(1izo'11~is)island. - higp

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CHECKLIS'l' "''h... I tra. construction PermitS __ Pump Installation Permit __ water Use Permit Required Also Well Name & Number MQ{b'{CA..- Applicant DOLA1 1. Consultant P. R., Dr; It; "1 I &2 __ Landowner ______________________ __ Date application received .... .... •.•..•.•.•••••.. ___ / I v Date acknowledged receipt/request more info ••••... ______________ __ Date filing fee deposited ...•••.•.•.••.•..•.•••..• _____________ _ VApplication sent to B Date sent [ St:tfe. ral1"h Dept. of Heal th L _______ _ , . Wtt>+ewo..1{,Y' Bnr.V)l.h Offlce of Hawallan Atfalrs Dept. of Hawaiian Home Lands state Historic Preservation Div. sierra Club Legal Defense Fund -Honolulu Doat:d sf WiiltQ:r Supply Haui Dept. ot Uater 8uppl-y Kauai Dept. of Water Supply OQ!3t. sf Hate%: Stipply Hawaii Dept. of public HorJE£ RoolaUloa NB ,2S (Oahuy -Additional Llst (Molokai) Erio Hirano/ Lyann MizuFt9-- pIV. OF AGIJ.All C. R.-= S. Comments received Date agenda .... ••••.•...•...•..• ....... ••...•• . t - d 1 .. 1,/2 ,.1/7e; 7 Date subml ·tai ue .............. .......... •..••.. ___ __ __ i Date submittal sent to applicant ...... •..•.•••.••. -----,----r----- Date applicatj on __ approved OR __ disapproved ••. Date applicant notified of decision ......... •••••• ____________ _ Remarks: ----------. ------------------------------------ tv'\(1.F ' ct.5 Slj h. we l( Ylo. ('PeV\c.:t I I [ND tX /5 U rn M A-n..y) ,'", book (tv\a. \'\ucd) I _ (\ tAM I'll). -te.r (WUL PEP-M ITt;)

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__ water Use Permit Required Also
Well Name & Number MQ{b'{CA..-V~J..s Applicant DOLA1 ~ti 1. ])tU~J5 Consultant P. R., Dr; It; "1
I &2 (1IZO'11~IS)Island. __ Landowner ______________________ __
Date application received ....•....•.•..•.•.•••••.. ___ q~/~(~6~/c+1~3L----- / I
v Date acknowledged receipt/request more info ••••... ______________ __
~ Date filing fee deposited ...•••.•.•.••.•..•.•••..• _____________ _
[ St:tfe. Dr·II'\.I~i(l.1I1Vt:\.l£r ral1"h
Dept. of Heal th ~ L _______ _ • , . Wtt>+ewo..1{,Y' Bnr.V)l.h
Offlce of Hawallan Atfalrs
state Historic Preservation Div.
RoolaUloa NB ,2S (Oahuy
Erio Hirano/ Lyann MizuFt9-­ pIV. OF AGIJ.All C. R.-= S.
Comments received
Date agenda ~ue ....••••.•...•...•..•.......••...•• _~/~(f!~2~ij~~~7~3~_ . t - d 1 .. 1,/2 ,.1/7e; 7 Date subml ·tai ue ..............•..........•..••.. ___ ~~_~~~~f~2 __ __
i
Remarks:
----------. ------------------------------------ tv'\(1.F ' ct.5 Slj h. we l( Ylo. ('PeV\c.:t I I ~ [ND tX /5U rn M A-n..y) !..o~ ,'", lo~ book (tv\a. \'\ucd) I _ (\ I~_ tAM I'll). -te.r (WUL PEP-M ITt;)
BENJAMIN J. CAYETANO GOVERNOR Of HAWAII
Mr. Richard Thies P.R. Drilling Company 235 Kellog Street Wahiawa, HI 96786
Dear Mr. Thies:
HONOLULU. HAWAII 96809
JUL 30 1997
Well Completion Reports for Well Nos. 1120-17 & 18 Tax Map Key 4-9-14-20. Moloaa. Kauai
/ MICHAEL D. WILSON
HERBERT M. RICHARDS • ..F.
RAE M. LOUI. P.E. DEPV1Y
As you are aware, we are attempting to obtain information for the well construction/pump installation completion reports for the above wells. The landowner/permittee has identified the PR Drilling Job Number is #2539 and the cancelled check numbers for payment are #596 and #592.
Attached is a copy of the completion reports. Any missing information that you could provide to us would be much appreciated. Thank you in advance for your attention to this matter.
If you have any questions, please contact Lenore Nakama at 587-0218.
LN:ss Attachment
Mr. Douglas I. Daniels P.O. Box 539 Anahola, HI 96703
Dear Mr. Daniels:
RECr.IVt:D
DEPARTMEN;JFAJ~D ~~:N~~l JLR1Es "10: 0 3 COMMISSION ON WATER RESOURCE MANAGEMENT
P. O. BOX 621 HONOLULU, HAWAII 968~s....
, " !! I "1 111~-1.iU~1f,nSSIOH ON W~. nR . t(ESOLt~CE ~t.N~\GEMENT
Well Completion Reports Moloaa-Daniels Wells 1 & 2 (Well Nos. 1120-17 & 18)
Moloaa. Kauai
HERBERT M. RICHARDS, JR.
RAE M. LOUI, P.E. DEPUTY
As you are aware, we are attempting to obtain well construction/pump installation information for Well Nos. 1120-17 & 18 for our records. We understand that the wells were drilled and pumps installed, but we have very little information beyond that.
Attached is a copy of a letter from PR Drilling Company. The new owners of PR Drilling Company have expressed their willingness to research their records. If you are able to provide the job number or photocopy of your cancelled check, please contact Lenore Nakama at 587-0218 or toll-free at 274-3141, extension 70218.
Thank you in advance for your attention to this matter.
Sincerely,
RAE M. LOUI o "o?;j;"j7' -If .. ". . ... '). <) Deputy Director r f'- 41Vl//./'1/;;" b !~ .. ' I~j:):) I -01
LN:ss Attaclmlent / - / /- 1'1
Mr. Douglas I. Daniels P.O. Box 539 Anahola, HI 96703
Dear Mr. Daniels:
HONOLULU, HAWAII 96809
JP,' ~,') !(,07
Well Completion Reports Moloaa-Daniels Wells 1 & 2 (Well Nos. 1120-17 & 18)
Moloaa. Kauai
HERBERT M. RICHARDS, JR.
RAE M. lOUI, P.E. DEPUTY
As you are aware, we are attempting to obtain well construction/pump installation information for Well Nos. 1120-17 & 18 for our records. We understand that the wells were drilled and pumps installed, but we have very little information beyond that.
