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P11r. BLOCK "7" KEAAU, PUNA, HAWAII Ld. Ct. App. 1053, Mop 58 SUBJECT TO CHANGE

......._.u.:,u.~

JAXA- MAPS -IAU IYATI Of IIAWM

lAX MAP Ttl; -- .... ,

56 -

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0 0 10. PROPOSED WELL SECTION (Please auech schematic if different from diagram provided below)

Hole Diameter: ~ln. Elevation at top of casing _51_ ft., msl* Minimum of 2' Radius & 4• Thick Concrate Pad (to contain benchmark

suM>yed to nearest 0.0~ ft.) 5 O . GroUld Elevation: ___ ft., msl*

"""'o::..L..--.,J,,...-,..-Please refer to the

Cement Grout ___ ft. (min. 70% of distance from ground elevation to top of water sutface or 500 ft., wtichever is less.)

HAWAII WELL CONSTRUCTION AND PUMP INSTALLATION STANDARDS to ensure that your as-built is in complance

with applicable standards.

Solid Casing:(;, 90% x (Ground Elev.-Water Level Elev))

Annular space bei>M!en hole and casing (min.3•):

Total Length: 5 0 ft.

Nominal Diameter: 6 in. 3 in. Wall Thickness: • 2 5 0 in.

Bottom Elevation: _______ _ lt,msr Rock or Gravel Packing:

14 ft. Open Casing: ~ Perforated o Screen Material:

Total Length: 1 0 ft. 0 Crushed Basal o Rounded Gravel -~6~ __________ 111..

Estimated Water LIIII'BI

Elevation:

~ft.msl*

--:6·~2~5-\:1-0 ---111•• Bottom Elevation: _.:.t...,O:..______ ft., msr

note: ,.._ beniDnile nor mud should be used in

NlhlmfArl7'nnA rlurinn rlrillino

Length: ______ N__:_/_A _________ ft •.

~meter: ____________ ln •.

Bottom Elevation: It, msl*

• The approximate elevation must be referenced to mean sea level (msl) at the time of application filing. Final elevations of well componenls shal be sul:mitted 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-5811 water Basal Wols -bottom elevation r1 well should not be deeper then 1/4 of aquifer thickness or,

Bottom Elevation of Well Limit = (water Elevation - 41 x Waler ~ Elevation )

~: Estimated+2ft.Walerleve1Eiev. -BottomEJevationofWelllim1=(2-~~ = -18.511.

Solid Casing Material; Carbon Steel: compliant with (check one or more): o ANSVAWWA C200 o API Spec. 5I.. ~ ASTM A53 o ASTM A 139

And compliant with (check one or mae): o ASTM A242 o Type E o TypeS o Grade B o Other

Stainless Slael: (check one): o ASTM A409 (production wells) o ASTM A312(rnonitorwells)

ASS Plastic conforming to AS)"M F480 and ASTM D1527: (check one) o Schedule 40 o Schedule 80

PVC Plastic conforming to ASTM F480 and (ASTM D1785 or ASTM D2241 ): (check one): o Schedule 40 o Schedule 80 o Schedule 120

lllennoset Plastic: (check one) o Filament Wound Resin Pipe conforming to ASTM D2996 o Centrifugal}' Cast Resin Pipe conforming to ASTM D2997

o Reinforced Plastic Mortar Pressure Pipe confonning to ASTM D3517 o Glass Fiber Reinforced Resin Pressure Pipe conforming to AWWA C950

o PTFE Auorocarbon Tubing contonning to ASTM D3296

o FEP Fluorocarbon Tubing conforming to ASTM D3296

Open Casing Material: CartlonSteel: compliant with (check one or more): o ANSI/AWWAC200 o API Spec. 5L ~ ASTMA53 o ASTM A139

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

Stain!-Sleel: (check one): o ASTM A409 (production wells) ' o ASTM A312 (monitor wells)

M&l'tallttc confonning to ASTM F480 and ASTM D1527: (check one) o Schedule 40 o Schedule 80

PVC Plastic confonnlng to ASTM F480 and (ASTM D1785 or ASTM D2241 ): (check one): o Schedule 40 o Schedule 80 o Schedule 120

lllennoset Plastic: (check one) o Filament Wound Resin Pipe confonnlng to ASTM 02996

o Centrifugaly Cast Resin Pipe conforming to ASTM D2997

o Reinforced Plastic Mortar Pressure P"lpe conforming to ASTM D3517

o Glass Fiber Reinforced Resin Pressure Pipe conforming to AWWA C950

o PTFE Fluorocarbon Tubing contonning to ASTM D3296

o FEP Fluorocarbon Tubing contonning to ASTM D3296

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' '

State cC)awaii COMMISSION ON WATER RESOURCE MANAGEMENT Department of Land and Natural Resources APPLICATION FOR PERMIT )' Well Construction and/or 2b Pump Installation

lntllluctions: Please print in ink or type and send completed application with attactwnerm to the Commission on Water ResotJ"ce Management, P.O. Box 621, Honolulu, Hawai 96809. Application must be acmmpanied by 5 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, cal the Regulation Branch at 587-0225. For flrlher infonnation and updates to this application form, visit httpJ/www.s-.hlus/clnr/cwnn.

APPLICANT INFORMATION: {FiD out all three, if applicable, and place a check next to the primary contact)

1.(a) o weu.oWNER:Rick Shea eontactPerson: Rick Shea

Mailing Address: 240 El Portal Encinitas CA

r Official Use Only:

Phone( 760) 436~1286 92024

Fax: E-mail: rickshea@sdcoe k1 2. ca. us (b) 0 LANDOWNER: \~\L..k S ~ Contact Person: Pc..t £ 1 '{ X Phone: ~lob -y 1\1

MailingAddress: 2lfD ~tSth §'L Pof'i'lbl EN<.~~it"o..;:,. (A qd_O~'f Fax: ~5 ~ '5')\- l.,()4lc E-mail: .,... \<..\s.~b.~ @)C;;.t> <...O E.. k \ ;.}., ( A c. 0 S.

(c) o CONTRACToRFred Page Drilli~tactPerson: Fred Page Phone: ( 808) 965-5339 MailingAddress: PO Box 1434 Pahoa HI 96778 Fax: ( 808) 965-5339 E-mail:--------- Uc#: C-7----;~~1 ::-'6--'6'--5~3

(circle one: C-57, C-57a, or A)

WELL & PUMP INFORMATION: (Please fill in the diagram on the back of this loon.)

2. WELL NAME: Island:

Address 0111~ ~ \-\1\W ~"~'"<- P1< Tax Map Key: _I_ - __s:::_ _ 5 ~ : Zone Sec Plat --=P,...ar-ce""'I-

Attach: (a) portion of a 7.5-Minute Series USGS topographic map (scale 1:24,000) with weH location labeled and indude the name of the quad map (b) a property tax map, showing well location referenced to established property boundaries

3. PROPOSED WORK: )(_Construct New Well ~ Install New Pump*

(check all that apply) 0 Modify Existing WeH* D Modify Pump•

0 Abandon/Seat•

*State Well No.: ________ (if unknown, please call Commission at 587-0225)

4. CONSTRUCTION: ll( DriHed 0 Dug D Shaft 0 Tunnel

Is this well part of a battery of wells? DYes 'KINo (Please describe)

5. PROPOSED PUMPING RATE: 15.gp&t gallons per minute

6. PROPOSED USE: 0 Municipal (including hotels, stores, etc.) 0 Industrial (check all that apply) ~omestic (individual, noncommercial water system)

Does this well serve 25 or more people at least 60 days per year or have 15 or more service connections? D Yes~ No

0 Irrigation (crop) 0' No. of Acres: l 0 Military 0 Other (explain):

7. (a) PROPOSED AMOUNT OF WITHDRAWAL: __ 3=--=.0-=0:....:0::..__ _____ gallons per day

{b) METHOD OF FLOW MEASUREMENT: }!(Flowmeter D Open-pipe D Weir 0 Orifice D Other(explain)

OTHER IMPORTANT INFORMATION:

8. LEGAL REQUIREMENTS: If required, these permits must be obtained before the Commission can legaUy issue a permit.

Conservation District Use Permit (COUP) To find out if a COUP is necessary, cal DLNR Land Division at 587-0414

-~Not Required If required, date approved ____ _

Environmental Impact SWWment (EIS) or Environmental Assessment (EA) To determine if an EIS or EA is necessary, can OEQC at 586-4185

.;/.Not Required If required, date published in OEQC bulletin ____ _

Special Management Area Permit (SMAP) To determine if an SMAP is necessary: on Oahu, call 527-5374; on Hawaii, caR 961-8288; for Maui county, call270-7235; on Kauai, call241-8677.

de Not Required !!required, date approved ____ _

9. REMARKS, EXPLANATIONS:

(if more space is needed, please attach additional sheet)

NOTE: Signing below indicates the signatories understand and swear that the information provided on this application is accurate and true to the best of their knowledge. Further, the signatories understand that approval of this application attaches the folowing standard conditions: 1) the proposed work is to be completed within two (2) years of the approval date; 2) the contractor shaH submft to the Commission a weH completion/abandonment report within 60 days after the completion date of the permitted work; 3) monthly water use data shall be submitted to the Commission; 4) such approval shall not constitute a determination of correlative water rights and shall not guarantee the pump capacity or future use up to the permitted pump capacity; 5) in the event that the application is not completed correctly, any permft may be suspended until the ftem is brought in to compliance, and any work done whHe th~rmft is in suspension may result in fines of up to $1000/day.

Well Owner \-<\~\<. "'h~ Landowner Rick Shea

(~nt legibly) 0 , '~, (print legibly)

Signature f"w.-IL __. Signature

Date 3\ i () Date Date

For official use only Latitude ______ Aquifer System No. Longitude State Well No.

/

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LINQA LINGLE GOVERNOR OF HAWAII

Mr. Rick Shea HCR 2 Box 9548 Keeau, HI 96749

Dear Mr. Shea:

Q

STATE OF HAWAII DEPARTMENT OF LAND AND NATURAL RESOURCES

COMMISSION ON WATER RESOURCE MANAGEMENT P.O. BOX621

HONOLULU, HAWAII 96809

May 3, 2004

Well Completion Report for Well No. 3586-03

PETER T YOUNG CHAIRPERSON

MEREDITH J. CHING CLAYTON W. DELACRUZ

JAMES A FRAZIER CHIYOME L. FUKINO, M.D STEPHANIE A WHALEN

ERNEST Y.W. LAU DEPUTY DIRECTOR

3586-03.ack

We received your co}tlpleted Well Completion Report Part II for the Shea Well (Well No. 3586-03) on April21, 2004 and acknowledge that it is complete.

If you have any questions, please contact Ryan Imata of the Commission staff at 587-0255 or toll-free at 974-4000 (Hawaii), 274-3141 (Kauai), 984-2400 (Maui), or 1-800-468-4644 (Lanai & Molokai), extension 70255.

RI:ss

c: Fred Page

Sincerely,

w.nh 1'z.

ERNEST Y.W. LAU Deputy Director

I

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AP .. R-2Jf~~004 09:53 AM Fred Page Dri 11 ·1 n~ I ~ ... ~ nt. "L 808 965 5339 ~' P.01 """"'\ ._., . """""

FRED PAGE DRILLING INTERNATIONAL INC. I

PO BOX 1434 LlC.NO. C-16653 TEU I' AX (808) 965-5339 PAHOA, HI 96778 FRED PAGE, PRESIDENT

FAX

We are transmitting fl pages. Including this cover letter. If you do not receive all of the page~ please notifY us as soon as possible. ·

TiilS INFORMATION IS DELIVERED TO:

DATE: #{.p.l/.q«

NAME: ~ ,fa,._4

COMPANY: 1J '- ./i/, ,Q

FROM: ilf41( ~«

MESSAGE: (},£~ ~H;. ;t;ru4../-*¢e.~.1 ~#( "-?'~ .._:_ ~ ttm.% .

.. , ..

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l lenoh rnartc ultvdon . •u~ tDII8MNit0.01 fl."" _. _ft. m•n .. .,. ; ......_ _____ ......... ,

Bench mark has bee~ submitted to DLNR.,

I I I .

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Pump Intake dept~ • ft. ('*rei'Ad to berl;h mortO

Chase lUbe depth • ft. (reflmJnced to bench mark) ·

If airline Installed, bo.IIPDl cA airline elevation s --.-: N f_ A ft. rnt1n ... IIWII

P.82

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TR~MISSION

APR-16-04 17:17 ID:8085870219 WATER RESOURCE MGT

START TIME APR-16-04 17: 16

TELEPHONE NUMBER 818089655339

NAME<ID NUMBER>

TRANSMISSION MODE G3

RESOLUTION STD

PAGES TRANSMITTED 000

MAILBOX OFF

SECURITY OFF

INFORMATION CODE 009

REDIALING TIMES 00

MACHINE ENGAGED 00'00

JOB NUMBER 485

THIS TRANSMISSION WAS NOT COMPLETED. PLEASE RETRANSMIT.

LAST SUCCESSFUL PAGE 000

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FROM: ERNIE

TO:

COMM.JON ON WATER RESOURCE MANAGE.QT (03/03)

FEB 12 2004 I DATE: SUSPENSE DATE:

INIT. TO:

LAU, E. MATHIAS, T. NAKAMA, L. NAKANO, D.

I NIT: FOR: PLEASE:

Approval See Me Signature Review & Comment Information Take Action

·.i--' __ Type Draft

1, ,

11 1 r J

t OHYE, M. t t ; 1 r , . .~ '···

Type Final File SAKODA, E.

-A- SUBIA, S. SWANSON, S. UYENO, D. YODA, K. YOSHINAGA, M.

Xerox __ copies

t. , f}_t \d ' \\ t f:.J til\ iJ /Lt. : J

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L.IHOA LIHGI E I'JOV\.IUNM OF """'"'

Mr. Rick Shea 240 El Portal Fncini~ CA 92024

Dear Mr. Shea:

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STATE OF HAWAII 1 ~ARTMENT OF LAND AND ~'I f' URCES

COMMISSION ON WAt;,: 8~~~UI!E JINAGEMEN HONOLULU, liAWAII 111111D1

March 3. 2003 I

I !

