~,6?€¦ · benjamin j. cayetano governor of hawaii mr. steve goldberg oasis water systems p.o....

BENJAMIN J. CAYETANO GOVERNOR OF HAWAII

Mr. Steve Goldberg Oasis Water Systems P.O. Box 535 Kilauea, HI 96754

Dear Mr. Goldberg:

STATE OF HAWAII DEPARTMENT OF LAND AND NATURAL RESOURCES

COMMISSION ON WATER RESOURCE MANAGEMENT P.O. BOX 621

HONOLULU. HAWAII 96809

October 15, 2002

Well Completion Report for Well No. 1121-01

GILBERT S. COLOMA-AGARAN CHAIRPERSON

BRUCE S. ANDERSON MEREDITH J. CHING

CLAYTON W. DELA CRUZ BRIAN C. NISHIDA

HERBERT M. RICHARDS. JR

LlNNEL T. NISHIOKA DEPUTY DIRECTOR

1121-01.wcr

We received your Well Completion Report Part II for the Nancy Irene Well (Well No. 1121-01) on September 24, 2002 and acknowledge that it is complete.

If you have any questions, please contact Lenore Nakama ofthe Commission staff at 587-0218 or toll-free at 274-3141 (Kauai), extension 70218.

LN:ss

~,6? LINNEL T. NISHIOKA Deputy Director

/

IFAX TO:

Phone FtirPllone

Icc:

8(18..587-0219

I REMARKS: 0 Urgent

Hi Lenore:

I ~ 7311M)2

FROJII:

Phone FaxPlJone

SteveGoHwp Oasis water System$lnc. P.O.80x635 KIlauea Hi H754

181 For your I9wew 0 Reply ASAP 0 Pless" Comment

Enclosed well completion report part 2 for well # 1121-01

Thanks,

Steve

Hl 39!;;1d 5 IS!;;IO 8LLB8l88B8 8E:Pl lBBl/Pl/6B

,

~ PUMP INSTALLATION PERMIT v.J Nancy Irene. Well No. 1121-01

Note: This permit shall be promlnentIV di!IPlayec/ fit the site fJntll the work i§. comel9ted

In accordance with Department of Land and Natural Resources, Commission on Water Resource Managemenfs Administrative Rules, Section 13-168, entitled "Water Use, Wells, and Stream Diversion Works", this document permits the pump installation for Nancy Irene (Well No. 1121-01) at Koolau Road, Kauai, TMK 5-1-3:1, subject to the Hawaii Well Construction & Pump Installation Standards (1123197) which include but are not limited to the following conditions:

1. The Chairperson to the CommiS6ion on Water Resource Managflment (Commission), P.O. Box 621. Honok.llu, HI 96809, $hall be notified, in writing, at least two (2) weeks before any work covered by this permit commences and staff snail be allowed to inspect installation activities in accordotlCG with § 13-168-15, Hawaii Administrative Rules.

2. The pump installation permit shall be for Installation of a 30 gpm capacity, or less, pump in the well.

3. The permittee, well operator. and/or wen owner snail proVide ana maintain an approved mater or other appropriate means for measuring and reporting withdrawals and water levels. and appropriate devices or means for measuring chlorides and temperature. These data shall be measured monthly and reported to the Commission on a monthly basis, on fonn& provided by the Chairperson (.dtached).

4. The proposed use shall not adversely affect existing or future legal uses of water in the area, including any surface water or esl3blished inS1ream now standards. This permit or the authorization to pump water from a well shall not constitute a determination of correlative water rights. The permittee, well operator, and/or well owner are notified and by this provision understands that the quantity of water taken from the _II CQuld be reduced b)' tho CommiUion in the future. ThiS permit is not a commitment that the pump capacity permitted here or even some lesser amount is gvarantged In the future.

5. The permittee, well operator, and/or well owner shall complete and submit as-built drawings and Part II - (Permanent) Pump Installation Report of the Well Completion Report (ilttillched) to ttle Ctlairperson within Sixty (80) days after completion or work,

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

7. The pump installation permit application and any related staff submittal approved by the Commission are incorporated into this permit by reference. ThiS permit 1$ also subject to the Hawaii Well Construction & Pvmp 1i'1S~llation S~na3tds (1/23197), If ~ HWCPIS are not followed and IiIII iii coneequenoa wal.9l' Is wastod or contaminated. a lien on the property may result.

8. The permit may be revoked if work Is not startad within six (6) months after the date of approval or if work Is suspended or abandoned for 5ill (6) months, unless otherwise specified. The work proposed In the pump installation permit application shall be completed within two (2) yean> from the date of permit approval, unle511 olherwioe specified. !he permit may be extended by the Chairperson upon 8 showing of good cause and good-f3lth perfonnance. A request to extend the permit shall be submlttod to the Chairperson no Iatar than three (3) months prior to the date the permit expires. If the COfT\lIlQncament date is not met, the Commission may revoke the permit after giving the permitt99. wall operator. andlor well owner notice of the proposed action and an opportunity to be heard.

Q. If the well is not to be used It must be properly capped. If the well is to be abandoned then the permittee, well operator, and/or well owner must apply for a well abandonment permit in accordance with §1:}o168-12(f) prior to any well sealing or plugging work.

10. The permittee, Its successors. and assigns snail Indemnify, derond, and hold the Slate of Hawaii harmless from and against any loss, liability. claim, or dlltmBnd fOr property damage, peRlOnal injvry, or death ariSing out of any act or omiSSion of the applicant. aSSigns. officerS, employeQs, contractors. and agents under this pennit or relating to or connected with the granting of this permit.

specJaloon"_inlh ......... "'." ...... illal_'.,.~~~ t Date of Approval: July 18.2002 Git'BES:COlOMA-AGARAN, Chairj)TSOn

11.