Attached is a copy of a letter from PR Drilling Company. The new owners of PR Drilling Company have expressed their willingness to research their records. If you are able to provide the job number or photocopy of your cancelled check, please contact Lenore Nakama at 587-0218 or toll-free at 274-3141, extension 70218.
Thank you in advance for your attention to this matter.
LN:ss Attachment
June 3, 1997
VIA US MAIL
STATE OF HAWAII
235 KELLOG STREET • WAHIAWA, HAWAII 96786
TELEPHONE (808) 622-2631 • FAX (808) 622-0082
DEPARTMENT OF LAND AND NATURAL RESOURCES COMMISSION ON WATER RESOURCE MANAGEMENT POBOX 621 HONOLULU HI 96809
A~ten: Lenore Nakama
RE: STATE WELL NO.: 1120-17 & 18 MOLOAA-DANIELS 1 MOLOAA, KAUAI, HAWAII
Dear Ms. Loui:
~g u:I -I
~~ ; c:::=- ~~ rna CJ)
., . ., :3;,~ ., i'11 r"l'1' ~::x>. f"4
In response to your letter dated April 14, 1997, please be advised that based on the information provided, PR Drilling Co. (PRO) is unable to find records pertaining to this project. If the landowner knows the job number which PRO assigned to this project, please have them provide same to the undersigned so that we may search our records more thoroughly. In addition, if the owner could provide us with a photocopy of the canceled check that was used to pay PRO for its services, this may also assist us in tracking information about this project.
Should you have any questions in the interim, please contact the undersigned at 622-2631.
Very truly yours,
PR DRILLING COMPANY
Richard Thies President
EXPLORATION DRILLING • ENVIRONMENTAL SERVICES • TEST BORING • CONCRETE DRILLING • GROUTING
BENJAMIN J. CAYETANO GOVERI'JOR OF HAWAII
Mr. Richard Thies P.R. Drilling Company 235 Kellog Street Wahiawa, HI 96786
Dear Mr. Thies:
HONOLULU, HAWAII 96809
APR 14 \997
Well Completion Reports for Well Nos. 1120-17 & 18 Tax Map Key 4-9-14-20. Moloaa. Kauai
MICHAEL D. WILSON ClWRP£RSON
ROBERT G. GIRALD DAVID A. NOBRIGA
LAWRENCE H. MilKE RICHARD H. COX
HERBERT M. RICHARDS, JR.
RAE M. LOUI, P.E. DEPUTY
We received the attached well completion reports for Well Nos. 1120-17 & 18. The landowner/permittee has completed it to the best of his ability, however, vital information regarding the well construction/pump installation is missing.
We understand that the work was performed by P.R. Drilling (under Paul Kuchler) in 1993-1994. We are hopeful that some of the old records still exist in your files and request your help in providing additional well construction/pump installation information.
please fill in as much information as may be available in your files and return the forms to our office. Thank you in advance for your help and attention to this matter.
If you have any questions, please contact Lenore Nakama at 587-0218.
LN:ss Attachments
;)_,;)1-- 97
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. ""'77 ...,-~ 11·' ~ .~)J+ IE: [)F IT,4I.Of+I I -V/f;ti R:" (' t "ll' 11 "56 ) " d ~ fcC t<.)Afel:: {,,7 L~ R _ ' / _ ~-, / s -: ;-::': 2
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I • I
("j 0 Wate of Hawaii COMMISSION ON WATER RESOURCE MANAGEMENT Department of Land and Nat&il'Resottrces
WELL COMPLETION: REPc9RTA 8: 02 3/20/16 WCR Form
(Check Appropriate Box) l2tWell Construction Wermanent) Pump Installatio j'(6 Pur1.jJ .J Instructions: Please print or type and submit completed report within 30 days after welt-C:omplEitibn tty the Commission on Water Resource Management, P.O. Box 621, Honolulu, Hawaii 96809. An as-built drawing of tl'lE!well aod ,chemical analysis should also be submitted. For assistance call the Commission Regulation Branch at 587-0225, or 1-800-468-4644 Extension 70225. " , •
1. State Well No.: 1120-18 Well Name: Moloaa-Oanjels 2 Island: .... K~a ... y ... a .... i ____ _ 2. Location/Address: ..IMlU.o~lllOo:llai.lila.L. • .I.lKlilllai.liluilla.L.i ____________ _ Tax Map KeY:..::l4t;;l-9~-.L:14:E;;-a.l20L-__ _
WEL.t..CQNSTRUe"l"IPNRapORW<' ' ................................................................
Drilling Company: ) (.4,. .• -::) .~t;-kt:AJ...j)C"t"- .::;;-::; 'A1!//.:jI!t.'A I
Name of driller who performed work: ' lEv f~ -x(.E:' 1./1~ 71: 7 f b Type of rig/construction: Rc-' """'\/. ("7c,Z/'o/'tE..1 Date(s) Well Construction and pu p tests (if any) completed: -, r/;leoA ) GROUND ELEVATION (referenced to mean sea level, msl): ft.
Well Bench Mark (descriptionllocation): Elevation(msl): ft. 8. DRILLER'S LOG: Please attach geologic log (if available or if required by permit)
Depths (ft.) Rock Description, Water Level, Dates, etc. Depths (ft.) Rock Description, Water Level, Dates, etc.
to to to to
(If more space is needed, continue on back.)
9. Total depth of well below ground: '7 G' ft. 10. Hole size: inch dia. from ______ ft. to ft. below ground
______ inch dia. from ft. to ft. below ground __ ..,---___ inch dia. from ft. to ft. below ground
11. Casing installed: '-I in. I. D. x ___ in. wall solid section to ______ ft. below ground ____ in. I.D. x in. wall perforated section to ft. below ground
Casing Material/Slot Size: __ f_''T_,,7_, ....;~~ ______ _
12. Annulus: Grouted from ________ ft. below ground to _____ ft. below ground Gravel packed from ft. below ground to ft. below ground
13. Initial water level: ft. below ground. Date and time of measurement: _______ _ 14. Initial chloride: ppm Date and time of sampling: ________ _ 15. Initial temperature: of Date and time of measurement: _______ _ 16. PUMPING TESTS: Reference Point (R.P.) used: _________ , which eievation is ft.
