob:;;...-.1(;Wr __ uV __ l.r_.~:::......--=--______ _ Phone: .-.:cf&e-=.. --"--,-·~_W_~ __

Signed: __ ---7"~~~....=.-f-Jl.~-- Date: GJ: ~·O ~

.JU~j-04-2009 09: 18AI'1 FAX: 8085854352 ID:DLNR CWRM PAGE:003 R=95%

OS-04-20]9 09:18am From-DEPT OF HEALTH ENVIRONMENTAL UNGMT 8085864352 T-167 P.001/003 F-169 , -

Fax to: Company:

......., FAX TRANSMITTAL

State of Hawaii Department of Health Environmental Management Diviaion

Clean Water Branch· EngiDeering Section Phone No.: (808) 586-4309

Fax No.: (808) 586-4352

Mr. Ryan Imata I:MI. Charley Ice ~. D~ise M~ Commission On Water Resource Management Department of Land and Natural Resources

Date: (0-4. 0 5 Fax from: Joanna L. Seto (y

Fax No.: 587-0219 Total Pages, incl. cover: 2+ l

Subject: Well Construction/Pump Installation Permit Application(s) WeUNo(s). 0"32--'- 02

The Department of Health. Clean Water Branch (CWB) has the following comments:

1. For Well-Drilling Activities

Any discharge to State waters of treated process wastewater effluent associated with well drilling activities is regulated by Hawaii Administrative Rules (HAR), Title II, Chapter 55, Appendix I, effective October 22, 2007. Treated process wastewater effluent covered by this general pennit includes well drilling slunies, lubricating fluids wastewater9 and well purge wastewater. This general permit does not cover well pump testing. The applicable Notice ofIntent (NOl) Forms and filing fee shall be submitted at least 30 calendar days before the start of discharge to the:

Department of Health Clean Water Branch 919 Ala Moana Boulevard, Room 301 Honolulu, Hawaii 96814-4920

The CWB-NOI Fonus are available online at http://www.hawaii.govlhealthlenvironmental/water/cleanwater/fonns/gen1~index..html.

Inquiries may be directed to the CWB at (808) 586-4309 or by fax (808) 586-4352.

2. For Well Pump Testing

The discharger shall take all measures necessary to prevent the discharge of pollutants from entenng State waters. Such measures shall include, if necessary, containment of initial discharge until the discharge is essentially free of pollutants. lfthe discharge is entering a stream or river bed, best management practices shall be implemented to prevent the discharge from disturbing the clarity of the receiving water. lithe discharge is entering a stonn drain. the discharger must obtain written permission from the owner of the stonn drain prior to discharge. Furthennore, best management practices shall be implemented to prevent the discharge from collecting sediments and other pollutants prior to entering the stOlID drain.

JUN-04-200909:18AM FAX: 8085864352 ID:DLNR CWRM

06-04-2009 09:18am From-DEPT OF HEA~TH ENVIRONMENTAL MNGMT ~ - B085B64352 T-167 P.ooz/ooa F-169

Mr. Ryan Imata I Mr. Charley Ice I Ms. Denise Mills Commission On Water Resource Management

.~

FAX TRANSMITTAL Page 2

3. For Construction Activities Disturbing One (1) or More Acres of Total Land Area

By HAR) Title 11, Chapter 55, Appendix C, effective October 22,2007, an NPDES pennit or Notice of General Permit Coverage is required before the start of the construction activities that result in the disturbance of one (1) or more acres of total land area, including clearing, grading, and excavation. The total land area includes a contiguous area where multiple separate and distinct construction activities may be;: taking place at different times on different schedules under a larger common plan of development or sale. An NO! (see Comment No.1, above) shall be submitted 30 calendar days before the start of construction activities.

JUN-04-200909:18AM FAX: 8085864352 ID: DLNR CWRM PAGE:002 R=96%

JUN-02-2009 14:46 From:DOWSAFE ["IATER BRANH 8085854351 To:808 587 0219 P.1"2

RECEIVED c ., ArE DRli!:mm WATER DRM~CH

~ ;.,..---...... ~INDAUMGLE

~'1r.1tINOP!Ortol"W"'11 ~ JUN - 2 ,COg LAURA H. T~I~LEN

!;:H&.11I"·Sl)ft

STATE OF HAWAII DEPARTMENT 01' LAt-.lO ANO NATURAL RESOUROJ;S

COMMISSION ON WATER RESOURCE MANAGEMENT po. 8011 ~Z'

HONOLULU, HAWAII MOO9

May 29, 2009

MI;Rt;CITH J. CHING NEA~ S FUJIWA~A

CH/VOtolE L ~UKINO, M.D ~ONNA rAY K KlYOs.AKl, P E LAWR!;NOIO H MilKe. M.D. J 0

K~N C. KAWAHARA. r.E. OJ."II',"" DlRFtTOA

TO: Honorable Chiyome L. Fukino, M.D., Director Department of Health Attention: Tomas See, Chief, Wastewater Branch

~tuart Yamada, Chief, Safe Drinking Water Branch Alec Wong, Chief, Clean Water Branch

FROM: f1,....-t,aura H. Thielen, Chairperson ~ Dr. Keith Kawaoka, Office of H d Evafua . ~ ant Emergency Response

1" Commission on Water Resource Managem t

SUBJECT: Well Constructiol1/Pump Installation Pe t Applicaf n Flow Well (Well No. 0321-03). TMK (4) l:I--4-011 ;032

Transmitted for your review and comment is a copy of the captioned Well Construction/Pump Installation permit application. The maps attached to the permit application show the proposed well location.