I ! I

Well Ggmpletion Report fpr~Wcll No. 3586-0~ I I

Pt!Tt:R f VOUN<:-r..~fl$t,,a

loii:HF.OITli J. CHING CLAYTON W OELA CRUZ CliiYOMf L. FtJI<IfojO, M.D

BAlAN C. NISHIOA Hl!RBEMT M. RICHARDS. JR

PEAH ~. IW<AHO IICIIIOGIJIIINIIUIIfOil

We have received your Well Completion Report Part II for the ea Well (Well No. 3586-03). Please fill in lines 11 and 12~ describing the· chloride and te rature information prior to the pump test. We also recognize that you are requesting an e nsion to your surveyor's report. You may turn in your surveyor's report prior to the expiration d te of your pennit (June 28, 2004). but you will not receive your pump installation permit (and t erefore not be able to use your pump) until the surveyor's report is completed

If you have any questions, please contact Ryan Imata of the Co~mission staff at (808] ss1~o2ss. I

Sincerely, I

~d.~ DEAN A. NAKANO I Acting Deputy Director

Rl:ss

c: Fred Page Drilling

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, State of Hawl 0 COMMISSION ON WATER RESOURCE MANAGEMENT Department of Land and Natural Resources

For Official Use Only:

WELL COMPLETION REPORT - PART II Installation

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.hawaii.gov/dlnr/cwrm/

·~~ fE812 A9: 32

1. State Well No.: 3586-03 Well Name: ~S:..:.he.=..:a::...:..:W:..:e:..:.:ll~-------- Island: Hawaii

2. Address: One Road, HPP Tax Map Key: --=-1--=5-..:-5:.::6:.:.:-=3..::.5 _______ _

3. Pump Installation Company: f?R. E 0 PA5 CE ORtl.ltNg t N't §RtJ A"TION AL ~~~P~piM~~: ~h~j~~7D-~~~--~~~~~~=~~~~~~~~~~~~

mcfnyMay ear 5. PERMANENT PUMP INFORM TION

Pump Type, Make, Serial No.: TA C u "t-'2-1 S A--..1 D .f-1-A ~ h'l\-tJ d ~EP.. Rated Capacity: ___ ,_':;"';:.__, ______ gpm at head of: ,.bo J.. b 'S • ft.

Mo~rTyp~H.~.Vo~age,rpm: -~~~~~~~~~~~~~~~~·~~\~· ~~~~·--~~~·~~~B~R~~~·-~ Type of flow meter: which measures in ----------------------

Model Number -------- Serial Number

Pump type (check one):

0 Deep Well Turbine

p1 Submersible

0 Centrifugal

6. Method of flow measurement:

.Jii!'Rotary

0 Rotary-Displacement

o Rotary-Gear

o Propeller

0 Reciprocating

0 Impulse

o Flowmeter Manufacturer Make Size --------0 Weir )2!""o~en Pipe o Orifice* o Other*, explain below

*attach schematic

7. Fill in the as-built section on the other side of this sheet.

8. Attach photograph of well and concrete pad clearly showing benchmark on concrete pad.

9. Other remarks/comments:

Pump Installation Contractor (print) F R }.f. D 41\ s e S~nature &J ¥

Permittee (print) K.'-~ARc\ P. s~~~ Signature

c - /66 ..s:s C-57/C-57a/A Lie. No. (- / D<a" 0 j

Date \ \ J...3 1 0 4-\ I

Date --~-=-{_14-{ ~-'1!.....--___ _

WCR2 Form 4129103 Page 1 of 2

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Bench mark has bee~ submitted to DLNR.;

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(Please attach as-built if different from .,iagr;,m ,;rovic~c tJq/owJ

E~e~tatV-!n of top of ctuase tu~ N I A tt. mean sea level

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1 Pump intake depth "'_]]___ft. J......._. (referenced to bench mark) I

Chase tube depth • N A ft. (referenced to bench mark) ·

If airline Installed, bottopt of airtine elevation ... _N_t ~ft. mean sealevel

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.MP INSTALLATION PERMIT A Shea Well, Well No. 3586-03 W

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 Shea Well (Well No. 3586-03} at One Road, Hawaii, TMK 1-5-56: 035, subject to the Hawaii Well Construction & Pump Installation Standards (1/23197} which include but are not lirnited to the following conditions:

1. 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.

2. The pump installation permit shall be for installation of a 15 gpm rated capacity, or less, pump in the well.

3. The permittee, well operator, and/or well owner shall provide and maintain an approved meter or other appropriate means for measuring and reporting withdrawals and water levels, and appropriate devices or means for measuring chlorides and temperature. These data shall be measured monthly and reported to the Commission on a monthly basis, on forms provided by the Chairperson (attached).

4. The proposed use 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 pump water from a well shall not constitute a determination of correlative water rights. The permittee, well operator, and/or well owner are notified and by this provision understands that the quantity of water taken from the well could be reduced by the Commission in the future. This permit is not a commitment that the pump capacity permitted here or even some lesser amount is guaranteed in the future.

5. The permittee, well operator, and/or well owner shall complete and submit as-built drawings and Part II - (Permanent) Pump Installation Report of the Well Completion Report {attached) to the Chairperson within sixty (60) days after completion of work.

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

7. The pump installation permit application and any related staff submittal approved by the Commission are incorporated into this permit by reference. This permit is also subject to the Hawaii Well Construction & Pump Installation Standards (1/23/97). If the HWCPIS are not followed and as a consequence water is wasted or contaminated, a lien on the property may result.

8. The permit may be revoked if work is not started within six (6) months after the date of approval or if work is suspended or abandoned for six (6) months, unless otherwise specified. 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 good-faith performance. A request to extend the permit shall be submitted to the Chairperson no later than three (3) months prior to the date the permit expires. If the commencement date is not met, the Commission may revoke the permit after giving the permittee, well operator, and/or well owner notice of the proposed action and an opportunity to be heard.

9. If the well is not to be used it must be properly capped. If the well is to be abandoned then the permittee, well operator, and/or well owner must apply for a well abandonment permit in accordance with §13-168-12(f) prior to any well sealing or plugging work.

10. 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.

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

Date of Approval: Expiration Date:

January 12,2004 January 12, 2006

jrp~Aiu~'7.chairperson Commission on Water 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 conditio!) 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 also understand that non-compliance with any permit condition may be grounds for revocation and fines f up to $1000 per day starting from the permit date of approval.

Permittee's Signature: '(? ,U ~- Date:~ Printed Name: R,~~n! ~. S~tv. Firm or Title:-----------------

Installer's Signature: ~~~,.__.,.~?/~<-__.__--::o~--- C-57, C-57a, or A License#: C- t t ~ S iJ Date: fb{f 0 ~ OCf ~ -~~ C-1~?13~ I / C/J~~ ~ ~d~ ..L.. Printed Name: , ~ e:=.JL.. ----;:,-~ Firm or Title: ' V~L. ~r ~ o1~

Please sign both copies of this permit, retum one to the Chairperson, and retain the other for your records.

Attachments c: USGS

Department of Health/ Safe Drinking Water & Wastewater Branch Hawaii Department of Water Supply Fred Page

/

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·' State of Hawe 0 COMMISSION ON WATER RESOURCE MANAGEM NT Department of Land and Natural Resources

WELL~COMPLETION REPORT • PART t • ell c n

lnetructlona: PltaM print In ink or type end send completed report (with ettachmentl, if IIPP!Iceble) Commiltlon on Wiler Resource Man~gement, P.O. Box 821, Honolulu, Hawaii 18109. The COmmil may not accept Incomplete report~. TNa fo4'm shall be tubmll1ed within 80 days of the c:ompletlon of work. 11111tanee, .... CCM~tUit ttlt HIWIU Well COMinlctiOn and Pump lnltaUitlon Stlndlldt or Clll the-Ufdon Bnlnch at 181.0221. For updates to this fonn or ICklltlonal Information, pit .. vld our wtbl ttttp:l/wwN.atate.hl.ulldlnrlewrm/

1. State Well No.: 3588.03

2. 3.

Wen Name: Shea Well •

For Offtdat Use Only:

/ Oft 'fEB 1Z A 9: 3 2

4. Drilling method used during contruction: Rotary ,.Cl Percuss n o ~ ~ 1,.oo'Z..

5. Date Well Construction (drllled,cased,groutecl) completed: I?..~ :21 Fill out attached Driller's Log ffQIIN~

In flddltlon to the drtller'l lo(l, It a fi80iofllc lofl wa PfiPMtd, piHatiUIHrtlf with fhl•

6. Was the subject well cored? o Yes Jl1 No

7. Initial water-level encountered 3' 1 ft. below ground

8. Step-Drawdown Test completed? .!~""No 0 Yes est form (1Jit7187 SDPTD Form)

9. Constant Rate Aquifer Test completed? ;a"' No o Yes Attach CoMtant "* ulfer T•t form (U/17117 CRPTD Form)

Parameters prior to pump test 10. Wa~er-level: ~I ft .. above msl

11. Chloride: 1M a 'i ppm

12. Temperature: ___ .... a~~..._- •F Date and time of m '

13. Fill In the aaebullt section on the other elde of thle sheet.

14. Fill In attached aurveyor'a report.

15. If a pump is not planned to be installed, please describe (below in the remarks ction} how well Is secured to prevent unauthorized access (example: lockable cover, threaded coupling, etc.)

16. The proposed manufacturer's rated pump capaoity is /~ f

17. Remarks: h --r;

Licensed Driller (print) ~~..o ~.~~-~e, v C-57 Lie.

Signature ~~ Permittee (print) R,~\t: Sb~~

Signature ~iL. Da e

70 ft.

,20 hi'S

'-. !.b6q-8

.y/¢~~

WCR1 Form 8112101 Pfl(le 1 of 4

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13. AS-BUll T wew.._sECTJON (Please attach as-built if dHrerent from 611Qf8m f)fOtlit»d '*>wJ

\.f . . Hole OiaiMter: 1 2 in.

Elevetian at top of casing- ft., mst• - .. ·-·- Minimum of 2' Radiua & 4" ThiCk Concrete Pad (to neareat 0.01 ft.)

Bench mark elevation: ~4.oS r _ft.,ma (Survey to nearest 0.01 ft.)

Cement Grout: • ft. (min. 70% of d' from ground elevation to top of water surface or 500 ft .• whichavflr illtss.) -+

, .. Ground EleVation: ___ ft., msl

..... ,;if"-''-·-,--d.,.(.;a,;,-;.Jf.7.lll ..• !.'\\

i

~~ ~~ j r-- Solid Casing: (~ 90% x (Ground ~lev:;Witer Level Ellv)) := : Length; 3 2 .·. . · .. ..: · ' ft. Annular space be1ween

hole and casing (min.3"):

-:5 in. ~ \ =~=er: ~ 2~0 :; ~.!., .. · .. :~: 1 : 31 t:: ·: ..

~ ~

Rock or Gravel Packing:

~: Bottom ElevatiOn:~· · ·· • ft., mal

10 ft.' Material:

.k \ i '"\"1- . ~ Cruthed Basalt

Cl Rounded Gravel

Water Level Elevation:

~I .- ft. met'

"mal• mean sealevel

i ~. Ill~

I

Open Cuing: o Screen r•rforated Len;tl\: ____ 1..;.0+· . .;..· ..,.....· __ .,_. __ ft.

Nominal Diameter: .....,6_~·-· .... · ~...-. ..... _.......__in.

waH Thlckneu: _· .. ~~~.l'.o_· __ -:7'" __ 1n.

Bott..- E'-·•atJon·. 41 ··; . ...... ..., -- ~i· ft., mal

Open Hole: ·I Lengtn: _______ ~ ____ ft.

Diameter: _in.

Bottom Eltvltion: ft., mal

SolldCaelngMittda!: 1>,. ~S<blo,. 0 ~ :7\k-~A: I Carbon Stetl: compliant with (check one or moll): Cl ANSVAWNA C200 o API Spec. 5L "ASTM A53 tJ AS1'M A 139

And compliant with (Check ohe or more): o ASTM A242 c Type E o Type S l o Grade B I c Other Stalnlt18 StMI: (cneck one): o ASTU A409 (production wells) c ASTM A312 (monitor wells) !

ABS Pla8tlc conforming to ASTM F480 and ASTU 01527: (check erne) o Schedule 40 o SChedule 80 +I PVC Plaatlc conforming to ASTM F4SO 1nd (ASTM 01785 or ASTM 02241): (clttck one): o Schedule 40 c Sched · 80 o Schedule 1?0 Thennout Plastic: (check one) o Filament Wound Retln ~ conforming to ASTM 0299e ,

I o Centrifugally Cast R•ln Pipe conforming to ASTM 02997 1 o Relnfotced Plestle Mortar Pressure Pipe conforming to ASTM 03517 .

1 Cl Glul rtber Reinforced Resin Presaure Pipe conforming to AWNA ceso I o PTFE Fluorocarbon Tubing coi'lfonning to ASTM 03298 o FEP Ftuorocalbon Tubing conforming to ASTU 03296 !

Qpen Claing Material~ t

Carbon lWei: compliant with (check one or more); o ANSIIAWWA C200 a API SpK. &L M ASTM A53 o ASf,M A 139 And compliant with (Check one or more): c ASTU .A242 o Type e o Type S o Grade B 1 o Other

I Stalna.te Stnl: (check one): CJ ASTM M09 (production wells) o ASTM A312 (monitor wells} l ABS Platlc conforming to ASTM F480 and ASTM 01527: (check one) o Schedule 40 o Schec:kJie 80 : PVC Plastic confomling tc ASTM F480 and (ASTM 01786 or ASTM 02241 ): (oii&Ck one): o Schedule 40 o Schedule 80 o Sche<lule 120

. I ThtrmOHt Plutlc: (checl< one) a FHament Wound Resin Pipe conforming to ASTM 02996 :

o Centrifugally Cast Resin Pipe conforming to ASTM 02997 c Reinforced Plastic Mortar Preaaure Pipe conforming to ASTU 03517 o Gina Fiber Reinforced Retln Pressure Pipe conforming to AYNYA C950 o PTFE Fluorocarbon Tubing c:onfomllr.g to ASTM 03296 o FEP Fluorocarbon Tubing conforming to ASTM D3296

i

WCR1!Form 9112/01 Page 2 of 4

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·' 0 DRILL!R'I LOG

weu. NUitta , .. : )sa 6-o 3

-~·~J~'---J;•i~~R~~k _______ 1_1.1._27./0._2_··· to------·---------------0. ,, •. ,, Q . .rgL Q¥ e.. . _

,..;.>,...1 ... o .. '.JI•~ .... ~,....s-· ... __ L,.a._1 £ilollft..,.h_o..,e ... h_o_e ____ ,_,_l_2~ I o 2 _to_ --------- __ _

25' 32' Blue Rock 12/02/02 + r.·.~--·------....... ---------· __ to_-------------

, .. nJi· .. T t •. t 1 . .., ... _10 _______ , __ _

_to.-__-----------.. -..........,._to.___ __ -----------

_.,_ ------------__.....,_.to ....... .-..... .......... _________ ----

-----------------_to_ .. -----·------·-

----~----·-----------------_ ., __ ------~------

_to __ ---------·---

_ to_------------_to_---------Rem~: Static Water level at 31'

with no noticeable drawdown.