Expiration. Date: July 18, 2004 Commission'on Water Resource Management

_____ . ___ . ___ L.l1a¥.e_caad...tI:te.-&Dnditionti .am1.tortn:l.Qf..thl.<l. pmY.IilB.nd !,I~~~~"ct ~~~'" I !I~~"p~.~n~.a~.t~_~~ tha.!:!I.~"d.I~~~r:'.&_:lC_!l._ ...... _ .. prerequisite and underlying condition of my i1bility to proc:aed and undef5tand that I shall not commence work until I and the pump installer have signed, dilted, and returned the permit to th- Commlsalon. I also u"der'$tand that non-compllance with any permit condition may be grounds for ocation and fines of up to $1000 per day St4lr1lng from the permit date of approval.

~~~~~~~ .. ~ .. ~ Permittee's Signature: m 7"""' ?/ Date: 08/23/02

Printed Name:

Installer's Signature:

Printed Name;

C-57, C-57a. or A License #:Q..J l.f 57 Date: 1''')3-02-Firm or Title: D/ts/5 ().J ~

Please $ign both copies of this permit, retrlm OIIe to • crr.irperson, and retain file other for your reco,,"-

Attachments c; usGS

Department of Health! sa'l!; Drlnklflg WEJler & waGtGWater 8ranc" Ko",ai Department d W. Supply JOSIiIph and Suzanne Kobayashi

, .... II_;fitlJ, .. ' .. ,~"IIH.,.f· •• IIi',...III.hll",1 I·',MI-, ~",qhll~.NIi.IIK.,"Ii,,, iii "~'"'''''''''' ... ,' "f,."

SIS'ilO 8LHI8l8808

I, III, 1,1"., I

,

~ ~~ State of Hawaii For Official Use Only~ COMMISSION ON WATER RESOURCE MANAGEMENT Department of Land and Natural Resources

WELL COMPLETION REPORT .. PART II Pump Installation

InstruGtIorw: P\e88Q print In Ink or type and Hod eomplcltDd report (with attachments, if epplieahlA) to the Comm'-'Ion on water ResOurce Management, P.O. Box 621. Honolulu, HawaII 96809. The Commission rnay not accept incomplete reports. TIllS form shan be submitted Within 60 days 01 the completion of woltt. For assistance, please eQnsult the Hawaii Well COnstruction and Pump Installation .Standard. or can the Regulation Btanch at 587-0225. For upc:lates to this form or additional information, please visit our website at http://www.etatG.hl.usJdlnr/cwrml

1. 5tateWeil No.: 1121-01 Well Name: Nancy Irene Island: Kaual --"-"=::~----

2. Address: _Koolau Road Tax Map Key: _5::..-...::.'....::..;i...::.:,~ _______ _

3. Pump Installation Company: "..Ot..!A~Su.I-""~L-;:t\):!o,j·l...!4...L.....J+L....:~::::I.::~~ _____________ _ 4. Date Pump Installed: ,_ ~ /",-(1'2-

moT.itd~r 5. PERMANENT PUMP INFORMA nON. (~.pump. speoifications and rating -c;trve) .. "

Pump Type, Make, Serial No.: Sv b fVt ~~ tl, \ e ~/\)~ as I , ~ S 50 -;tvI

Rated Capacity: . /6 gpm at head of: ---,,~,,-. _______ ft.

Motor Type, H.P., Voltage, rpm: 6~ kl,y '3" a a'1Q 3 "IszJ , Type of flow meter: ____ ~ ________ which measures in

Model Number _______ 'Serial Number

o Rotary o Propeller

Pump type (check one): o p{ep Well Turbine

¥Submersible o Rotary-Displacement D ReCiprocating

o Impulse o Centrifugal o Rotary-Gear

6. Method of ftow measurement:

o Flowmeteyl" Manufacturer

o Weir tf Open Pipe 0 Orifice·

Make Size ------ -------- ------o . Other". explain below

*attach schematic

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

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

9. Other remarks/comments:

~p 1".lIotionp~ w.tHdL Signature .

Pannittee (print)

Signature

E0 391;1d

.. .. .

JOSEPH N~ KOBAYASHI . SUZANNE N. KOBAYASHI

5151;10

C-57/C-57a1A Lie. No. 21'fS '7 Date 1-:;'J~

WCR2 Form 1214101 Page 1 of 2 , I , " , i, ' . 1,1 ! '" ~ •

8LL08l8808

..- ,

,,,..'M,

I. AS-BUILT pW SECTION (PIN$It et#Ioh a-buiIl' dlIremnl ~ ptOVIded bfIIow)

Beneh mark ellwation IUI\feY8d to ......ut 0.01 fl. =

it m8llln .. Iuvef

P0 39'i1d SIS'i10

PllroP ,Intake depth 1:1 It (tifcrinc~no bench -m: ...... ~

c .... tube. <M--........... -+-~ (refinnced to

If llirtine installed. • bottom of airline' elevation = I

• it mean see tevd ..-..-J

8LL08l8808

BENJAMIN J. CAYETANO GOVERNO~ Of HAWAII

Mr, Steve Goldberg Oasis Water Systems P.O. Box 535 Kilauea, HI 96754

Dear Mr. Goldberg:



HONOLULU, HAWAII 96809

July 24, 2002

Pump Installation Permit Nancy Irene (Well No. 1121-01)




HERBERT M. RICHARDS, JR.


1121-01 Nancy Irene.pip2

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

The permittee, well operator, and/or well owner are responsible for all conditions of the permit. This includes ensuring that the pump installation contractor submits a completed Part II of the Well Completion Report form (enclosed) within sixty (60) days after the pump installation work is completed. Be advised that you may be subject to fines of up to $1000 per day for any violations of your permit conditions starting from the permit approval date.

Please sign and have the landowner sign both permit originals and return one for our files. A copy of the Well Completion Report (Part II) and a copy of your water use report form are enclosed for your use.

IMPORTANT - Pump installation shall not commence until a fully signed permit is returned to the Commission. Except for the monthly water use report form, please provide copies of all the information in this packet to your pump installation contractor.