We would appreciate your COmments on the captioned application for any conflicts or inconsistencies with the programs, plans, and objectives specific to your department. Please respond b!, returning this cover memQ form by June 30, 2009. If we do not receive comments or a reque:st for additional review time by this date, we will assume that you have no comments.

If you have any questions about this permit application, request additional information, or request additional review time, please contact Denise Mills ofthe Commission staff at 587·0251.

dem;ss Attachment(s)

RESPONSE: [ J

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Th!s well qualities as a ~Ollrc::e which will serve ~~ a WIITCC' ()fpQlable waler to a public water $~SleJ1\ (defUlcd M serving 25 Or more peoplt a! least 60 days per year or h.as 15 I;Ir mor~ s~rvice CQIlI1t;ctions) ;md must receive Pircctor of H~aJtl1 approval ptiot 10 its use to comply with Hawaii Aciminbtrativc RuJe~ (HAR). Tiil~ 11. ChilJlt~r 20, Rule!; Relating (0 Potable Water Systems, §11-20-i9,

ThiS well does not qualifY as a source serving a public water system (selVes less than 25 pe()ple or more ~covle at least 60 dayg per year or I ~ service conne<;1ions) and iftllc:: well water is used for drinking, the private owner should test for bacteriOlo,ical 11111 chemical prl:Sence before initiating suCh use an.:! tOutiI1Cly monitor the wliter quality thereafter. However, if fup.>rc planned use fr<lm this source lIlcreas~s t<l .met the public water system definitioJ1\llcn Dlrcctor of Health approval i. required pri~r to implementation.

If th~ well.s used to supply both potable and non-potable purpos"~ in a single, system. t~" us .. , !hall eliminate cro><-cQtl'le.;tWns and backflow connections by physically separating potable and non-potabl~ systems by an air gap or an appr()ved batkftow prcvcnter. and by cleady labeling all notl-potable spigots with ",srnm!:: ~isns to prevent inadvertent consumJltio,. of non-potable water. Backtlow prellention devi<;es should be rouhn.,ly insp<;:cttQ 1lJ1d tesled. It does not appear that this weI! WIll be \l$ed for co,.sumpbw purposes ;wd is ncr\ sl.ibject to Safr Drinkinl1 Wate, Reguhtiont.

For Ih" applicant'~ informlltion. a source of possible wastewater conl~tiOn [ Jis i [ J is not l()cated nesr the proPOSt!! Wtl1 site (information attach.cd).

An NPDES penna is required,

Other relevant DOH rules/regulations. tnfOnnation. or r~cornmendations are attached. In the !:Vcnt that the loc3tion of tbe well changes but is still within the parcel described on this appli~ation, (Jur d)visioJ) considers the comments to still be applicable, and U/~ do not need 10 revil!W tlle, hew lo,ation No comm~tllSI()bj~elions

Contact Person: _J..M~~~I--Y9f=~L---"~UCId'---fS'A.~tJ""-l+lt2Agc::.. ___ _

Signed: -----:::.-;T,.,.dr.,.... ~4~/"-i· ............ .",....A:..lod..:---;------

Phone: 2" - 4::?S:.J.~F

Date; " /z./a:1

JUN-02-2009 02:46PM FRX:8085864351 ID:DLNR CWRM PRGE: 001 R=94~;


o o RECEIVED

'.5' t!l' ~'~:VISIOH



CHIYOME L. FUKINO, M.D.

ZOOq MAY 2q P 3: 33 STATE OF HAWAII

DONNA FAY K KIYOSAKI, PE LAWRENCE H. MilKE, M.D., J.D.

TO:

FROM:

SUBJECT:

DEPARTMENT OF LAND AND NATURAL RESOURCES i .

COMMISSION ON WATER RESOURCE MANAGEMENT

Morris Atta, Administrator Land Division

po. BOX 621 . . HONOLULU, HAWAII 96809

May 29,2009


KEN C. KAWAHARA, PE. DEPUTY DIRECTOR


We would appreciate your comments on the captioned application with regard to the programs,~ plans, and objectives specific to your division. Please res ODd b returniD this cover memo ti C JUDe 30, 2009. Ifwe do not receive comments or a request for additional review time by this dat e oJ, will assume you have no comments. ~ ~t;;~

1t C"l <pi'" If you have any questions about this permit application, request additional information, or ret)uest;~

additional review time, please contact Denise Mills of the Commission staff at 587-0251. ~,... o4!. ... ';t:.~~ ~ ~~

dem:ss CI 'i~ Attachment(s) '" ~ ~~~~~~--------------------------------------------------------------~~~. ~

RESPONSE:

[ ] A water lease/permit is required of this applicant and an application for such will be requested by our division.