(1) Step-Drawdown Test Date (2) Long-term Aquifer Test Date ____ _ Start water level ft. below RP. Start water level End water level ft. below RP. End water level
17. Aquifer Pump Test Procedures data & graphs (119196 LTAT Form) attached? _ Yes 18. As-built drawings attached attached? _ Yes _ No 19. Other remarks/comments: (On back of this form)
_____ ft,. below RP. _____ ft,. below RP.
No
Signature Date ____________ _
Surveyor (print)
!PARTIL' (PISRMANI;NT) < PUMP .IHS'TALLAl'ION"RE"ORT I 20. Pump Installation Company: 21. Name of person performing work: 22. Date Pump Installation Completed: 23. PUMP INSTALLATION:
Pump Type, Make, Serial No.: Capacity: gpm Motor type, H.P., Voltage, rpm: Depth of Pump Intake Setting ft. below , which elevation is ft. Depth to bottom of airline ft. below , which elevation is ft Pumping Head is ft. Type of flow meter: which measures in
24. As-built drawings attached attached? _ Yes No - 25. Other remarks/comments: (See below)
Pump Installation Contractor (print) C-57 Lic. No.
Signature Date
Applicant (print)
Signature Date
8.(cont'd) DRILLER'S LOG (cont'd):
Water Level Depth (ft.) Rock Description, Remarks, Water Level Depth (ft.) Rock Description, Remarks, Dates (ft.) Dates (ft.) ____ to ____________________________ __ ____ to ________________________ __ ____ to ____________________________ __ ____ to ____________________________ __
____ to ____________________________ __ ____ to ____________________________ __ ____ to ____________________________ __ ____ to ____________________________ __ ____ to ____________________________ __
"-/:}' -If" /,-. 19.& 25. Remarks:>- to. '-- ~ t- .. :-.I... ".\
, .':,. I I /: r"- // (,' i)J ~ {:-,'l ' ( ! i_," I· ~ -',f, .' I ,) _ !-
__ __ to _______________________ __
____ to _________________________ __
[ . 1\/ fl'u J/) lcv{T ,I.c' 7' /). Ilj () iC~ '7 ( J 'ii/ l / 11/'- ) r" 7-11.'(':) /':} c:: 12/1
( ___ ~-,'_o - f i,
( I
Q 0 "tate of Hawaii COMMISSION ON WATER RESOURCE MANAGEMENT Department of Land and NaturcH Resources
f' 'e. r:-"-;-, f"\-
WELL COMPLETION REPORT P. 8: 02 3120/96 WCR Form
(Check Appropriate Box) I2t\iVeIl Construction ~rmanent) Pump Installation 1 ." L ,
Instructions: Please print or type and submit completed report within 30 days after'well completion to the Commission on Water Resource Management, P.O. Box 621, Honolulu, Hawaii 96809. An as-built drawing of the well and chemical analysis shQuld also be submitted. For assistance call the Commission Regulation Branch at 587-0225, or 1-800-468-4644 Extension 70225.
1. State Well No.: 1120-17 Well Name: Moloaa-paniels 1 Island: ..... K~a .... y .... at.L.i ____ _ 2. Location/Address: ... M .... o.,..l .... o""a ... a .......... K ... au...,a ... i'--___________ _ Tax Map Key:....;;4~-9L-;..L1;;::.4-;;tI2LXO ___ _
1I·.PARl'l.>.i .. ...........
Wi~~GONSTRUC1'IONR~P()R'I' > ····1
3. Drilling Company: t:1f'. aRI,J.)..jNq ~o . .;7 3-:';-!(~.L.t-t>(r 5'/. l lA.~/)-lflJ}-wlt If / tl7g-:b 4. Name of driller who perfw,ed work:~O(ecre- PRE'//"')4' ... .jJ > /
5. Type of rig/construction: t/A-'<?'Y fTRti Ct'\.... i"'70';~f') ..)
6. Date(s) Well Construction and pump tests (if any) completed: G/.- 9 "'1 (firrX't:Jj[, 7. GROUND ELEVATION (referenced to mean sea level, msl): I~ ft.
Well Bench Mark (descriptionllocation): Elevation(msl): ft. B. DRILLER'S LOG: Please attach geologic log (if available or if required by permit)
Depths (ft.) Rock Description, Water Level, Dates, etc. Depths (ft.) Rock Description, Water Level, Dates, etc.
to to -- -- -- -- to to -- -- -- --
(If me;;, sPJce is needed, continue on back.)
Total depth of well below ground:· ft. 10. Hole size: inch dia. from ft. to ft. below ground
inch dia. from ft. to ft. below ground inch dia. from ft. to ft. below ground
11. Casing installed: ~ in. 1.0. x in. wall solid section to ft. below ground in. 1.0. x ,d~)Ve" perforated section to ft. below ground
Casing Material/Slot Size:
12. Annulus: Grouted from ft. below ground to ft. below ground Gravel packed from ft. below ground to ft. below ground
13. Initial water level: ft. below ground. Date and time of measurement: 14. Initial chloride: ppm Date and time of sampling: 15. Initial temperature: of Date and time of measurement: 16. PUMPING TESTS: Reference Point (RP.) used: , which elevation is ft. '
(1) Step-Drawdown Test Date (2) Long-term Aquifer Test Date
Start water level ft. below RP. Start water level ft. below R. P. End water level ft. below RP. End water level ft. below R. P.
17. Aquifer Pump Test Procedures data & graphs (1/9/96 LTAT Form) attached? _ Yes No - 18. As-built drawings attached attached? _ Yes - No 19. Other remarks/comments: (On back of this form)
Well Drilling Contractor (print) C-57 Lic. No.
Signature Date
. . ....
(PER-MANENT) PUMP INSTALLATIONREPORT<> 20. Pump Installation Company: _---"'....-____ ......... ,....---.---........,......,........ __ _ 21. Name of person performing work: C\'ti.{'f-f . .iU, '1>1+4: 1'5:i- '\ 22. Date Pump Installation Completed: ____________ _
23. PUMP INSTALLATION:) _ _.r' / '('\ ," /7) Pump Type, Make, Serial No.: SkftR. \ tt f-,jti ()/1EI'oi?~~ Capacity: __ I_'L_'_ gpm
Motor type, H.P., Voltage, rpm: jill~~:::::' :;,)~~-----r----------------- Depth of Pump Intake Setting I t: ft. below (;. A. , , which elevation is _______ ft. Depth to bottom of airline ft. below , which elevation is ft Pumping Head is ft. Type of flow meter: which measures in ____ _
24. As-built drawings attached attached? __ Yes ...::::~N6 25. Other remarks/comments: (See be/ow)
Pump Installation Contractor (print) ____________ C-57 Lic. No. ____________ __
Signature Date _____________ __
Applicant (print)
Signature
8. (r,ont'd) DRILLER'S LOG (cont'd): Water Level Depth (ft.) Rock Description, Remarks,
Dates (ft.) __ to ______________ _ __ to ______________ _ __ to ________________ _ __ to _______________ _
__ to _______________ _ __ to _______________ _ __ to ________________ _ __ to _______________ _
Date ________________________ __
Water Level Depth (ft.) Rock Description, Remarks, Dates (ft.) __ to ______________ _ __ to _______________ _ __ to _________________ _ __ to ________________ _
to __to ______________ _ __to _______________ _ __to _______________ _
GOVERNOI\ OF HAWAII
LAWRENCE H. MilKE
HERBERT M. RICHARDS, JR.