_to_--------· _to_---·--------_to_------------

_to_-----------·-_to_

-~, . .........__ --------- ---_to_------·-----_to ____________ _

_ to_·---------- __ _

_.,_ --------- ---_to_--------- __ _ ..... ..__to ................. .......-------

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•' e o AECOS lABORATORY OF HAWAII 7 4-5602 Alapa Street Suite 656 • Kailua-Kona, HI 96 7 40 Telephone/Fax (808) 329-8411

4124/03

CLIENT: Fred Page Drilling

LOCATION: Shea Well

Aloba Beeyl and Fred.

Following are the results of the 4/17/03 well test

Total Coliform(cfullOOml)

Fecal Coliform(cti&llOOml)

Cbloride(mWLl

Please call if there are questions.

27

1

140

MF

MF

325.3

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0

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flrllc! !3)_1-5 -Sb::JS

Lc:7T 2'i4B, BLol. ''-, HAwR 1111 ,; PllflllPISE

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l qo :Js's-7 11 N I S~t~ S"' '38 ",!#E1At. SIJ61}

[!] oveP. weLt,.

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_ _.__ _____________ .

PLOT PLAN (Provide Latitude and Longitude of well referenced to NAD2f to nearest second)

WeU Elevation

Bec.c:hmark Elevation '34. (0.0 1 ft. above msl)

Bencbmark reference cog,trol point

I

T13m ~ + ;J,.,~~~~~ ()JJ . Z I t.r In HI1W~"f4" Pt.rd . P~rlG ,

T!<. P-1 214~7f E/~J

Suryeyor•s stanw and signature

r··

W'CR 1 Form 9112101 P~tge 4 of 4

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0 .. 0 .. .. CJ1 .,J ,

t:l 01 n ~ ... ...... a. :lie ... 0 .,:

~ 0 al I

cc en en I

(J1 .. ... 0

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..,..,...., COMMISSION ON WATER RESOURCE MANAGEMENT

ROUTE SLIP FOR PERMIT ISSUANCE

·----~~~~~-- SUSPENSEDATE: --------------

3 Approval --3-Signature --4-lnformation

\

PLEASE:

See Me --1-Review & Comment ---Take Action -Type Draft --2-Type Final -5-File --Xerox _copies

WELL NUMBER ""3s-B(;, ~ 0 '3 WELL NAME __ ...J<;;:....~~..:...;;..-\.J...J(I\~\;:__ __________________ _

0 WELL CONSTRUCTION

ATIACHMENTS FOR WELL CONSTRUCTION PERMIT: 1 COVER LETTER 2 PERMIT (2x)

COMMENTS: 3 SDWB 4 WWB 5 CWB 6 HEER 7 LD 8 HP

TO BE SENT TO APPLICANT

9 PUMPTEST 10 WCR I FORM

FOR OFFICE USE ONLY ~~,·M 11 '~r \~ l~h'k-). ' .

9( PUMP INSTALLATION

ATIACHMENTS FOR PUMP INSTALLATION PERMIT: 1 COVER LETIER ~ 2 PERMIT (2x) 'II'

COMMENTS: 3 SDWB 4 WWB 5 CWB 6 HEER 7 LD 8 HP 9 WCRII FORM

10 WURFORM FOR OFFICE USE ONLY

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LINOA LINGLE GOVERNOR Of HAWAII

Ms. Minerva Shea HCR 2 Box 9548 Keeau, HI 96749

Dear Ms. Shea:

0 0


COMMISSION ON WATER RESOURCE MANAGEMENT P.O.BOX621


Pump Installation Permit Shea Well (Well No. 3586-03)

PETER T. YOUNG CHAIRPERSON

MEREDITH J . .CHING CLAYTON W. OELA.cRUZ

JAMES A. FRAZIER CHIYOME L. FUKINO, M.D. STEPHANIE A. WHALEN

ERNEST Y.W. LAU DEPUTY DIRECTOR

January 14, 2004

Enclosed are two (2) originals of your approved Pump Installation Permit for the captioned wel~s) that authorize permanent pt:Jmp installation work for your well(s). As part of the Chairperson's approval, the following special conditions were added and are part of your permit under Permit Condition 11:

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. Please enclose the pump specification and rating curve for the installed pump with the Well Completion Report.

The permittee, well operator, and/or well owner are responsible for all conditions of the permit. Be advised that you may be subject to fines of up to $1000 per day for any violations of your permit conditions starting from the permit approval date.

Please sign and have the contractor sign both permit originals and return one for our files. A copy <>f your water use report form is enclosed for your use.

Except for the monthly water use report form, please provide copies of all the information in this packet to your pump installation contractor. -

Finally, this letter is notice that we have accepted your Well Completion Report- Part I as complete.

If you have any questions, please call Ryan lmata of the Commission staff at 587-0255 or toll-free at 97 4-4000 (Hawaii), extension 70255.

Sincerely,

kP:b.vb l ,. Chairperson

Enclosure

c: Fred Page

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C PUMP INSTALLATION PERMITQ Shea Well. Well No. 3586-03

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 Watsr Resource Management's Administrative Rules, Section 13-168, entitled 'Water Use, Wells, and Stream Diversion Works", this document permits the pump installation for Shea Well (Well No. 3586-03) at One Road, Hawaii, TMK 1-5-56: {)35, subject to the Hawaii Well Construction & Pump Installation Standards (1/23/97) which include but are not limited to the following conditions:



3. The permittee, well operator, and/or well owner shall provide and maintain an approved meter or other appropriate means for measuring and reporting withdrawals and water levels, and appropriate devices or means for measuring chlorides and temperature. These data shall be measured monthly and reported to the Commission on a monthly basis, on forms provided by the Chairperson (attached).

4. The proposed use 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 pump water from a well shall not constitute a determination of correlative water rights. The permittee, well operator, and/or well owner are notified and by this provision understands that the quantity of water taken from the well could be reduced by the Commission in the future. This permit is not a commitment that the pump capacity permitted here or even some lesser amount is guaranteed in the future.

5. The permittee, well operator, and/or well owner shall complete and submit as-built drawings and Part II - ~Permanent) Pump Installation Report of the Well Completion Report (attached) to the Chairperson within sixty (t)O) days after completion of work.

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

7. The pump installation permit application and any related staff submittal approved by the Commission are incorporated into this permit by reference. This permit is also subject to the Hawaii Well Construction & Pump Installation Standards (1/23/97). If the HWCPIS are not followed and as a consequence water is wasted or contaminated, a lien on the property may result.

8. The permit may be revoked if work is not started within six (6) months after the date of approval or if work is suspended or abandoned for six (6) months, unless otherwise specified. The work proposed in the pump installation permit application shall _!)e <:OITIPieted within two (2) years from the date of permit approval, unless otherwise specified. The permit may be axtended 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 three (3) months prior to the date the permit expires. If the commencement date is not met, the Commission may revoke the permit after giving the permittee, well operator, and/or well owner notice of the proposed action and an opportunity to be heard.


10. 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.


Date of Approval:

Expiration Date:

January 12,2004 January 12,2006

:JPEU:Ai:tlchairpersoo Commission on Water Resource Management

1 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 also understand that non-compliance with any permit condition may be grounds for revocation and fines of up to $1 000 per day starting from the permit date of approval.

Permittee's Signature: Date: ___ _

Printed Name: Firm or Title:-----------------

Installer's Signature: C-57, C-57a, or A License#: Date: ___ _


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

Attachments c: USGS

Department of Health/ Safe Drinking Water & Wastewater Branch Hawaii Department of Water Supply Fred Page

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0 PUMP INSTALLATION PERMITO Shea Well. Well No. 3586-03


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 Shea Well (Well No. 3586-03) at One Road, Hawaii, TMK 1-5-56: 035, subject to the Hawaii Well Construction & Pump Installation Standards (1/23/97) which include but are not limited to the following conditions:



3. The permittee, well operator, and/or well owner shall provide and maintain an approved meter or other appropriate means for measuring and reporting withdrawals and water levels, and appropriate devices or means for measuring dllorides and temperature. These data shall be measured monthly and reported to the Commission on a monthly basis, on forms provided by the Chairperson (attached).

4. The proposed use shall not adversely affect existing or future legal uses of water in the ar-ea, including any surface water or established instream flow standards. This permit or the authorization to pump water from a well shall not constitute a determination of correlative water rights. The permittee, well operator, and/or well owner are notified and by this provision understands that the quantity of water taken from the well could be reduced by the Commission in the future. This permit is not a commitment that the pump capacity permitted here or even some lesser amount is guaranteed in the future.

5. The permittee, well operator, and/or well owner shall complete and submit as-built drawings and Part II - (Permanent) Pump Installation Report of the Well Completion Report (attached) to the Chairperson within sixty (60) days after completion of work.

6. 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.

7. The pump installation permit application and any related staff submittal approved by the Commission are incorporated into this permit by reference. This permit is also subject to the Hawaii Well Construction & Pump Installation Standards (1/23197). If the HWCPIS are not followed and as a consequence water is wasted or contaminated, a lien on the property may result.

8. The permit may be revoked if work is not started within six (6) months after the date of approval or if work is suspended or abandoned for six (6) months, unless otherwise specified. 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 Chaifl)erson 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 three (3) months prior to the date the permit expires. If the commencement date is not met, the Commission may revoke the permit after giving the permittee, well operator, and/or well owner notice of the proposed action and an opportunity to be heard.


10. 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.


Date of Approval: January 12, 2004 ~ P!Cf~AiJ. Chairperson Expiration Date: January 12,2006 · Commission on Water Resource Management

1 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 also understand that non-compliance with any permit condition may be grounds for revocation and fines of up to $1000 per day starting from the permit date of approval.

Permittee's Signature: Date: ____ _


Installer's Signature: C-57, C-57a, or A License#: Date: ____ _

Printed Name: Firm or Title:----------------


Attachments c: USGS

Department of Health/ Safe Orin king Water & Wastewater Branch Hawaii Department of Water Supply Fred Page

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PLOT PLAN (Provide Latitude and Longitude ofwel_l referenced to NAD27 to nearest second)

WeD Elevatioo

Beochmark Elevation "34. (0.0 1 ft. above msl)

Benchmark reference cootrol point

I

T l3 rn ~ + (J,.c fAd,,$~ a-J . 21 t,r in Ji~M.tit.f4~t P6rd . PAriG ,

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Surveyor•s stamp and signature

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W'CR1 Form 9112./0t Pttge 4 of 4

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PLOT PLAN (Provide Latitude and Longitude of well referenced to NAD27 to nearest second)

Well Elevation

Bencbnwk Elevation "34, (0.01 ft. above msl)

Concrete Pad

Benchmark reference control point

T13 m ~ + Pdlr ~GJ,.j.e ~ z 1 !.t 1n HawAit"cc~~. P~rd· Pt4rk. ,

TR P-7 2£4~7'1 El~

Surveyor's stamp and signature

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MEMO and ROUTE I_IP ft:)2.f'-~ CIQf I (J., / ~~ c:r, 1)D :;,cJ~ 4till. 05/20/03

[ WCR 1 Check for Well No. 3586·03 (survey to regulation memo) .I

1. Pum11. Tests Check Glenn Bauer

Step-Drawdown Test:

followed WCPI Stds analysis attached proposed pump cap o.k.

Aquifer Pump Test:

followed WCPI Stds T & S analysis attached

Well Interference: estimated Steady-State drawdown at 1-mile radius is--:---:--- ft.

analysis attached

(initial) Yes No If no1 describe deficiencl£

0 0

~~ 0 0 0 0

/~¥ ~~ 0 0

0 0

0 0

.. 14

/0

'JZ,

Stream Surface Water Impacted: 0 0 .._ If yes, identify most probable stream

Geology Code for Well Index: ____ _

2. Construction Check Mitch Ohye ____ (initial) Yes No If no1 describe deficiencl£

data complete 0 0 followed Special Cond & elevations 0 0 well database updated 0 0

Latitude Longitude

NAD27

NAD83

?'?; ) '

I 1? '

3. Charley/Lenor@ ____ (initial) take action based on above analysis

ATTACHMENTS FOR PUMP INSTALLATION PERMIT: 1 COVER LETTER

2PERMIT (2x)

3 DOH COMMENTS

4LAND DIV. COMMENTS

5WCR2FORM

6WURFORM

4. Roy ____ (initial) check 5. Subia (initial) finalize 6. Dean I) signature 7. Charley/Lenore yan ile

__ not necessary - only WCP.

To be sent to applicant

171' ']l " '

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State of HawcG 0 For Official Use Only:

COMMISSION ON WATER RESOURCE MANAGEMENT Department of Land and Natural Resources

WELL.COMPLETION REPORT - PART t • Well Construction

Instructions: Please print in ink or type and send completed report (with attachments, if applicable) to the A 9 •. \ 7 Commission on Water Resource Management, P.O. Box 621, Honolulu, Hawaii 96809. The Commission mQ.3 not accept incomplete reports. This form shall be submitted within 60 days of the completion of work. ~r 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 .

1 l'.ll \'' 1'. TtR

http://www.state.hi.us/dlnr/cwrm/ C M~~\SSlOh \'1'\ 'YJ' ,... 1 -A l -..~ ..

1. State Well No.: 3586-03 Well Name: Shea Well • Island: Hawaii

2. Address: One Road, Hawaiian Paradise Park Tax Map Key: _1..::....·....:.5....;:.-5::...:6:..:.: ....:.3.=..5 ___ _

3. DrillingCompany: ~ ~ ~ /~~~ 4. Drilling method used during contruction: J2! Rotary o Percussion o Other (describe) ,.., 5. Date Well Construction (drilled,cased,grouted) completed: t:?ec ..2 ~ Fill out attached Driller's Log

month/day/year In addition to the driller's log, if a geologic log was prepared, please submit with this form.

6. Was the subject well cored? o Yes .Z1' No

7. Initial water-level encountered ft. below ground Date and time of measurement: ~ (1.2- 'J..·a:J, monthlda)i1year ~

8. Step-Drawdown Test completed? ifNo 0 Yes Attach Step-Drawdown Test form (12117197 SDPTD Form)

9. Constant Rate Aquifer Test completed? %No 0 Yes Attach Constant Rate Aquifer Test form (12117197 CRPTD Form)

Parameters prior to pump test:

10. Water-level: -:;?I ft. above msl Date and time of measurement:

11. Chloride: lb o ppm Date and time of sampling:

12. Temperature: ____ ,#t!!!f!!;...4...1£___,_ __ Date and time of measurement: '

"F

13. Fill in the as-built section on the other side of this sheet.

14. Fill in attached surveyor's report.

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. The proposed manufacturer's rated pump capacity is 1<' gpm at a head of 7 0 ft.