D(] A water lease/permit is not required of this applicant.

[ ] A water lease/permit has been obtained by the applicant through lease no. __________ _

[ ] Other relevant Land Division rules/regulations, information, or recommendations are attached.

[ ] No objections

Other comments: Original source of private title is Grant 8162 issued prior to statehood.

Contact Person: Gary Martin

Signed: ~~ Phone: -----;5'*8H-7--.JQI;I"4M!2:-+1-

Date: __ '1.Llll..u.I t,,-l _-_1L-L.2U1.DDw9

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I'f1 ' ~ c,,~· f:

o o LINDA LINGLE

GOVERNOR OF HAWAII

RECEIVED COMMISSION ON WATER

RESOURCE MANAGEMENT LAURA H. THIELEN

CHAIRPERSON

• JJN -It PfI It It' STATE OF HAWAII

DEPARTMENT OF LAND AND NATURAL RESOURCES COMMISSION ON WATER RESOURCE MANAGEMENT

P.O. BOX 621 HONOLULU, HAWAII 96809

May 29,2009


CHIYOME L. FUKINO, M.D. DONNA FAY K. KIYOSAKI, PE



TO: Honorable Chiyome L. Fukino, M.D., Director Department 9f Health Attention: ~omas See, Chief, Wastewater Branch


FROM: /1rLaura H. Thielen, Chairperson . ~ Dr. Keith Kawaoka, Office ofHa rd EVrluaf n atyl Emergency Response

1" Commission on Water Resource Managem t


Transmitted for your review and comment is a copy of the captioned Well ConstructionlPump Installation permit application. The maps attached to the permit application show the proposed well location.

We would appreciate your comments on the captioned application for any conflicts or inconsistencies with the programs, plans, and objectives specific to your department. Please respond by returning this cover memo form by June 30, 2009. Ifwe do not receive comments or a request for additional review time by this date, we will assume that you have no comments.

If you have any questions about this permit application, request additional information, or request additional review time, please contact Denise Mills of the Commission staff at 587-0251.


RESPONSE: [ 1 This well qualifies as a source which will serve as a source of potable water to a public water system (defined as serving 25 or more

people at least 60 days per year or has 15 or more service connections) and must receive Director of Health approval prior to its use to comply with Hawaii Administrative Rules (HAR), Title 11, Chapter 20, Rules Relating to Potable Water Systems, §11-20-29.

[ 1

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This well does not qualily as a source serving a public water system (serves less than 25 people or more people at least 60 days per year or IS service connections) and if the well water is used for drinking, the private owner should test for bacteriological and chemical presence before initiating such use and routinely monitor the water quality thereafter. However, if future planned use from this source increases to meet the public water system definition then Director of Health approval is required prior to implementation.

If the well is used to supply both potable and non-potable purposes in a single system, the user shall eliminate cross-connections and backflow connections by physically separating potable and non-potable systems by an air gap or an approved backflow preventer, and by clearly labeling all non-potable spigots with warning signs to prevent inadvertent consumption of non-potable water. Backflow prevention devices should be routinely inspected and tested.

It does not appear that this well will be used for consumptive purposes and is not subject to Safe Drinking Water Regulations.

For the applicant's information, a source of possible wastewater contamination [ lis / [ ] is not located near the proposed well site (information attached).

An NPDES permit is required.

Other relevant DOH rules/regulations, information, or recommendations are attached. In the event that the location of the well changes but is still within the parcel described on this application, our division considers the commeljts to still be applicable, and we do not need to review the new location.

No c&h~ntsiobjections NO "'f,()) rtfS: . Contact Person: Lori Vetter, Eng. on Kauai 241-3323

Signed: . \f!ji, ~. Of') eJ, (,{

Date: ltJ-O~- 01

,*!"'" :'

'I:. !L

f., :S H'1 ~- !1l1L elo~

SS 6 MY Z Nnr 101 HONVoo d3J.VIll,3lSVM

H1TV'3H :10 lN3W1H'Id30

CO~SION ON WATER RESOURCE MANAGEMENT 0 ROUTE SLIP FOR NEW APPLICATIONS

FROM: DENISE DATE: 21-May-09 SUSPENSE DATE: -----------------

CHING, F. KUNIMURA, I. FUJII, N. -5-Mills, D. GOODING, K. NAKAMA, L.

1 Approval -3-Signature -4-lnformation

~ 1 HARDY, R. jj( -4-OHYE, M. HIGA, D. --SAKODA, E.