DEPARTMENT OF LAND AND NATURAL RESOURCES COMMISSION ON WATER RESOURCE MANAGEMENT
P. O. 80X621
Mr. Douglas f. Daniels P.O. Box 539 Anahola, HI 96703
Dear Mr. Daniels:
HONOLULU, HAWAII 96809
FEB 18 1997
Moloaa, Kauai
Our records show that well construction/pump installation pennits were issued for the subject wells on November 9, 1993 (attached).
Since we did not receive any written notice of the start of work (Standard Condition 1) for the subject wells, we assume that no work was done under these permits, which have expired. Be advised that new applications for well construction/pump installation permits must be made and approved by the Commission on Water Resource Management prior to any future well construction or pump installation work.
DEPUTY
In the event that the wells were constructed and pumps were installed under the permits, please submit the following items that are required under Standard Condition 5 within thirty (30) days from the date of this letter:
a. Well Completion Report (fonn enclosed). b. Elevation (referenced to mean sea level) survey by a Hawaii-licensed surveyor. c. As-built sectional drawing of the well. d. Plot plan and map showing the exact location of the well. e. Complete pumping test record; including time, pumping rate, drawdown, chloride
content, and water quality data.
Be advised that failure to comply with the terms of your permit may result in daily fines of up to $1000.
If you have any questions, please contact Lenore Nakama at 587-0218 or toll-free at 274-3141, extension 70218.
LN:ss Enclosure
JOHNWAIHEE
COMMISSION ON WATER RESOURCE MANAGEMENT
P.O. BOX 621
HONOlULU. HAWAII 96809
HUV - 9 1993
J. DOUGLAS ING. Esa. RICHARD H. COX. P.E.
GUY K. FUJIMURA
RAE M. LOUI. P.E. OEPUTY
The Commission on Water Resource Management (Commission), on October 27, 1993, took action on six permits for the construction, testing, and installation of pumps in wells at Moloaa Bay, Kauai.
The Commission considered denying the permits due to the possibility of contamination of the wells from nearby cesspools and! or septic tanks. Alternatives were discussed, such as connecting to the Department of Water's system or the formation of a private water system to serve all of the residents in the area. Since some of the issues raised are not within the jurisdiction of the Commission, and since property owners have the right to drill a well on their own property, the Commission reluctantly approved the permits, with the condition that the applicants, other users in the area, and State and County officials be notified of the Commission's concerns. By this letter we are so notifying you.
We will discuss this matter with State and County officials to determine if the Commission can be of assistance in any way.
Very truly yours,
~~~ KEITH W. AHUE
cc: State Department of Health Environmental Management Division Environmental Health Services Division
County of Kauai, Dept. of Public Works County of Kauai, Dept. of Water
JOHN WAIHEE
\ \ \
n'::J \rnH '>9 AID.' .1.1 I]J iU'f C. '1 '1 STATE OF HAWAII
DEPARTMENT OF HEALTH P. O. BOX 3378
r , t<t . r HONOLULU. HAWAII 96801
November 18, 1993
Mr. Keith W. Ahue, Chairperson commission of Water Resource Management P. o. Box 621 Honolulu, Hawaii 96809
Dear Mr. Ahue:
File:
Thank you for transmitting a copy of the letter addressed to Moloaa Water Users concerning the construction, testing and installation of well pumps at Moloaa Bay, Kauai. Since drilling of wells are viable alternatives, we wish to specifically address the concerns pertaining to potential noise impacts from such activities.
Noise and vibration associated with drilling operations can have adverse effects on the residential communities. since background (or environmental) sound levels are anticipated to be extremely low within the Moloaa Bay area of Kauai, noise emanating from such an operation can definitely be a potential nuisance. Noise monitoring of similar activities have resulted in sound levels of 65 - 70 dBA at a distance of approximately 50 feet.
In terms of regUlating such activities, there are currently no regUlations pertaining to vibration. The Department of Health has the authority to regulate excessive noise levels through its noise rules, however, these rules are presently applicable only to the island of Oahu. The department has proceeded with the development of a draft statewide noise rules and is proceeding toward adoption of these rules.
~/f
I . .....
Mr. Keith W. Ahue Page 2 November 18, 1993
Although our current authority on noise control does not extend to the neighbor islands, we wish to take this opportunity in recommending that mitigative actions be implemented to reduce potential excessive noise levels from drilling operations. Such actions may include adequate muffling and coverings on drill rig engines, restrictions on hours of drilling operations, establishment of buffer zones between the drilling activity and impacted residents, as well as, developing an effective communication program, informing the impacted community of the proposed activities.
We emphasize that the health and well-being of the residential community should be an important consideration in terms of possible noise impacts resulting from such construction activities. In absence of rules regulating noise disturbances on Kauai from such operations, we are recommending that positive measures be considered in minimizing potential noise problems.
Should you have any questions or require additional information, please call me at 586-4576 or Mr. Jerry Y. Haruno, Environmental Health Program Manager, Noise and Radiation Branch, at 586-4701.
Very truly yours,
Environmental Health Services Division
JOHNWAIHEE GOVERNOR OF HAWAII
COMMISSION ON WATER RESOURCE MANAGEMENT
P.O. BOX 621
HONOlULU. HAWAII 96809
for
MQloaa. Kauai
J. DOUGLAS ING. ESQ. RICHARD H. COX. P.E.
GUY K. FUJIMURA
TO: Douglas I. Daniels P.O. Box 539 Anahola, HI 96703
In accordance with the Department of Land and Natural Resources Administrative Rules, Section 13-168, entitled "Water Use, Wells, and Stream Diversion Works", your application to construct, test, and install a pump in Moloaa-Daniels WeIll (Well No. 1120-17), for domestic use, is approved subject to the following conditions:
1.
2.
3.
4.
5.
6.
The Commission on Water Resource Management (Commission), P.O. Box 621, Honolulu, HI 96809, shall be notified, in writing, before any work covered by this permit commences.
The permit shall be for construction, testing, and installation of a 10 gpm capacity, or less, pump in the well. The applicant shall submit the test results and permanent pump information to the Commission.