Finally, this letter is notice that we have accepted your Well Completion Report - Part I as complete as of July 18, 2002.

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

Enclosure

c: Joseph and Suzanne Kobayashi

.I

,. - PUMP INSTALLATION PERMIT~ o Nancy Irene. Well No. 1121-01 "'wI 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 Nancy Irene (Well No. 1121-01) at Koolau Road, Kauai, TMK 5-1-3:1, subject to the Hawaii Well Construction & Pump Installation Standards (1/23/97) which include but are not limited to the following conditions:

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

2. The pump installation permit shall be for installation of a 30 gpm capacity, or less, pump in the well.

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

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

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

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

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

8. The permit may be revoked if work is noistarted within six (6) months after the date of approval or if work is suspended or abandoned for six (6) months, unless otherwise specified. The work proposed in the pump installation permit application shall be completed within two (2) years from the date of permit approval, unless otherwise specified. The permit may be extended by the Chairperson upon a showing of good cause and good-faith performance. A request to extend the permit shall be submitted to the Chairperson no later than three (3) months prior to the date the permit expires. If the commencement date is not met, the Commission may revoke the permit after giving the permittee, well operator, and/or well owner notice of the proposed action and an opportunity to be heard.

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

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

11. Spod" oo,"mo", In Ihe ,lie"'" 00"" '",,,,mllle"ettec 'co 'noo~: ;"6+ Date of Approval: July 18. 2002 ~MA-AGARAN. Chaitn Expiration Date: July 18, 2004 Commission on Water Resource Management

I have read the conditions and terms of this permit and understand them. I accept and agree to meet these conditions as a prerequisite and underlying condition of my ability to proceed and understand that I shall not commence work until I and the pump installer have signed, dated, and returned the permit to the Commission. I also understand that non-compliance with any permit condition may be grounds for revocation and fines of up to $1000 per day starting from the permit date of approval.

Permittee's Signature: Date: ____ _

Printed Name: Firm or Title: ________________ _

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

Printed Name: Firm or Title: _______________ _

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

Attachments c: USGS

Department of Health! Safe Drinking Water & Wastewater Branch Kauai Department of Water Supply Joseph and Suzanne Kobayashi

J

o Q MEMORANDUM FOR THE RECORD

FROM: Lenore Nakama SUBJECT: Wall Thickness for 1121-01

Steve Goldberg called on 7/18/02 to inform us that the wall thickness is 3/8 inches.

MEMO and ~UTE SLIP Q

I WCR 1 Check for Well No. 1121-01 (survey to regulationmemo)

1. Puml1. Tests Check Glenn Bauer (initial) Yes No If no, describe deficiency

Step-Drawdown Test:

followed WCPI Stds 0 0 analysis attached 0 0 proposed pump cap o.k. 0 0

Aquifer Pump Test:

followed WCPI Stds 0 0 T & S analysis attached 0 0

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

analysis attached 0 0

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

2. Construction Check Mitch Ohye \I\J-?' (initial)

data complete followed WCPI Stds well database updated

Yes No If no, describe deficiency

~ i

0' /"Y

o O

,--\ /' .'/,J .~

o

06/13/02

3. Charley/Lenore/Ryan ---",l(0:!..-=:.. __ (initial) take action based on above analysis

ATTACHMENTS FOR PUMP INSTALLATION PERMIT: 1 COVER LETTER

2 PERMIT (2x)

3 DOH COMMENTS

4LAND DIV. COMMENTS

5WCR2FORM

6WURFORM

~'Y~initial) check

5. ubia (initial) finalize Linnel (initial) signature

7. Charley/Lenore/Ryan File

__ not necessary - only WCP.

To be sent to applicant

, ~ "/



Dear Mr. Goldberg:




June 25, 2002

Well Completion Report for Well No. 1121-01

GILBERT S. COLOMA·AGARAN CHAIRPERSON





1121-01.let

We have received your Well Completion Report Part I for the Nancy Irene (Well No. 1121-01). However, matters which must be addressed before we accept your report as complete are as follows:

1. Please provide the wall thickness for the solid casing.

Please respond to the above item(s) within thirty (30) days of this letter's date. Failure to do so may result in fines of up to $1000 per day.

If you have any questions, please contact Lenore Nakama of the Commission staff at 587-0218 or toll-free at 274-3141, extension 70218.