-2-HOAGBIN, S. == SWANSON, S. ICE,C. __ __UYENO, D. IMATA, R. -- YODA,K.

-3- KAWAHARA,K. YOSHINAGA, M.---

WELL NUMBER 03~-V3 WELL NAME Flow

~ WELL CONSTRUCTION ~ PUMP INSTALLATION

ATIACHMENTS FOR APPLICATION PROCESSING - Both applicant & staff generated 1 TRANS. LETTER

2 PERMIT PROCESS TABLE

3 CWRMMAP

4 APPL. FORM (11 COPIES)

5 USGS MAPS (11 COPIES)

6 TAX MAPS (11 COPIES)

7 PARCEL OWNER VERIF.

8 CONTRACTOR VERIF.

9 ALL INFO FILLED IN

10 BACKGROUND CHECK

11 $25 FEE DEPOSIT SLIP

~ V

~ ~

~ V MLS PRINTOUT

---v- DCCA LICENSE SCREEN PRINTOUT

~ ~

v

28-May-09

PLEASE:

See Me -1-Review & Comment

Take Action --Type Draft acknow letter -2-Type Final, label file folder, update People.db -5-File

Xerox copies

WUP Number

o WUPA

12 DHP/CDUP/SMA pre·screen ~ (SMA map printout http://gis.hicentral.com/website/parcelzoninglviewer.htm.,or INGRID'S SMA/CD MAP) (LUC map printout http://luc.state.hLus/luc_maps.htm., or INGRID'S SMA/CD MAP)

FOLDER: ,.l.../ ~ MADE NEW FILE FOLDER, ATIACHED o FILE FOLDER ALREADY MADE, IN FILE CABINET

INCOMPLETE ACTION DATES:

DATE ACTION



Dear Mr. Simmons:

o o




May 29,2009



CHIYOME L. FUKINO, M.D. DONNA FAY K. KIYOSAKI, P.E.



0321-03 wcpipa,ack.doc

Well Construction/Pump Installation Permit Application for Well No. 0321-03

We acknowledge receipt, on May 20,2009, of your completed Well ConstructionlPump Installation permit application and filing fee for the Flow Well (Well No. 0321-03). You can expect your application to be processed within ninety (90) days from this date. The attached table shows the process, responsible parties, and deadlines for drilling or modifying a well and installing, modifying or replacing a pump.

By this acceptance letter, we are also notifying the well operator/landowner that water may not be pumped for purposes other than testing until the certificates of well construction completion and pump installation completion have been issued to the well operator and landowner. Additionally, the Commission may reduce the permitted pump capacity shown on the pump installation permit if the results of a pumping test do not support the proposed pump capacity. No certificate of pump installation will be issued until the Commission has determined that the pump capacity will not have adverse effects on the aquifer, other nearby wells or streams. If the Commission requires that a smaller capacity, you may need to remove the pump and install a smaller pump at the Commission's discretion before you can withdraw water for purposes other than testing.

If you have any questions about your permit application, please contact Denise Mills of the Commission staff at 587-0251 or toll-free from Kauai at 274-3141, extension 70251.

DEM:ss Attachment

Sincerely,

. t;'---C. KA AHARA, P.E.

D puty Dire or

c: Dwain Hill, Dwain L. Hill Trust & Susan A. Hill Trust

o o LINDA LINGLE


CHAIRPERSON




May 29,2009


CHIYOME L. FUKINO, M.D. DONNA FAY K KIYOSAKI, P.E.



TO: Honorable Chiyome L. Fukino, M.D., Director Department of Health Attention: Tomas See, Chief, Wastewater Branch


FROM: /lv--Laura H. Thielen, Chairperson '. ~ Dr. Keith Kawaoka, Office ofH d EVrluaf n anf Emergency Response

l' Commission on Water Resource Managem t



We would appreciate your comments on the captioned application for any conflicts or inconsistencies with the programs, plans, and objectives specific to your department. Please respond by returning this cover memo form by June 30, 2009. Ifwe do not receive comments or a request for additional review time by this date, we will assume that you have no comments.


dem:ss Attachment( s)

RESPONSE: [ 1 This well qualifies as a source which will serve as a source of potable water to a public water system (defined as serving 25 or more

people at least 60 days per year or has 15 or more service connections) and must receive Director of Health approval prior to its use to comply with Hawaii Administrative Rules (HAR), Title II, Chapter 20, Rules Relating to Potable Water Systems, §11-20-29.

[ 1

[ 1

[ 1 [ 1

[ 1

[ 1 [ 1

[ 1

This well does not qualify as a source serving a public water system (serves less than 25 people or more people at least 60 days per year or 15 service connections) and if the well water is used for drinking, the private owner should test for bacteriological and chemical presence before initiating such use and routinely monitor the water quality thereafter. However, if future planned use from this source increases to meet the public water system definition then Director of Health approval is required prior to implementation.

