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PUBLIC RECORD DATA .. TMK # 4-5-1-5-14

Owner: HAWTHORNE, JOHN P LIV TR 4360-D WAlLAPA RD

of8

Tax Payer: HAWTHORNE, JOHN P Tenure: Fee Simple Tax Bill: PO BOX 969, KILAUEA, HI 96754 USA Annual Tax(2010): $15,384.48

Zoning: A Assessed Value (2010) Exemption Size Buildings: 4

Dwellings: 4

Subdivision: Kilauea Farms

Land: $1,906,500

Total Buildings: $1,522,200

Total: $3,428,700

$0 24.47 ac

$391,000 9,663 sq ft

$391,000 Project: Bedrooms/Baths: 1/1

SALES

PITT Code: 5-AGRICULTURAL(AII Island)

Land Use:

Census Tract: 401.00 Lot#: L-12-A

9/12/1985 AAS-F

10/30/1985 AAS

$23,000

$130,000 B/P 19043/40 CARPENTER MARK C ETAL

12/30/1988 DEED $182,500 B/P 22727/702 WINNINGHAM BENJAMIN L

12/22/1989 AS $250,000 B/P 24039/349 HYUN TAHN/MARGARET

10/30/1995 TRANSD-F $0 DOC 95-140994 UNO 14.32% UNT; LOT 12A = 24.470 AC WINNINGHAM, BENJAMIN, LEE, Trustee(Tenants in Severalty) *TRUSTEE BENJAMIN LEE WINNINGHAM LIVING TRUST(Tenants in Severalty)

8/7/1996 TRANSD-F $0 DOC 96-113601 UNO 21.42% INT; POR RP 8323,LCA 8559-B:38 = 24.70 AC MAYNARD ,LARRY *AN UNMARRIED MAN

8/7/1996 RELAS-F UND 21.42% INT; POR RP 8323,LCA 8559-B:38 = 24.70 AC HUYN,TAHN(Joint Tenancy) HYUN,MARGARET(Joint Tenancy) *(SATISFIED A/S: 24039/349)*

12/31/1996 QD-F LOT L-12-A = 24.47 AC; UNO 21.42% INT

$0 DOC 96-113602

$350,000 DOC 96-184928

KREUTZMANN,WILLIAM, Single Person or Individual

12/30/1998 QD-F $1,000 DOC 98-195866 UNDIVIDED 21.4200000% INTEREST HAWTHORNE, AARON, Single Man(Tenants in Common) HAWTHORNE, HARMONIE, Single Woman(Tenants in Common)

9/5/2003 DEED-F $1,030,000 DOC 03-189098 BOC UNO 21.42% INT SMITH, ANDREW J, H/W(Tenants By Entirety) SMITH, JILL S, H/W(Tenants By Entirety)

http://webIO.hawaiiinformation.com/REsearchIHIS/Search/search PUB.asp?SRC=LNK&STRM=TMK&KEY=... 5/9/2011

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FROM: ¢It ..... y

m IMATA, R.

UYENO, D. =CHONG,R.

KIMURA. J.

~OHYE,M. FUJU, N.

- YOSHINAGA, M. = SWANSON, S. _ KUNIMURA, I. _. _ ENGLAND, D.

m . !tilL .;3. KAWAHARA, K. LHARDY,R. ~ _ SAKODA, E. ~ _ NAKAMA, L. _

DAN BARRA, S M7" . :z;;: HOAGBIN, S. ~ _YODA,K. _CHING,F.

EQ& LApproval ...a Signature

Information

'26Jun07 '~

PLEASE: Review & Comment

_ Type Draft --': Type Final

File _ Xerox _ copies

Take Action:

Please See Me

+, LINDA LINGLE GOVERNOR OF HAWAII

STATE OF HAWAII DEPARTMENT OF LAND AND NATURAL RESOURCES

COMMISSION ON WATER RESOURCE MANAGEMENT P.O. BOX 621

HONOLULU, HAWAII 96809

December 7, 2007

Mr. William Kreutzmann P.O. Box 1268 Kilauea, HI 96754-1268

Dear Mr. Kreutzmann:

LAURA H. THIELEN

MEREDITH J. CHING JAMES A FRAZIER NEAL S. FUJIWARA

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

LAWRENCE H. MIlKE, M.D., J.D.

KEN C. KAWAHARA, P.E. OEPUTY DIRECTOR

1223-03.ccpi

Certificate of Pump Installation Completion for Well No. 1223-03 (TMK 5-1-005:014)

We are pleased to inform you that the Pump Installation work permitted for the Bill's Well (Well No. 1223-03) is complete and acceptable and welcome you as a new member to the community of well owners and groundwater users in Hawaii. This certificate of pump installation completion allows you to commence pumping your well for reasonable & beneficial water use.

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

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

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

3. In the event that the well operator and/or landowner changes, the Commission shall be notified of the change prior to the change, and all forms shall be transferred to the new owner.

4. In the event the benchmark in the concrete base of the well is altered in any way, an updated elevation survey (page 5 of the Well Completion Report Part I) shall be submitted to the Commission. The Well Completion Report Part I can be obtained by contacting staff or at www.hawaii.gov/dlnr/cwrmlforms.htm.

5. Your approved pump has a capacity of 50 gpm at a head of 240 ft. In the future, pump replacements of equal or lesser capacity will not require an additional permit from the Commission, but will require the submission of a Well Completion Report Part II by the licensed pump installer. If the pump replacement is greater than the existing pump, you will need to apply for a new pump installation permit.

/

-\

Mr. William Kreutzmann tit Page 2 December 7,2007

6. The landowner shall cause the well operator to maintain the installed 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 annual basis, on forms provided by the Chairperson (attached), in accordance with § 13-168-7, HAR.

7. 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. The authorization to drill a well and/or install a pump shall not constitute a determination of correlative water rights. The landowner and well operator are notified that the quantity of water taken from the well and/or the pump capacity could be reduced by the Commission in the future.

8. In the event that your installed pump is less than 70 gallons per minute, and no elevation survey has been completed, you may be required to do one in the future.

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

If you have any questions, please contact Charley Ice of the Commission staff at 587-0251 or toll-free at 274-3141 (Kauai) extension 70251.

CI:ss Encl: Water Use Report Forms

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

Sincerely,

Wf7f7 1't

KEN C. KAWAHARA, P .E. Deputy Director

LINDA LINGLE GOVERNOR Of HAWAII

Mr. Barry Simmons




December 7,2007

Oasis Water Systems, Inc. P.O. BoxS07 Hanalei, HI 96714

Dear Mr. Simmons:

Well Completion Report Part II for Well No. 1223-03

LAURA H. THIEL€N CIWRPElISOH

MEREDITH J. CHING JAMES A. FRAZIER NEAL S. FUJIWARA

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

KEN C. KAWAHARA, P.E. DEPUTY DIRECTOR

1223'()3.wcr2.acc

We received your Well Completion Report Part II for the Bill's Well (Well No. 1223-03) on November 1, 2007 and acknowledge that it is complete.

This completes your obligations under the pump installation permit. A certificate of pump installation completion will be issued to the well operator/landowner and you will receive a copy. The certificate transfers responsibility of all aspects of well usage and maintenance from you to the well operatorllandowner.

If you have any questions, please contact Charley Ice of the Commission staff at 587-0251 or toll-free at 274-3141 (Kauai), extension 70251.

CI:ss

c: William Kreutzmann

Sincerely,

w.f'rl-'J 1't

KEN C. KAWAHARA, P.E. Deputy Director

/

LINDA LINGLE LAURA H. THIELEN GOVERNOR OF HAWAII C...........,N




December 7, 2007


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

KEN C. KAWAHARA, P.E. OEPOTY DIRECTOR '

1 223-03.ccwc

Mr. William Kreutzmann P.O. Box 1268 Kilauea, III 96754-1268

Dear Mr. Kreutzmann:

Certificate of Well Construction Completion for Well No. 1223-03 (TMK. 5-1-005:014)

We are pleased to inform you that the Well Construction work permitted for the Bill's Well (Well No. 1223-03) is complete and acceptable and welcome you as a new member to the community of well owners and groundwater users in Hawaii.

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

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

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

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

4. In the event that the well operator and/or landowner changes, the Commission shall be notified of the change prior to the change, and all forms shall be transferred to the new owner.

5. In the event the benchmark in the c~ncrete base ofthe well is altere~ in any way,an upd~ted elevation survey (page 5 of the Well CompletIOn Report Part I) shall be submitted to the Commission. The Well Completion Report Part I can be obtained by contacting staff or at www.hawaii.gov/dlnr/cwrmlforms.htm

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

If you have any questions, please contact Charley Ice of the Commission staff at 587-0251 or toll-free at 274-3141 (Kauai) extensIOn 70251.

CI:ss

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

Sincerely,

Wf7M 1't


J

LINDA LINGLE GOVERNOR Of HAWAII

Mr. Barry Simmons P.O. Box 507 Hanalei, HI 96714

Dear Mr. Simmons:


COMMISSION ON WATER RESOURCE MANAGEMENT P.O.80X621


December 7, 2007

Well Completion Report Part I for Well No. 1223-03

LAURA H. THIELEN CHAIRPERSON

KEN C. KAWAHARA, P.E. OEPUTY DIRECTOR


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

1223-03.wcrl.acc

We received YOJr Well Completion Report Part I for the Bill's Well (Well No. 1223-03) on November 1,2007 and acknowledge that it is complete.

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

If you have any questions, please contact Charley Ice of the Commission staff at 587-0251 or toll-free at 274-3141 (Kauai), extension 70251.

CI:ss

c: William Kreutzmann.

Sincerely,

Wf7n "'-


J

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• e MEMO and ROUTe-BLIP (ver. 8/31/2007)

I WCR 1 Checkfe'r Well No. 1223-03 (sIJrvey to regulation memo)

1. Pump Tests Check Diane England~itial) Yes No

11/07/07

8r{t{'S • 1-P"tr4- l6rEL (~ b-4J) ~H~

Step-Drawdown Test: followed WCPI Stds analysis attached (V ~pm no test required

Constant Rate Test: followed WCPI Stds analysis attached proposed pump cap o.k.

~

Potential Well Interference:

Potential Stream Impacts:

Additional Testing or Data Required:

Pump Test Comments Attached:

o o

o

o

o

o

2. Well Log Check Geology Code for Welllnde::.x:~~_ Fm Name: .....::.w:.u.~;.&...;;(J_/._t.>_. D. Englan&mitial)

3. Construction Check Mitch Ohye (initial) Yes No If no. describe deficiency

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

\, QI..('-S1 \ t) ... ) Ci rJ C, p~

NAD27

NAD83

Latitude Lonaitude

4. CharleY/~I--__ (initial) take action based on above analysis

ATTACHMENTS FOR PUMP INSTALLATION PERMIT (2x): 1COVER LETTER 2COUNTY COMMENTS (OWS/SMA)

300H COMMENTS 40LNR COMMENTS (LO/OCCUOHP)

SWCR 1 Accept

not necessary - only WCP or BOTH. fa be sent to driller/pump installer

<----- To Landowner

} Staff internal checks

5. Roy (initial) check (Entered WCR 1IWCCC accept date into database) 6. Susan Hoagbin (initial) finalize 7. Mitch (initial) signature (Entered PIP issue date if required) 8.Charle~e

~

- -,

','. e e • OF., State of Hawaii

• COMMISSION ON WATER RESOURCE MA. NAGEMENT Deparbnent of Land and Natural Resources

WELL COMPLETION REPORT - PART I Well Con.truction

InnuctIOn8: Please print in ink or type and send completed report (wiIh attachments, If applicable) to the Commission on water Resource Management, P.O. Box 621, Honolulu, Hawaii 96809. The Commission may not accept Inc:omp/ete reports. ThIs form shaD be submitted within 60 days of the completion of work. For assistance, please consult the Hawaii Well Construction and Pump InstaDation Standards or call the Regulation Branch at 587-0225. For updates to this form or additional information, please visit our website at hlIp:JlwvNt.state.hi.usldlnrJcwrml

For Official Use Only:

RECEIV!O

07 It i A7 i 14

1. State Well No.: /223 - "3 Well Name: --::&\....;... \...:..\'..;;..s_\N,,--,=eJ...:..~ \.:..-______ Island: ):(o..1J~ 2. Address: 147D ~ci\\o.~<A. R.ei Tax Map Key: ~-)-005!O\1 3. Drilling Company: Oo.~S ~d\€K ~;s\~.rn~J :Lac:-4. Drilling method used during construction: Rotary )(Percussion D Other (describe)

5. Date Well Construction (drilled,cased,grouted) completed: 210 J;;r»J Attach Completed Drll ..... Log ~day/year

6. Was the subject well cored? DYes t.ll No

7. Step-Drawdown Test completed? ~ No D Yes Attach Step-Drawdown Test form (12117197 SDPTD Form)

11. After casing installation (this Information should be before any pump tests are performed with casing Installed)

Chloride: ~ ppm, Temperature: 73. 7 OF

tneansea subtract the depth to the water level.