17. Remarks: ___:_(?..__:_-.J_.-n__,f.~~ d~~v.J~<=.=!Iuf~cJJ~t ....!..Ji h~-fi~~~r~C?.....!::t~:..:..!r174~~~:..p:!!-..:....__=~~h_;os-=---.:..._f\I~O .. 0~0 ~

Licensed Driller (print) ~e.o ;C'/JtfE,. C-57 Lie. No. c .;-66 r5' v

Signature ~~ Date ~~61o3_ I

Permittee (print) R,~" s~'SJO.., /

Signature ~iL, Date

WCR1 Form 9J

,./

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Benchmark elevation:

13. AS·BUIL T WE.ECTION (Please attach as-built if different f~am provided below)

_ Hole Diameter: _11,_ _in. V Elevation at top of casing __ ft., msl" -, (to nearest 0. 01 ft.) Minimum of 2' Radius & 4• Thick Concrete Pad

,--Ground Elevation: ft., msl

1-...----·····--·----- ···-----··· -._t, ,_

Please refer to the

_ft.,msJ• (Survey to nearest 0.01 ft.)

Cement Grout: • \ 4 ... (min. 70% of dls'fa'nce from ground elevation to top of water surface or 500 ft .• whichever is less.)

~~ .•. ! j:

~t1;'lifi);'rJK~8iR~flN%ttof

Total Depth

t.O"' _n.

i

I

I

Annular space between hole and casing (min.3"): ~ ..:I.. in.

Rock or Gravel Packing:

1 0 ft.Material:

,11 Crushed Basalt

o Rounded Gravel

Water Level Elevation:

U- ft.ms1•

_)

_l__________ ---

•msl = mean sea level

' w' I - r

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~i '. i ~: 11: ~~ )(

';/. ~ N

,/ /

to ensure that your as-built is in compliance wlth applicable stand am.

Solid Casing: {C!: 90% x (Ground Elev.-Water Level Elev)) . . .. -r:· j

Length: 3 2 · .. <- , ft.

Nominal Diameter: 6 · ; J: · ~ in.

Wail Thickness: • 2 5 0 -: :- '"· . ' .... Bottom Elevation:_;__. 31 '- • . : 11..,msl

Open Casing: o Screen J'!:rtorated Length: 1 0 . . · ft.

Nominal Diameter: 6 ·.· . _ _... in.

Wall Thickness: -·~2;.;;5~0~----~~-Bottom Elevation: .i..1 \;.

-~

~n.

tt., msl

Open Hole: ·1 Length: ft.

Diameter: _in.

Bottom Elevation: I ft., msl

Solid Casing Material: Carbon Steel: compliant with (check one or motS): a ANSVA'MNA C200 o API Spec. 5L rhSTM A53 o AS1M A 139

And compliant with (check ohe or more): o ASTM A242 a Type E a Type S ;-·o Grade B 1 a Other Stalnl ... Steel: (check one): CJ ASTM A409 (production wells) CJ ASTM A312 (monitor wells) ABS PI-* confo1ming to ASTM F480 and ASTM 01527: (check one) Cl Schedule 40 CJ SChedule 80 I PVC Pladc conforming to ASTM F480 and (ASTM D1785 or ASTM 02241): (check one): CJ Schedule 40 a Schedur so CJ Schedule 1?0 Thermoset Plastic: (chec:k one) o Filament Wound Resin Pipe conforming to ASTM D2996

1 o Centrifugally Cnt Resin Pipe conforming to ASTM 02997 o Reinforced Plastic Mortar Pressure Pipe conforming to ASTM 03517 1

o Glass Fiber Reinforced Resin Pressure Pipe conforming to AW/t/A C950 I o PTFE Fluorocarbon Tubing conforming to ASTM D3296 CJ FEP Fluorocarbon Tubing conforming to ASTM 03296 I

Open Casing Material: l Carbon Steel: compliant with (check one or more): a ANSIIAWNA C200 o API Spec. 5L H ASTM A53 o AS , A 139

And compliant with (check one or more): o ASTM A242 o Type E o Type S o Grade B 1 o Other

Stalnl ... Steel: (Check one): a ASTM A409 (production welts) o ASTM A312 (monitor wells) !

ABS Plastic conforming to ASTM F480 and ASTM D1527: (check one) o Schedule 40 o Schedule 80 I PVC PlastlcconformingtoASTM F480 and (ASTM D1785 orASTM 02241): (Check one}: o Schedule 40 o Schedule 80 o Schedule 120

I Thermoset Pintle: (Check one) o Filament Wound Resin Pipe conforming to ASTM D2996 1

o Centrifugally Cast Resin Pipe conforming to ASTM 02997 I'

o Reinforced Plastic Mortar Pressure Pipe conforming to ASTM D3517 o Glass Fiber Reinforced Resin Pressure Pipe confo1ming to A'WNA C950 i o PTFE Fluorocarbon Tubing conforming to ASTM D3296 I o FEP Fluorocarbon Tubing conforming to ASTM D3296

1

I

WCR11Form 9/12101 Page 2 of 4 ' !

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0 DRILLER'S LOG

WELLNUIII& · .. : ... ~58Q-03

Dtptha (It) Rock Oelc:rtption, Water L8\'el. etc. OHtl

...,.0.,.1 .,...·;.a•·te~·· ,.J,...Q_1 _ .. ....,........,F,.i,.r.m,..· ..... R""lo.-c ... k ____ ~1 ~1 .t..L.::..2 ?I Q2 .:_to ____ ------ ___ _

.r 1;9' •~··"""2,..s_~ .... -__ L._~..,.P....,a_h_o.,.e_h_o_e..,. ____ 1_1_1_281 02 _to_--------- ---251 32 1 Blue Rock 12102102 ........ ·t'l:...· ..... _____ .....,________ __to_---------- ---3 2 I 4 1 I · .. A I A ~.. ..R ...... o .... c. k_. 1 2 I 0 3 I 0 2

... '!!. ,,·:•·~·•• """-i~_.....,io;,;i ..... ;oil.--......,--..---· ---.;to_----·----- __ _

_10_ ------·---

_to_.__---------- ___ _ _to_-----------_ao_ ------------

_.to __ ---------__ .., __ --------------to_ .. ----------_......._. __ _

_ to_----------· _ to_--------· -----to_.._..._ --·-----------' ----

--.....to __ ..._--------·----

_ to_----·------ __ _ _to, ___ ---·---·---

Rema~: Static Water level at 31 1

with no noticeable drawdown.

_to_------------_to_---------------~- --------- ---_to_--------- --_tc_ --------- --·-

_to ___ ----------- __ _

--to··-- ________ ,.,.._...._ ---

_to_-----------_to __ --------- ----

...._..,._to_ ...... _. _____ ........... __ _

.----..to ............... --·-------- ---

_to_------------_tc_ ---------- __ _

·------to-- -

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PLOT PLAN (Provide Latitude and Longitude of weiJ referenced to NAD27 to nearest second)

Well Elevation

Benchmark Elevation ---{0.01 ft. above msl)

Concrete Pad

Benchmark reference co~trol point

Surveyor's stamp and signature

WCR1 Fonn 9112101 Page 4 of 4

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0

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/ ' e o

AECOS IABORATO~~JVT:ITIAWAII 7 4-5602 Alapa Street Suite 656 • Kailua-Kona, HI 96 7 40 Telephone/Fax (808) 329-8411

4/24/03

CLIENT: Fred Page Drilling

LOCATION: Shea Well

Aloha Beryl and Fred,

Following are the results of the 4117/03 well test:

Total Coliform(cfullOOml)

Fecal Coliform(cfullOOml)

Chloride(mg!L)

Please call if there are questions.

1Ctuuv~ Karen Klein, Director

03 MAy 19 A 9 : I 7

Result Method

27 MF

1 MF

140 325.3

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- .-

0 ..

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• -----~~~ State of H-aii 0 i .-:- COMMISSION ON WATER RESOURCE MANAGEMENT \1 f.J Department of Land and Natural Resources

\; ~'I WELL.COMPLETION REPORT - PART t • - Well Conetructfon

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:Jiwww.state.hl.us/dlnr/cwrm/

For Offieial Use Only: RECflVED

DB FEB 3 P I : 4 4

COM~11SSION ON \IJ.ATER ~ESOLRCE ~.t'.N,~GEMEHT

1. State Well No.: 3586-03 Well Name: Shea Well • Island: Hawaii

2. Addr~ss: . One Road, Hawaiian Paradise Park Tax Map Key: 1-5-56: 35

3. Drillingcompany: ~r~ ~ /~~~-·---_-_-_-__ -_:· 4. Drilling method used during contruction: .0" Rotary D Percussion D Other (describe)

5. Date Well Construction (drilled,cased,grouted) completed: _t?~ ~ .!'~111 oJ!~hed Driller's Log monthldaylyeat

In addition to the driller's log, if a geologic log WBlf prepared, please submit with this form.

6. Was the subject well cored? o Yes ;!1 No

7. Initial water-level encountered _:J_J __ ft. below ground Date and time of measurement: ~ (1.2- '.J..·t:Jt:J, month/day/year time

8. Step-Drawdown Test completed? 0 No 0 Yes Attach Step·Drawdown Test form (12117197 SDPTD Form)

9. Constant Rate Aquifer Test completed? 0 No D Yes Attach Constant Rate Aquifer Test form (12/17/97 CRPTD Form)

Parameters prior to pump test:

10. Wa~er-level: ___ -::? /______ ft. above msl Date and time of measurement

11. Chloride: ______ • --·---- ppm

12. Temperature: •F

Date and time of sampling:

Date and time of measurement

-~,..,......,-...,....------month/daylye;tr time

--..,.........,--,----- .. monthlday/y~ar time

. -----.,...---·-month/day/year time

13. FIJI In the as-built section on the other side of this sheet.

14. Fill In attached surveyor's report.

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. The proposed manufacturer's rated pump capacity is /P-/~ gpm at a head of 1 0 ft.

17. Remarks: .t£e.. ~Cff!'J;{el/_ ~ ""trh ~r &~.AI- /5$=~ __ foY a*~hr'"j. r~eYe. /A/~ rve> 0~~ t?ot.kJ/\J · ~ ~

Licensed Driller (print) _...:...r-;...;.~__::~::.::0==-..__:..~_,;.....;._'/fi..J.-/?-, ___ _ v

C-57 Lie. Nth C-166 S"3-.

Signature

Permittee (print}

Signature Date

WCR1 Form 9112/01 Page 1 of4

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0 Q

. I (')

. I I ., . ·' .

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MEM() ~Od RouR SLIP 0 I WCR 1 Che.ck for Well No. 3586-03 (survey to regulation memo)

1. Pump Test~ Check Glenn Bauer ~ (initial) 7 Yes No If no. describe deficiency

Step-Drawdown Test:

followed WCPI Stds D analysis attached D proposed pump cap o.k. D

Aquifer Pump Test:

followed WCPI Stds T & S analysis attached

Well Interference: estimated Steady-State drawdown at 1-mile radius is ____ ft.

analysis attached

D D

D

D D D

D D

D I <"'

Stream Surface Water Impacted: D

t~ .

/·· .• ~· ) . . .. ·f i \

D .,_ If yes, identify most probable stream

J ./ Geology Code for Well Index: -----

2. Construction Check Mitch Ohye ' . '~.J (initial) \

data complete followed WCPI Stds well database updated

Yes No

D D D

A-t)? ·)

If no, describe deficiency

Ingrid Kunimura ____ (initial) Latitude Longitude

NAD27

NAD83

3. Charley/Lenore:=> (}v-- (initial) take action based on above analysis

ATTACHMENTS FOR PUMP INSTALLATION PERMIT: 1 COVER LETTER

2 PERMIT (2x)

3 DOH COMMENTS

4LAND DIV. COMMENTS

5WCR2FORM

6WURFORM

__ not necessary- only WCP.

To be sent to applicant

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0 0

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LINDA LINGLE GOVERNOR OF HAWAII

Mr. Rick Shea 240 El Portal Encinitas, CA 92024

Dear Mr. Shea:

0 0




March 3. 2003

Well Completion Report for Well No. 3586-03

PETER T. YOUNG CHAIRPERSON

MEREDITH J. CHING CLAYTON W DELACRUZ CHIYOME L. FUKINO, M.D.

BRIAN C. NISHIDA HERBERT M. RICHARDS. JR.

DEAN A NAKANO ACTING DEPUTY DIRECTOR

3586-0J.let

We have received your Well Completion Report Part II for the Shea Well (Well No. 3586-03). Please fill in lines 11 and 12, describing the chloride and temperature information prior to the pump test. We also recognize that you are requesting an extension to your surveyor's report. You may tum in your surveyor's report prior to the expiration date of your permit (June 28, 2004), but you will not receive your pump installation permit (and therefore not be able to use your pump) until the surveyor's report is completed.

If you have any questions, please contact Ryan Imata of the Commission staff at (808) 587-0255.

RI:ss

c: Fred Page Drilling

Sincerely,

DEAN A. NAKANO Acting Deputy Director

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We w()~lt7 )t!<'e ~ r;-s£ ~ /1/V 5x7~,o-./ ~ ~<!!!!. ?lev.RfiarvS ~ ~~ ~ {A,../.tf/1"9,-f./,...,t:j J~/ /j, -e..

\.'?~~yo-.c<...~"" v ~..,

~~

PLOT PLAN (Provide I .atilude and Longitude of well referenced fO NAD27 fO nearest second)

I I I l

Well Elevation

Benchmark. Elevation __ _ (0.01 ft. above msl)

Concrete Pad

Benchmark refqe~ co~trol point

' Survevor·§~~mp and~

WCR1 Fotm 9/12101Page4of4

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0 0 DRILLER'S LOG

WELL NUMBER: "3 $""' ~- 0 S.