LN:ss

atej,~. LINNEL T. NISHIOKA Deputy Director

, r

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

WELL COMPLETION REPORT - PART I Well Construction

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

Well Name: /V.I1vc1 :r=~rL ---l~<-="--,=""~~------.---------- Tax Map Key:

1. State Well No.: , .......... -i-'---'

2. Address:

3. e.1-

For Official Use Only: r·~ --..

I":' .I.' fl • ·'"1·9 r •• i ......

Island: tr \L}o ~ ~ 5-\-3::J

4. Drilling method used during contruction: 0 Rotary 0 Percussion 0 Other (describe)

5. Date Well Construction (drilled,cased,grouted) completed: 9-9-0 I Fill out attached Driller's Log month/day/year

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

6. Was the subject well cored? 0 Yes 0 No

7. Initial water·level encountered ;);3..5 ft. below ground Date and time of measurement: month/day/year time

8. Step·Drawdown Test completed? ,,~ 0 Yes

9. Constant Rate Aquifer Test completed? tW'No 0 Yes

Attach Step·Drawdown Test form (12117197 SDPTD Form)

Attach Constant Rate Aquifer Test form (12117197 CRPTD Form)

Parameters prior to pump. te~

10. Water·level: ---l+-et"------- ft. above msl Date and time of measurement: 9 -\5- 01 11. Chloride: ___ 0=-.:0=--____ ppm Date and time of sampling:

12. Temperature: :J') month/~a~year time Date and time of measurement:

month/day/year time


14. Fill in attached surveyor's report.

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

Licensed Driller (print) ~G1:Q'''.nl'''&I. C-57 Lic. No. -~J~SJ-----------

~-Permittee (print) ~ee_~~~

Signature

Signature Date _________________________ _

WCR1 Form 9112/01 Page 1 of 4

/

" f

'1'

13. AS·BUIL T QL SECTION

Elevation at top of casing 3LY. t ft., msl* -, (to nearest 0.01 ft.)

Bench mark elevation:

3J).8ft., msl* (Survey to nearest 0.01 ft.)

I/;'JA\

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

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

(Please attach as-built if different froQgram provided below)

~ Hole Diameter: _-J..:3 ____ in.

Minimum of 2' Radius & 4" Thick Concrete Pad

_ Ground Elevation: ~L~ __ ft., msl , (,:.;~-'-L-.-_ //;XM, //~\

~'. 6. ••••

. :",' ~:;::

Please refer to the HAWAII WELL CONSTRUCTION AND PUMP INSTALLATION STANDARDS to ensure that your as-built is in compliance

with applicable standards.

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

Length: ___ ~~=z _______________ ft .

/

,<" \ \

;\ \:\ \ :'~<l: ~ ":, iii __ .2_ in.

NominaIOiametes-0c _____________ in.

Wall Thickness: ~4~~~-~jL----in. ,<,/'-- \.-r'.t-

Bottom Elevation: __ :. __ O ___________ ft., msl \ .\l.-'-

Total Depth

_5JUft.

Rock or Gravel Packing:

*' o O'J 1\1

~ __ ft. Material:

~----------------~.~ r------------,Vl\·-,-~\ ....

Open Casing: 0 Perforated 0 Screen _ ",\

)(

o Crushed Basalt Length: _____________________________ ft. o Rounded Gravel Nominal Diameter: _______________________ in.

w7f3evel Elevation:

__ __ft. msl*

Wall Thickness: _____________________ in.

Bottom Elevation: ______________ ft., msl

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

*msl = mean sea level

Solid Casing Material: ~~~ASTMA139 Carbon Steel: compliant with (check one or more): 0 ANSIIAWWA C200 0 API Spec. 5L

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

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

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

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

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

o Centrifugally Cast Resin Pipe conformin9 to ASTM 02997

o Reinforced Plastic Mortar Pressure Pipe conforming to ASTM 03517

o Glass Fiber Reinforced Resin Pressure Pipe conforming to AWWA C950

o PTFE Fluorocarbon Tubing conforming to ASTM 03296

o FEP Fluorocarbon Tubing conforming to ASTM 03296

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

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

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

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

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


o Centrifugally Cast Resin Pipe conforming to ASTM 02997





WCR1 Form 9/12101 Page 2 of 4

.'" .

wU'lm e me

FILE No.431 04/13 '01 AM 10"~ ID:Joseph Kobayashi Attmy. FAX:008;:~,22 9436 P~E 1

~ ",., A.Q,..... State of Hawaii For C)fIcW U .. ChIllI

CO...allON ON WAT." RlaOURCI MANACI .. NT Det*'m.m of &..nclancl ............. ,...

WILL COMPLETION ".'ORT • PART I ......... 1. • ... Will No.: 1111 .. 1 wei Nn,: ..,;Np!=~OfL.:I:.:.;:ren=. _______ 11IInd: 2. MchIM; ....... :.:.I~I!d!:3l.t... __________ Tex,., Kty. ... J::_1Mi1:i~:1 _____ _

3. 0tttIInSI ~IJ: 4. If dried. t'tPe of RII: c ftot.ry C ~n

5. o.ta Well COnltNollotl (drItd.OMeCI,groutad) cam_ed; . ..... ~ t. .. (?AMI Dt ..... "' ....................... ,....,.""'_~-=.".-.... .. In. ~ ~ ft. below 810UnG ~ 81d time of ",_l,Irtment: -:iRIi:=:MIi;::-