12. As-bullt ,ectlon filled in completely D

DYes

13. Photograph of well and concrete pad .howlng benchmark on concrete pad attached g/' 14. GPS coordinates provided in degrees, minutes, second, r:1' 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: lockabie cover, threaded coupling, etc.)

16. Remarks: evM~ -k'b\- de.(e.({4 - L... So fffY'

Ucensed Driller (print) ~~_-':-'-----"-__ --'" ____ _ C-57 Lie. No. 2 \ 16 I Signature Date IO--dt, -;;).007

WCR1 Form 6/12107 Page 1 of 5

/

or . ~

...

12. AS-BUIL T WELL SECTION (Please attach as-bui/t If different from diagtam provkJed below)

Elevation at top of casing .2!.:L ft., msr l ( (to nearest 0.01 ft.) f- Minimum of 2' Radius & 4" Thick Concrete Pad

-.--. b ~~ r Ground Elevation: 3}1,8 ft., msI "SUrveyed 0 Bench martc '1.':';':':; to", ".<1.

Hole Diameter· 13 in

elevation: /I~' ... · ., N""," 'N""" ..... · . •• 4._ A .. 'S Please refer to the

317,5 ft., msl* . ' .

fro .'. .'. ~ HAWAII Mil CONSTRUCTION Mig Cement Grout: ft. .:.'~' :. ~. ~ (Surveyed to (min. 70% of distance from .~:.:

.. ' J PUMP INSTALLATION IIANDARDS 4. 0"

nearest 0.01 ft.) ground elevation to top of -."..r;." :: ;. 3 to ensure that your as-buIIt Is in compliance

~::: :~ :l:: o (Estimated) water surface or 500 ft., .... 4: li with appUcabie standards. whichever is Jess.) .....

i--' -} .. '.~: ". ~ t-.< ;.-: "::l :. ~. .