Depths (ft.) Rock Description, Water Level,etc. Dates Depths (ft.) Rock Description, Water Level, etc. Dates

_Q_ to~ P1ed. ~ h t'\Vd"' • __ to __ ---------- ___ _

__ to __ __ LP,. __ ~;;_~_h...;...;o::.....,__,b:.L..G;;;....Jf_· __ _ __to __ ---------- ___ _

__ to __ ---------- ___ _ __ to __ ---------- ___ _

__ to __ ---------- ___ _ __to __ ---------- ___ _

__ to __ ---------- ___ _ __to __ ---------- ___ _

__ to __ ---------- ___ _ __ to __ ---------- ___ _

__ to __ ---------- ___ _ __to __ ---------- ___ _

__ to __ ---------- ___ _ __to __ ---------- ___ _

__ to __ ---------- ___ _ __to __ ----------

__ to __ ---------- ___ _ __to __ ---------- __ _

__ to __ ---------- ___ _ __to __ ----------

__ to __ ---------- ___ _ __to __ ---------- __ _

__ to __ ---------- ___ _ _ __ to ________________ _

__ to __ ---------- ___ _ _ __ to __ ---------- ___ _

__ to __ ---------- ___ _ __to __ ---------- ---·-

__ to __ ---------- ___ _ _ __ to __ ---------- ___ _

__ to __ ---------- ___ _ _ __ to __ ---------- ___ _

__ to __ ---------- ___ _ __to ________________ _

Remarks:


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9. AS-BUll T PUMPOTION (Please attach as-built if different from diO provided below) If /Jz, /P ~ Bench mark elevation surveyed to nearest 0.01 ft. = __ ft. mean sea level

Elevation of top of chase tube ____ ft. mean sea level

Pump intake depth = ft. (referenced to bench mark)

Chase tube depth = r· (referenced to bench mark)

If airline installed, bottom of airline elevation = ___ ft. mean sea level

WCR2 Form 11112102 Page 2 of2

------------------------------------------------------------------~·~

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0

August 27, 2002

Mr. Gilbert s. Coloma-Agaran, Chairperson Department of Land and Natural Resources Commission on Water Resources P .0. Box 621 Honolulu HI 96809

RE: SHEA WELL (Well No. 3586-03)

Dear Mr. Coloma-Agaran;

0

·rr2 AUG 28 Pl2 : I 0

-.

i:' ~

This is the required notification of the commencement of work authorized by the enclosed well construction permit in accordance with the 13-168-15 Hawaii Administrative Rules.

Rick Shea I Fred Page

Enc.

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July 15, 2002

Gilbert S. Colama-Agaran Chairperson State of Hawaii

0

Department of Land and Natural Resources Commission on Water Resource Management

Dear Sir:

0

Pl2 : I 0

As you mentioned in your letter of July 5, I qualify for and wish to take advantage of the Commission's April 15, 1998 ruling No. DEC- ADM 98- G5 and request that I be allowed to install a permanent pump prior to final pump installation permit.

Sincerely,

Rick Shea Owner Shea Well {3586-03) T.M.K. {3) 1-5---56-35 One Road, Hawaiian Paradise Park

Mailing Address 240 South El Portal, Encinitas CA 92024

-------------------------------------------------------------------------------------------

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c Q COMMISSION ON WATER RESOURCE MANAGEMENT

FROM: RYAN

BAUER, G. CHING, F. DANBARA, S.-FUJII,N. -GOODING, K.--

-1-HARDY, R. ~ HIGA,D. HIRANO, E. ICE,C. --

-5-IMATA, R.

JINNAI, R.

ROUTE SLIP FOR PERMIT ISSUANCE

DATE: ___ 1..:.._(_-z.,_( O_V __ SUSPENSE DATE:

KUNIMURA, I. 3 Approval HIAS, T. -3-Signature

KAMA, L. -- 4 Information

KANO,D. == r HIOKA, L. ~ \ 1, \l;01/

4 OHYE, M. .JJ.L:::=" --SAKODA, E .• -2-SUBIA, S. --SWANSON, S.

UYENO,D. --YODA, K.

WELL NUMBER 'SS£ ~ - 0 3

~ WELL CONSTRUCTION

WELL NAME

ATTACHMENTS FOR WELL CONSTRUCTION PERMIT: 1 COVER LETTER 2 PERMIT (2x)

COMMENTS: 3 SDWB 4 WWB 5 6

CWB HEER

7 LD

: Ps:2sT 10 WCR I FORM

D PUMP INSTALLATION

~~ TO BE SENT TO APPLICANT

1q1; USE ONLY 4-l61~.

ATTACHMENTS FOR PUMP INSTALLATION PERMIT: 1 COVER LETTER 2 PERMIT (2x)

COMMENTS: 3 SDWB 4 WWB 5 CWB 6 HEER 7 LD 8 HP 9 WCRII FORM

10 WURFORM

TO BE SENT TO APPLICANT

FOR OFFICE USE ONLY

PLEASE:

See Me Review & Comment Take Action Type Draft

-2-Type Final File 5 Xerox copies

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0 0 BENJAMIN J. CAYETANO GILBERT S. COLOMA-AGARAN

GOVERNOR OF HAWAII CI-WRPERSON

BRUCE S. ANDERSON MEREDITH J. CHING

CLAYTON W. DELACRUZ BRIAN C. NISHIDA

HERBERT M. RICHARDS, JR.

LINNEL T. NISHIOKA




July 5, 2002

DEPUTY DIRECTOR

3586-03.wcp


Dear Mr. Shea:

Well Construction Permit Shea Well (Well No. 3586-03)

Enclosed are two (2) copies of your approved Well Construction Permit for the captioned well(s) that authorize well construction activities but excludes installation work for your permanent pump. As part of the Chairperson's approval, the following special conditions were added and are part of your permit under Permit Condition 13:

Special Conditions

1. Attached for your information is a copy of the Department of Health's (DOH) review comments. Please note DOH's requirements related to discharge of effluent from well drilling and testing activities.

This permit does not authorize work for your permanent pump installation. Approval and issuance of your pump installation permit is contingent upon completed application and information provided to and accepted by Commission staff as required in the Well Construction & Pump Installation Standards (1/23/97) and any special conditions performed under this permit. However, a permanent pump may be installed prior to the permanent pump installation permit issuance in accordance with the Commission's April 15, 1998 Declaratory Ruling No. DEC-ADM98-G5, which states that:

"Permanent pump installation for capacities between 0-70 gpm and where the proposed use is for private individual needs in non-ground-water management areas may be allowed prior to the final pump installation permit issuance. When required as a condition of the well construction permit, subsequent pumping tests shall validate the acceptability of the permanent pump. The permanent pump installed prior to final pump installation permit issuance is subject to removal if the testing shows that a smaller pump is required to reduce the potential of affecting neighboring wells and localized upconing at the applicant's well."

If you qualify and wish to take advantage of this ruling, please include a written request to install the permanent pump prior to final pump installation permit issuance when you return to us your signed well construction permit.

/

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:. Mr. Rick Shea Page 2 July 5, 2002

0 0

Please sign and have the contractor sign both permit originals and return one for our files. Also, copies of the aquifer pump test worksheet and the well completion report form are enclosed for your use.

IMPORTANT - Drilling work shall not commence until a fully signed permit is returned to the Commission. Please provide all the information in this packet to your well drilling contractor. The permittee, well operator, and/or well owner are responsible for all conditions of the permit. This includes ensuring that the well construction contractor, or other party who constructs the well(s), submits a completed Part I of the Well Completion Report form (enclosed) within sixty (60) days after the well construction work is completed. Be advised that you may be subject to fines of up to $1000 per day for any violations of your permit conditions starting from the permit approval date.

If you have any questions, please call Ryan lmata of the Commission staff at 587-0255 or toll-free at 974-4000 (Hawaii}, 274-3141 (Kauai}, 984-2400 (Maui), or 1-800-468-4644 (Lanai & Molokai) extension 70255.

Enclosures

Aloha,

-l(jQ0 ' .). lf,+ rr· ~ \ ! I -~ I; V / l

J . \ / GILBERT S. COLOMA-AGARAN Chairperson

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f

- CvELL CONSTRUCTION PERMIT 0 Shea Well, Well No. 3586-03


In accordance with Department of Land and Natural Resources, Commission on Water Resource Managemenrs Administrative Rules, Section 13-168, entitled 'Water Use, Wells, and Stream Diversion Works", this document permits the construction and testing of Shea Well (Well No. 3586-03) at One Road, HPP, Hawaii, TMK 1-5-56: 35, subject to the Hawaii Well Construction & Pump Installation Standards (1/23/97) which include but are not limited to the following conditions:

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

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.

The well construction permit shall be for construction and testing of the well only. A minimum 1114-inch diameter monitor tube shall be permanently installed, in a manner acceptable to the Chairperson, fo accurately record water levels. The permittee, well operator, and/or well owner shal coordinate with the Chairperson and conduct a pumping test in accordance with the Standards (a pump testing worksheet is attached). The permittee, well operator, and/or well owner shall submit to the Chairperson the test results as a basis for supporting an application to install a permanent pump and withdraw water for use. No permanent pump may be installed until a pump installation permit is approved and issued by the Chairperson.

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.

The permittee, well operator, and/or well owner 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 subsurface cultural remains such as artifacts, burials or concentrations of shells or charcoal are encountered during construction, the permittee, well operator, and/or well owner shall stop work and contact the Department's Historic Preservation immediately.

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 construcfthe well shall not constitute a determination of correlative water rights.

The following shall be submitted to the Chairperson within sixty (60) days after completion of work: a. Well completion report, (attached- Part I, Well Construction Report). b. Elevation (referenced to mean sea level, msl) survey by a Hawaii-licensed surveyor. c. As-built sectional drawing of the well. d. Plot plan and map showing the exact location of the well. e. Complete pumping test records, including time, pumping rate, drawdown, chloride content, and other data.

The per;mitteE!_Lyvell op~rator, and/or well owner shall comply with all applicable laws, rules, and ordinances; non-compliance may be grounds for revocation of m1s perm1t.

The well construction permit application is incorporated into this permit by reference and is subject to the Hawaii Well Construction & Pump Installation Standards (January 23, 1997; HWCPIS). If the HWCPIS are not followed and as a consequence water is wasted or contaminated, a lien on the property may result.

The permit may be revoked by the Commission if work is not started within six (6) months after the date of apP.roval or if work is suspended or abandoned for six (6) months, unless otherwise specified. The work proposed in the well construction perm1t 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 three (3) months prior to the date the permit expires. If the commencement date is not met, the Commission may revoke the permit after giving the permittee, well operator, and/or well owner notice of the proposed action and an opportunity to be heard.

If the well is not to be used it must be properly capped. If the well is to be abandoned then the permittee, well operator, and/or well owner must apply for a well abandonment permit in accordance with §13-168-12(f) 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, P.ersonal injury, or death arising out of any act or omission of the applicant, assigns, officers, employees, contractors, and agents under this perm1t or relating to or connected with the granting of this permit.

Special conditions in the attached cover transmittal letter are incorporated herein by referen~~?. · / /( /\~ i ; ;A.,r "---' j. ! ) \

Date of Approval: June 28, 2002 June 28, 2004

GILBERTS. OLOMA-AGARAN, Chairpeq:;pn Commission on Water Resource Managem~nt Expiration Date:

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 driller have signed, dated, and returned the permit to the Commission. I also understand that non-compliance with any permit condition may be grounds for revocation and fines of up to $1000 per day starting from the permit date of approval.

Permittee's Signature: ______________ _ Date:-------


Driller's Signature: ______________ C-57 License#: _____ Date:-------



Attachment c: USGS

Department of Health/ Safe Drinking Water, Wastewater, and Clean Water Branches Hawaii Department of Water Supply

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I l

'• 0vELL CONSTRUCTION PERMITO

Shea Well, Well No. 3586-03 " • 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 construction and testing of Shea Well (Well No. 3586-03) at One Road, HPP, Hawaii, TMK 1-5-56: 35, subject to the Hawaii Well Construction & Pump Installation Standards (1/23/97) which include but are not limited to the following conditions:

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

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.

The well construction permit shall be for construction and testing of the well only. A minimum 1114-inch diameter monitor tube shall be permanently installed, in a manner acceptable to the Chairperson, to accurately record water levels. The permittee, well operator, and/or well owner shall coordinate with the Chairperson and conduct a pumping test in accordance with the Standards (a pump testing worksheet is attached). The permittee, well operator, and/or well owner shall submit to the Chairperson the test results as a basis for supporting an application to install a permanent pump and withdraw water for use. No permanent pump may be installed until a pump installation permit is approved and issued by the Chairperson.

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.

The permittee, well operator, and/or well owner 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 subsurface cultural remains such as artifacts, burials or concentrations of shells or charcoal are encountered during construction, the permittee, well operator, and/or well owner shall stop work and contact the Department's Historic Preservation immediately.

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 determinalion of correlative water rights.

The following shall be submitted to the Chairperson within sixty (60) days after completion of work: a. Well completion report, (attached -Part I, Well Construction Report). b. Elevation (referenced to mean sea level, msl) survey by a Hawaii-licensed surveyor. c. As-built sectional drawing of the well. d. Plot plan and map showing the exact location of the well. e. Complete pumping test records, including time, pumping rate, drawdown, chloride content, and other data.

The pe~mitteE'l_Ly.tell op~rator, and/or well owner shall comply with all applicable laws, rules, and ordinances; non-compliance may be grounds for revocation of m1s perm1t.

The well construction permit application is incorporated into this permit by reference and is subject to the Hawaii Well Construction & Pump Installation Standards (January 23, 1997; HWCPIS). If the HWCPIS are not followed and as a consequence water is wasted or contaminated, a lien on the property may result.

The permit may be revoked by the Commission if work is not started within six (6) months after the date of approval or if work is suspended or abandoned for six (6) months, unless otherwise specified. 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 three (3) months prior to the date the permit expires. If the commencement date is not met, the Commission may revoke the permit after giving the permittee, well operator, and/or well owner notice of the proposed action and an opportunity to be heard.

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

Date of Approval: June 28, 2002 June 28, 2004 Expiration Date:

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 driller have signed, dated, and returned the permit to the Commission. I also understand that non-compliance with any permit condition may be grounds for revocation and fines of up to $1000 per ~rom the permit date of approval.

Permittee's Signature: 'I (v"vk ~ Date: l ~ 15' -Oat

Printed Name: K \ ~ \s: S h~ Firm or Title: ---'~=--1\t-~_-.·.,;,.._..,_ __ , _ .. , ___ _

Driller's Signature: ~ (7~ C-57License#~ - 16653 Date: '~[27/i~02 Printed Name: Fred Page Firm orTitleFred Page DrH 1; ng.)IfrJ;ernational

Please sign both copies of this permit, return one to the Chairperson, and retain the other for your records. I D't •

Attachment c: USGS

Department of Health/ Safe Drinking Water, Wastewater, and Clean Water Branches Hawaii Department of Water Supply

rv

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Well No.