;;;Ii" ...... 1M 7. ~T.llaomplltld? 0 No I:) v ...... ,DnM_,....,TMttonnC1a1',.,wro,.,.. e. conetInt R_ ~I,A_ Tilt oo~MId? C No 0 V.. MIIeh c..-", ... Aqulflt T_ .... ('I"fM1c,.ra ~

Pwem .... "lOr., pump tilt •. WIler ....

10. ChIor*: , 1, T."."..,.,.": _______ .,

12. PIli ........................... , ................. .

,,, MIoh plat." IftdIUMYO'" __ .. n,.,n.

1.. If. purI1J lit not pIInned tD • ~, pia. deeonbl (below In tI'II flmI!'kI HCtIon) hOW _I lit HOUrId to ~ ~ &QIII (lXM'Ipll: tockIbl. cover. t!'ll'lldtO coupIInQ, tIC.)

1 I. "emara:

LIeeI'I ••• DrIller (prIM) ___________ _ C-S1Uc. No. ______ _

0ItI _______ _

14I:='!..=r:,...,::::r---------- L.P.L.S.lle. No. ______ ..... _ IIIn1CUre

1)- ________ _

t9 ~d ...

., ~ ELEV =314.40' ~-IO • 0 .

,

~ CASING

4" CO NCRETE SLAB

\ ~ELEV =312.40

. . . . . . . . . . . . . . . ~ .,".. .. ,...... . .. . . . . ., .. . . · . · · · . . . , . . · . . . · . . . · · . . . . . . . . . . . OR . ' . . . . . . . . . . . . . · . · . · · OUND

I' I

II' I

I I I ' I

III, I

I I I I I I I -'

WELL ELEVA TION

WELL #1121-01

OWNER:JOSEPH KOBAYASHI

T .M.K.( 4 )5-1-37:01

("NANCY

PETER N. TAYLOR

LICENSED PROFESSIONAL LAND SURVEYOR No.9149

ENCH MARK USBD: WELL SITE #1120-27 HAVING AN ELEVATIION OF 311.38'

o o

WELL NUMBER: \ \1'- Q \

DRILLER'S LOG (7/28/91 DL Form)

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

.-!Lto~ ~~'" ~~o. C'Ai Sot, \ _to_?,.~';>"J-O( NtoBJ Y ~~ ~Lk 5\-r~\(s0 _ _ \_(. __

\31toJJl ~;()~£:i\VLl4c\'( ~ w~cJ~ \\ ~lol3S ~e~ \A.>~~ ~c\( '-k~~4=( ?-~e-Dl_ ~Iom £AC~u~J ~\ueJl-..OC\" lowlci~~~ l\ ~2J ~031] ~~C·~Ai VvL4kn-~k s- \-0\ 3l1to3b5 {(uAc6CLeJ ~ 'u~ ~~to_ \ \

'3.b5-to!::L35 ~\0<-- ttOc \( ~ YI AC\--O~ ~c..l-c 3-2,-0 l 435-lo~ ~\OL- ~c\'( _10_ \.\

~lo5QB W~~ ~ctt ~ ~u~~~Jt~c9. ~c.\c 3~-{)1 wz. ~105JD 'b \uL ~ck _to_ \. '-__ 1o _______ _ _10 _______ _

_ 10 _______ _ _1o _______ _

_ 10 _______ _ _10 ________ _

_ 1o _______ _ _10 _______ _

_ 10 ________ _ _10 _______ _

__ 10 _______ _ __ 10 _______ _

__ 10 _______ _ _10 _______ _

Remarks:

FILE No.728 04/03 '02 PM 03:OrD:Joseph Kobayash i Attrn}l. FAX:8080 9436

WELL CONSTRUOTION PERMIT H!nav Irene, Well No. 1121-01

NoJtJ: ThJ. pennlt .,,111 bt l)IOI1fInentJy dlspll)'«J lit the ",. until tilt wotk's «InfP/ftttd

PAGE 2

In aoooltfanoe with tllplr1monl of LItI<t and *tu .... R~. Comml .. lOn on Wl1Ir FtNOlol'CO MJnagemenra Mmlnlltretlve RUleI.. SeoIIon 1$-188. ri1Ied 'Water Un, WeIfa •• nd 8h.wn Dlvettktn Wedel". fh/a ~nt palmlta the CONtrI.don ",d tetUng of Naooy 'ranlS (Welt No. 1121-01) at KooIeu Road, KaauaI. TM!< 5-1-3:1 •• ubJtct to b HaweD weI CoI\atructIon & Pu~ IntfaUatlon Slel'lderda (1J23197) ¥IIhIch IMIUd. but .. re not IImIt8d ID the fmlowlng candlflona:

1.

2.

3.

4.

e.

'T.

8.

9.

10.

11.

12.

Date of Approval: March 13, 2002 expiration Date: March 13, 2004

I haw /'tad tM oondJ1lona and t..rm. otthla ptITIIlt and IIndwaland th-. llOOtpt and .0 .... w mHf "' ... condition, •• ~1IitftI an4 U".~ CIbMltlon of M'/ abIIlt.Y to JII'OCMd ami undIrwtlm4 that I ..,.. no\ aommtnee work until I W the drill4lr ....... !UntC!, _&tel. md ,ttumed 1M '-"""" to N Com.-..n. lliao UIId ........ d flat nOftoCompl1llnct with ...,y ptrmlt DOndltlon may be 8I'OundI fW I'tY\KlIItIOn and tinea 01 sip to ~OOO I*' day atartln, from 1M PIl'f/llt daCt of IIPpl'OVIt. ~ /

Permittee', Signature' tH't:.... ~ Oate: r-I ~(j ~ S~,_,~~ ~

Pr1nttd Nama: _~O:...::W:x...;.\J;;;;,;t:.:;:=;;..;It..~ ______ _

DrlIIer's Signatura:

Prlnt&CI N1/'T\6:

.LJJ~'..t8J.~~~--~ C-51 Ucen .. fI! 21t.t.(l Date: J-c?A-opt -..A-o,L.X1ll~=--.....-,~-- Firm or Title: Q frS, 5 Lu Men...

S~SAS ~3i~M SI~ eLLliJ8lS9a9

BENJAMIN J. CAYETANO GOVERNOR Of HAWAII





lINNEL T. NISHIOKA




March 20, 2002

DEPUTY DIRECTOR

1121-01 Nancy IreneWCP


Dear Mr. Goldberg:

Well Construction Permit Nancy Irene (Well No. 1121-01)

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

Special Conditions

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

2. Standard Condition 2 is modified and Standard Condition 7.e. is waived to exempt the permittee from the requirement for pumping tests if the capacity of the permanent pump to be installed is less than 50 gpm.

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

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

/

Mr. Steve Goldberg Page 2 March 20, 2002

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

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

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

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

Aloha, .. ~ ,q~ ERT S. COLOMA-AGARA~ GIL

Chairperson

Enclosures

c: Joe Kobayashi

OvELL CONSTRUCTION PERMITO Nancy Irene, Well No. 1121-01

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