Grouting method: Annular space between .~:-: ~.:.: i SolId Casing: (~ 90% x (Ground Elev.-Water Level Bev») hole and casing (1.5" for o.:t>-'

~~~ W Length: 31QI ft. )d. Positive positive displacement. 3" ~ '2 1 (.:, displacement (if for other methods): .... ·.0_ :::J Nominal ~iameter: In. · . e annular space is / : ....... .. 4 ...

~in. p ..... ;'"':4 ~ WaH Thickness: j In. less than two f---' :. ~. -: :: )(

inches, attach ~.:. 4. 0" il- Bottom Elevation: ft.,msl photo of tremIe)

Rock or Gravel Packing: - i- I' I

8 o Other N

::lh fl ~ Open Casing: .. Perforated o Screen o Crushed Basalt ~ Length: 40 fl

V " o Rounded Gravel Nominal ~iameter: In. '"

. ~ WaD Thickness: In • water Level Elevation:

ft.msr Bottom Elevation: ft., msl Total Depth _L- i:l - t-

350 ft. (Item 11 from page 1)

Open Hole:

,JiB Length: ft.

Diameter: in. - Bottom Bevalion: ft., msl

*msI = mean sea level . Solid Casing Materia': 1..,. 1l-1-~ ... 03 S/fA.,.& ~ Carbon Steel: compliant with (check one or more): 0 ANSIIA'IMIA C200 0 API Spec. 5L )f' ASTM A53 0 ASTM A 139

And compliant with (check one or more): 0 ASTM A242 or A606 0 Type E 0 Type S )it Grade B 0 Other Stainless Steel: (check one): 0 ASTM M09 (production wells) 0 ASTM A312 (monitor wells) ABS Plastic conforming to ASTM F480 and ASTM 01527: (check one) 0 Schedule 40 0 Schedule 80 PVC Plastic conforming to ASTM F480 and (ASTM 01785 or ASTM 02241): (check one): 0 Schedule 40 0 Schedule 80 0 Schedule 120 Thermoset Plastic: (check one) 0 Filament Wound Resin Pipe conforming to ASTM 02996

o CentrifugaDy Cast Resin Pipe conforming to ASTM 02997 o Reinforced Plastic Mortar Pressure Pipe conforming to ASTM 03517 o Glass Fiber Reinforced Resin Pressure Pipe conforming to A'IMIA C950 o PTFE Auorocarbon Tubing conforming to ASTM D3296 o FEP Fluorocarbon Tubing conforming to ASTM 03296

Qpen CulDa Material: Carbon Steel: compliant with (check one or more): 0 ANSIIA'IMIA C200 0 API Spec. 5L lit ASTM A53 0 ASTM A139

And compliant with (check one or more): 0 ASTM A242 or A606 0 Type E 0 Type S )I Grade B 0 Other Stainless Steel: (check one): 0 ASTM M09 (production wells) 0 ASTM A312 (monitor wells)

ASS PIa8tk: conforming to ASTM F480 and ASTM 01527: (check one) 0 Schedule 40 0 Schedule 80 PVC PlastIc conforming to ASTM F480 and (ASTM 01785 or ASTM 02241): (check one): 0 Schedule 40 0 Schedule 80 0 Schedule 120 Thermoset PIa8tk:: (check one) 0 Filament Wound Resin Pipe conforming to ASTM 02996

o Centrifugally Cast Resin Pipe conforming to ASTM 02997 o Reinforced Plastic Mortar Pressure Pipe conforming to ASTM 03517 o Glass Fiber Reinforced R8$In Pressure Pipe conforming to A'IMIA C950

o PTFE Fluorocarbon Tubing QO!lformIng to ASTM 03296 o FEP Fluorocarbon Tubing CO'*orming to ASTM 03296

WCR1 Form 6112AJ7 Page 2 of 5

, . • , I •

,

'S~te of Halii e COMMISSION ON WATER RESOURCE MANAGEMENT Deparbnent of Land and Natural Resources DRILLER'S LOG

For Om£ial Use Only:

purCEIVEO Nt¥ .

07 e I A 7: 15 Wen Number: ..::.;122=3:...::-0:,=:3 _____ _

Depths (ft., Rock descriplion, Water level, etc. Datas Depths (ft., Rock description, Water level, etc. Datas

0 to 4 Brwn mud wlsand 5125107 144 to 160 brwn weathered meet hard rock 617/07

4 to 10 brwnmud 5I2BI07 160 to 173 brwnmud 617107

10 to 15 brwnmud 5127107 173 to 176 very hard 619/07

15 to 16 bright r&d mud 5fZ1107 176 to 185 weaIhered brwn rock 619107

16 to 35 brwnmud 5127107 185 to 191 hard rock 6110/07

35 to 43 brwnmud 5128107 191 to 203 r&d clay mud 6112107

43 to 45 Hard rock 5128107 203 to 215 finned up weatherad rock & mud 6112107

45 to 56 brwnmud 5128107 215 to 220 hard rock cutting - gray 6113107

56 to 59 hard rock 5128107 220 to 250 hard gray rock 6119/07

59 to 80 weatheled rock & mud" 5I30I07 250 to 255 r&d clay 1 sticky mud 6119107

80 to 84 mud 5131107 255 to 263 r&d mud (not sticky) 6I20I07

84 to 88 blue rock 5131107 263 to 285 brwn weather&d rock 6130/07

88 to 90 bwn mudlwealhered rock 5131107 285 to 325 gray cuttings 713107

90 to 106 brwn weather&d rock 611107 325 to 343 brwn sticky mud 7/5107

106 to 113 hard rock 612107 343 to 346 dark mud 7/5107

113 to 117 brwnmud 6/3107 346 to 350 color lighter. not sticky 716107

117 to 127 mad. hard weathered rock 6/3107 to

127 to 144 hard rock 616107 to

Remarks: * Initial water encountered

DL Form 06I2AII2004

Benchmark Elevation ~'1 • 5~ I

Well Elevation e 12 1. ~ - 03

Attach photos of completed well and concrete pad showing benchmark location.

I certify that the elevation shown above:

1 ) Was done in accordance with acceptable surveying practices 2) Is accurate to the nearest 0.01 ft. 3) Is referenced to mean sea level

LicenseNo ..

SHE.D

Attach photos of completed well and concrete pad

~'

..

0

~ ... ~'

LA.T

LoNG

.... ,

,,2.-~~ (,,4-") N

J •

2.~o 12·1 ~ f 'N 'sO: .2..1· J &0

1

t 2(" t- (It-'')

EXAMPLE

Lat: 19"36'45"

SKETCH OF WELL LOCATION (Referenced to permanent landmark, i.e. building, ro, ce, etc.)

Provide Latitude and Longitude of well referenced to NAD83 to neare t second'

WCR1 Form 1117106 PIIge 4 of 5

-MEMO and ROUTE SLIP (ver.8/31/07) 11/07107

I WCR 2 Check for Well No. 1111ff . (surv~to regulation memo)

1. Pump Tests Check'special condition of PIP? Yes/No) D. England (initial if yes)

Step-Drawdown Test:

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

Aquifer Pump Test:

followed WCPI Stds T & S analysis attached

Potential Well Interference:

Potential Stream Impacts:

Additional Testing or Data Required:

Pump Test Comments Attached:

2. Pump Installation Check Mitch Ohye

data complete followed Special Cond & Elev.

well database updated

3. CharleY/RY(: :2 (initial)

ATTACHMENTS FOR ACCEPTANCE: 1WCR2 ACCEPTANCE LETTER 2PUMP INST. COMPLETION CERTIFICATE

Yes No If no. describe deficiency

0 0 0 0 0<70 gpm no test required 0 0

0 0 0 0 0<50 gpm no test required

0 0

0 0 stream names:

0 0

0 0

(initial) No If nOI describe deficiency

f;/ 0 ... 1/ 0 (,,V 0 '- ¥

take action based on above analysis

1" To be sent to driller

3METER INSTALL. REPORT (IF NECCESSSRy) __ _ J To be sent to landowner/operator

} Staff intemal ~hecks 4. Roy (initial) check(Entered WCR 2/PICC accept date into database)

5. Susan Hoagbin (initial) finalize

6. Faith Ching (initial) enter into WUR database

..,J;. ... ,

~ State of Hawaii For Oftldal Use Only: / V • COMMISSION ON WATER RESOURCE MANAGEMENT

~ ) Deparbnent of Land and Natural Resources ftECEIVED

WELL COMPLETION REPORT - PART II tJDV ~ Pume Installation B7 ... I A 7: 14

InetructIona: Please print In Ink or type and send completed report (wIttr attac:tmenIa, If appUcabIe) to the Commission on Water Resource Management, P.O. Box 621, Honolulu, Hawaii 96809. The Commission may not accepIlncomplete A!pOIts. ThIs form shaft be submitted within 60 days of the completion of wortt. teMMneH ON WATI For assistance, please consuII the Hawaii WeD Construction and P\mp InstaIIaIIon Standards or caD the

RESc.i!.:iCtMANAC4:M! T Regulation Branch aI S87-022S. For updates to this form or addltlonallnforma1lon, please visit our website aI htIp:JlwwN.hawall.gov/dlnrlcwrm/

1. State Well No.: /'223-03 Well Name: ~j\\'5 Well Island: Ka\.X0 2. Address: ~410 ~\~ ed. Tax Map Key: 5-1-005:0\4 3. Pump Installation Company: Oo..~'.s \k)Q~ $~~S I ~. 4. Date Pump Installed: U ~ '1 /J,OQ7

monthI /year

5. PERMANENT PUMP INFORMATION

Pump Type, Make, Serial No.: Q(V(\Ofu,S 40556- ~5 ~ p\ D{o31,\)S 6CO I Il'b300L5 Rated Capacity: SO gpm at head of: ~40 ft.

Motor Type, H.P., Voltage, rpm: F(lA:a'u\i!1 t\~\C ,I .£ h~ I ..130 V I 34S0(~YY\ Pump type (check one):

o Deep Well Turbine o Rotary o Propeller

~ Submersible o Rotary-Displacement o Reciprocating

o Centrifugal o Rotary-Gear o Impulse

6. Method of flow measurement:

1z!l Flowmeter wI totalizer Manufacturer O'\clfx N\tl4tModel no. S) 03b7,lSize J" o Other, explain and attach schematic

7. Fill In the as-bullt section on the other side of this sheet.

8. Attach the rating curve for the Installed pump.

9. Attach photograph of well clearly showing the benchmark on the concrete pad, the well head, and the method of flow measurement.

10. Well Owner Company Contact ~M. K(e.0'\" 1...JVVlQb

Address P.O. ~~ l'l.b~ I ¥-\~CN€AI \-\J:.. 9biS4 Phone(11~1S9- ~~d.- Fax

11. Land Owner Company S:Mv\e ClJntact

Address

Phone Fax

12. Remarks

"'---~ &rv~ SjroMDN~ C-57/C-57a1A Lie. No. ~,~S7

fO -;1b ~ 9.001 Date Signature -WCR2 Form 02/26107 PtIge 1 of 2

, -~ r' ...

-

7. AS-BUILT PUMP SECTION (Please attach as-built if different from diagram provided below)

Bench mark elevation SU!jSed to nearest 0.01 ft. = 31 ft. mean sea level

-Elevation of top of chase tube '31~.5 ft. mean sea level

---- Pump intake depth = \5 () ft. (referenced to bench mark)

Chase tube depth = 111 ft. (referenced to bench mark)

If airline installed, bottljA of airline elevation =

N ft. mean sea level

WCR2 Fotm 03117/06 Page 2 of 2

I

/

. ,.

". • •

./ . , ·PERFORMANCE CURV~ 40 GPM e MODEL40S

, \'l/t.,?,~ \~c;. ~ ~----------------------------~--~~~~~~--~------------------------------------~~

~'.'"

FLOW RANGE: 24 - 55 GPM

1700

1 300

1 200

1 100 -t-W. w 1 000 u. -0 Lti 900 J:

800

700

600

5q)-~ r-= ~15 j5 HPJ 400 -----1=~12(5HP ....... 300

__ 1._1

-~ 4Osao:9 (3 HPll -200 -=t40S20-7 (2 HP): ,..

'-+140S15-5 ,11/2 HP

100 ~~40S10-3 ~1 HP)

I o o 5 10 15

OUTlET SIZE: 2 II NPT NOMINAL DIA. 411

20

3450 i- RPM -

OPERATING RANGE: 24 to 55 GPII ..... +-+-1--+-.;-,1. tCAPI\CmES l!EJ..(M 24 GPM SEE MOOEL 25S I-+-!-, ---+-C!-+'+-+'-+-+±±:' . r-

, I ! :-- r-r-t l!

,

I""" ro

r"" 1""""'" I -.... I ,

!

1 ~

j , ,

1'"10 j

! -, ...

I j

25 30 35 40 45 50 55 CAPACITY (GPM)

SPEClRCATIONS SUBJECT TO CHANGE WITHOUT NOTICE. Performance conforms to ISO 9906. 1999 (E) Annex A Minimum submergance is 5 feet. MOTOR STANDARD. 1·.10 HPI3450 RPM.

MOTOR STANDARD.15-20 HPI3450 RPM. • Also available with 6" motor. .

~----------------------------------------------------------------------------------~~~ GRUNDFOS'~ 4-?1

Oasis Water Systems <[email protected]/m>

08/28/2007 11 :40 AM

Is today okay?

To [email protected]

ce

bee

Subject Re: Bill's Well No. 1223-03 - Intent to install pump

--- [email protected] wrote:

> Hi Betsy, > > Do you have an estimated date? Our database has a > date field that needs > to be filled in. thanks > > > > Oasis Water Systems <[email protected]> > 08/28/2007 11:15 AM > > To > Lenore Nakama <[email protected]> > cc > > Subject > Bill's Well No. 1223-03 - Intent to install pump > > > > > > > Hi Lenore -> We will be installing Mr. Kreutzman's pump in the > near > future. > Aloha, > Betsy Lis > Oasis Water Systems, Inc. > >

PUMP INSTALLATION PERMIT BW's WelL Wen No. lW=03

N.; uR """""""'k",.",."",, 1Wcml" 0,""II11II/ 0, !fOrt " comel"", In accordaDce 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 docmnent permits the pump Installation for Bill's WeD (Well No. 1223-03) at TMK 5-1-005:014, Kauai, subject to the Hawaii Well Construction & Pump Installation Stindards (HWCPIS - February 20(4) which include but are not limited to the following conditions:

1. The ChaiJpersoo to the Commission on WtJlef Resource Managcmeot (Commission), P.O. Box 621, Honolulu, HI 96809, shall be notified, in writing. at least two (2) weeks before any work COVCRd by this permit commenc:es and SIaff shall be allowed to inspect Installation activities in accordanc:e with 113-168-15, Hawaii Administrative Rules.

2. No withdrawal of water shall be made odJcr than for testing until a Certificate of Pwnp Installation Completion has been issued by the Commissioa.

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

4. The pump installation pennit shall be for installation of a SO gpm rated capacity. or Jess, pump in the well. This pennancnt capacity may be TCduced in the event that the pump test data docs not support the capacity •

.s. A watcr-Jcvcl measurement access shall be permanently installed,. in a manner aa:eptable to the a.irpetson, to acc:uratc1y rcconI water levels.

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