Well Name Applicant

3586-03 0 0

0

SECTION 1: WELL LOCATION INFORMATION

Island

Aquifer System

Aquifer Sector

HAWAII

##### #####

data

Date of Review

Reviewer

Proposed Use

Proposed Withdrawal

System Sustainable Yield

7/2/2002 RRI

#VALUE!

0 17

SECTION 2: WELL SECTION DATA (enter data in grey cells only)

Elevation at top of casing

Ground Elevation

Cement Grout

Rock Packing

Hole Diameter

Total Depth

Estimated Head Calculated Aquifer Thickness

County Water Supply (YIN ?)

ft., m.s.l.

ft., m.s.l.

ft. ft. in.

ft.

---ft., m.s.l. 2050 ft.

Solid Casing

Material

Designation Length

Diameter Wall Thickness

Casing

Material

Designation

Length

Diameter

Wall Thickness

Openings

Open Hole

Length

Diameter

SECTION 3: CHECKLIST (values to check are shaded)

Well Depth Theoretical Thickness of Aquifer

1/4 Aquifer Thickness

Depth of Well below Sea Level Well Casing

Minimum Wall Thickness

Material

County or Non-County Minimum Thickness per standards

Wall Thickness Provided Minimum Length of Solid Casing

90% of ground to top of aquifer

Length of solid casing Provided Cssing Material

Annular Space Depth of Grouting

Calculated Depth of Grouting

Depth of Grouting provided Thickness of Annular Space

Steel

2050 ft. 512.5 ft.

10ft.

non-county #N/A in.

0.250 in.

0 ft. ----5-0ft.

ASTMA53

0 ft. -----,-Oft.

3 in. -----

okay (refer to HWCPIS Section 2.2) (disregard if the well is not basal)

#NIA (refer to HWCPIS Section 2.4 c) (disregard this if this is a non-county well)

okay (refer to HWCPIS Section 2.4 d) okay (refer to HWCPIS Section 2.4 e) If the cell above reads #NIA, reference HWCPIS)

okay (refer to HWCPIS Section 2.6 c) okay (refer to HWCPIS Section 2. 6 d)

Page 1

./I .f.

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0

BENJAMIN J. CAYETANO G~IOP ... AII

GILBERT S. COl.OJAA.AGAIVIN -. ··· .. ··

lJJZ ,, !)( 'i I L \ •• hta 1,_ t .-\ O; ·:~r

BRUCI! S.. ANDERSON loti:RE;OITH J, CHI"'G

CI.AY·roNW. O!iL.ACHU.t BRIAN C. NI8HIDA

HEABERT U. RICHARDS, JR.

TO:

FROM:

SUBJECT:

.. ),) STATE OF HAWAII :· i• .. · ·•

DEPARTMENT Of" LAND AND NATURAL Rt:SOURCHS

COMMISSION ON WATER RESOURCE MANAGEMENT P.O.ItO>IIIl1

HONDLUW, HAWAI ll8IIOII

June 17. 2002

Honorable Bruce S. Anderson, Director Department of Health

liNIEL t. Ni8HIOKA DMIIYIIIIIiCIOII

Attention: Dennis Tulang, Wastewater Branch William Wong, Safe Drinking Water Branch Dr. Keith KawaokaW'azardous Evaluation and Emerg~ncy sponse

GilbertS. Colo:~~::::.·~~:;;.e;:rBranch i~•/:') j A Commission on Water Resource Manageme~\....:) , U Well Construction/Pump Installation Pennit Application Shea Well (Well No. 3586~03}

Transmitted for your review and comment is a copy of the captioned Well Construction/Pump Installation permit application. ·

We would appreciate your comments on the captioned application for any conflicts or inconsistencies witli the programs, plans, and objectives specifiC fo ~ur department. Please respond b~ returning this cover memo form ~ June 28. 2002. If we do not receive comments or a reque$ fOr additional revtew bme by thts da~ we will assume that you have no comments.

Please find the attached maps to locate the proposed well. If you have any questions about this permit application_. request additional information.~. or request additional review time, please contact Ryan lmata or the Commission staff at 587-0~55.

Rl:ss Attachment(s)

RESPONSE:

I I

I I

ll

I I

I I

II

l I

'»

Thili wall quanr- as 11 soutce which INIIIaewe n " IIOUrca or ~bla walar to a JK!bllc walar ·~tam (dalinod as sOf'tlng <15 or more people 4111041!11 60" (!Aye ~r year ar hao; 15or mara survietl conllectlons) arid mWII receiVe Director of Health epl)tOYIII J!!!!!!: toils usa Ia comply with Hawaii Aitrnnlatralive Rules (HAR), Tille 11, Ch<Jptor 20, Rules Relating 10 Poteble Welef Systems, §11-20..211.

Tllili wull duos 1101 quail~ as a source eervlng a public water •YJ!Iam , .. ,_ leulhllll 25 ~pia or moro ~pte tl teeet 80 daya per year or 15 service conriiiCtiolie) 111111 if the wei watur~s uaod ror dr'inkinQ, the llti>talo owner ahciulcr lee& tor beotet1daalcalllnd dWrnlCill lltasonco before Initialing euch uea and roulir1aly monitOr lha ~~r.~tat gualltlt lharaaflor. Howovor1 II future plennea UMIIItlm thiS coutt:a lnc;~a•ee to meet tha pUblic willet system deftnlllon then Olrec:tor of I-IHRh eppiOVIIII• requlraa 11!11! to •mplementadon,

If the well It used 10 ~pp=both potable and noti•JlOiable (lllrposes In a slnale ·~· the uaer llhelletlmen.t. crou-c:annectlane and backllow connection• bY k:aa;l separadng pc;neblo end n~le IIYI-me by an air gap or an apptavod baddlow pleverller, and by claarfy labeling 1111 non-po e s ts wllh wamtng tlgna to prevent lnadvarfllnt conaulllpuon or non-potable weler. 81N;kllow preventioli devices ahould be tcutlnely lnsp ad tnd tealed.

It does •lOI:Jppear lhat thla wall will be U58d for consump~vo puiPQSOS and It not sublectiO Safe Drinking Water ReOulatlont,

I' or tho aoplfcaol'll loforrnatlcm. e aource of po&&ible W"d:lilawalet c:ontaminaaon [)II () Is not locatod nHr tha piOJIO'ad well Site (lnrormatron auacnedJ.

An NPDES permit IIi required.

Olher relevant OOH rulee/regul~tlione. information. ar racommendallons are auachod.

NocommoniSiobjectlons We defer to wastowater and drinking water concerns.