The proposed use shall not adversely affect existing or future legal uses of water in the area, including any surface water or established instream flow standards. This permit or the authorization to construct and pump water from the well shall not constitute a determination of correlative water rights. The permittee is notified and by this provision understands that the quantity of water taken from the well could be reduced by the Commission in the future. This permit is not a commitment that the pump capacity permitted here or even some lesser amount is guaranteed in the future.
The applicant shall comply with all applicable laws, rules, and ordinances.
The applicant shall not be required to measure and report monthly water use if the quantity of use (averaged over a one-year period) remains below 50,000 gallons per month.
The following shall be submitted to the Commission within 30 days after completion of the work:
a. Well Completion Report.
b. Elevation (referenced to mean sea level) survey by a Hawaii-licensed surveyor.
c. As-built sectional drawing of the well.
\ \
o WELL CONSTRUCTION AND PUMP INSTALLATION PERMIT Well No. 1120-17
d. Plot plan and map showing the exact location of the well.
Page 2
e. Complete pumping test record; including time, pumping rate, drawdown, chloride content, and water quality data.
7. The 1?ermit application and staff submittal approved by the Commission at its meettng on October 27, 199~ shall be incorporated herein by reference.
8. This permit may be revoked if work is not started within six months of the date of issuance or if work is suspended or abandoned for six months. The work proposed in the permit application shall be completed within two years from the date of permit approval.
9. Water from the well shall not be used for drinking water unless properly tested and treated.
10. The applicant shall contact the State Historic Preservation Division (Telephone: 587-0047) before starting any work on the project. The applicant shall obtain a written statement from the State Historic Preservation DiVISIon indicating that their concerns have been addressed, and a copy of that statement shall be sent to the Commission befor~ work is started on the project.
Date of Issuance
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.
Applicant's Signature: __________ Date: ____ _
Finn or Title: ___________________ _
Please sign and return one copy of this permit to the Commission and retain a copy for your record.
cc: USGS Department of Health
Safe Drinking Water Branch Ground Water Protection Program Wastewater Branch
Kauai Department of Water State Historic Preservation Division P.R. Drilling
JOHNWAIHEE GOVERNOR OF HAWAII
COMMISSION ON WATER RESOURCE MANAGEMENT
P.O. BOX 621
HONOLULU, HAWAII 96809
for
Moloaa. Kauai
J. DOUGLAS lNG, ESQ. RICHARD H. COX, P.E.
GUY K. FUJIMURA
TO: Douglas I. Daniels P.O. Box 539 Anahola, HI 96703
In accordance with the Department of Land and Natural Resources Administrative Rules, Section 13-168, entitled "Water Use, Wells, and Stream Diversion Works", your application to construct, test, and install a pump in Moloaa-Daniels Well 2 (Well No. 1120-18), for domestic use, is approved subject to the following conditions:
1.
2.
3.
4.
5.
6.
The Commission on Water Resource Management (Commission), P.O. Box 621, Honolulu, HI 96809, shall be notified, in writing, before any work covered by this permit commences.
The permit shall be for construction, testing, and installation of a 10 gpm capacity, or less, pump in the well. The applicant shall submit the test results and permanent pump information to the Commission.
The proposed use shall not adversely affect existing or future legal uses of water in the area, including any surface water or established instream flow standards. This permit or the authorization to construct and pump water from the well shall not constitute a determination of correlative water rights. The permittee is notified and by this provision understands that the quantity of water taken from the well could be reduced by the Commission in the future. This permit is not a commitment that the pump capacity permitted here or even some lesser amount is guaranteed in the future.
The applicant shall comply with all applicable laws, rules, and ordinances.
The applicant shall not be required to measure and report monthly water use if the quantity of use (averaged over a one-year period) remains below 50,000 gallons per month.
The following shall be submitted to the Commission within 30 days after completion of the work:
a. Well Completion Report.
b. Elevation (referenced to mean sea level) survey by a Hawaii-licensed surveyor.
c. As-built sectional drawing of the well.
- o WELL CONSTRUCTION AND PUMP INSTALLATION PERMIT Well No. 1120-18
Page 2
7.
8.
9.
10.
d. Plot plan and map showing the exact location of the well.
e. Complete pumping test record; including time, pumping rate, drawdown, chloride content, and water quality data.
The 1?ermit application and staff submittal approved by the Commission at its meenng on October 27, 1993 shall be incorporated herein by reference.
This permit may be revoked if work is not started within six months of the date of issuance or if work is suspended or abandoned for six months. The work proposed in the permit application shall be completed within two years from the date of permit approval.
Water from the well shall not be used for drinking water unless properly tested and treated.
The applicant shall contact the State Historic Preservation Division (Telephone: 587 -004 7) before starting any work on the project. The applicant shall obtain a written statement from the State Historic Preservation DiVlSlon indicating that their concerns have been addressed, and a copy of that statement shall be sent to the Commission before work is started on the project.
KEITH W. AHUE, Chairperson Commission on Water Resource Management
NOV - 9 1993 Date of Issuance
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.
Applicant's Signature: __________ Date: ____ _
Firm or Tide: ___________________ _
Please sign and return one copy of this permit to the Commission and retain a copy for your record.
cc: USGS Department of Health
Safe Drinking Water Branch Ground Water Protection Program Wastewater Branch
Kauai Department of Water State Historic Preservation Division P.R. Drilling
JOHNWAIHEE GOVERNOR OF HAWAII
, . tf -'- 'P.O: ~OX 621 .,-
J. DOUGLAS lNG, ESQ. RICHARD H. COX, P.E.
GUY K. FUJIMURA
Mr. Thomas Arizumi, Chief Envirorunental Management Division State Department of Health
SAFE DRINKING WATER BRANCH
Five Waterfront Plaza 500 Ala Moana Blvd., Suite 250 Honolulu, Hawaii 96813
Attn: Mr. William Wong
Well Construction and Pump- Installation Permit Applications
I Pleasf- :J;eview the following pennit applications and submit your comments to us by
~OV - 4 1993 .
Island Well Name Well No. Ap p Ii ca ti 0!l1:.YJ2.~
Kauai Moloaa-Sparks 2 1120-13 Well Construction Kauai Moloaa-Mattson 2 1120-14 Well Construction Kauai Moloaa -Littlefield 1120-15 Well COllstruction Kauai Moloaa-Boiser 1120-16 Well Construction Kauai Moloaa-Daniels 1 & 2 1120-17 & 18 Well Construction
Should you have any questions, please contact the Commission on Water Resource Management staff at 587-0225.
JZ:ky Enc.