7. Well Completion Report Part U shan be submitted to the Chairperson within 60 days after completion of work. This form can be obtained by contacting statJ or on the internet at www.hawaii.gov/dlnrlcwrm.

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

9. The pump installation permit application and any related staff submittal approved by the Commission arc Incorporated into this permit by retbrence. This permit is also subject to the HWCPIS. If the HWCPIS ere not followed and IS a COII8eqUCIICC water is wasted or contaminated, a lea .. tile property .. ay ..... 1t. Any variances fiom the HWCPIS shall be approved by the Cbairperson prior to invoking the variance.

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

II. The permittee, its successors, and assigns shall indemnify, defend, and hold the State of Hawaii harmless from IIIld against any loss, liabnity, claim, or demand for property damage, personal i,gary, or death arising out of any act or omission of the applicant, assigns, oflic:ers, employees. conttactors, and ~ under this permit or relating to or connected with the granting of this permit.

) 2. Special conditions in the attached cover lnIIISIIIittalleucr are incorporated herein by rd'crenc:c:.

. W-'It1 Date of Approval: Expiration Date:

January 19,1007 January 19,1009

PETER T. YOUNG, Chairperson Commission on Waf« Resource Management

1 bav. read the eonditiou and terms of this permit and Indentaad th.m. I accept and aane to meet tbese condition. a. a prerequisite and Dnderlylnl coudltiOR of my ablHty to proceed nd •• derstand tII.t I .... u Dot eoaa.eace work .ntU I and the pump IRStaIler ..... e .... .,., dllt'" .Dd ret.rlled tile ....... It to tile CoaamissioL I u ........ that this permit is Dot to be trusferred to .ay ....... ntity. I .... aDdenan. that Doa<oapUaace with .ay permit eoadltioD may be aroDnds for revocation and fin .. of up to S!5.GOO per day starting from the permit date or .pproval.

Installer's Signature: fAtebIth U C-S7, C-S7a, or A License #: 21457

Printed Name: _Bar!y=.:.L..:S=iu::,:dD=OIlS=-__________ Finn or Title: Oasis Water Systems. Inc.

PI .. "gn both copt. o/tlll, pennlt, ,.,,,. one to tile 0,.",.,.."". .n4 mtlill 1M IIIIter lor ytIIII' IWCfJl'fI&

Attac:hmenIs

/

Oasis Water Systems <[email protected]>

05/31/200701:00 PM

Aloha Lenore -

To Lenore Nakama <lenore.y.nakama@hawaiLgov>

ee

bee

Subject Bills Well No 1223-03

I hope you enjoyed your time away from the office.

Attached please find the executed permit for Bill's Well - State No. 1223-03. We intend to begin drilling this well in two weeks.

Mahalo, Betsy Lis .. Oasis Water Systems, Inc. 1223·03 Ellecuted Permil.pdf

WELL CONSTRUcnON PERMIT

Bill's WelL Well No. 1223-03 Note: This permit shall be prominently displayed at the construction site until the work is completed

In accordance with Department of Land and Natural Resources. Commission on Water Resource Management's Administrative Rules, Section 13-168, entitled "Water Use, Wells, and Stream Diversion Works", this document pennits the construction and testing of Bill's Well (Well No. 1223-03) at TMK 5-1-005:014, Kauli, subject to the Hawaii Well Construction &. Pump Installation Standards (HWCPIS - February 2004) which inClude but are not limited to the following conditions:

1.

2.

3.

4.

s.

6.

7.

s.

9.

10.

11.

12.

13.

14.

15.

The ChaifEn oCthe Commission on Water Resource Management (Commission), P.O. Box 621, Honolulu, HI 96&09, shall be notified, in writing, at least two ) weeks before any work authorized by this permit commences and statf shall be allowed to inspect installation activities in accordance With §13-168- 5, Hawaii Administrative Rules.

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

The well construc:tion permit shall be for construction and testing of the well only. The permittee shall coordinate with the Chairperson and conduce I!Jlwnping test in accordance with the HWCPIS (the latest pUmp test worksheet can be obtained by contacting Commission staff or at www.bawaii.gov/dlnrlewnn/fonu.btm). The ~ittee shall sutimit to the Chairperson the test results as a basis fur supportina an !lPPlication to instaU a ~anent pump. No ~t P.UIIIP m~ be Installed until a punt!! installation permit is approved and issued l>Y the Chiirperson. NO withdrawal of water Shall be made for purposes other ihan testing without a Certificate of Pump Installation Completion. The permitted pump capacity described on the pump installation permit may be reduced in the event that the pump test does not support the capacity.

In basal ~ wate'l_':'te depth of the well may not exceed one-fourth (Jl4) of the theoretical thickness (41 times initial head) oCthe basal ground water unless otherwise authorized uy the ChairpersoR-

The ~ittee shall incorpomte mitigation measures to prevent construction debris from entering the aquatic environment, to schedule work to avoid periods of - high'rainfilll, and to revegctate any cleared lR8S as soon as possible.

In the event that historically significant remains sUeb as .-tifacts, burials or concentrations of shells or charcoal an: encountcml during construction, the permittee shall stop work ana imJnediately contaCC the Department of Land and Natural Resources' Division of Historic Preservation.

The proPQSed well oonstruction shall not adversely affect existing or future Iega1 uses of water in the area, including any surface water or established instrcam flow staildards. This permit or the authorization to construct the well shall not constitute a determination of condative water rights.

The Well Completion Report Part I shall be submitted to the Chairperson within sixty (60) days after completion of work (please contaCC staff or visit www.bawaILgov/dlnr/ewnntformt.btm fur current furm). .

The permittee shall comply with all applicable laws, rules, and ordinances; non-c:ompJiance may be grounds fur revocation of this permit

The well construction~it application and any related staff submittal approved by the Conunission an: incorporated iJWo this pennit by reference. This pet1I!it is also subject to the HWCPIS. If the HWCPIS are not fullowed and as a consequence water is wasted or contaminated, a Ilea OR die property may mlllt. Any variances from the HWCPIS shall be approved by the Chairperson prior to inVoking the variance.

The work DrODOSecI in the well construction ~it application shall be completed within two (2) years ftom the date of permit approval. unless otherwise specified. 'rbC ~t may be extended by the Chairperson upon a showing of good cause and good-fiIitb performance. A request to extend the permit shall be submitted to the Chairperson no Jater than the date the permit expires.

If the well Is not to be used it must be properly capDecl. If the well is to be abandoned during the course of the project then the permittee must apply for a weD abandonment permit in accordance with § 13-) 68-12(1) prior to any weD sealing or plugging work. .

The permittee, its successors, and assigns shall indemnify, defend, and bold the State of Hawaii harmless from and apinst any loss, liability, claim, or demand for P:OPCrtY dl!ID" personal injul"l', or death apsing ~ of any, act or omission of the applicant, assigns, officers, employees, contractors, and agents WIder this permit or relating to or connected With the gJ8IItlng oTthls permit.

This permit shall apply to the location shown on the ~icalion only. If the well is to be relocated, the permittee shall apply for a new well construction/pump installation permit ID 8ccordance with Hawaii Administrative Rules §13-168-12(1).

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

Date of Approval: January 19,2007 Expiration Date: January 19,2009

PETER T. YOUNG, Chairperson Commission on Water Resource Management

I have read the conditions and terms oftbls permit and undentand them. I accept and alree to meet these conditio ... a prerequisite and underlying condition of my ability to proceed and undentand tIIat I sball not commence work until I have signed, cblted, and returned the permit to the Commission. I undentand that this permit is not to be transferred to any otber entity. I also understand tbat uon-compliance with any permit condition may be grouucls for revocation and fines ofup to $S,OOO per day starting from the permit date of approval

C-S7 License #: .....:2:.:1:...:4=..;57:....-__ _ Date: Slot Ira Printed Name: Barry Simmons Firm or Title: Oasis Water Systems. Inc.

PIeIlse sign both copies of this permit, return one to the Chairperson, tUUI rtIlfIln the other for}Oll' reconl&

Attachment

1 i-II LINDA LINGLE

GOVERNOR OF HAWAII

Ref: 1223-03.wcp

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

Dear Mr. Simmons:




Well Construction Permit Bill's Well <Well No. 1223-03)

PETER T. YOUNG

MEREOITH J. CHING JAMES A. FRAZIER NEAl S. FWIWARA

CHIYOME l. FUKlNO, M.D. LAWRENCE H. MilKE, M.D., J.D.

STEPHANIE A. WHALEN

DEAN A. NAKANO ACTING DEPUTY DIRECTOR

January 30, 2007

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 a permanent pump. As part of the Chairperson's approval, the following special conditions were added and are part of your permit under Permit Condition 13:

Special Conditions

1. Attached for your information are copies 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.

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

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

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

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

If you have any questions, please call Lenore Nakama of the Commission staffat 587-0218 or toll-free at 274-3141 (Kauai), extension 70218.

Sincerely,

Wfrl-i; 1'L

Peter T. Y ouog Chairperson

Enclosures

c: William Kreutzmann (with applicable comments - DOH SDWB, CWB) USGS KauaiDWS

/

•

- e e WELL CONSTRUCTION PERMIT

Bill's Well. Well No. 1223-03 Note: This permit shall be prominently displayed at the construction site until the work is completed

In accordance with Department of Land and Natural Resources, Commission on Water Resource Management's Administrative Rules, Section 13-168, entitled "Water Use, Wells, 'and Stream Diversion Works", this document permits the construction and testing of Bill's Well (Well No. 1223-03) at TMK 5-1-005:014, Kauai, subject to the Hawaii Well Construction & Pump Installation Standards (HWCPIS - February 2004) which include but are not limited to the following conditions:

I.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

IS.

The Chail'J!erson 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 stat'( shall be allowed to inspect installation activities in accordance with §13-168-15, Hawaii Administrative Rules.

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

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

In basal ground water, the depth of the well may not exceed one-fourth (1/4) of the theoretical thickness (41 times initial head) of the basal ground water unless otherwise authorized by the Chairperson. .

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

In the event that historically significant remains such as artifacts, burials or concentrations of shells or charcoal are encountered during construction, the permittee shall stop work and immediately contact the Department ofLand and Natural Resources' Division of Historic Preservation.

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

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

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

The well construction 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 HWCPIS. - If the HWCPIS are not followed and as a consequence water is wasted or contaminated, a lien on the property may result. Any variances from the HWCPIS shall be approved by the Chairperson prior to invoking the variance.

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

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

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