Phone: __ s_a_6_-_4_2_4_9 __ _

~~~l-UI m .liUii.d*i'liiUJII,IIIi~-S~ned: ______ +-----~----~~~~~~~------- Date: ';; tk~

I ••. i.lti u•, ,,,,,

10'd 100'0N 17(;:6 c;o.sc; Nnr l£Sl-98S-808:QI HJN~~8 3SNOdS3~ 'AN3

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0 0 ., ..

BENJAMIN J. CAYETANO dOVERNOR Qjf HAWAII

GILBERT S. COLOMA-AGARAN CHAIRPERSON



HERBERT M. RICHARDS. JR.

LINNEL T. NISHIOKA

0 , . .1' . . . STATE OF HAWAII DEPUTY DIRECTOR

i/ '-,- • · · · DEPARTMI;NI .OF LAND AND NATURAL RESOURCES '.' ~.: -:: .CO.MMISSIQN·ON.WATER RESOURCE MANAGEMENT

;) '·' · . • '' P.O. BOX621 HONOLULU, HAWAII 96809

June 17, 2002

TO:

FROM:

SUBJECT:

Dede Mamiya, Administrator Land Division

Linnel T. Nishioka, Deputy Director ~· j rJ/ Commission on Water Resource Managemen , () t\.. \__., Well Construction/Pump Installation Permit A:pplica 1on Shea Well (Well No. 3586-03)

Transmitted for your review and commen(is a copy of the captioned Well Construction/Pump Installation permit application.

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 28, 2002. If we do not receive comments or a request for additional review time by this date, we will assume you have no comments.

Please find the attached maps to locate the proposed well. If you have any questions about this permit application, request additional information, or request additional review time, please contact Ryan lmata of the Commission staff at 587-0255.

Rl:ss Attachment(s)

RESPONSE:

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

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

[ 1

[ 1

[ 1

A water lease/permit has been obtained by the applicant through lease no. ------~...,.....-

This well project [ 1 requires :fdcdoes not require a COUP. If a COUP is required it [ fKas [ 1 has not been approved and [ 1 is [ 1 is not currently active. §j

- ·* .. -._. Other relevant Land Division rules/regulations, information, or recommendations are attached. ,...,

co No objections

"T1 ,,

[ 1

kk ::t:>

Othercomments:original source of private title is L c·:Awafi:$ Np. ~8559:B issued between 1845 and 1855. _J

Contact Person: ___ G_a_r--=.y_M_a_r_t_i_n _______ _

~ -r __ -;· Signed:_.:;:;;~~L-..:=---=-+----"~~.r--=-==-=:._:_:::Jo..--------

Phone: 587-0421

Date: JUN 2 6 2002

c:.J1 CJ1

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. . 0 0 BENJAMIN J. CAYETANO

GOVERNOR OF HAWAII GILBERTS. COLOMA-AGARAN

CHAIRPERSON




STATE OF HAWAII LINNEL T. NISHIOKA

DEPUTY DIRECTOR

TO:

FROM:

SUBJECT:

DEPARTMENT OF LAND AND NATURAL RESOURCES COMMISSION ON WATER RESOURCE MANAGEMENT

P.O. BOX621 HONOLULU, HAWAII 96809

June 17, 2002

Honorable Bruce S. Anderson, Director Department of Health Attention: ~ T~. Wastewater Branch

William Wong, Safe Drinking Water Branch Dr. Keith Kawaoka, Hazardous Evaluation and Emergency

GilbertS. Colo:~~::~:n~· ~~:~~=s:~r Branch i A·/:) j Commission on Water Resource Manageme~\..) ,

Well Construction/Pump Installation Permit Application Shea Well (Well No. 3586-03)

Transmitted for your review and comment is a copy of the captioned Well Construction/Pump Installation permit application.

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 memo form by June 28. 2002. If we do not receive comments or a reques for add1fronal rev1ew trme by th1s date, we w1ll assume that you have no comments.

Please find the attached maps to locate the proposed welL If you have any questions about this permit application, request additional information, or request additional review time, please contact Ryan lmata of the Commission staff at 587-0255.

Rl:ss Attachment( s)

RESPONSE: [I

[ 1

I I

I I

This well (lualifies 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 l-ieallh approval 0g8r to liS use to comply with Hawaii AClministrative Rules (HAR), Title 11, Chapter 20. Rules Relating to Potable Water Systems. §11-2 - .

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 1s used for drinking, the J?rivate owner should test for bacteriological and chem1cal presence before initiating such use and routinely monitor the water guahty thereafter. However, if future planned use from this source 1ncreases to meet the public water system defimtion then Director of Hearth 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 pllysically separating potable and non-potable syslems by an air 9ap 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 r Ys [)Is not located near th~pro~ed well ~-~;;."t (information attached). Yr · . · :

I I c._

An NPDES permit is required. ~ .:J

~ )(

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

No comments/objections

Contact Person: {._Q /11 ~ f':aJ 'j'w ai(A_; Phone:

signe~==-----17_-~--+-+-~-_. _· __ Date:

~?Cf4

~,:J.f>-5fbr];< = '' -. ·; l

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,Ju~-25-Q2 C3:39am From-S OF H ~Eo HEALTH Hll.O t180E93304CO

0 T-G14 P.O' r:-053 • •

liNJt.llll J. CAVITAIIIO ClOt- COl ... WI'II

11\UCI I. »11:111'11011, Ill\, , 1.1.1'.104, ~10( ~TO~ Dr 101'1~

Subject:

STATE OF HAWAII CEPAATMENT OF HEALTH

MONO!.I.Il.U, HA~ IIUOI

FICiimlle Request and Co\rll' Sheet Wastewater Branch

919 AJa MOJM SJvd. R.aam 309 Honoluluf Hawaii 95814·4920

(SOB) 586..4J2~ Fex (808) 586-4300

rT~lr_l& z.4. Total Pages ~- Q_

Laverne Hayamoto Hawaii District Health Offlc:e {Hllo)

Lcrl l<ajlwara, Plannlng/Ce.slgn Section Emell: [email protected]

Request for lnfarrnatlon

Ph (808) 933·0401 Fax (808) 933-0400

Do you have any IWS files or records on gr neertw the following:

C3)_l-~- ~: ·35 Ont ~ti haw po.vadi·~~ pari(..~

Please check all that appiYJ [ J sewered [ J no record [ J cesspool [)(] septic tan!( [ J aerobic unit

File# If applicable: ___ _ #of Bedrooms __ _

Record Date:

SUbmit Pate;

Plan Approval Date:

Inspection Date:

System "Approval for Use" Date:

aher: ______________________________________________________ _

Please fax site/plot plan If available. Thank you.

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,-----,, ~----~r·J2:2.6-r __ ~ j--------~-----==i - -· ---- -- J~- ---[_- ~ -~---- ~"":_':_~y---, ~

- :200' ..,. I ~ --- --- ---- ----- -- -- ------ --- --~--- - I -~

IJ I I I I

J I ~-----c.__ /

~: -- -iT,/ r m1 I I -~·-~ I s.e. 1

I I I I

--PROPO'".£D , , I I ..-tATER JI'IELL t' JC t~ A-~;>noN UD

1

PROPOSED--REStDEHC..E

~tiU/-7*11-1~- 100~----~--- ~-

F'FWPOSED SEPTICJ TANK

1

''-----' I I ~I I -,

1ft .c I S.8. I I

t Jl L_ __ () 0 ...,..___ 30' ---i til ---- ~~ACK92-26: -- --~ - ! -- --- - - -- - - - - _j I i

-- --c.=__------- --:Y-------- -.fC--~-l!f'-:.~ ;,;;/-_j

NOTES:

l. Maintain W'/ft. slope on all sewer lines.

2 No planting of trees 4" in diameter or larger within 10' of IWS.

3. All downspouts from house gutter system shall be directed away from JWS.

PROPER.lf LINE

SITE PLAN sc,, I":: 3o'

Owner: Richard Shea

Lot Size: 1.00 acre

T.M.K.: (3) 1-5-56:35

-. r..:...

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N U1

I "-' "'

n ... 0

"' I ""

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. I I

' L I

808-586-4370

0 T-494 P.Ol/02 F-397

I·· I I • 'ReRlfE'D~II!HHiiii•Mf* 11 "'~~~;.,,,.lltl ... "m r1• . • .

I . SAFE DRINKING ~ATER f§IWO~~N .

I .... ~ •. ,~ ; Jl PR...i:~ B, 1\I'IQI!I'SON ' . . · .. I

""l.lJ. L ,.,, '.lrlnf!l MliRI"'lffH J,'CHJNG . JJ.NC. C!.A"(TCN W pr::J,.,\(!fi!Jl

.llfCWl c: Nl81111l' 111'-f'(T' M· fi!C:IWU)II, Jjl, I

, June 17, 2oo2: . · i . I . I I I .

t.INN!il. T. l'illltiiOI<A IJFI'III'f..--

:: j . I ·

TO:· Honorable BJ'Lice ~. Aljlde,.aon, Director · · i ~ . · · .· 1 • Department of Healtfl : ; 1 • • ·

ll .. A~ ~e~~==~~~~..,d~~.;~-~~----~pel~~~··----------------

. AI~~ Won!J, CJean·vvater. e·ram~h I : . ' .

FRO : . .. · Gilberts. ColomaJAQ~ran, Chalf'P.s.rson · : ,, .... fJ.i:£:) j·; XJ1 • · .. j . :! Commission on Wrtft~ Resource Managemerg~0 . . , : U f\.: .

SUBJI=CT:: Well construction/f?~mP Installation Pennlt Application: : I :i Shea Wall (.Well No: 358fJ..03) : : . . •

,~ Trf;lnsmltted for your ravt~-;:tJd pomment Is a co~y of the Ja~loned W~IJ Constructlon/Purl,p Jnsta latlop permit application. 1 . 1 · · : ~ ! · . ; ·

WfJ would appreciate your. pP.fhments on #1" captiom3r:J aP.dilcal;on for any oonflicts or · inco slatencies wltli lh& rogram~l PI na, and objeptives $pectfjc tO Y.OUr department •. Please 'I ra o r t s CO\Iat. m o fo · Ju a 28.200 ·llfwe dO notlrecente comments or a Iqu's or a 1ona rev ew 1 y· lEi a • we WI . &!ifiumel th~.YOLi hav~ np comme~ts. ·

. P~' ase find the attached ~a'!l to· locate the propormd wen., lf,l'ou have Jny ques~ons aPt>ut this errn applicatio.!J, re~uest addiUj naf informationJ. or rpquast a~dtqonal· reVIew time, plea~e pon~ct R an lmata or the CommlpS staff at 587-0"55. . ; · . I

RI;$J .i ! I ' I • : •

AttaChment(&) 1 I I .

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- ~un-Z&-OZ OZ:39pm Fro11-HI DEPT OFrLTH

'"""' . ,,

808-58&-4370 ~ ~

T-494 P.OZ/OZ F-397

· sk35s6:.o3 lliiwaif .... .. ··· ·~· · ~ ....... ·- ...

The:jDepJtrllneJJt of HeaJib, S~~ Drlnldng Water Branch haS tb~ following mfditjonaJ cotdpJen~fi for tbe WeU Con~tru~UQn/ Pump ll!Bt~ll~tion PeJimit Applic~tion for tbe Sllea WeJ:I (WeJJ No. 8~3586~03 ~flwnii): : _ _

J • The SlUe Drinldng W ttt~ Bnmcb has concerns re~urain~ the pot~ntia! of con.taminq.tion to thls weU ~ue UJ- Jhe following reasons:• ;

.; The sballo~ne~s qfthe weJl (60'):: _ ! ·

• The propo~e(J welJ section fails to indicate any ceim:nt ~ou~ in the annlllar sptf':; lan4 • · i

• The surrou~uUqg area js un~Jcwer~d and seryJced by ce~~pools that : discharge #Ho ~e groLJndwaten beneath tl1e sijbdivision; J;~pstream of the

I. ' propo~ed ,eJJ.: _ . < ___________ _ 1 Please be advised ~t Jtie DepfU"tment of Health has ~P,eriel)ced cJrjllking water

and groundW4tet co~im•tion by submerf.liple pumps~;:ontpining:marc~ll'Y· SpeciticuJJy, the failure pfJ:be aeats of the PLJmps allow~4 mercury ~D leak out ,into the well shaft resulung iP conmmin~t:ion of the weU andlthe waJer~~ervell by lhe well. If you intend~ inslall a s·ulmletr;jbte pLJmp, plCiijle review ypur pLJmp specifications lO tJ~ surelthat the f:IUbmcrsibJc pump(s) y~u propo~e to use do~ not

' co!l~ matertala wh~c? ~~uJd result jn either grounclwR~or conUI~nation or dnnl<rng water conta,-mrlfltlon. :

. i

6/26/02

.. ------· -r--------- ···- ---

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. -., · • lun-2.(-2002 04: 30pll Fr011-DEPT OF HEf'~ ' ENVI RONt.ENTAL t.IGt.IT 8085864352 T-585 P.OOZ/002 F-584

... ..:

TO:

FROM:

..... ,

JUN 2 A

STATE OF HAWAII DEPARTMt:NT OF LAND AND NATURAL. RESOURCES

COMMISSION ON WATER RESOURCE MANAGEMENT P,O.IIOII &:!1

HONOLUW. HAWAII 11111108

June 17, 2002

Honorable Bruce S. Anderson, Director Depanment of Health

l::::Af._

Attention: Dennis Tulang, Wastewater Branch WUiiam W~. Safe Drinking Water Branch Dr. Keith Kawaoka1_1;iazardous Evaluation and Emergen~sponse Alec Wong, Clean vvater Branch

GilbertS. Coloma:Agaran, Chai~rson ··~·f_·A) j A11 commission on Water Resource Manageme~\...J • U I~

SUBJECT: Well Construction/Purn~ Installation Permit Application Shea Well (Well No. 3586-03)


RESPONSE: l I

[ ]

( J

[I

( l

II

~

This wall gualilie6 II& 1111 II(IUflle which wll Hnl8 ali a &Dun:& af IIOCallle water 10 a public ~~~raw SIISfCnl (dafinad a& &II!Villg z=i or mora people atleaet 60 CII'Y.I ~ ylfllr or hll 16 or mont II8Ntca c;onnoc:Uotis) and mu&t fllllllive t:lir'lc;uW «Health aJIP..IO'II!II!!'!M to 111 IHIIIID comPit with Hawaii A'lmt11illmlt1Ve Rules CHAR), Tille 11. Chapler 20, RUleS Relating to Pots~ W118r Systems. § 1 1 -2o:21r.'

Thi& wall doee n~ ~Kfy ao a source serving • JIUblic weter 1~ (IBn/liS Ia&& 1111111 ~DOODle or mora PB!IPB at hNII1110 day& par YVIIIr or 16 setlriCa cannactiona) and if 1fle well Wllhlr rs used for dririllirlg, llie private owner shciuld' teat for 118Cteri1110Qieal ...., ct1eml08l PtWIII'ICII before initiating !!uch UliB anQ ~ manftol' lhe Will8r gUIIIfty lllet8lftet, ~ if future planned Ule from thi& 101.WC8 lnc:nlaHiilo meat the pllblic: waters~ dafinilicm then Direc:tor ofHeaftte ~~~is '"""""""Ill!!!!: to tmp.,menlllllan.

If ltl• ~ i!io ueedto iUPPIY= ancl non-polabla PUIPCIIIIS In a Single synwn. lhe user shill eliminall cross-connec:flons and bac:ldlow connections titj Ph · ly ~ ~ anel fton-JXIII!ble ~s by an air gap ar afl a~ed llecki!Ow JBINWilW, 1ne1 by c101r1~ l1bellng a1 no~ le S$)18015 wilh Wllmil'lll •illn• to pnwenl iniiiMinant eoiiiLimpiiOtl of non-potable weter. BaCktlaw ~on davillllli shaula ba rou~ llllpec:led and leslad.

11 doe& nDIIIppeltlnlt 1n1t well Will be used for aon&Umptive purposes and Ui not &UbjaciiO Safe Drinking V\la111r RagulatiQns.

f.~IPOiicanrs infOrmalian. a saun:a of pllillllble ow~SI81Niter contaminallcn [ )Is [ J Is nvt located naar tha propoiiOCI well Site (I tldn ll\IChOCI).

An NPDES pemlk Is n~qulted.

Other raleVIInt DOH l\lleslreg~~lallons. lnrormation. or 1111Xl111m11'1Cai!Ons are attachad.

NO COMI'II6n1&1abjacli11111i

Phone:

Date:

~b-l.f--5o1

(,; L~li-( OJ, 1

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·. .. Juri-24-2002 04:29pm From-DEPT OF HE~~ ENVIRONMENTAL MNGMT

'··"" 8085864352

The Department of Health, Clean Wate~ Branch has the following comments:

1. Fer Well-Drilling Activities

T-585 P.OOl/002 F-584

Any discharge to State waters of treated process wastewater effluent associated with well drilling activities is regulated by Hawaii Administrative Rules, Title 11, Chapter 55, Appendix I, effective Septel'!lber 22, 1997. Treated process wastewater effluent covered by this general permit includes well drilling slurries, lubricating fluids wastewaters, and well purge wastewaters. This generaJ.permit does net cover well pump testing. The applicable Notice of Intent Forms and filing fee shall be submitted at least thirty (30) days before the start of

·discharge to the· Department of Health, Clean Water Branch at 919 Ala Moana Boulevard, Room 301, Honolulu, Hawaii 96814--4920 or P.O. Box 3378, Honolulu, Hawaii 96801-3378. Inquiries may be directed to the Clean Water Branch at (808) 586-4309 or by fax at (BOB) 586-4352.

2. For Well Pump Testing

The discharger shall take all measures necessary to prevent the discharge of pollutants from entering State waters. Such measures shall include, if necessary, containment of the initial discharge until the disCharge is essentialiy free of pollutants. If the 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. If the discharge is entering a storm drain, the discharger must obtain written permission from the owner of that storm drain prior to discharge. Furthermore, best management practices shall be implemented to prevent the discharge from collecting sediments and other pollutants prior to entering the stor~ drain.

JS/cr

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BENJAMIN J. CAYETANO GOVERNOR Of HAWAII


Dear Mr. Shea:

c 0




June 17, 2002

GILBERT S. COLOMA-AGARAN CHAIRPERSON




LINNEL T. NISHIOKA DEPUTY DIRECTOR

3586-03.ack.doc

Well Construction/Pump Installation Permit Application for Well No. 3586-03

We acknowledge receipt, on May 10, 2002, of your completed Well Construction/Pump Installation permit application and filing fee for the Shea Well (Well No. 3586-03). You can expect your application to be processed within ninety (90) days from this date.

For your information, the process of constructing a well is normally regulated and permitted in two (2) steps. First, a well construction permit is issued for drilling and testing purposes only. Based upon information provided by you through a Well Completion Report Part 1 (Well Construction), a pump installation permit (upon completed application) may then be issued to authorize pump work. If a pump is installed then a Well Completion Report Part 2 (Pump Installation) is required.