~at~ IRAE M. Lour ~eputy Director
Response: ( ) We have no comments ( ) We have no objection~; 1)<) Comments attached ( ) Additional information requested ( ) Extended review period requested
Contact Person: _~_
Page No. 10/19/93 MOLOAA WELL . ISLAND OF KAUAI
SITECOOE SAMPLEDATE SAMPLETIME SAMPLEAGEN LABNAME LAB NUMBER TESTDATE COMPOUND CONCENTRAT DETECTlIM RECOVERY NOTES TREATMENT CONFIRM ENTRYDATE 2091120001 07/13/81 0830 DOH P7-1-131 07/22/81 DBCP 0.211 0.020 2091120001 07/30/81 1220 UH / / DBCP 2091120001 07/18/83 0.18 0.020 0942 DOH P7-3-79 6273360003
07/19/83 DBCP 0.19 0.020 65.0
N
N
N
CF PC PC
Reference is made to your letter dated October 14, 1993, concerning wells being drilled in the Moloaa area, Wells No. 1120-13 to 18.
A notice should be sent to the persons planning to drill in the sources in this area. The owner of any new well(s) should have contaminants before the water is used for domestic consumption. exceeded drinking water maximum contaminant levels.
Moloaa area, that DBCP has been found in the well(s) tested for drinking water
Besides DBCP, levels of nitrates have
""If you "ha~e; "a:Iiy ""questions, please call William Wong, Chief, Safe Drinking Water Branch at 586-4258.
12/31/87 12/31/87 12/31/87
PHONE NO: (808) 245-6986 FAX NO. 245-5813
November 1, 1993
Ms. Rae M. Loui Deputy Director DLNR - COWARM P. O. Box 621 Honolulu, HI 96809
Re: Well Construction and Pump Installation Permit Applications for Moloaa-Sparks Well 2, Moloaa-Mattson Well 2, Moloaa-Littlefield Well, Moloaa-Boiser Well and Moloaa-Daniels Well 1 and 2
We have no objections to these Well Construction and Pump Installation Permit Applications.
remiah M. Kaluna cting Manager and Chief Engineer
..•.. !
..... ';
DEPARTMENT OF LAND AND NATURAL RESOURCES STA.TE HISTORIC PRESERVA.TION DIVISION
33 SOUTH KING STREET. 6TH FLOOR
HONOLULU. HAWAII 96813
November I, 1993
MEMORANDUM
TO:
FROM
Rae M. Loui, Deputy Director & Edward Sakota Commission on Water Resource Management
!IF Don Hibbard, Administrator State Historic Preservation Division
KEITH AffiJ'K.ClWllrERSON BOARD Of lAND AND NATU/\AI. RESOURCE
0EP\ITIE8
AQUACULTURE DEVELOPMENT
, REBOUAO!ft"ENFORCEMENT
CONVEYANCE8
, DlVI&ION LAND M~AGEMENT •• 8T AtE PAl'llt1
C'tJ~~~~PMENT DOC~N6 931 ONM 19
SUBJECT: Historic Preservation Review -- Application for Well Construction & Pump Installation Permit Application Well No. 1120-13 (Moloaa - Sparks 2) Well No. 1120-14 (Moloaa - Mattson 2) Well No. 1120-15 (Moloaa - Littlefield) Well No. 1120-16 (Moloaa - Bosier) Well No. t t 20- t 7 & 18 (Moloaa - Daniels) Moloaa, Kawaihau, Kauai
We have reviewed the above pennit applications. No archaeological surveys have taken place in any of the projects area, so we are uncertain if significant historic sites are present. If the land is altered, then sites may not be present. However, if the land is unaltered then sites could be present. A review of our files indicates that several burials sites and possible abandoned taro pondfields exist nearby. This makes it likely that historic sites are present, if the land is not disturbed.
Given this infonnation we recommend two alternatives to all of these pennits. One, if the land is unaltered:
To insure that no significant historic sites are present, i.e., buried cultural deposits or human remains, a qualified archaeologist shall monitor the ground disturbing activities associated with the well construction. Soil core samples shall be taken for analysis. A report on the findings shall be submitted to the State Historic Preservation Office for review and approval. All work must stop in the area if intact human burials are found.
Alternatively, if a well site has had its land surface extensively disturbed in the past, the applicant should submit a description of the disturbance, so we can process a "no effect" detennination.
If you have any questions, please call Ms. Nancy McMahon at 587-0006.
NM:amk
c
HONOLULU. HAWAII 96805
October 25, 1993
The Honorable Keith W. Ahue, Chairperson Commission on water Resource Management Department of Land and Natural Resources P. O. Box 621 Honolulu, Hawaii 96809
Dear Mr. Ahue: Well & Pump Permits
('," ~ ~ :
HAWAIIAN HOMES COMMISSION
'f
Thank you for the opportunity to respond to the following Kaua'i applications:
Moloaa-Sparks 2 (1120-13) Moloaa-Mattson 2 (1120-14) Moloaa-Littlefield (1120-15) Moloaa-Boiser (1120-16) Moloaa-Daniels 1 & 2 (1120-17, 18)
These are not expected to affect Hawaiian home lands; we have no specific objections. We note that, with the addition of these wells, the overall density of withdrawals is significantly increased. While no pumps are proposed to withdraw large amounts, it would aappear that groundwater management must begin to scrutinize them carefully.
HLD:BH:ci
Warmest aloha,
!II' #Idt; A m ~j . J6~kU L.~~?Chalrman Hawaiian Homes Commission
Commission on Water Resource Management Honolulu, Hawaii
OCT 1 4 1993
u{ Henry M. Sakuda, Administrator /Oi:.ision of Aquatic Resources
Rae M. Loui, Deputy Directo Commission on Water Resour
- ---------- ~-.---
Olv. of Aouatlc ~Otlrt~ SUBJECT: Well Construction & Pump Installation Permit Applications
Please review the following permit applications and submit your comments to us by NOV -4 1993
Island Well Name Well No. Application Type
Kauai Moloaa-Sparks 2 1120-13 Well Construction Kauai Moloaa-Mattson 2 1120-14 Well Construction Kauai Moloaa-Littlefield 1120-15 Well Construction Kauai Moloaa-Boiser 1120-16 Well Construction Kauai Moloaa-Daniels 1 & 2 1120-17 & 18 Well Construction
Should you have any questions, please contact the Commission on Water Resource Management staff at 587-0225.
JZ:ky Enc.
Response: ( ) We have no comments m We have no objections ( ) Comments attached ( ) Additional information requested ( ) Extended review period requested
Contact Person: ___________ _
JOHNWAIHEE GOVERNOR OF HAWAII
COMMISSION ON WATER RESOURCE MANAGEMENT
Mr. Douglas I. Daniels P.O. Box 539 Anahola, Kauai, HI 96703
Dear Mr. Daniels:
P.O. BOX 621
HONOLULU, HAWAII 96809
OCT 1 4 1993
We have received your applications and filing fee for pennits to construct Moloaa-Daniels 1 & 2 Wells (Well Nos. 1120-17 & 18) at Moloaa, Kauai, (TMK 4-9-14:20). We are reviewing the applications for completeness.