This permit shall apply to the location shown on the application only. If the well is to be relocated, the permittee shall apply for a new well construction/pump installation permit m accordance with Hawaii Administrative Rules § 13-1 68-1 2(f).

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

Date of Approval: January 19, 2007 Expiration Date: January 19, 2009


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

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

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

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

Attachment

/

" r 'J

LINDA LINGLE GOVERNOR OF HAW,,"

Ref: 1223-03.pip


Dear Mr. Simmons:




Pump Installation Permit Bill's Well (Well No. 1223-03)

PETER T. YOUNG


CHIYOME l. FUKlNO, M.D. LAWRENCE H. MilKE, M.D., J.D.

STEPHANIE A. WHALEN

DEAN A. NAKANO ACT1NG DEPUTY DIRECTOR

January 30, 2007

Enclosed are two (2) originals of your approved Pump Installation Permit for the captioned well(s) that authorize permanent pump 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. Attached for your information are copies of the Department of Health's (DOH) review comments. Please note DOH's requirements related to discharge of emuent from well drilling and testing activities.

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

Please sign both permit originals and return one for our files.

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

If you have any questions, please call Lenore Nakama of the Commission staffat 587-0218 or toll-free at 274-3141 (Kauai), extension 70218.

Sincerely,

WFrfi 7't

Peter T. Young Chairperson

Enclosure

c: William Kreutzmann (with applicable comments - DOH SDWB, CWB) USGS KauaiDWS

/

• ~ •

• _ PUMP INSTALLATION PERMITa ., Bill's Well, Well No. 1223-03 •

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

In accordance with Department of Land and Natural Resources, Commission on Water Resource Management's Administrative Rules, Section 13-168, entitled "Water Use, Wells, and Stream Diversion Works", this document permits the pump installation for Bill's Well (Well No. 1223-03) at TMK 5-1-005:014, Kauai, subject to the Hawaii Well Construction & Pump Installation Standards (HWCPIS - February 2004) which include but are not limited to the following conditions:

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

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

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

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

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

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

7. Well Completion Report Part II shall be submitted to the Chairperson within 60 days after completion of work. This form can be obtained by contacting staff or on the internet at www.hawaii.gov/dlnr/cwrm.

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

9. The pump installation permit application and any related staff submittal approved by the Commission are incorporated into this permit by reference. This permit is also subject to the HWCPIS. If the HWCPIS are not followed and as a consequence water is wasted or contaminated, a lien on the property may result. Any variances from the HWCPIS shall be approved by the Chairperson prior to invoking the variance.

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

II. The permittee, its successors, and assigns shall indemnity, 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.

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

Date of Approval: Expiration Date:

January 19,2007 January 19,2009

W./iH 1't


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

Installer's Signature: C-57, C-57a, or A License #: 21457 Date: -------Printed Name: Barry Simmons Firm or Title: Oasis Water Systems, Inc.

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

Attachments

/

J I

t

LINDA LINGLE GOVERNOR OF HAWAII

•• .-

2\ AIO: 34

PETER T. YOUNG ctWRPERBOH


CHIYOME L. FUKINO, M.D. LAWRENCE H. MilKE, M.D., J.D.

TO:

FROM:

SUBJECT:

STATE OF •• tIOH Ot~ 'V::\T[~ DEPARTMENT OF LAND AN ; ~'~~~ENT

COMMISSION ON WATER R '!-MJ(N~(;EMENT P.O. BOX 621


October 18, 2006

Well Construction/Pump Installation Permit Application Bill's Well (Well No. 1223-03) TMK 5-1-005:014

,-' ~'

~_-,

~ ~ 0 C1 .-t

N c:>

p

9 r;:)

STEPHANIE A WHALEN

DEAN A NAKANO ACTING DEPUTY DIRECTOR

r-:::;: ::0

::s~ ,~~.i rn :::< -rn ~o C)

'Z

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 with regard to the programs, plans, and objectives specific to your division. Please respond bjreturning this ~over memo form by November 20. 2006. Ifwe do not receive comments or a request or 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 Lenore Nakama ofthe Commission staff at 587-0218. '

LN:ss Attachment( s)

RESPONSE:

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

kX A water lease/permit is lli!!required of this applicant.

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

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

[ ] No objections

Ddt Other comments: Original source of private title is land Corrmission Award 8559-B issued between 1845 abd 1855.

Contact Person: __ l.,lGr.cB ... r*¥--""M""B ... r ... t ... i.uu'--________ _ Phone: 587-0421 __~.L-><=<""""-_

Signed:_-I'~---'---+-~--="""""''''''''''''''''''''''''· ... ;:::------ Date: --------NOV 20 2006

Y, Oct-23~006 08: 3 lam

I LINDA LINGLE! jOOIARAOA OFHA'NM

I ,

From-DEPT OF HEALTH ENVIRONMENTAL MNGMT e 8085864352 T-065 P.002/002 F-958

PETER T. YOUNQ CttA,IIfEIIION

MeAEOfTH J. OiING ~

JAMES A. FAA!lER f'-. NIiAL II. FUJIWARA V'

,

Tp:

RESOURCES .......... "" .. II" .... J;; MANAGEMENT

Honorable Chiyome l. Fllkino, M.D., ni" .. .t-t ...... Department of Health Anention: DirectOr's Office

Harold Vee. Wastewater .LI~'a.JI ... 1I

STUart Yamada, Safe ater Branch Alec Wong, Clean Waler

Peter T. Young. Chairperson 1 Commission on Water Resource

Well Construction/Pump Installation Bill's Well (Well No. 1223-03}

ClilYOMe L ~UKlNO. M.D. LAWftENCE H. "II~ M.Il. J.D.

STEPl'IANli A. WHAI.6N

ClEAN A. NAKANO AGntC DlI'UfY ~R

Transmitted for your review and comment is a IU~IIW1J1aul..'u permit application.

of the captioned Well ConstructionJPump

t'a.l'lhtllrlel'l application for any conflicts Of OOlleCtives ,,",,·r>n,,1' to your depattment. Please respond bI

I'~~foi'~~~~~~~!fart~~~~~~~t Tfwe do not receive comments or a request Iii have no comments.

l!

Please find the attached maps to locate the orc~oo:sea well. If you have any questions about this it applic8fion, request additional information, or additional review time, please contact

Nakanla of the Commission staffat 587·0218.

Thii well FlUilliflc.; 15;a iC)1)fgC wlliI,.h willliClVC iii II iiOIII"l:C ofpollble WaICI'lO a dll)'i ~rycsr or hao IS or 1IKIrO~ conncctiOl18j and m_ n;ceive Oit"""", RliJeti (HAA). Title II, ChaplCr 26. Rules Rtialill3 10 Porabl£ W_ ~.~ Ii 1

11li. W$1l ~ 1~ llMa\i,)! as. a SQutCe olefYlliB a publK: WiKer ~)'IiWIII U(\nneatiOll~) iU1d if the w~u waIer is II$CKI for dfinkins. rhe ~nd routilNlly monitQr 1M Wi\IIIf qilillily tbcl"lllliler. Ho\\<;vcr. if fUllur':DlA"I~ dlen Direll(OI" of Heallh Ipproval ia required m:i!! 10. implemOllw,OJI.

If rlle \\<ell is lISed 10 $Uj)ply boJh poIable and lIon'(IOUIbie pUI"(KIQIS in the user ~hall climinlllC ~llOaicl'ls iIlId ballkllow !:OIIIIectioll> by ph)/Sioalf)r Ii,:pufilnnu potable aDd non-pollibie 5yllltms III appra • ...t batkflow prcWlll«, md by clearl)' labeling 81140,1" patIIblc spiGOB with wami.1l 6igns 10 prevelll iWldvcncllr COJlS<j,"priOR of noo-potl.dl,k _orr. &.cktlo1O prcvcnnon dc:ViCH shOuld be (Qo\till~ly illSJ)llel,d illl41ostCci.

Ir doc! DOllppc&r thar tbis wtll will be IIIICd for cOlI&bmplivc p~ *"4 i$ JlQ\

For lbe applicam's inf;mnatioo. a iOUfCt afpossible wasrtwaru col~al\li~o. I II it not 10l'i<1.:d ~ [he propolCd well site (inforlnalioll all",Clled).

An NPOes !'=lit i, rlll1uir.:d.

GIber rcle"'/II DOH IUicalregll18lions. infonn8lion, or teCO'llO.e,\CIIIri(1Q;! iII1:

In 1I.e ~VfIII Ullllihe IQCaliOil ofille Mll Ch~n!!e:s but is ~tiIl wilhin the parctl awHc:abh:. and we ;10 not need 10 IC!villW the new location.

on Ihis applicalion, 0111' 4ivi~iOll eonsider1 rhe ~Olllmcnl6 to &till be

No COIII'II~IU"'objCNriOIll

I'..o1l}.1I1.a' .. " Person: _-I-+~=-=~IUo..L.l,.jc..c==-l-______ +-_

QWl.29

OCT-23-200608:12AM FAX: 8085864352 IO:DLNR CWRM PAGE:008 R=97%

".7" .. _ .. -. __ .~ ...... - .----.... -.----.... -.~-.--.-.-

, 0, '-1:./006. 08, 3D.. Fr .. ~DEPI OF HEA*NVI RCII~NT Al "'GIlT -;0858643~2----

~nI of Health, aun Wate, Branch bas the lollowlng mmenls: •

T-065 P.OOI/OOZ F-958

,,,-Drilling Activities I

\flY di~ch r ~ tD Slate ~t~rs o! treated process wastewater effl ent a~sociated ~ well dnling activities 'is egulated awaHAdmlnistratlve Rules, Title 11. Chapter 55, pendlX I, e~lVe'Septe~ber 22,1997. rreated.pt ss wastewater effluent covered by this general pe it includes well drilling slurnes, lubricating ILdds Wast ,tars, and well purge wastewaters. This general·pe it does not cover well pUmp testing. The Ipplleable of.iCe of Intent Forms and filing fee shall be 5ubmitte at least thirty (30) days· before the start of jischarge tfW'Department of Health, Clean Water Branch at 9 9 Ala Moana Boulevard~ Room 301, ionol~lu, i'fa" 96814..4920 or P.O. Box 3376, Honolulu, Hawa i 96801 .. 3378. Inquiries·may be directed to ;M.Clean ter Branch at (80B) 586-4309 or by fax at (808) 58 352.

. ,

2. II Pump Te~ting

I r shall ia~ all measures necessary to prevent the isch8,.ge of pollutants from entering State waters .. S measures shall indude-, if necessary. cQntainment of the initial discharge until til,. disCh~rg~ Ii easenti I frea of poll.,rtants. If the discharge is entering 8 str am or river bed. bast m..,.ment' . . practices a~ be implemented to prevent the discharge from di rbing the clarity of the receiving .water. If the 'di&ch ~ is e~terin" ~ storm drain. the di5~arger must 0 in writte~ permission. ~m tI1e owner af that storm ,..in prior to dIScharge. Furthermore, best manage nt practices shall be lI11p1emented to pr.ven~ th d,scharge f",m colecting sediments and other pollut nts prior to entering the sto~ drain. . .

JSlcr

'. ,

,I '

I·

_._-----_. -.-- -_.--" .-~.--

".

...

OCT-23-200608:11AM FAX: 8085864352 ID:DLNR CWRM PAGE:007 R=96%

r 11-15-06 ~ ....

02: 32 pm From-DOH/Sate Dri~' Water Branch 8085864351 p.ooa/01D F-912

UNOAUNGLE ~01' ........ OCT 20 3D)

eH ~ 1'.1l)- ....7 6,.. -

PE;TeR T. YOUNG 0IIt01RP£RlOlo

TO:

FROM:

STATE OF HAWAII DEPARTMENT OF LAND AND NATURAL RESOORCes

COMMISSION ON WATER RESOURCE MANAGEMENT P.O. 80)(621

HONaUAU.~~I~

October 18,2006

Honorable Chiyome L. Fukino. M.D., Director Department of Health Attention: Director's Office

Harold Yee, Wastewater Btanch Swart Yamada. Safe Drinking Water Branch Alec Wong. Clean Water Branch

PeterT. Young. Chairperson ~ Commission on Water Resource Man~aement

MEReDrrH J. CHING JAMES A. FRAZIER NeAL S. FUJIWAAA

CHIYOME L F\JK,NO. M.D. LAWReNCE H. MIlKE. M.D .. J.~.

STEPHANIE; A. WI-W.EN

DEAN A. NAKANO AOTIIIIi ... ...".., OoI'E¢TO,

SUBJECT: Well COn$buct101lfPump Installation Permit Application Bill's Well <Well No. 1223-03)

. Transmitted for your review and comment is a copy of the captioned Well ConstructionlPump InstalIation 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 by returning this cover memo fOnD by November 29.2006_ Ifwe do not receive comments or a request for additionaI review time by this date,. 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 pcnnil application. request additiona1 information, or request. additional review time. please contact Lenore Nakama of the Commission staff at 587-0218.

LN:ss Attachment(s)

RESPONSE: I J

[ J

[ J

J I

[ 1 [oJ

[ I

[ I

This "I!:UIILGilir,,,,, a$ is '""""" wIDen Mil serve ~s a """'" ofpotablCWBteI"tD apllblic WIIlCf S)l5lClII (der.JII!d3$"..."mg 25 Ol"moIe people at least 60 day\< per yl$Ir or has 15 oT more 5eI"'i~ ~ectiOllS) and 8nlSf receive Direclor ()f~th apptO\Iill pr'ior 10 ;15 'I$! 10 QOnIPly willi Hawaii AdminiBtmive Rilles (HAR). Title 11. CIIIIpt:r 20. RlIks ReliEiag 10 Pomble We:rJ:t SyilOfd, Ii J J ·20-29.