In accordance with Department of Land and Natural Resources, Commission on Water Resource Management's Administrative Rules, Section 13-168, entitled "Water Use, Wells, and Stream Diversion Works", this document permits the construction and testing of Nancy Irene (Well No. 1121-01) at Koolau Road, Kauai, TMK 5-1-3:1, subject to the Hawaii Well Construction & Pump Installation Standards (1/23/97) which include but are not limited to the following conditions:

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

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

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

In basal ground water, the depth of the well may not exceed one-fourth (114) of the theoretical thickness (41 times initial head) of the basal ground water unless otherwise authorized by the Chairperson.

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

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

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

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

The per:mitteEtl..well op~rator, and/or well owner shall comply with all applicable laws, rules, and ordinances; non-compliance may be grounds for revocation of uns permit.

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

The permit may be revoked by the Commission if work is not started within six (6) months after the date of approval or if work is suspended or abandoned for six (6) months, unless otherwise specified. The work proposed in the well construction permit application shall be completed within two (2) years from the date of permit approval, unless otherwise specified. The permit may be extended by the Chairperson upon a showing of good cause and good-faith performance. A request to extend the permit shall be submitted to the Chairperson no later than three (3) months prior to the date the permit expires. If the commencement date is not met, the Commission may revoke the permit after giving the permittee, well operator, and/or well owner notice of the proposed action and an opportunity to be heard.

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

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

Special conditions in the attached cover transmittal letter are incorporated herein by reference..___. ~o--./

Date of Approval: March 13, 2002 / March 13, 2004 Expiration Date:

I have read the conditions and terms of this permit and understand them. I accept and agree to meet these conditions as a prerequisite and underlying condition of my ability to proceed and understand that I shall not commence work until I and the driller have signed, dated, and returned the permit to the Commission. I also understand that non-compliance with any permit condition may be grounds for revocation and fines of up to $1000 per day starting from the permit date of approval.

Permittee's Signature: ______________ _ Date: ______ _


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



Attachment c: USGS

Department of Health! Safe Drinking Water, Wastewater, and Clean Water Branches Kauai Department of Water Supply Joe Kobayashi

Well No.

Well Name

Applicant

1121-01 Nancy Irene

J. Kobayashi

o

SECTION 1: WELL LOCATION INFORMATION

Island

Aquifer System

Aquifer Sector

KAUAI

LIHUE

KILAUEA

data

Date of Review

Reviewer

Proposed Use

o

Proposed Withdrawal

System Sustainable Yield

fill!!;;!!;;;; RRI

Domestic

8000

17

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

Elevation at top of casing

Ground Elevation

Cement Grout

Rock Packing

Hole Diameter

Total Depth

Estimated Head

Calculated Aquifer Thickness

County Water Supply (YIN ?)

ft., m.s.1.

ft., m.s.1.

ft. ft. in.

ft.

ft., m.s.1.

3198 ft.

Solid Casing

Material

Designation

Length

Diameter

Wall Thickness

Casing

Material

Designation

Length

Diameter

Wall Thickness

Openings

Open Hole

Length

Diameter

SECTION 3: CHECKLIST (values to check are shaded)

Well Depth

Theoretical Thickness of Aquifer

1/4 Aquifer Thickness

Depth of Well below Sea Level

Well Casing

Minimum Wall Thickness

Material

County or Non-County Minimum Thickness per standards

Wall Thickness Provided

Minimum Length of Solid Casing 90% of ground to top of aquifer

Length of solid casing Provided

Casing Material

Annular Space

Depth of Grouting

Calculated Depth of Grouting

Depth of Grouting provided

Thickness of Annular Space

Steel

3198 ft. 799.5 ft.

198 ft.

non-county #N/A in.

0.313 in.

210.6 ft. 357 ft.

ASTMA53

163.8 ft. 240 ft.

4 in.

okay (refer to HWCPIS Section 2.2)

(disregard if the well is not basal)

#N/A (refer to HWCPIS Section 2.4 c)

(disregard this if this is a non-county well)

okay

okay

(refer to HWCP/S Section 2.4 d)

(refer to HWCP/S Section 2.4 e)

If the cell above reads #NlA, reference HWCPIS)

okay (refer to HWCPIS Section 2.6 c)

okay (refer to HWCPIS Section 2.6 d)

Page 1

Search Results Page 1 of 1

o o Copyright 3/15/2002 by Hawaii Information Service

• PUBLIC RECORD DATA Property

Taxkey Subdiv/CondoTnrAddress 4-5-1-3-1 Waipake F

Land Owner/Lessee Beds Baths area KOBAYASHI,JOSEPH N/SUZANNE 1.99 ac N

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