Should you have questions, please call the Commission on Water Resource Management staff at 587-0225.
Sincerely,
J. DOUGLAS lNG, ESQ. RICHARD H. COX, P.E.
GUY K. FUJIMURA
JOHNWAIHEE GOVERNOR OF HAWAII
COMMISSION ON WATER RESOURCE MANAGEMENT
P.O. BOX 621
HONOLULU, HAWAII 96809
J. DOUGLAS lNG, ESQ. RICHARD H. COX, P.E.
GUY K. FUJIMURA !
OCT 1 5 1993
Honorable Hoaliku L. Drake, Director Department of Hawaiian Horne Lands
Mr. Clayton H.W. Hee, Chairman & Trustee At Large Office of Hawaiian Affairs
Keith w. Ahue, ChaiIperso~ Well Construction & Pump Installation Permit Applications
Please review the following permit applications and submit your comments to us by NOV - 5 1993 .
Island Well Name Well No. Application Type
Kauai Moloaa-Sparks 2 1120-13 Well Construction Kauai Moloaa-Mattson 2 1120-14 Well Construction Kauai Moloaa-Littlefield 1120-15 Well Construction Kauai Moloaa-Boiser 1120-16 Well Construction Kauai Moloaa-Daniels 1 & 2 1120-17 & 18 Well Construction
Should you have any questions, please contact the Commission on Water Resource Management staff at 587-0225.
JZ:ky Enc.
Response: ( ) We have no comments ( ) We have no objections ( ) Comments attached ( ) Additional information requested ( ) Extended review peri~d requested
Contact Person: ________________________ __
o State of Hawaii
DEPARTMENT OF LAND AND NATURAL RESOURCES Commission on Water Resource Management
Honolulu, Hawaii
Mr. Henry M. Sakuda, Administrator Division of Aquatic Resources
Rae M. Loui, Deputy Directo Commission on Water Resour
Well Construction & Pump Installation Pennit Applications
Please review the following pennit applications and submit your comments to us by NOV -4 1993 .
Island Well Name Well No. Application Type
Kauai Moloaa-Sparks 2 1120-13 Well Construction Kauai Moloaa-Mattson 2 1120-14 Well Construction Kauai Moloaa-Littlefield 1120-15 Well Construction Kauai Moloaa-Boiser 1120-16 Well Construction Kauai Moloaa-Daniels 1 & 2 1120-17 & 18 Well Construction
Should you have any questions, please contact the Commission on Water Resource Management staff at 587-0225.
JZ:ky Ene.
Response: ( ) We have no comments ( ) We have no objections ( ) Comments attached ( ) Additional information requested ( ) Extended review period requested
Contact Person: ___________ _
DEPARTMENT OF LAND AND NATURAL RESOURCES
COMMISSION ON WATER RESOURCE MANAGEMENT
J. DOUGLAS lNG, ESQ. RICHARD H. COX, P.E.
GUY K. FUJIMURA
P.O. BOX 621
HONOLULU, HAWAII 96809
RAE M. LOUI, P.E.
Mr. Raymond Sato Manager & Chief Engineer Department of Water County of Kauai 4398 Pualoke Street Lihue, HI 96766
Dear Mr. Sato:
OCT 18 1993
Well Construction and Pump Installation Permit Applications
... Please review the following permit applications and submit your comments to us by _){QV f 8 199J \ .
Island Well Name Well No. ApQlication TYJ2e
Kauai Moloaa-Sparks 2 1120-13 Well Construction Kauai Moloaa-Mattson 2 1120-14 Well Construction Kauai Moloaa-Littlefield 1120-15 Well Construction Kauai Moloaa-Boiser 1120-16 Well Construction Kauai Moloaa-Daniels 1 & 2 1120-17 & 18 Well Construction
Should you have any questions, please contact the Corrunission on Water Resource Management staff at 587-0225.
JZ:ky Ene.
Response: ( ) We have no comments ( ) We have no objections ( ) COllunents attached
Sincerely,
DEPUTY
COMMISSION ON WATER RESOURCE MANAGEMENT
Mr. Thomas Arizumi, Chief Environmental Management Division State Department of Health Five Waterfront Plaza 500 Ala Moana Blvd., Suite 250 Honolulu, Hawaii 96813
Attn: Mr. William Wong
J. DOUGLAS ING. ESO. RICHARD H. COX. P.E.
GUY K. FUJIMURA
Well Construction and Pump Installation Permit Applications
N Pleas~ :.;eYiew the following permit applications and submit your comments to us by
OV - 4 199J .
Kauai Moloaa-Sparks 2 1120-13 Well Construction Kauai Moloaa-Mattson 2 1120-14 Well Construction Kauai Moloaa-Littlefield 1120-15 Well Construction Kauai Moloaa-Boiser 1120-16 Well Construction Kauai Moloaa-Daniels 1 & 2 1120-17 & 18 Well Construction
Should you have any questions, please contact the Commission on Water Resource Management staff at 587-0225.
JZ:ky Enc.
~~ M. LOUI eputy Director
Response: ( ) We have no comments ( ) We have no objections ( ) Comments attached ( ) Additional information requested ( ) Extended review period requested
Contact Person: ____________ _
COMMISSION ON WATER RESOURCE MANAGEMENT
Ms. MaIjorie Ziegler Sierra Club Legal Defense Fund, Inc. 212 Merchant Street, Room 202 Honolulu, Hawaii 96813
Dear Ms. Ziegler:
P.O. BOX 621
HONOLULU, HAWAII 96809
OCT 14 1993
J. DOUGLAS ING. ESQ.
RAE M. LOUI, P.E. OEPUTY
Well Construction and Pump Installation Permit Applications
NOVle~si 19~ew ~le following permit applications and submit your comments to us by
Island Well Name Well No. Application Type
Kauai Moloaa-Sparks 2 1120-13 Well Construction Kauai Moloaa-Mattson 2 1120-14 Well Construction Kauai Moloaa-Littlefield 1120-15 Well Construction Kauai Moloaa-Boiser 1120-16 Well ConslTuction Kauai Moloaa-Daniels 1 & 2 1120-17 & 18 Well Construction
Should you have any questions, please contact the COllunission on Water Resource Management staff at 587-0225.
JZ:ky Ene.