This \\leU dOllS 1101 \}Ualify as a i!O= IiCI"\'i11g ~ ~I~lic water &)'5I1D1 <_It:&s 1II1II25 people cr ~ore people aJ Ie8$! 60 dlIy$ """ )'I:l,," or 1 S savio:e C~OI15) and if tile 'MIll _ is used for III1IIIdJJg.lbc priVllC 0WlICI" slaould tell for b2efl!l'iolopcaJ ;Uld o;11l:mi<;;l1 J'RICIl4IC bl:fDn: iniDariD~ sucb usc and J~ moaitor thcwamr 'l.uaJity 'lhcreaftcr. ~,itfuIute p~ 11M f",m \"illlO~. iD_ to meet 1bc public: Wiler syScm definition Ihen Di.-ur uf Hcnllh IIJII)l'IMII II IIIQIRrW I!!:i!!t to imJll.mmtiltim.

If the _n is used m 5llJlply both J!OllIble and 'lQ".po13ble JlUtpQSeo; in a ~jlle S)"$IfI1II. I~~ user sIJaII elimlDate cross-eonnccriODS aDd htcld10w CQlIDj!()[jOtlS by pll~ll' ~ns po!:sbl~ ""II non-pot.Jbl< r.y&:CI1II5 II)' an air gap or an spprov::d bacIdIowpreYOlrtJ'. ud by clearly "lin! ,,11_jIOIahle $piBQI~ Min w;mring ,,;gt1~ 10 ~ inad'VlmcJrt ~DlUlllPtiOD of~lIb1c Water. Backflow ptevenliun d.:vi.:es .uld bI: TOImnely impccted 1III<I1c>tcd.

It doc& not appear mat !his well willlx used 1br COl_pi vI!! plltpOSoU ""d he bOl ... I!js:t tQ S.-de Orinldns Water ReguladoDs.

For the <lPplieallt'& information. a SOIII'Ce of possible W85tCW_ collllll1Ww.ion [ liS I J is Jlot locale(! ' ...... lhI: 1ITtlPQm\ well sit: (inf<lnnillion II1llIcb~.

An NPDES pem!it is rcquUcd

Otber rckvaDt DOH JUles1ftgW:Wo.\s, infOl'lllldiQn, Ut n:c()Inm""d;.li~ .-R a1t~.

In the CVCIX tbar !he 1ocati0ll 6fllle well clw.!,'2S bal i$ ",ill Mlhin the ~I d;&Q1W on this IJIPiicatiOll, our dillisioD considets the: IlOmllleJlLS III SLiU be aDQIicable. tid wt do nO! ,lta1lu n:vim Lh~ now IC>Cilli..... •

:No COJmnI!DWobjl!CtiDM

Contact Person: Stua:r;t Yamada Phone: 586-4258

Signed: ___ ~-:I~;C;f-______ -"':"~ Date:

" .

NDV-15-2006 02:36PM FAX: 8085864351 ID:DLNR CWRM PAGE:003 R=96%

,.., 11-15-06 .--.,

02:32pm From-DOH/Sate Dr~nl Water Bran"h 8085864351 T-749 P.004/010 F-912

2-1223-03 Kauai

The Department of Health. Safe Drinking Water Branch has the following additional comments for the Well Construction I Pump Installation Permit Application for the Bill's Well (Well No. 2-1223-03 Kauai);

Undergound Injection Control (UIe) Comments:

Well water quality should be initially and periodically tested for its acceptable and intended use, especially if it is to be used for hwnan consumption. Water quality should not be presumed acceptable and unchanging. Land-based activities around the well and within the well's recharge area may, over time, have an unacceptable affect on the well's water qua\ity- Well construction materials and related equipment could also affect water quality. .

10126/06

NDV-15-2006 02:36PM FAX: 8085864351 ID:OLNR CWRM PAGE:004 R=97%

LINDA LINGLE OOVBRNOll OF HA WAD

ftECE1VED

PlenR T. YOUNG CBAJIU'I!IlSON

BOAJU) OF LAND AND NATURAL uaotJIlCD COIOOSSION ON WATBRltESOURCZ MANAODOIH'I'

ROBOT K. MASUDA DEPtrrY oa.croR· LAND

DBANNAKANO ACJ'DfOmrPUTYDIIt.ECI"OR.WATD.

AQUATIC USOURCIS BOA'I1NO AND OCI.AN JtEClt.EATION

BtJU.A.U OF CDNVEYANCM ~ONWA".uoURCZMANAODOlH'l'

STATEOFHAWAIIR mv 8 p3: ~~~::~~~ DEPARTMENT OF LAND AND NA~Ri~OUR.CES P~~Dun

BrBTOJtJC PRUJ!:RVAnoN

STATE HISTORIC PRESERVATION DIVISION 1Wl0000WEIILAND~VECOIOOllllOll 601 KAMOKILABOULEVARD, ROO~l~\SS\ON ON W~it~ IrrA1B.AJlI<S

KAPOLEI, HAWAII 96707 RESO!;:~CE t.V.Nt~.GE~EHT

November 1, 2006

Dean Nakano, Acting Deputy Director Commission on Water Resource Management P.O. Box 621 Honolulu, Hawaii 96809

Dear Mr. Nakano:

LOG NO: 2006.3233 DOC NO: 0610NM26 Archaeology

SUBJECT: Chapter 6E-8- Historic Preservation Review - Well Construction/Pump Installation Permit Bill's Well (Well No. 1223-03) Kilauea, Hanalei District, Island of Kauai TMK: (4) 5-1-005: 014

The aforementioned permit is for a well and pump installation in former cane lands.

We believe that "no historic properties will be affected," because: ~ Intensive cultivation has altered the land ~ Residential development/urbanization has altered the land ~ Previous grubbing/grading has altered the land o An accepted archaeological inventory survey (AIS) found no historic properties o SHPD previously reviewed this project and mitigation has been completed o Other:

In the event that historic resources, including human skeletal remains, are identified during routine construction activities, all work needs to cease in the immediate vicinity of the find, the find needs to be protected from additional disturbance, and the State Historic Preservation Division, Kauai Section, needs to be contacted immediately at (808) 742-7033.

Aloha,

NM:jen

• LINDA LINGLE CEIYED PETER T. YOUNG

CHAIAPERSOH GOVERNOR OF HAWAII

TO:

FROM:

31 pl' 17

STATE OF~~OltQ.H w ~ TEft COMM~~;~~~~~~A~~~A~'§~~"'~

P.O. BOX 621 HONOLULU, HAWAII 96809

October 18, 2006

Honorable Chiyome L. Fukino, M.D., Director Department of Health Attention: Director's Office

Harold Vee, Wastewater Branch Stuart Yamada, Safe Drinking Water Branch Alec Wong, Clean Water Branch

Peter T. Young, Chairperson 11 Commission on Water Resource Management

MEREDITH J. CHING JAMES A. FRAZIER NEALS. FUJIWARA

CHIYOME L. FUKINO, M.D. LAWRENCE H. MIlKE, M.D., J.D.

STEPHANIE A. WHALEN

DEAN A NAKANO

~'.~-~

SUBJECT: . Well Construction/Pump Installation Permit Application Bill's Well (Well No. 1223-03)


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 by returninl! this cover memo form by November 20.2006. Ifwe do not receive comments or a request for additiOnal review time by this date, 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 Lenore Nakama of the Commission staff at 587-0218.


RESPONSE: [ I

[ I

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This well qualifies as a source which will serve as a source of potable water to a public water system (defined as serving 25 or more people at least 60 days per year or has 15 or more service connections) and must receive Director of Health approval I!!i2!: to its use to comply with Hawaii Administrative Rules (HAR), Title II, Chapter 20, Rules Relating to Potable Water Systems, §11-20-29.

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 IS service connections) and if the well water is used for drinking, the privatc owner should test for bacteriological and chemical presence before initiating such use and routinely monitor the water quality thereafter. However, if future planned use from this source increases to meet the public water system definition then Director of Health approval is required prior to implementation.

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

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

For the applicant's information, a source of possible wastewater contamination [ lis ( I is pot located near the proposed well site (information attached).

An NPDES permit is required.

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

In the event that the location ofthe well changes but is still within the parcel described on this application, our division considers the comments to still be applicable, and we do not need to review the new location. X No comments/objections N 0 ~ft/.! .

Contact Person: UJvj rn 0"1 I<uJn , Phone:

Signed:~~ Date:

e·- • Oasis Water Systems <[email protected]>

To Lenore.Y.Nakama@hawaiLgov

cc 11/06/200612:10 PM

bcc

Subject Re: Contact Info for Bill Kreutzmann - Well No. 1223-03

Hi Lenore -I found the phone number to the caretaker for Bill's property. His name~s John Hawthorne and his phone number is 635-3856. He does not have a fax machine. Sorry for the delay. Betsy Lis Oasis Water Systems, Inc.

P.S. I have not yet heard back from Barry on the Pilaa question.

--- [email protected] wrote:

> Hi Betsy, > > I forgot to ask about the phone #, fax #, and email > address for Bill's > Well (1223-03). Those weren't filled in on the > application. Can you > provide? thanks, lenore

/

LINDA LINGlE GOVERNOR OF HAWAII


Dear Mr. Simmons:



HONOLULU, ':IAWAII 96809

October 18, 2006

PETER T. YOUNG CHMlPEllION

MERfDllli J. CHING JAME8A.F~R NEAL S. FWPNARA

CHIYOME L FUKINO, M.D. LAWRENCE H. Mill<!, M.D., J.D.

STEPHANIE A. WHALEN

DEAN A. NAKANO ACTING DEPUTY DltECTOR

1223-03.rev

Well ConstructionlPump Installation Permit Application for Well No. 1223-03

We understand that you are requesting expedited processing of the subject application, which has been deemed incomplete pending the resolution of outstanding issues with other permits, as outlined in our October 11, 2006 letter.

To expedite the permitting process, we will send your incomplete application for review, and if the review warrants the issuance of a permit, a letter of assurance will be issued. The letter of assurance will indicate that a permit will be approved and issued provided that the following conditions are met: a) you have no outstanding issues with the Commission; b) there have been no significant changes to the application; c) there have been no significant changes to applicable laws, rules, regulations; d) there have been no significant changes to hydrologic conditions. Until the permit is issued, no drilling shall commence. Drilling without a permit is subject to fines of up to $5,000 per day. .

For your information, the attached table describes the process, responsible parties, and deadline requirements for drilling or modifying a well and installing, modifying, or replacing a pump.

By this acceptance letter, we are also notifying the well operator/landowner that water may not be pumped for purposes other than testing until the certificate of well construction/pump installation completion letter is issued to the well operator and landowner. Additionally, the permItted pump capacity described on the pump installation permit may be reduced in the event that the pump test does not support the capacity. No certificate of pump installation will be issued until the Commission has determined that the pump capacity will not have adverse effects on the aquifer, other nearby wells, or streams. In other words, you may need to remove the pump and install a smaller pump at the Commission's discretion before you can withdraw water for purposes other than testing.

If you have any questions about your permit application, please contact Lenore Nakama of the Commission staff at 587-0218 or toll-free at 974-4000 (Hawaii), 274-3141 (Kauai), 984-2400 (Maui), or 1-800-468-4644 (Lanai & Molokai) extension 70218.

LN:ss Attachment


Sincerely,

w.frH 1'l

DEAN A. NAKANO Acting Deputy Director

LINDA LINGLE GOVERNOR Of' HAWAII

PETER T. YOUNG '-SON

TO:

FROM:




October 18, 2006

Honorable Chiyome L. Fukino, M.D., Director Department of Health Attention: Director's Office

Harold Yee, Wastewater Branch Stuart Yamada, Safe Drinking Water Branch Alec Wong, Clean Water Branch . 1i

Peter T. Young, Chairperson Commission on Water Resource Management


CHIYOME l. FUKINO, M.D. LAWRENCE H. MilKE, M.D., J.D.

STEPHANIE A. WHAlEN

DEAN A. NAKANO ACTING DEPUTY OtRECTOft

SUBJECT: Well ConstructionlPump Installation Permit Application Bill's Well (Well No. 1223-03)

Transmitted for your review and comment is a copy of the captioned Well ConstructionlPump 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 by returning this cover memo form by November 20. 2006. Ifwe do not receive comments or a request for additional review time by this date, 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 Lenore Nakama ofthe Commission staff at 587-0218.

LN:ss Attachment(s )

RESPONSE: [ J

[ J

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This well qualifies as a source which will serve as a source of potable water to a public water system (defined as serving 2S or more people at least 60 days per year or has 15 or more service connections) and must receive Director of HeaIth approval J!!i2[ to its use to comply with Hawaii Administrative Rules (HAR), Title II, Chapter 20, Rules Relating to Potable Water Systems, 011-20-29.