Living area

http://webre1.hawaiiinformation.comIREsearchi AsplFunctions/Property ISearch TMK.asp? AC 3/15/2002

"'RR-l~-212!~2'12!'3:12 FROM:KRURI HISTORIC PRES 81218742732'3 T -.l ~

\.J ..... ~O ... "'-4. /~ . .. .

TO: 2086'328020 I"",""",

'-" IfZN..IMoII .. J CA ,("u"o COV.,.,.Oll OF HAW.\II

1A."'/,"·'8 111 """,

/y-~'\

• GI~T C:O\O~~ ,AGAIUN eHIIfIP8l$QN lOAN) OP LAND AND NAT""~ Rl50URC1f,5

STATE OF HAWAII

DEPARTMENT OF LAND AND NATURAL RESOURCES

STAn HISTORIC PfI£SlRVATION DIVISION 601 IC.A~OIULA BlVD •• ROOM 6"

IlAPOUJ. HAWAII 86707

HAW Ai' 1 HlSTORlC PRESERVATION DIVISION REVIEW

~IES

uae r .. .aNO UNNEL I'lI$NOIlA

AQUACUI,TUfIII Ol'/1il.Op ..... ,NT ftIOGI\.4oM

AQUA TIC I\I.SOUIIC~

C:ONS""'ATIOIOI AND

IMIIIIOIIIMENTA~ AHNRS COOl68lVATIO" ANO

IlESOU'lr:U INFQRC:EMENT

eONVIVANC:U FO"i5TR'f' AIID WlUlUFIE ~TOIIIC ....,.."Al1ON

DNlIIIO. IJUIIO MANIIQ80qMT 5T",...",," WATIIt AIIID \.NIID a.vIl.OP!Io1ENT

Log#~ Doc#:

t?~C,7 \( Q3NMO

TO l-\r\"e,( --r ~Ltih. c kit" ~ .... i1 .o,~ec-.h,,,.. Name ofAgcncy/Applicant: Ccmfh.,s.SlcJn IJ& /fh,,1-er ~#v"'<.-<.. Address of Agencyl Applicant.

SUBJECT

Ahupua' a: J...<., p:(. v \ ; District, Island' _~I~t'-'C:Z~Q~I,fdau.vl::.r-_.J::~:::....LA-~,.tI • ..I.A= ......... ( ____ _ TMK S-- , - 3 - I'

1 We believe there are no historic properties present, because:

a. b

G intensive cultivation has altered the land residential development/urbanization has altered the land previous grubbing/grading has altered the land .dcl. an acceptable archaeological assessment or inventory survey found no historic properties

e. other -----------------------------------------------------

;>< Thus, we believe that "no historic properties will be affected" by this undertaking.

-/11'1 2. This project has already gone through the historic preservation review process, and

mitigation has been completed.

""",-.. "" .. ~ ... -,~,~ .. ",,,---------------------

~" '

\ i

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\

. 1'iAR-18-a~e2 09: 12 FROM: KAUAI HISTORIC PRES / ~" ~

8087427329 TO: 8086928020

'JIll J-v ~rC ..

1

I

I . I i

1

DEI'LJIlIAIN J CAYETANO QOYIANOA nr MAWAIi

TO:

FROM;

SUBJECT:

0'

STATE OF HlWAM~,R ··l\ A \0: 32 DEPARTMENT OF lAND AND NATUAAL RESOURCES

COMMISSION ON WATER RESOURCE MANAGEMEN'r

Don Hibbard, Administrator Historic Preservation

po. BOlt 621 .;::_ .~ C" HONOLULIJ. HAwllllt~e~g : ~ .: \ ~ i

. ~,

March 1, 2002

Linnel T. Nishioka, Deputy Director ~. j Commission on Water Resource Management ,

Well Modification/Pump Installation Permit Ap Icatio Nancy Irene (Well No. 1121-01)

GILBERT S. COLOIM.AC .... R;.N CtW""U()1II

BRUCE SANDERSON MEREDITH J CHING

CLAYTON W. OElA CRUZ BRIAN C. NISHIDA

HERBI<:RT IA. RICHAROS. JR.

LlNNEL T NISHIOKA DCJIIVTV~:'OM

'" .. )

~

Transmitted for your review and comment is a copy of the captioned Well Modification/Pump Installation permit application. 1 • ..-:

We would appreciate your comments on the captioned application with regard to the programs~·.· plans, and objectives specific to your division. Please respond by returning thIs cover me~orm by March 20.2002. If we do not receive comments or a request for adaitionai review time by thIs te/\¥Eb will assume you have no comments. :'--.) :.:;

0"' Please find the attached maps to locate the proposed well. If you have any questions about t~

permit application, request additional information, or request additional review time, please contact Lenora Nakama of the Commission staff at 587-0218.

LN:ss Attachment{s}

RESPONSE:

( 1 There may bo areas in the vicinity of the well site that contain subsurface cultural remains such as ar1lfacts, burials or concentrations of shells or charcoal.

( 1 Other relovant Historic Preservation rules/regulations, information, or recommendations are attached.

~. No objections

~ Other comments: It ,,(LAu~lto/1 0/ (,/C I ~ ft~ L<.' «_ (

Contact person:_....I.M~fr1J,~V{~_l1f.....1<..c....!,1"~~:.!:.4.;L.tf..,j't~:~;.:"J~ ___ _ Phone: 7'1J.· '7 oD

oate:_3-L-l #-1 'J~/,--o_' 2._

c o t~ . L\. I."

If-' BENJAMIN J. CAYETANO

GOVERNOR OF HAWAII GILBERT S. COLOMA-AGARAN

TO:

FROM:

SUBJECT:




March 1, 2002

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

William Wong, Safe Drinking Water Branch

CHAIRPERSON



HERBERT M. RICHARDS. JR.

LlNNEL T. NISHIOKA OEPUTY DIRECTOR

Dr. Keith Kawaoka, Hazardous Evaluation and Emergency Response Alec Wong, Clean Water Branch, ~

Gilbert S. Coloma-Agaran, Chairperson ',-" i A'A) j Commission on Water Resource Managemen~v '

Well Modification/Pump Installation Permit Application Nancy Irene (Well No. 1121-01l

Transmitted for your review and comment is a copy of the captioned Well Modification/Pump InstaHatfon 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 March 20, 2002. If we 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.

LN:ss Attachment( s)

RESPONSE:

[ I

[ I

[ I

[ I

~ [ I

'xf .~