If you have any questions about your permit application, please contact Ryan lmata of the Commission staff at 587-0255 or toll-free at 974-4000 (Hawaii), 274-3141 (Kauai), 984-2400 (Maui), or 1-800-468-4644 (Lanai & Molokai) extension 70255.

Rl:ss

Sincerely, /']

~~ ir::J 1 1')(_1

. /

C_fY'\ ~· l )

LINNEL T. NISHIOKA ---Deputy Director

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0 0 BENJAMIN J. CAYETANO

GOVERNOR OF HAWAII GILBERT S. COLOMA-AGARAN

CHAIRPERSON

TO:

FROM:

SUBJECT:


COMMISSION ON WATER RESOURCE MANAGEMENT P.O.BOX621


June 17, 2002

Honorable Bruce S. Anderson, Director Department of Health Attention: Dennis Tulang, Wastewater Branch

William Wong, Safe Drinking Water Branch Dr. Keith Kawaoka, Hazardous Evaluation and Emergency

GilbertS. Colo:~~::~an:.·~~:~~=sa~~r Branch i :/0 ~ Commission on Water Resource Manageme~\) J, Well Construction/Pump Installation Permit Application Shea Well (Well No. 3586-03)






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 memo form lly June 28. 2002. If we do not receive comments or a reques for add1f1onal rev1ew hme by th1s date, we w1il assume that you have no comments.



RESPONSE:

I I

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This well gualifies as a source which will serve as a source of potable water to a public water s~tem (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 apl)roval R!!.Qr to 1ts use to comply with Hawaii Administrative Rules (HAR), Title 11, Chapter 20, Rules Relating to Potable Water Systems, §11-2~

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 wafer is used for drinking, the private owner should test for bacteriological and chem1cal presence before initiating such use and routinely monitor the water guahtv thereafter. Howevelj if future planned use from this source 1ncreases to meet the puolic water system defimtion then Director of Heafth approval is requireo 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-polaole spigots with warning signs to prevent inadvertent consumpllon 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 []is [] 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.

No comments/objections

Contact Person: _________________ _ Phone: -------------

Signed: ___________________ _ Date: _______ _

.~--------------------------------------------------------------........................................ ~.--

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c 0 BENJAMIN J. CAYETANO

GOVERNOR OF HAWAII GILBERT S. COLOMA·AGARAN

TO:

FROM:

SUBJECT:




June 17, 2002

Dede Mamiya, Administrator Land Division

Linnel T. Nishioka, Deputy Director ~l? • A Commission on Water Resource Management J

r ' Well Construction/Pump Installation Permit ~pplica 1on Shea Well (Well No. 3586-03)


CI-WRPERSON





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 28, 2002. If we do not receive comments or a request for additional review time by this date, we will assume you have no comments.



RESPONSE:

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

[ ) A water lease/permit is not required of this applicant.

[ ) A water lease/permit has been obtained by the applicant through lease no. ----------

[ ) This well project [ ] requires [ ] does not require a COUP. If a COUP is required it [ ) has [ ] has not been approved and [ ] is [ ] is not currently active.

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

[ ) No objections

[ ) Other comments:

Contact Person: ________________ _ Phone: -------

Signed: __________________ _ Date: _______ _

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0 0 BENJAMIN J. CAYETANO GILBERT S. COLOMA-AGARAN

GOVERNOR OF HAWAII

TO:




June 17, 2002

Don Hibbard, Administrator Historic Preservation

CHAIRPERSON




LINNEL T. NISHIOKA DEPUTY DtRECTOR

FROM: Linnel T. Nishioka, Deputy Director -fJ • rl 1 Ol~ Commission on Water Resource Management _,

1-IA.

1., g~·Vf.V )

/.i\ 1 ·....__.} (...1 \

Well Construction/Pump Installation Permit ApPffcation' '"" SUBJECT: Shea Well (Well No. 3586-03)


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 28. 2002. If we do not receive comments or a request for additional review time by this date, we will assume you have no comments.



RESPONSE:

[ ) There may be areas in the vicinity of the well site that contain subsurface cultural remains such as artifacts, burials or concentrations of shells or charcoal.

[ ) Other relevant Historic Preservation rules/regulations, information, or recommendations are attached.

[ ) No objections

[ ) Other comments:

Contact Person: ________________ _ Phone: ______ _

Signed: __________________ _ Date: _______ _

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OOCLX-1ENT flO. ~c OR ATTACHED WORKSHEET . DATE: JU N ·I a ?nro SRC/ CO~T -

F YR /JPP DOBJ CTR PROJECl PH ACT N-'Ol.NT NAME/DESCRIPTION ·cwMG INPUT)

s 02 326 c 1026 0752 (1) 25.00 Richard P. Shea & Minerva M. Covarrubi. - -- --- - ---- ---- ----- -- --- ----------------· --- - ---- ---- ------ -- --- (2) -------------------· - ----- - ---- ---- ------ -- --- (3)

----------~--------· - --(4) - -- --- - ---- ---- ------ -- --- -------------------·

TOTAl- 25.po

RE1-4ARKS: LINE (1) Well No. 3586-03 (WCPA)

LINE (2)

LINE (3)

LINE (4)

.....

·•. (

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aMISSION ON WATER RESOURCE MANAGEMEROUTE SLIP FOR NEW APPLICATIONS

FROM: RYAN

BAUER, G. CHING, F. FUJII, N.

DATE: 14-May-02

M,A. KAMA, L. KANO, D.

SUSPENSE DATE:

3 Approval -3-Signature -4-lnformation

-1-HARDY,R. ~ HIGA, D. HIRANO, E.

SHIOKA, L. 4 OHYE, M.

SAKODA, E. Vb:7- b-~-ov

• ICE, C. 2 SUBIA, S. -5-IMATA, R.

JINNAI, R. KUNIMURA, 1:-----

WELL NUMBER ) S"B" _ ())

0 WELL CONSTRUCTION

SWANSON, S. UYENO, D. YODA, K.

WELL NAME Shea

0 PUMP INSTALLATION

ATTACHMENTS FOR APPLICATION ,PROCESSING- Both applicant & staff generated 1 TRANS. LETTER ~ 2 CWRMMAP V 3 APPL. FORM (3X) ---;r--4 USGS MAPS (3X) ~/ 5 TAX MAPS (3X) ~

6 PARCEL OWNERVERIF. ./, MLS PRINTOUT 7 CONTRACTOR VERIF. ~DCCA LICENSE SCREEN PRINTOUT 8 ALL INFO FILLED IN 9 BACKGOUND CHECK

F 1'-- I ..v'"'"' ~'"'G" ~ FOLDER: ,...L: -

(J MADE NEW FILE FOLDER, ATTACHED 0 FILE FOLDER ALREADY MADE, IN FILE CABINET

INCOMPLETE ACTION DATES:

DATE ACTION

PLEASE:

See Me 1 Review & Comment

--Take Action 5 Type Draft acknow letter 2 Type Final, label new file folder

-5-File --Xerox copies

¢seTH

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Search Results Pagel of 1

'f action menu

Taxkey Subdiv/Condo 3-1-5-56-35 Hawaiian Paradise

Park

Copyright ©6/7/2002 by Hawaii Information Service

• PUBLIC RECORD DATA Property

TnrAddress F

Land Owner/Lessee BedsBaths area SHEA, RICHARD P & MINERVA 1.00 ac MC

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

Living area

http:/ /webre2.hawaiiinformation.com!REsearch/ Asp/Functions/Property /Search. asp 6/7/2002

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Well Background Check

Approved Well No. Well Name Applicant

Shea Rick Shea

2485-02 Rupa Barbara McKenzie

3/8/2002 3586-02 NuiWaiwai Utae Suzuki

Tuesday, May U, 2002

Driller Type

C-16653 BOTH

C-16653 BOTH

C-16653 BOTH

Well Construction Issued Signed WCR1 Accept

3/18/2002

Pump Installation Issued Signed WCR2 Accept

---

Pagel ofl

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--- State QMiawaii .corOffic:iaiUse~: COMMIS- ON WATER RESOURCE MANAGEMENT¥ Department of Land and Natural Resources APPLICATION FOR PERMIT )? Wei Construction and/or >b Pump Installation

lnatrucllons: Please print in ink or type and send completed application with atlaChnents to the CommiAion on Water Rescuce Managemant, P.O. Box 621, Honolllu, Hawai 96809. Application must be IICCXlfJlpWiied by 5 copies and a non-fefundable filing fae of $25.00 payable to the Dept. of Land and N8lunll Raeourl:es. The Commission may not accept incomplete applications. For assistance, cal the Regulation Blanch at 517~. For flrlher information and updates to INs application foml. visit http:/,_.state.hllltllllnrtcwnn. , ._ ·

APPUCANT INFORMATION: (FII out all three. if appicable, and pe.. a chec* ll8lll to the primary conlac:t._) __ -..+.j.;,.L-+,o.,;..-...;.,.,..v,.....-~ A 10 1.(a) o WEU.OWNER:Rick Shea ContactP&ISOII: Rick Shea

MailingAddress:240 El Portal Encinitas CA Phone(760)436-1286 92024 i t~1··: r.· • ,, ·• ~

Fax: E-mait:z:;ick&h&[email protected].~a 'US (b) 0 LAND OWNER: \3 \L..k s h<M. Contact Person: p~ f· '{ X Phone: C\1-k ~ -y.' I I

Mailing Address: J.'fD ~ ... j"h S"L Por--tt.M ENo ~ itQA. (A q -O~If Fax: 16S ~ '5'')\- L..<>Y.it> E-mail: .,. \<..\s,~;.M.o., €> ~bU> £. k ( ~ .. (" Be. IJ >

(c) o CONTRACTORF'red Page Drilli~tact"-: Fred Page Phone: ( 808) 965-5339 MaYingAddress: PO Box 1434 Pahoa HI 96778 Fax: (808) 965-5339 E~=---------------- Ucl: c 16653

(cin:le one: C-57, C-57a, or A)

WELL & PUMP INFORMATION: (Please fill In the ciagram on the bad! of 111111 form.)

2. WEU NAME: Island:

Address 01'11~~ \.l,~~ f.\)ttl~.V.... Pk TaxMapKey: -'-- ___£_- 5" : ?J?" Zone Sec Plat -""PIII'::;,cei,;,..,...-Aitach: (a) portion of a 7.5-Min.-e Series USGS topoglaphic map (acale 1:24,000) with_. location labalad and Include the nane of the quad map

(b) a property tax map, showing well location rafarenced to ll8labllhad property boundaries

3. PROPOSED WORK: )(Construct New Wall .,t Install New Pump'

(check 811 that apply) 0 Modify Existing Wei' 0 Modify Pump'

0 Abandon/Seal'

'State Wei No.: -------- (I unknown, pie.& call Commission at 587.0225)

4. CONSTRUCTION: Oi( Driled 0 Dug 0 Shaft 0 Tunnel

Is this well part ofa battery ofweUs? DYes "i!No (Please describe)

5. PROPOSED PUMPING RATE: 1 5gp& gallons per minute

6. PROPOSED USE: 0 Municipal (including hotels, stcxes, etc.) 0 Industrial (check 811 that apply) )l;t

1 7' Domestic (indivldua~ nonc:ommen:ial water system)

Doss this well serve 25 or more people at ie81180 days per year or have 15 or m0111 aeMc:a connections? D Vas~ No

0 lnigaUon (crop) o' No. rl Aaetr. _ _,_] _____ _

0 Miitary 0 Other (llllplain):

7. (a) PROPOSED AMOUNT OF WITHDRAWAL: 3 0.01) gallons per day

(b) METHOD OF FLOW MEASUREMENT: • Rowmeter 0 Open11ipe 0 Weir 0 Orillce 0 Othar(tll(JIIlm)

OTHER IMPORTANT INFORMATION:

8. LEGAL REQUIREMENTS: ff t&quired. these {HifrTIQ !!!!!B be obl1linad before the Cotnmis8ion cen 1ege1y issue a pemrit.

Cona.vetlon Dlatrtct UM Permit (CDUP) To lind out If a COUP Is neceaaary, cal DLNR Land Divilllon at 587.Q414

.!It Not Required If--· dam appr<MOd --------

Eminll_,l8llmpllc:t--(EIS)orEnvfroo_n.., ~u•nment~ TodalamlineifanEISarEAis--.y,caiOEQCat586-4185

~Not Required If required, date pubtiahed in OEQC IUietln -----

Special Management Area Pennit (SMAP) To determine If an SMAP is ,_sary: on Oahu, cal 527-5374; on Hawaii, cal 961-8288; for Maui county, cal 270-7235; on Kauai, caH 241-6677.

tK Not Required If required, date approved ------

9. REMARKS, EXPLANATIONS:

(If mora space is needed. f)!ease attach additional sheet)

NOTE: Signing below indicatas the signatories undemand and swaer that the lnfomlatlon pn:Mded on 111111 application Is accurate and true to the beet of their knowledge. Flll1her, the signatories under!ltand that approval r1111111 appllcalon atlllc:Ms the fallowing ll8ndanl conditions: 1) the pltiiiOIIIId wor1< is to be completad within two (2) years of the approval date; 2) the contractor ahallllbmit to the Canmiaaion a _. camplelionlabendonmant report within eo days after the completion data of the pennitted work; 3) monthly water uae data shall be submit! ad to the Commission; 4) such approval shall not constilute a delamlination of correlative water rights and shall not g-.- the pump capecily or Munt use up to the pennitted pump capecity; 5) in the evant that the application is not completed correctly, any pennlt may be suspended until the kern is brought in to compliance. and any wor1< done whie ~is in suspension may result in fines of up to $10001day.

weu Owner l-<1.<.,\s. <Ob~ LandownerRick Shea (print legibly) 0 . \ • (print legibly)

Signature '\'W--fL ~ Signature

Date .3 ' ' ~ (():a.. Date Date

For official use only Latitude ------ Aquifer System No. Longitude State Well No.

/

) .

·~--------------------------------------------------------------------------·~

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0 10. PROPOSED WELL SECTION (Please attach sclrema1k if dlffelent from diagrwn ptOIIided below)

Hole Diameter. _lLin.

Elevation at top of casing _51_ ft., msl* ~imum of 'r Radius & 4* Thick Concrete Pad (to contain benclmarl< surwyed to 11118R1St 0.01 ft.) S O

. Gromd Elevation: ___ ft., msr

Br'-..--D.,..-,~ Please l1lfer to the

Cement Grout ft. (min. 70% of distance from ground elevation to top of water surface or 500 ft., whichever is less.)

HAWAII WELL CONSJRUC!!ON AND PUMP INSTALLATION STANDARDS to ensu"e that your as-built is in compliance

with applicable standards.

Annular space between hole and casing (min.3*):

__ 3_in.

Sold caaing: (~ 90% x (Ground Elev.-Water LtMJI Elev))

Total Length: s a 11.

Nominal oana.: -~6:-;;--.... -------'in.

Wall ThickMss: --·-=2=-S::::....:::O ____ ...;in. Bollom Elevation: ______ _ fl,msr

Rock or Gra .... Packing:

14 ft. Open Casing: XJ Perforated c Screen Maleliat D Crushed Basal

D Rounded Gra ....

Total Length:

Nominal DBna.:

Wall ThickMss:

Bollom Elevation:

10 ft.

6 in.

6aao in.

tt.,msr

E~~: ~flmsl*

note: Neither b8nlonile 1101" mud should be used in

"""""""' """"durinnd,.,linn

\ ,' Open Hole: Length: ___ N..:.../_A ____ tt. Diameter. ------------'in . . Bollom Elevation: ft., msr

* The approximate elevation must be referenced to mea~ sea ~ (msl) at the time of application fiing. Final elevations of well components shal be submitted in the Well CompletioruWell Abandonment repol1s and rvferenced to a benchmark which has bean estabished by a surveyor licensed by the Stata.

For non-salt water Basal Wels -bottom elevation of well should not be deepa" than 1/4 of aqufer thickness or,

Bottom Elevation otWell Limit= (water Elevation. 41 xWl!!!!r~ EJayaljan) ~: Estimated+ 2ft. W-LIMII Elev. - BoltDm Elevation of Well Umi • ( 2 • ~~ = ·18.5 ft.

Solid Casing Material: Carbon SIMI: oompliall with (check one« mcre): o ANSVAWWA C200 o API Spec. 5I.. ~ ASTM A53 a ASTM A139

And compliant with (check one or mere): c ASTM A242 c Type E c TypeS c Grade B o Other

Stainl- S_.: (c-one): o ASTM A409 (production wells) a ASTM A312 (monitor-)

ABS Plastic conforming toASTM F480 and ASTM 01527: (check one) o Schedule 40 o Schedule 80

PVC Plastic conforming to ASTM F480 and (ASTM 01785 or ASTM 02241 ): (check one): o Schedule 40 o Schedule 80 o Schedule 12.0

Thermoset Plastic: (checll one) o Filament Wound Resin Pipe confonning to ASTM 02996

o CenbifugaUy cast Resin Pipe confonning to ASTM 02997

o Reinforced Plastic Mortar Pressure Pipe confonning to ASTM 03517

o Glass Filer Reinforoed Resin Pressunt Pipe IXII1fonning to AWWA C950

o PTFE Fluorocarbon Tlbing oonforming to ASTM 03296

o FEP Fluorocarbon Tubing confonning to ASTM 03296

Open Casing Material: CarbonS_.: compliant with (check one« mcre): o ANSl/AWWA C200 o API Spec. 5L ~ ASTM A53 o ASTM A139

And compliant with (check one« mae): o ASTM A242 o Type E a TypeS o Grade B o Other

Stalnl- Sleel: (~one): o ASTM MOO (production wells) o ASTM A312 (monitor wells)

M81'1atic conforming to ASTM F480 and ASTM 01527: (check one) c Schedule 40 o Schedule 80

PVC Pl..tlc: conforming to ASTM F480 and (ASTM 01785 or ASTM 02241): (check one): o Schedule 40 o Schedule 80 o Schedule 120

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

o Ganlrifugaly Cast Resin Pipe conforming to ASTM 02997

o Reinforced Plastic Mortar Pressure Pipe confonning to ASTM 03517

o Glass Fiber Reinforced Resin Pressure Pipe amforming to AWWA C950

o PTFE Auorocarbon Tubing amforming to ASTM 03296

o FEP Fluorocarbon Tubing conforming to ASTM 03296

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