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 I S service connections) and if the well water is used for drinking, the private owner .'ollld test for bacteriological and chemical presence before initiating such use and routinely monitor the water quality thereafter. However, if future planned use from this source increases to meet the public water system definition then Director of Health approval is required J!!i2[ 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 PI' or an approved backflow preventer, and by clearly labeling all nonpotable spigots with warning signs to prevent inadvertent consumption of non-potable water. Backflow prevention devices should be routinely inspected and tested.

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

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

An NPDES permit is required.

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

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

No comments/objections

Contact Person: Phone: ____________ _ ------------------------------------Signed: ______________________________ _ Date:

LINDA LINGLE GO\IEItHOII OF ..........

PETER T. YOUNG CIWItI'IIIION


CHIYOME l. FUK/NO, M.D. LAWRENCE H. MilKE, M.D., J.D.

TO:

FROM:

SUBJECT:




October 18, 2006

Russell Tsuji, Administrator Land Division

Dean A. Nakano, Acting Deputy Di~ctor ~ Commission on Water Resource Management

Well ConstructionlPump Installation Permit Application Bill's Well (Well No. 1223-03) TMK 5-1-005:014

STEPHANIE A. WHALEN


Transmitted for your review and comment is a copy of the captioned Well ConstructionlPump 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 b1returning this cover memo form by November 20.2006. Ifwe do not receive comments or a request or additional review time by ibis 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 Lenore Nakama of the Commission staffat 587-0218.

LN:ss Attachment(s)

RESPONSE:

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

[ ] A water lease/pennit is !!!!! required of this applicant.

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

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

[ ] No objections

[ ] Other comments:

ContactPe~on: _______________________________ _ Phone: -------------

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

LINDA LINGLE GOVERNOR OF HAWM

PETER T. YOUNG CHAIRPERSON

MEREDITH J, CHING JAMES A. FRAZIER NEAl S. FUJIWARA

CHIYOME l. FUKINO, M.D. LAWRENCE H. MilKE, M.D., J.D.

TO:

FROM:

SUBJECT:




October 18, 2006

Melanie Chinen, Administrator Historic Preservation

Dean A. Nakano, Acting Deputy Director ~ Commission on Water Resource Management

Well Construction/Pump Installation Permit Application Bill's Well (Well No. 1223-03) TMK.: 5-1-005:014

STEPHANIE A. WHAlEN



We would appreciate your comments on the captioned application with regard to the programs, plans, and objectives specific to your division. Please respond b1returning this cover memo form by November 20. 2006. If we do not receive comments or a request or additional review time by this date, we WI assume you have no comments.

Please find the attached maps to locate the proposed well. If you have any questions about this permit application or request additional review time, please contact Lenore Nakama of the Commission staff at 587-0218. If you require additional information regarding specific information that can be provided by the applicant, please contact the applicant directly at the contact information provided on the application form.


RESPONSE:

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

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

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

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

Signed: __________________ _ Date: _______ _

_":'~LenOreY -: Nakama/DLNRIStateHiUS

.... 10116/200610:37 AM

Hi Betsy,

To Oasis Water Systems <[email protected]>

cc

bcc

Subject Re: Pump Installation Cpt Rpts - Wells 1020-05 & 1123-081]

Yeah, was quite an experience for us here too. Power outage kinda sucked though. But, guess it was a good wakeup call for emergency preparedness - which we were not!

I used to be more on top of expiring permits, but I've been so busy lately ... Anyway, I will start the review process for the Falko applications (1120-48 &49) and Bill's well (1223-03), but we won't be able to issue the actual permits until the completion reports for 1020-05 & 1123-08 come in. Here's the WCR Part 1 for 1020-05.

-m DOC.PDF



10/16/2006 09:35 AM

Good Morning Lenore -

To Lenore Nakama <lenore.y.nakama@hawaiLgov>

cc

Subject Pump Installation Cpt Rpts - Wells 1020-05 & 1123-08

Did you survive yesterday's wake-up okay? We even felt it over here, and we never feel 'em!

I received your letters regarding the pump installation permits expiring for wells 1020-05 and 1123-08 - the completion reports were supposed to have been done by the previous owner (back in '03) and we had no idea that they had not been received by you. I have reviewed our files and for well 1020-05 we do not even have a copy of the well completion report part 1.

Do you have a copy of it you could fax to us? I will be contacting the well owners to see if they have a copy of the Cpt Rpt II. Barry and I are very upset about this lack of follow-thru by the previous owner. And we will be working hard to get this problem corrected ASAP. Please forgive ...

Is there any way we can get the Falko Wells 5 & 6 permits going? We are onsite there now and would like to be able to continue working with them without having to re-mobilize our equipment.

Mahalo, Betsy Lis

LINDA LINGLE GOVERNOR OF HAWAII

PETER T. YOUNG CHAIRPERSON


/

CHIYOME L FUKlNO, M.D.




October 11, 2006

LAWRENCE H. MilKE, M.D., J.D. STEPHANIE A. WHALEN


1223-03.ack Mr. Barry Simmons Oasis Water Systems, Inc. P.O. Box 507 Hanalei, HI 96714

Dear Mr. Simmons:

Well ConstructionlPump Installation Permit Application for Well No. 1223-03

We have received your Well Construction/Pump Installation permit application and filing fee for the Bill's Well (Well No.1223-03). However, your application is incomplete. Matters which must be addressed before we accept your application as complete are as follows:

1. Please update us as to the status of the pump installation permit for Well No. 1123-08. Our records show this permit expired on August 16, 2006. If the pump has been installed, please submit the Well Completion Report Part II. Ifno pump installation work has been performed and this permit should be cancelled, please notify us in writing~~~~'L-

2. Please update us as to the status of the pump installation permit for Well No. 1020-05. Our records show this permit expired on July 2, 2006. If the pump has been installed, please submit the Well Completion Report Part II. Ifno pump installation work has been performed and this permit should be cancelled, please notify us in writin~~ "",C.VJ.

Upon receipt ofthe above information, we will accept your application as complete and you can then expect your application to be processed within ninety (90) days.

If you have any questions about your permit application, please contact Lenore Nakama of the Commission staffat 587-0218 or toll-free at 274-3141 (Kauai), extension 70218.

LN:ss


Sincerely,

Wf7f7 1't

DEAN A. NAKANO Acting Deputy Director

Well Background Check

Approved Well No. Well Name Applicant

Falko/Koolau 5 Falko Partners, LLC

0621-01 Einrogel Fanns 2 Einrogel Fanns LLC

FalkolKoolau 6 Falko Partners, LLC

111611998 0844-01 Puu 0 Hoku 1 Puu 0 Hoku Ranch

7/1312000 1324-02 Namahana Acres Jackie Yellin

10/1912000 1120-32 Larsen Beach Ricardo Russell

Well Construction Driller Pump Inst. Type Issued Signed WCR1 Accept

C-21457 C-21457

C-21457 C-21457

C-21457 C-21457

C-21457

C-21457 C-21457

C-21457 C-21457

BOTH

BOTH

BOTH

WELL 1111711998 7/1712000 313012001 7/1812001

BOTH 711812000 812212000 4/1612001 4/1612001

BOTH 11/312000 31612001 6114/2001 7/1712001

1011912000 0618-10 Kealia 2A Kealia Mauka Holdings, LLC C-21457 C-21457 BOTH 10/20/2000 10/2312000 2120/2001 2120/2001

1011912000 0618-09 Kealia 1A Kealia Mauka Holdings, LLC C-21457 C-21457 BOTH 10/20/2000 10/2312000 212012001 2120/2001

Pump Installation Issued Signed WCR2 Accept

511412001 6116/2001 112812003 21512003

6/812001 811012001 912812001 912812001

212312001 212712001 212612002 318/2002_

212312001 212712001 212612002 31812002-

412312001 1120-34 Ke Hoomaka Craig H. Maas

EWM Kauai LLC

C-21457 C-21457 BOTH 51712001 511412001 112312003 311412003 11/1712003 1211212003 12I28l200312I28l2003

412412001 0020-03 EWM.;L

71912001 0720-03 Kealia Mauka 1 Kealia Mauka Holdings

812712001

9/1312001

1223-01

1124-01

101312001 1221-10 Pilani~;-;

101312001 1222-05 Pilaa3';'"

Louise Zweben

Neal & Melissa Nonnan

James Pflueger

James Pflueger

1211312001 6734-03 KukuitJiele Explo Hawaii DWS

311312002 1121-01 Nancy Irene Joseph Kobayashi

7/1012002 0720-04 Kealia Mauka 2 Comer Stone Hawaii

81912002 0919-06 Aina Anahola Joseph Hanwright

812012002 1122-01 Green Thumb Ben Cassidy

812012002

912412002

5721-02

1123-08

Banyan Harbor Irr Banyan Harbor AOAO

Max 1 John Maxwell

1012212002 1020-05 Papaa-Lindner Jeffery S. Lindner

21312003 1019-04 Aliomanu Estates Aliomanu Estates

61212003 0919-11 Hui Road 5

61212003 0919-08 Hui Road 2

61212003 0919-07 Hui Road 1

Fridoy, September 08, 2006

Hui Road, LLC

Hui Road, LLC

Hui Road, LLC

C-21457 C-21457

C-21457 C-21457

C-21457

C-21457

C-21457

C-21457

C-21457 C-21457

C-21457 C-21457

C-21457

C-21457 C-21457

C-21457 C-21457

C-21457

C-21457 C-21457

C-21457

C-21457

C-21457

C-21457

C-21457

C-21457

C-21457

C-21457

.BOTH 5/412001 1011112001 1/1812002 1/1812002

BOTH 7/1212001 7/1312001 212112002 212112002

"·.:BQT-H 916/2001 91712001 811212002 811212002

<BOTH 912112001 11/812002 8116/2003 9/1812003

BqTH 1011712001 211512002 9f28I2002 1112012002

BOTH 1011712001 211512002 912812002 11120/2002

WELL 1211412001 1211712001 11120/2003 1112012003

BOTH 312012002 41212002 611212002 7/1812002

BOTH 7/1812002 1I8l2003 811812003 911812003

PUMP

BOTH 812812002 9I2l2002 411812003 5I8l2003

BOTH 812812002 9120/2002 811812003 811812003

BOTH 913012002 216/2003 811812004 8116/2004

BOTH 10/2512002 11212003 611112004 71212004

PUMP

BOTH 7I2l2003 411112005

BOTH 71212003 4/1112005

BOTH 7I2l2003 411112005

112812002 411212004 2/912004 41112004

31412002 416/2002 611212002 611212002

812512002 7/16/2002"~7f1812002 7/16/2002

9130/2003 12I22l2003 . !!I.1812oo3 911812003 .. ~-

3I8l2003

31612003

712412002 9/2312002 9124/2002 912412002

9/30/2003 1011312003 811812003 9116/2003

812812002 1/1612003 112812003 211812003-

511512003 112812005 813/2008

9/3012003 1212212003 8116/2003 8116/2003

813112004 ?~ , 71712004

3120/2003 3124/2003 4/6/2003 51912003

Page 10/2

Well Construction Pump Installation Approved Well No. Well Name Applicant Driller Pump Inst. Type Issued Signed WCR1 Accept Issued Signed WCR2 Accept

61212003 0919-10 Hui Road 4 Hui Road, LLC C-21457 BOTH 71212003 4/1112005

61212003 0919-09 Hui Road 3 Hui Road, LLC C-21457 BOTH 71212003 4111/2005

611312003 0519-04 Kapaa Homestea State DLNR C-21457 WELL 612512003 7/1712003 211612005 211812005

212312004 0519-05 Lydgate1 William Lydgate C-21457 C-21457 BOTH 31812004 1213012004 7I8l2005 10/1212005 1012412005 511912005

212312004 1224-02 River Ranch River Ranch, LLC C-21457 BOTH 31812004 211012006

411212004 1324-04 Pualei Properties PualeiProperties C-21457 C-21457 BOTH 411412004 812312005 1211912005 611312006 611412006 611912006

412212004 0521-09 Golden Pond Carrie Cowan C-21457 C-21457 BOTH 51412004 611712005 411912006 611612006 7/1112006 712412006 812812006

612112004 1225-02 Halasey Tom Halasey C-21457 PUMP 612412004 121212004 11128120051112812005

1212912004 5327-02 EAKT2 Eric A. Knudsen Trust C-21457 BOTH 11712005 313112005 e 111612005 1221-13 Barnhouse Falko Partners, LLC C-21457 WELL 112512006 211712006

612412005 1120-47 Toms Moloaa Bay Ranch LLC C-21457 C-21457 BOTH 71712005 71712005

... 1211912005 1121-02 FalkolKoolau 3 Falko Koolau C-21457 WELL 1212212005 211712006 :"'.0'1."