If the well is used to supply both potable and non-potable purposes in a single system, the user shall eliminate cross-connections and backflow connections by physically separating potable and non-potable systems by an air gap or an approved backflow preventer, and by clearly labeling all non-potable spigots with warning signs to prevent inadvertent consumption of non-potable water. Backflow prevention devices should be routinely inspected and tested.

It does not appear that this well will be used for consumptive purposes and is not subject to Safe Drinking Water Regulations.

For the applicant's information, a source of possible wastewater contamination [ lis / [ 1 is not located near the proposed well site (information attached).

An NPDES permit is required.

Other relevant DOH rules/regulations, information, or recommendations are attached.

In the event that the location of the well changes but is still within the parcel described on this application, our division considers the comments to still be applicable, and we do not need to review the new location.

No comments/objections

Contact Person: Phone: ------------------------------------- -----------------

Signed: ________________________________________________ __ Date:

c o LINDA LINGLE


CHAIRPERSON


CHIYOME L. FUKINO, M.D. DONNA FAY K. KIYOSAKI, PE. LAWRENCE H. MilKE, M.D., J.D.

TO:

FROM:

SUBJECT:



Morris Atta, Administrator Land Division


May 29,2009


KEN C. KAWAHARA, P.E. OEPUTY DIRECTOR





RESPONSE:

[ ] A water lease/pennit is required of this applicant and an application for such will be requested by our division,

[ ] A water lease/pennit is not required of this applicant.

[ ] A water lease/pennit has been obtained by the applicant through lease no. __________ _

[ ] Other relevant Land Division rules/regulations, infonnation, or recommendations are attached.

[ ] No objections

[ ] Other comments:

ContactPerson: _______________________________ ___ Phone: -----------

Signed: __________________ _ Date: -------------


TO:

FROM:

SUBJECT:

o o


COMMISSION ON WATER RESOURCE MANAGEMENT po. BOX 621


May 29,2009

Dr. Puaalaokalani Aiu, Administrator Historic Preservation


Well Construction/Pump Installation Permit plication Flow Well (Well No. 0321-03), TMK: (4) 4-4-011:032



CHIYOME L. FUKINO, M.D. OONNA FAY K. KIYOSAKI, P.E.





If you have any questions about this permit application or request additional review time, please contact Denise Mills ofthe Commission staff at 587-0251. If you require additional information regarding specific information that can be provided by the applicant, please contact the applicant directly at the contact information provided on the application form.


RESPONSE:

[ ] This is a [ ] public (county or state) project [ ] private project and [ ] will [ ] may disturb historic sites.

[ ] We concur that the work described under this permit will not disturb historic sites.

[ ] We do not concur that the work described under this permit will not disturb historic sites. We require the following for our concurrence:

Contact Person: Phone: ------------------------------------- --------------

Signed: __________________ _ Date: ---------------

Professional and Vocational Lic~ing (PVL) - powered by eHawaii.gov Page I of 1

'-' 0 Professional and Vocational Licensing (PVL) Search - General Licensee

GENERAL LICENSEE

L1C 10: CT-21457 Active/Inactive: ACTIVE

NAME: OASIS WATER SYSTEMS INC

TRADE NAME:

STATUS: CURRENT, VALID & IN GOOD STANDING

ENTITY: CORPORATION BUSINESS CODE:

ORIG L1C DATE: 05/19/1998 EXPIRE DATE: 09/30/2010

CLASS PREFIX: C SPECIAL PRIVILEGE:

RESTRICTION: EDUCATION CODE:

CONDITIONS AND LIMITATIONS:

BUSINESS ADDR:

MAILING ADDR: POBOX 507 HANALEI HI 96714

Click here to enter search criteria for prior complaints history -> For prior complaints and disciplinary history, contact licensing and business information center at (808)

587-3295.

License information on this site reflects information in the Professional and Vocational Licensing Division as of May 26, 2009; however, applicatio and forms are subject to standard processing time, and the information here does not reflect pending changes which are being reviewed. The site updated daily, Monday through Friday, except holidays. The State of Hawaii makes no guarantees as to the accuracy of the information accessed, the timeliness of the delivery of transactions, delivery the correct party, preservation of the privacy and security of users and makes no warranties, including warranty of merchantability and fitness fOI particular purpose. User is advised that if the information obtained herein is to be reasonably relied upon, user should confirm the accuracy of su information with the provider thereof.

http://pv1.ehawaii.gov/pvlsearchlapp? _ a=d& _ f=n&lictp=CT &licno=21457 &off=&nm=OA... 5/26/2009

o Page 1 of 1

Copyright 5/26/2009 by Hawaii Information Service

PUBLIC RECORD DATA TMK # 4-4-4-11-32-1 820 KAMALU RD, Apt A

Owner: HILL, DWAIN L REV LIV TR/ETAL Tax Payer: HILL, DWAIN L TR Tenure: Fee Simple

Tax Bill: 41 -720 KAMANAOIO PL, WAIMANALO, HI 96795 USA Annual Tax: $4,257.30 Assessed Value Exemption Size Buildings: 0 Zoning: A Land: $617,000 $0 3.17 ac Dwellings: 0 PITT Code: 500 - Agricultural