Response: ( ) We have no comments ( ) We have no objections ( ) Comments attached
Sincerely,
Contact Person: ________________________ ___
P. O. BOX 539 PH. 822-~ ANAHOLA, HI 96703
" o 1- JD 19i4-
",.:." 1366 KUHIO HIGHWAY ',', KAPAA, KAUAI, HI 96746
'~r_~ -2 -~ ~JU.~"'--'!.1L""",~ O"""""""'~ 5---'~1--': ~-'5-~-2-S ~:" 2 b 0 &7~
DOUGLAS I. OR DOROTHY, J. , DANIELS 019-14-5520 552-34-1640 . P. O. BOX 539 PH. 822-3725 A ANAHOLA, HI 96703 '."
FIRST HAWAIIAN 1366 KUHIO HIGH Y KAPAA, KAUAI, HI 96746
531$ , j ,~
~~ '~ :.j ::1 '\
c o COMMISSION ON WATER RESOURCE MANAGEMENT Department of Land and Natul'llfRiSOU~;:) Division of Water Resource Management
S3 SET' 16 pf2: 09
APPLICATION FOR: 0 Well Construction or 0 ~um~lnstailat.LQPrPERMIT ",.' , "",' , ", - ", -,f::. " r~ s~ [~"... ~-.. ;: ~_,,~~ ;
Instructions: Please print or type and send completed application with attachments to the Dlv. 01 Water Resource Management, P.O. Box 373, Honolulu, Hawaii 96809. Appllcallon must be aocompanled by a non-relundable filing lee 01 $25.00 payable to the Dept 01 Land and Natural Resources. (Fnlng lee waived lor govemment agencies.) II neceuary, phone 548-7643, Hydrology/Geology Section lor assistance.
1. WELL LOCATIONINAME: 3.:57t/'16,L~JfIt !?DID, .vBt>'l~land !(&<IA-I
Addre •• /lO, 84x.5"3'1Molfo~fIz. ~67c8TaxMapKey 71·· r-/f.~;W (Attach a USGS map, scale 1-.2000', and a property tax map owing well location referenced to estabUshed property boundaries.)
2. (a) WELL OWNER: (b) LANDOWNER:
3.
4.
5.
Firm Name 'D-uM.A5 L. 1),q dies Firm Name ______________ _ Contact Person __ ---'-________ _ Con~ctPerson _______________________ __ Address _____________ _ Address _______________ _
PROPOSED CONTRACTOR:
Nam. ~ ?!(D ler 1.-./-./ r«r '? Coo1n1Ctor'. Ucon •• No. --........ ---,----.:-"7""-=-...".
Addressdm..~Cz: -:s.-r; ~/flWA:, fi ( z.(p '7 g-~ ph· 6..;ld. -,;l" 3{
PROPOSED WORK: ~New Well 0 Deepen 0 Redrll
o Alter 0 Seal 0 Abandon
o Instail New Pump 0 Replace Pump 0 Modify Pump
(Briefly describe the proposed work 8nd fill In the dlllgr8m on the b8Ck of this form.)
PROPOSED USE: o M~pal (Including hotels, stores, etc.) r e150mestic (Individual", noncommercial water sys.)
o Military
7. PROPOSED PUMP INFORMATION:
Motor: Rated Pump Capacity:
o Gas ~, at a rated horsepower of .... /'--__
Landowner (print)_,...;;S=" ;.;,.A-;-.-:..-~I_c:..~ ____ _
I ~
J)R(I-~ 10/1 !loLP
PROPOSED SECTION OF WELL
.... ;".-...--
:!i ! !, .
I :, I'
Wall thickness
I I Material Rock Packing: ft. II.. I I Length
I I Diameter \.- r--
Diameter
* Approximate elevation at time of filing application. Final elevation (msl) by a surveyor licensed by the State must be submitted at start of construction.
ft. in. in.
sq.inJLF .
in.
-' . .I '" o COMMISSION ON WATER ResoURCE MANAGEMENT Department of Land and Natural Resources Division of Water Resource Management
APPLICATION FOR: 0 Well Construction or 0 Pump Installation PERMIT
Instruction.: Please print or type and send completed application with attachments to the Dlv. of Water Resource Management, P.O. Box 373, Honolulu, Hawaii 96809. Application must be accompanied by a non-refundabie filing fee of $25.00 payable to the Dept of Land and Natural Resources. (Filing fee waived for govemment agencies.) If necessary, phone 548-7643, Hydrology/Geology Section for assistance.
1. WELL LOCATIONINAME: MD/...b c:4:tsland f.(,Q.q!:l:f
Address e. D , Bt) )\ Tax Map Key 1-9-1-t-~o (Attach a USGS map, scale 1-.2000', and a property tax map showing well location referenced to established property boundaries.)
2. (a) WELL OWNER: (b) LANDOWNER: Firm Name ____________ _ Firm Name ______________ _ Contact Person ___________ _
Con~ctPerson ________________________ _ Address _____________ _ Address ______________ _
3. PROPOSED CONTRACTOR:
Nwne B~~/~ Address~3J C f6'r:rU (%>'7 ff/. 1:x'tractor's Ucense No.
£23'6
4. PROPOSED WORK: 0 Drill New Well )?{Oeepen 0 RedriU
5.
o Install New Pump 0 Replace Pump 0 Modify Pump
(Briefly de.crlbe the propo .. d work and fill In the dlagreJii un the back of thl. form.)
PROPOSED USE: o Municipal (Including hotels, stores, etc.) , o Military
o Industrial
Jil Domestic (lndlvlduaf, noncommercial water sya.) o Irrigation (specify) _______ _
6. PROPOSED AMOUNT OF WITHDRAWAL: I~' 6 0 b gallons per day
7. PROPOSED PUMP INFORMATION:
Rated Pump Capacity:
Landowner (print} __ ~S""",' ~&.L.-IJ-,--L_-~ __ _
Drue ______________________________ _
Latltude, ______ _
Longitude'--_____ _
'!
: lkEfJel'l eX/Sl7dtf;
"
Elevation at top of casing: ~ ____ ft., msl.
Jl . - 1-,...- --=G~ro=u=n:.d -=E=le~va=ti=o=n:~_ ft.,msl* · , . ' · : . · .' · " " ' " ,; , ,
'Cement Grout: ft. I
Wall thickness
I I Material Rock Packing: ft. L\ I I If
I I Length
Diameter
-Approximate elevation at time of filing application. Final elevation (msl) by
, '),
",1- ') ,J
1 .... 10LOAA
0 f'P' // /
",. "I
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\. 1\" : -1--c . ,,./,,: tI I V J"/DI>".I. .$rxvrz .,/ .. " *' 0" £.SJ'. 41. (i. "Ii"" . £~ -' fi.".",,_ .
• ' . ~~ ") 'b . . £. ",.,alI{ . ./ .....
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