1211912005 1121-03 FalkolKoolau 4 Falko Partners, LLC C-21457 WELL 12122/2005 211712006

,":" ;~11312006 1324-06 Lani Justin & Michele Hughes~<' - C-21457 C-21457 BOTH 112512006 _.r_~~!)."

112512006

.... '_.;,- 11312006 1324-07 Secret Beach Ma Justin & Michele Hughes .: .. C-21457 C-21457 BOTH 112512006 .. 112512006

Justin & Michele Hughes ••• ...

. r __ ~ ": 11312006 1324-08 NaNea C-21457 C-21457 BOTH 112512006 112512006

'"to

111412006 1326-03 Brescia Torey 1 Corey LLC C-21457 C-21457 BOTH 112512006 6I9l2OO6 112512006 611612006

;~':~'. " . - ..... --~ .

•. ···2f20iU2006 1221-14 KeHoomaka2 Craig H. Maas C-21457 C-21457 BOTH 212812006 .. { ........

212812006

311012006 0221-03 Opaekaa 1A Opaekaa Falls Land Co., LlC C-21457 C-21457 BOTH 311512006 311512006

311012006 0221-05 Opaekaa 2 Opaekaa Falls Land Co., LLC C-21457 C-21457 BOTH 312212006 3I22l2OO6

311012006 0221-04 Opaekaa 1B Opaekaa Falls Land Co., LLC C-21457 C-21457 BOTH 311512006 311512006

512612006 5738-01 Kapalawai 1 Kapalawai Resort, LLC C-21457 C-21457 BOTH 611412006 6/1912006 6/1412006 611912006

512612006 5738-02 Kapalawai2 Kapalawai Resort, LLC C-21457 C-21457 BOTH 611412006 611912006 611412006 611912006

7/1712006 1223-02 NaAinaKai Na Aina Kai Botanical Garden C-21457 C-21457 BOTH 712512006 712512006

7/1912006 1224-03 Kahili 1 Steve Goldberg C-21457 C-21457 BOTH 7I26l2006 712612006

FrldDy, September OB, 2006 Page2of2

,; • ,1Ii..-, .tt. .,:. :. ". 'c' ,. ~

Department of Commerce & corer Affairs - State of Hawaii - PVL ~ENSE CLAS... Page 1 of 1

Dpp,utment of Commerce and Con~ul11er Aft-firs r rofr , 1"111 <1n(1 Vocc1tlonZlI Lie .. nlH1 , ,11, I'.' "1

flruh'ssiolla I Hlld ,: o{'ational tit:t"'llsing Sl).a r(:h

CLASS CODE C57

LICENSE CLASS SCREEN

Please click a link listed below to display the other screen.

There was 1 specific license class on this licensee!

***** LICENSE CLASS FOR THIS LICENSEE ***** LIC: CT-21457 OASIS WATER SYSTEMS INC

CLASS TYPE EFFECTIVE RESTRICTED WELL . J ; P5/19/9~; /

~:t"i:'!'f:,~lr

<-Bm New Searcb->

STATUS

EMPLOYEES LIST I I EMPLOYERS LIST II INSURANCE/BONDI I LICENSE CLASS

Copyright 2002 Professional and Vocational Licensing Division

HawaII State homeDaae II ~II Professional and Vocational Llcensina Division

http://pvl.ehawaii.gov/pvlsearch/app? _ f=n& _ a=LC&licno=21457 &lictp=CT &off=O&nm= ... 9/25/2006

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510050140000 HAWTHORNE AARON

510050140000

510050140000 .

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510050140000

510050140000

510050140000

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WINNINGHAM BENJAMIN ...

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4360 WAILAPA RD

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Make your check or money order payable to:

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Mail to or pay in person at the following address:

COUNTY OF KAUAI REAL PROPERTY TAX COLLECTION 4444 RICE ST STE A463 LIHUE HI 96766

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http://www.kauaipropertytax.com!AccountSearch.asp?mnu=PSearch&submnu=Account&l... 9/25/2006

DOCUMENT NO ePARTMENT OF LAND AND NATURAL RES.CES

UAC OR ATTACHED WORKSHEET DATE A t 29 2006 .. ugus . SRCI COST

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

S 07 326 C 1026 0752 (1 ) $25.00 MicalSimon

" " " " " " (2) $25.00 John Siele

" " " " " " (3) $25.00 Oasis Water

" " " " " " (4) $25.00 Oasis Water

" " " " " " (5) $25.00 M. Frandsen

(6)

(7)

(8)

(9)

(10)

TOTAL $125.00

REMARKS: LINE (1) Turtle Well LINE (2) TMK: 2-3-3:50 LINE (3 Falko/Koolau #5 & 6 Well LINE (4) Bills's Well LINE (5) BobalouWell LINE (6) LINE (7) LINE (8) LINE (9) LINE (10)

"

•

. STATE:'WAII OEPARTII F LAND AND NATURAL RESOURCES COMMI ON WATER RESOURCE MANAGEMENT

• APPUCAllON FOR A WElL CONSTRUCllON I PUMP INSTALLATION PERMIT

WELL LOCATION INFORMATION

0IIIcIaI U .. Only:

1.STr;;~~-3Y~) I?:\~ We1\ 3.QAND 14.™K 2- 1 -~S: 014 - 5 Ko.\loJ. .... The-.u_ ... ___ .............. I1--'_......-: ._"'7.5-M __ USGS~.....,(_1:24.000) ______ 1he ........ "'1he ...... .....,

.P!-'YIax.....,.-.g-__ Io_P'-'Y-oPl\ologtllph "' ... ~ _ ... • A~ ........ ihowtng ... _ .... _.-___ ~

5. WElL OPERATOR'S 14HY 1 w" 0p0qIar'a Cooad 8. LANDOWNER'S NAMEJCOMP14HY I ~oCooad \Oi \\\ ~mKr"..u-\- 'Z.-f(\Q.t\n Wm- \((e0fzm""" ~fV't.R - ()pegIIar'o-.u_ ~.-.u-

~.o.l:ot- 12103 q~154-I;l.b1> 'i-\\ n. ~ 0... \-n: 504'Y\e

w .. 0pend0r'0-" 1_ 0p0qIar'a Fa 1_ ap..Ior'. E ...... ~.-.. I~·F"" I~·E"""

PROPOSED WELL CONSTRUCTION PROPOSED PUMP INSTALLATION 7. Propc.ad Work 8. ConstructIon Type ::t Propc.ad Work 11. Propc.ad Pumping RaIla. lIP'" 13. MeIhod dllow~

til Conatruct New WeI .DriIad Instal New Pump (gallons per mftIIa) 5 )D FIowmeIar D ModIfy Exieting WeI DOug D Replace Pump OC\P~ D OpanPipe D AbandonISaaI Wall D Shall 12. Propc.ad Amount d ..... D Weir

D Tunnel D Orifice WIthdrawal, ~ ~. per day) D Other (explain)

9. IIIh1a WIllI part d. batIary dwala? D Y .. ~ No ?>DO 14. PnIpaaad.....,._ ................ ca..,..,.,.. .......... far ..... .............. ...., .......... far_c!!!r'

......... 011 ......... ' ?~ '\ o..,\l\or- ~\L\q ~~ t:n

PROPOSED USE \ ~~ ~

D 15. Municipal (waIIIr aystsms seIVing gl8lllar than 2S indIviduaIII or 15 I8Nice COIII8CIioIIS) :<::.#! ~ t ~16. Domestic Number d units to be 181Wd: ';2. ~~ ,...

D 17. Industrial (cIeM:ribe) 3:~ CD .

D 18. InigaIion (cIeM:ribe crop and l1li. d_) ';:"·0 Z1ir ..

D 19. MilIary (deeatbe) c;~ c:,c)

D 20. Other (cIeM:ribe) ~:~ o.

OTHER LEGAL REQUIREMENTS If 18qU1red, lams 21. Md 22. nIUIIt be obtained beQw the CoInnRsIon CIII ":':t"!"'!' .c.

;;f' pemrIt: . .". .. 21. eor-vatIon DiIIriet Uee Penril (COUP) D Raqulrad, COUP II cIIIIIa~ ___ D Not RequiIad (1IIIach doCI.mantaIion from OCCL) ~ I have not checIc8d willi OCCL about whaIIw or not. COUP is rwquked. I undenIIand theI chedckIg willi OCCL prior to making IhIa appIIcaIIon will

upedIte my review. II'uI1har undenIIand IhIII __ rIIised by IhIa agency may delay or .... '" dIIniaI d the permftlsauanca, or rewcaIion of the oaimit IIIIar it is isaued.

22. Special ManIgernaIt AnIa Permit (SMAP) D RequIrad, SMAil cIIIIIa ~ ___ D Not RequiIad (1IIIach dOCUiii8iiiiiiI from appIIcIIbI8 County agency) )If I have not dIedcId willi the county abcU whaIIw or not .. SMA Perm! is reqund. I undenIIand IhIII chedckIg willi the CounIy prior to making IhIs

IppIicIJIion wlllIIlqIIIdIIIe my review. I further undenIIand I11III __ raI8ecI by IhIa agency may delay or .... In denIIII d the pennII--' or niIiocation d the DennIt ..... II is iIIued.

23. HItIDrIc "'-vIIion DIvision (HPO) of the DepaItmant dlllnd and NaIuraI ~ D I haw COIIIUIad willi the HPO reganIIng poIanIIaI ~ d wei COI1IInIcIIon acIiviIIII8 on hiItDric..... I have IIIIIII:hed applicable documenIaIIon

from the HPD. ,PI. I haw not CXlI1IdecI willi the HPD regarding poIanIIaI impacts d wei COI1IbUCtion acIiviIIII8 on hiItDric 8iIas. I undenIIand that checldng with the HPD = making this appIIcaIIon .. =my review. I further undanIIand =-raI8ecI by IhIa agency may delay or rasuIIln denial d the

Isauanca or rawcaIIon d the aIIIIIr it is iIaued. the d..a land ... is 1IIIached. AddIIionaII9InIfIcs. .. planations. Me. (1IIIach addIIIonaIlheet If _ IIIIC8 is nMded)

NOTE: Signing below IncIic:IIIaII thellllllIignIIIories undanIIand and _lhIIthe inJorInBIIon pnMdecI is IIOCUIIIIa and true 10 the beet d their knowledge. Fur1her, the IIignIIIDrIII undanIIand that upon permiI approval: 1) the propoead work is ID be compIaIad wiIhIn two (2) ~ d the approval dale; 2) the conIrac:IDr IIhIII Nlmllto the CornmiI8Ion a wei c:ompIaIionIlIbndonmant report wiIhIn eo dIIya IIIIar the COI11pIaIIon dale d the panni\IIId work; 3) In the avant IhIIIIII application is not compIaIacI conac:tIy, .." penni! may be 8IIII*1dad untIthe 111m is brought '" to compII8nca, and any work done whlla the ~1IIIY""In"'duPto~.

24. ~ ... _ outr~ 1I1Dr_ ConoIrudIan) 25. PUMP INSTALlER (1l000i'''- out r~ IIIDrPump_)

~!}~ms ?-1151 Some ~ Llcansa No. ~ buIIraa _ C{j71C-57e1A Llcansa No.

f?n((~ SIMm(!fJS~ SIg Print SIgnaIIn PrInt Date

e·O.&'')( 507 H<l(\(A\~~ I t\L qb7/1 AddI.a I. ca~l~ko.U>.A. AddI.a

$A~-1651 S;l{,' {,530 ~Q(),CDO\ Phone FIX Phone FIX E-maIl

WCPI App. Form 05112105

I

"

PROPOSED WELL SECTION fPl-ellllBclr 8d1t1tr1f111c, dI6tIIfInt 110m diagram ptr1IIided beloW}

Hole IlIameter: ~In. at top of C8IIng 30:2. It, msI" ~ [ MInrnum of 2' Radius & 4' Thi:k ConcreIe Pad (10 conIaIn bench

~ :;;:; -r;;r ~tor-.stO.011t!~~;' mark

0h '?'. ~.: r GIuund EIevaIian. It, msI" 'II"'" '.~:.

"~,, "'-" ""- refer to the ::( CeIneft GIouI: ~It ~.=:

(nin. 70% of dIIItIn:e from ::~4 HAWAII WILL CONSTBUCDON AND ground elevation to top of ~.:: .... :~ PUMP INSTALLATION SIANDAIlDS ::.; .:. to _ tho!)'OUr III-buiIt is in compliaace with WIII8r IUIface or 500 It, ~::: ;:::: wlllc:l.-Is Iess.) ..,picabIe 1WIdonIs. ,.:::

',: ~::~ Annular II*» '*-' hole

" ~. I'-- Solid CaIIng: (~ 9O'lI. x (Ground EIBv,-WIIIIIr LewI EIBv» ',:: ""',:

and C8IIng (1.5" for pcIIiIIw ',: ':.; ToCaIlangIh: 311) It dIspIacament, 3" for oller

v~ ~:;:~ meIhods): Nominal DianeIar: Jb* in •

....3.-1n. . ~. ;"0;

w"~: ,;2=- In.

t.~:· BoIIiom EIeYaIIon: ·IQ It,msI'' -i-

:-:; :. Rock or GraYeI PackIng:

Total Depth

3S£L.1t Alt r--, Open Caatng: J{ Perforated O~ MaI8riaI:

~o o Crushed IIasIIIl ToIIIIlangIh: It

b o Roundad GraYeI Y Nominal DIameIar: In.

" WaI~: '$ In. E8IimIIIsd WaIiItr llMII BoIIom EIeYaIIon: It, msI" Elevation:

naIII: foIeIIhIw bentonIe nor mud should be .-d In ~ltmsl" 1-"- -I-

88Iur&Ied mne during dtIIIng

Open Hole:

0 langIh: It

IlIameter: in. --'- BoIIom EIeYaIIon: It,msI''

• The approxImIdB eIeYaIIon must be raIanIncad 10 __ level (mal)

at 1he time of appIcaIIon lIIng. final eIevaIIon8 of well compona" ahaI be UImIIIIId in 1he Wei CompIeIIonIWeI Abandonment I8PDfIB and nIaranced 10 a benchmark which has bewI IIIIabIIshed by a ~ Iicansad by 1he Slate,

For fIDIHI8It WIII8r Basal WeIs - boIIom elevation of wellhould oot be daaper 1hIW11/4 of aqutrar thickness or, BoItom Elevation ofWal UmII = (Water Elevation _11IW_"'tElm!jpp )

e.npIe: ~+2I\.W_~EJev. _1IaIIOm ElevallancfWeI Urnt-(2-~) = -18.51\.

Solid Casing Material: C8rb0n ..... : ~ willi (chack one or mora): 0 NalAWWA C200 0 API Spac:. 5l lIiCASTM AS3 0 ASTM A139

And compliant willi (chack one or mora): 0 ASTM A242 (or 1\806) '1itType E 0 Type S jl!..Gntda B 0 Other

............... : (chack one): 0 ASTM A409 (produc:IIon wells) 0 ASTM A312 (monitor walls)

AIlS "'-CIc confonning 10 ASTM F480 and ASTM 01527: (chack one) 0 ScheduIa 40 0 ScheduIa 80 PVC "'-CIc confonningtoASTM F480and (ASTM 01785 or ASTM 02241): (chackone): 0 SchaduIa40 0 ScheduIa80 0 SchaduIa 120 TIIermoMt PIMtIc: (chack one) 0 FIIamant Wound ReaIn PIps confonnIng 10 ASTM D2996

o CenIrIIugaIIy ca.t Raain PIpa confonning to ASTM 02897 o RaInroraId PIaItIc MorIIIr "-PIpa c:cnIonnIng to ASTM 03517 o GIII8s FIber ReInforaId Raain "-PIps c:cnIonnIng 10 AWWA C960 o PTFE Fluorocarbon Tubing oonfonnIng 10 ASTM D3296 o FEP FIuorocarbcn Tubing confcnning IoASTM D3296

Open Casing Material: C8rb0n .... : compliant willi (chack one or mora): 0 NalAWWA C200 0 API Spac:. 5l )l(.ASTM AS3 0 ASTM A139

And compliant with (chack one or mora): 0 ASTM A242 (or 1\806) .Type E 0 Type S w: Gntda B 0 Other

.............. : (chack one): 0 ASTM A409 (produc:IIon weill) 0 ASTM A312 (monilorwalls)

AIIII "'-CIc confonnIng 10 ASTM F480 and ASTM 01527: (chack one) 0 Schedule 40 0 SchaduIa 80 PVC "'-CIc confonning 10 ASTM F480 and (ASTM 01785 or ASTM 02241): (chack one): 0 SchaduIa 40 0 ScheduIa 80 0 SchaduIa 120 T1MrmcIaI PIMtIc: (chack one) 0 FIlament WowId Raain PIpe conforming to ASTM D2996

o Cenlrllugally Cast RaaIn PIpe conIonnIng 10 ASTM 02997 o Rainforcad PIaeIIc MorIIIr '"'-"" PIpe conIonnIng 10 ASTM 03517 o Glasa Fiber Rainforcad AllIIn ~ PIpe confannIng to AWWA C960

o PTFE Fluorocarbon TutIq conIonnIng to ASTM D3296 o FEP Fluoroc:aIbDn Tubing conIonnIng to ASTM D3296

WCPI App. Form 05112105

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