Total Buildings: $0 $0 o sq ft Subdivision: Sleeping Giant Acres Land Use:

I I

Total: $617,000 $0 Project: LOT 5 SLEEPING GIANT ACRES Census Tract: 402.02 Bedrooms/Baths: 0/0 Lot#:

SALES 6/28/2002 DEED $280,000 DOC 02-114344

HILL, DWAIN LEE, Trustee(Tenants in Common) *DWAIN LEE HILL REVOCABLE TRUST UNDER *UNRECORDED TRUST AGREEMENT DATED FEBRUARY 17, *1993, UNDIVIDED 50% INTEREST DWAIN LEE HILL REVOCABLE TRUST, Revocable Trust(Tenants in Common) HILL, SUSAN AIKO, Trustee(Tenants in Common) *SUSAN AIKO HILL REVOCABLE LIVING TRUST UNDER *UNRECORDED TRUST AGREEMENT DATED FEBRUARY 17, *1993, UNDIVIDED 50% INTEREST SUSAN AIKO HILL REVOCABLE LIVING TRUST, (Tenants in Common)

BUILDING PERMITS FROM REAL PROPERTY TAX

Date I Number I Amount I Status I Purpose

4/2/2001 I 0000002871 -' $4001 Complete J SHEDS

This information has been supplied by third parties and has not been independently verified by Hawaii Information Service and is therefore not uaranteed.

http://web07.hawaiiinformation.comlREsearchiBase/Lib/ActionMenuPrintModal.htm 5/26/2009

o o Well Check Program 4/1/04 - Revised for update to Well Standards (February 2004) Data Input

Well Number 0321-03 Well Name Flow Ground Elevation 360 Cement Grout 225 Grouting Method I positive displacement Hole Diameter 13 Total Depth 350 ~ater Level 345 Depth to water 15 Public Water Supply Well? no Solid Casing Material steel not plastic Solid Casing Specification ASTM A53 Solid Casing Length 300 Solid Casing Diameter 6 Solid Casing Wall Thickness 0.250 Open Casing Length 40

Results

~ell Depth Theoretical Thickness of Aquifer 14145 1/4 Aquifer Thickness 3536.25 Depth of Well below Sea Level 10 okay Section 2.2

lWell Casing Minimum Wall Thickness

Material steel Minimum Thickness per standards #N/A Wall Thickness Provided 0.25 no standard Section 2.4(b)

Minimum Length of Solid Casing 90% of ground to top of aquifer 13.5 Length of solid casing Provided 300 okay Section 2.4(c)

Casing Material ASTMA53 in compliance Section 2.4(d) . (for pvc only - check for 200' limit) okay Section 2.4(d) ~nnular Space

Depth of Grouting Calculated Depth of Grouting 10.5 Depth of Grouting pruvided 225 okay Section 2.6(c)

Minimum Annular Space required 1.5 Thickness of Annular. Space 3.5 okay Section 2.6(d)

QARTMENT OF LAND AND NATURAL RESO~S D OC MEN NO U T .. UAC OR A TACHED WORKSHEET T DATE M 20 2009 ay ,

SRC/ COST F YR APP D OBJ CTR PROJECT PH ACT AMOUNT NAME/DESCRIPTION (WANG INPUT)

S 09 326 C 1026 0752 (1 ) $25.00 D. L. Hill and SA Hill

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

TOTAL $ 25.00

REMARKS: LINE (1) Flow Well LINE (2) LINE (3 LINE (4) LINE (5) LINE (6) LINE (7) LINE (8) LINE (9) LINE (10)

J

c o STATE OF HAWAII DEPARTMENT OF LAND AND NATURAL RESOURCES COMMISSION ON WATER RESOURCE MANAGEMENT

For <>wtetYVtBn/y: I OHHISSION ON WATER

R SOURCE MANAGEMENT APPLICATION FOR A WELL CONSTRUCTION I PUMP INSTALLATION PERMIT .. HAY 20 Attn: 2 ..

Instructions: Please print in ink or type and send completed application with attachments to the Commission on Water Resource Management, P.O. Box 621, Honolulu, Hawaii 96809. Application must be accompanied by 10 copies and a non-refundable filing fee of $25.00 payable to the Dept. of Land and Natural Resources. The Commission may not accept incomplete applications. For assistance, call the Regulation Branch at 587-0225. For further information and updates to this application form, visit http://WWW.hawaii.gov/dlnr/cwrm.

WELL LOCATION INFORMATION 14. TMK 4 _--.£ _QlL :

ZOile sec PiSI

3. ISLAND

ho..~\ 1. STATE WELL NO. (if already assigned) 12. WELL NAME

032-1 -03 . Flo I),:! The following must be attached before this application is accepted as complete:

• Portion of 7.5-Minute Series USGS topographic map (scale 1 :24,000) with well location labeled and Include the name of the quad map • Property tax map, showing well location referenced to established property boundaries • Photograph of the proposed well site • A schematic diagram showing the well site, access road and proposed well infrastructure • For dug wells, attach agradJrl!! plan with cross section profiles showing existing and finish grades

5. WELL OPERATOR'S NAME/COMPANY 1 Well Operator's Contact 6. LANDOWNER'S NAME/COMPANY

OW~\(\ lr-'Svt. \-\-1\\ O~I\ \\1\\ O~~~I'}'A:H-:ttL~~~T~ Well Operator's Mailing Address Landowner's Mailing Address

41-7?-O ""'Y'f\(A~IO ?\. UJ~IVy\M~\O ttL q bl C\5

Well Operator's Phone I Well Operator's Fax

80&-;15'\· 53ll I Well ~~s E-mail Landowner's Phone I Landowner's Fax

dWQ..I(\h,\\W7 e yCtI\cP. (OM

PROPOSED WELL CONSTRUCTION 7. Proposed Work

'g Construct New Well D Modify Existing Well D Abandon/Seal Well

8. Construction Type ~Drilled DOug o Shaft o Tunnel

9. Is this well part of a battery of wells? 0 Yes Qt No

PROPOSED PUMP INSTALLATION 10. Proposed Work g Install New Pump o Replace Pump

11. Proposed Pumping Rate, gpm (gallons per minute)

<50 12. Proposed Amount of IMthdrawal, gpd (gallons per day)

~501JOO

I Landowner's Conta~

D~i{\ \-\\\\

I Landowner's E-mail

13. Method of flow measurement ~ Flowmeter o Other (explain)

14. Proposed Surveyor name and license number (a surveyor is required for all Well Construction Permits and may be required for some Pump

Installation Permits) d~{ re..L\.. ~ 70 0{) cY\ PROPOSED USE '-'

o 15. Municipal (water systems serving greater than 25 individuals or 15 service connections)

o 16. Domestic Number of units to be served:

o 17. Industrial (describe)

~ 18. Irrigation (describe crop and no. of acres)

o 19. Military (describe)

o 20. Other (describe)

OTHER LEGAL REQUIREMENTS If required, items 21. and 22. must be obtained before the Commission can legally issue a permit:

21. Conservation District Use Permit (COUP) o Well is in Conservation District

o Required, COUP # date approved o Not Required (attach documentation from OCCL) ----o I have not checked with OCCL about whether or not a COUP is required. I understand that checking with OCCL prior to making this

application will expedite my review. I further understand that issues raised by this agency may delay or result in denial of the permit issuance, or revocation of the permit after it is issued.

-g Well is not in Conservation District o I have not checked if well is in or out of Conservation District. I understand that checking if the well is in a Conservation District may expedite my

review. I further understand that issues raised may delay or result in denial of the permit issuance, or revocation of the permit after it is issued. 22. Special Management Area Permit (SMAP) N..l.· c ",tA I'M.. 5(/)r.( c. o Required, SMA # date approved tTl ' V1 .::> ,- . V'" P6 c-, D Not Required (attach documentation from applicable County agency) ~ I have not checked with the county about whether or not an SMA Permit is required. I understand that checking with the County prior to making this

application may expedite my review. I further understand that issues raised by this agency may delay or result in denial of the permit issuance, or revocation of the permit after it is issued.

23. State Historic Preservation Division (SHPD) of the Department of Land and Natural Resources o I have consulted with the HPD regarding potential impacts of well construction activities on historic sites. I have attached applicable documentation

from the HPD. t8- I have not consulted with the HPD regarding potential impacts of well construction activities on historic sites. I understand that checking with the HPD

prior to making this application may expedite my review. I further understand that issues raised by this agency may delay or result in denial of the permit issuance, or revocation of the permit after it is issued. Additionally, the history of past land use is attached.

Additional remarks, explanations, etc. (attach additional sheet if more space is needed)

NOTE: Signing below indicates that the signatOries understand and swear that the information provided is accurate and true to the best of their knowledge. Further, the signatories understand that upon permit approval: 1) the proposed work is to be completed within two (2) years of the approval date; 2) the contractor shall submit to the Commission a well completion/abandonment report within 60 days after the completion date of the permitted work; 3) in the event that the application is not completed correctly, any permit may be suspended until the item is brought In to compliance, and any work done while the ~it is in sUSQension may result in fines of up to $5000/day. 24. WELL DRILLER (Must be filled out if application is for Well Construction) 25. PUMP INSTALLER (Must be filled out if application is for Pump Installation)

()()/~\~ ~~ ~~('(b, LAc:,:l \ 45 J ~S~ S~J,1Ilc. Otl4:$7 Licen~sin~ame I C-57 License No.

-=:'"i/~k/~'~~~ '\._ furc\JS'mmor'lS S"-Jq'Oq Signature,/ - Print I Date

Li".ee bu~name • . C-57/C-57a/A license No.

l'rYtA../j A/l '\ &Au ~ S,mmlf\S S -/ q -0 ~ -Signa~ Print Date

WCPI Application Form 0212612007

"."

.IS 1I"t, 'S '\I 'n·" .. : "" lJ '1" :.·U)

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PROPOSED WELL SECTION (Please attach schematic if different from diagram provided below)

Hole Diameter: I 3 in.

Elevation at top of casing ft., msl* lr-{ I~_ Minimum of 2' Radius & 4" Thick Concrete Pad (to contain benchma . ij surveyed to nearest O.O~ ft.) 3loD C;~ ft., msl* ,~. ,',<1':;:.:<1

~.: .• : {;. Ground Elevation: 11M<' 't>._ :...,.: :: /~ //1?0\\

" " Please refer to the .1I._ :;US ~.~: Cement Grout: ft. 0'.

RAW All WELL CONSTROCIION AND (min. 70% of distance trom :-f'- :.f'-

ground elevation to top of .~. ',: ~~'~. POMP INSTALLATION STANDARDS .:: ;. to ensure that your as-built is in compliance with

water surface or 500 ft., ';.:-~ :;:: whichever is less.) ::.~.,: applicable standards.

:',:: . '\>.-

:= . .' ."".-

o· • ;..:

Grouting method: Annular space between hole :. ~ :. ~. Solid Casing: (~90% x (Ground Elev.-Water Level Elev» .;,.: .. '

and casing (1.5" for positive ...... A, "

pc Positive -.:t>' :-:;. Total Length: ~OQ ft . displacement, 3" for other . ;. ~.

~:;:: rf fo displacement methods): ~,,:~:, in. ,...,.., Nominal Diameter: .. ' o Other ~in. V .4 ••

·~50 to' ,4 ~ .:1I Wall Thickness: in. - :: :: : .. ~ .. ~D ~ .. -: ~.:.: Bottom Elevation: ft., msl*

Rock or Gravel Packing: - I--- ~ I' ~ Total Depth ~ft. Open Casing: ~ Perforated o Screen 350 ft. -

~ Mate 'al:

e £fO o Crushed Basalt Total Length: ft.

~ o Rounded Gravel o~ V/ Nominal Diameter: in.

, ::>-~1S " Wall Thickness: In. Estimated Water Level Bottom Elevation: ~Q ft., msl* "I i Elevation: note: Neither bentonite nor mud should be used in 15

_L.- f--ft. msl* saturated zone during driIHng

Open Hole:

(,0 Length: ft.

Diameter: r?2 in. '-- Bottom Elevation: if) ft., msl*

* The approximate elevation must be referenced to mean sea level (msl) at the time of application filing. Final elevations of well components shall be submitted in the Well Completion/Well Abandonment reports and referenced to a benchmark which has been established by a surveyor licensed by the State.

For non-salt water Basal Wells - bottom elevation of well should not be deeper than 1/4 of aquifer thickness or,

Bottom Elevation of Well Limit = (water Elevation _ 41 x WaterLe~el Elevation )

Example: Estimated + 2 ft. Water Level Elev. --. Bottom Elevation of Well Limit = ( 2 _ 41 ~ (2» = -18.5 ft.

Solid Casing Material: Carbon Steel: compliant with (check one or more): 0 AN511AWNA C200 0 API Spec. 5L i2$ ASTM A53 0 ASTM A139

And compliant with (check One or more): 0 ASTM A242 (or A606) 111 Type E 0 Type 5 IS( Grade B 0 Other

Stainless Steel: (check one): 0 ASTM A409 (production wells) 0 ASTM A312 (monitor wells)

ABS Plastic: conforming to ASTM F480 and ASTM 01527: (check one) 0 Schedule 40 0 Schedule 80

PVC Plastic conforming to ASTM F480 and (ASTM 01785 or ASTM 02241): (check one): 0 Schedule 40 0 Schedule 80 0 Schedule 120

Thermoset PlastiC: (check one) o Filament Wound Resin Pipe conforming to ASTM 02996



o Glass Fiber Reinforced Resin Pressure Pipe conforming to AWWA C950



Open Casing Material: Carbon Steel: compliant with (check one or more): 0 ANSIIAWNA C200 0 API Spec. 5L 0 A5TM A53 bd ASTM A139

And compliant with (check one or more): 0 ASTM A242 (or A606) ~ Type E 0 Type S ~ Grade B 0 Other

Stainless Steel: (check one): 0 ASTM A409 (production wells) 0 A5TM A312 (monitor wells)


PVC Plastic conforming to ASTM F480 and (A5TM 01785 or ASTM 02241): (check one): 0 Schedule 40 0 Schedule 80 0 Schedule 120

Thermoset Plastic: (check one) o Filament Wound Resin Pipe conforming to A5TM 02996



o Glass Fiber Reinforced Resin Pressure Pipe conforming to AWINA C950



rk

WCPI Application Form 0212612007

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