This well qualifies as a source which will serve as a source of potable water to a public water system (defined as servin!) 25 or more people at least 60 days per year or has 15 or more service connections) and must receive Director of Health approval triOr to Its use to comply with Hawaii Administrative Rules (HAR), Title 11, Chapter 20, Rules Relating to Potable Water Systems, §11-2 -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 15 service connections) and if the well water is used for drinking, the private owner should test for bacteriological and chemical presence before initiating such use and routinely' monitor the water quality thereafter. However, if future planned use from this source Increases to meet the public water system definition then Director of Health approval is required prior to Implementation.

If the well is used to supply both potable and non-potable purposes in a single system, the user shall eliminate cross-{;onnections and backflow connections by physically separating potable and non-potable systems by an air \lap or an approved backflow preventer, and by clearly labeling all non-potable spigots with waming signs to prevent inadvertent consumplion 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 V;s []Is not located near the proposed weh S1t~ (information attached). .Y( -.

An NPDES permit is required.

Other relevant DOH rules/regulations, information, or recommendations are attached. -No comments/objections

((lV, N ,-I,.: n .. \/)\\Nfl Va Contact Person: --.!.1-.l.I-=-_'_--,-__ 1--,-'£,.l;_jt-_V_Iv ______ _

/JA -0

Phone: E5'80 -42/1'T c-'c,)

en

Signed: c£M;in. (*,&U'MJ'. ?- (~-" 1"10'21'.:) Date:_t_J ___ LV __ _

ENV HEALTH KAUAI ~. 08082413566 03/11 '02..J.4:40 NO.323 01/01

""J"MI~ J. c;:.o.y.,rANC ~"'EP:~".;,r '~""""I'

STATE OF HAWAII DEPARTMENT OF HEALTH

po. BOX~311

Facsimile Request and Cover Sheet Wastewater Branch

919 Ala Moanas 8lvd. R.oom 309 r10nolulu/ Hawaii 96614-4920

(SOB) 586-4294 Fax (80S; 586·4300 I

Date: /hcu'C.n~) I XC~_ Total Pages --L __ _

Subject:

Joe T!teyama, Kaul!i District Health OffIc:e Phone (808)241-3323 Fax (808)241-3566

Lori Kajiwaral Planning/Design Sectlcm Email: Ikajiwara®.I.Ia.health.state.hi.us

Request for Information

Please c;heck all that apply and fax sltelplot pl.n If .vallable;

( ] seNered [ J no record E ] cesspool {)(J septic tank r l aeroblc unit

File # If applicable: • .!.., 801 # of 5edroor'!'lS ~_

R.'~Qrd Date: Submit Da~: Pl~n Approval Oate:

Inspection Date: System "Approval for Use" Date:

"2.8/0. 'J e/).e./tP')

\ .

O\fltf; '3 Ll)4io 'EfLt.A.t'"f'<J 00-("6 r _ Dt ... 2.0J.t9 ~ i 81Z. "WE:l..~ IIJ6 ~ -

t '~fZ." .P1?'TtO~ A .... MOST c.d"M.P t..An'1E! l.W S 1.l0. ~"'6' ~ $

hJ ,U,T 1.)01" A.9fU>yel> p.cg t,l.S4i 'fer (~At.!,",t.,)o.~A'!' iUJP..:( .. ~ ~ s nut. e.,"t'. o~ ~

· lAar~2-02 to:29am From-HI DEPT 0t",~EALTH 808-586-4310 T-OOO P,01/02 F-t8t ---:---z---=----.

TD a From 6~OY\ Ne Co.lDepl. Co. $ PWS

GlUlERT 6. COLQMA.AGARAN -Fax" Fax" ~ .. 43 0 IIRUC" S. ANDeRSON M~REDITH J. CHING

CLAYTON w. DliI.A CRUZ IIRIIIN C. NISHIDA

HeRBERT M· ~11I\A09. JR.

TO:

FROM:

SUBJECT:

STATE OF HAWAII DEPARTMeNT of /.AND AND NATURAl RESOURCES

COMMISSION ON WATER RESOURCE MANAGEMENT RECEIVED ~~U~W~~I fI68O!I SAfE DRINKING WATER BRANCH

March 1, 2002 , •• -.~L~.N j 2002

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

William Wong, Safe Drinking Water Branch Dr. Keith Kawaoka, Ha~rdous Evaluation and Emergency Response Alec Wong, Clean Water Branch 0 O{G

GilbertS. Coloma-Agarsn, Chairperson ._.- i_°A) 1. Commission on Water Resource Managemen~v '

Well ModificationIPump Installation Permit Application Nancy Irene (Well No. 1121-01)

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

We would appreciate your comments on the captioned application for any conflicts or inconsistencies with the programs, plans, and objectives specific to your department. Please res,!ond by return,nH this cover memo form by March 20, 2002. If we do not receive comments or a request lor additiona review time by this date, we will assume that you have no comments.

Please find the attached rnars to locate the proposed well. If you have any questions about thjs permit application, request additiona information, or request additiona review time, please contact Lenore Nakama of the Commission staff at 587-0218.

IN:ss Attachment(s)

RESPONSE:

[ I

[ J

[ I

( I

[ J

III [ I

Thie well qlUllifies as a Mluree which will SCIf'IG 01& a Mlun;e of potable waIIIr 10 1\ public water SYSIlll11 (defined as serving 25 or more people 1l11eIIfJ1 W Clays per year Dr 11a& 1! or mare SBrvica CDIlnec1lans) and mll&\ rec:eive DIreClor of Health epJll'Ollai ndDr to ill; U!HIIO oomply willi Hawaii Adm,niritrlltr..e RuleS (HAR). Titlo 11, ChaJ)ler 20, Rule& Rolating 10 Potable Water SyeWfllS, §11-2d=li!9.

appear t:o Thili wall dDB6I1OWlUILIity as a source IiBrvinll II pubrre watar &y&IIIm (!HIMS less !han 25 people Of more paopla 1111411151110 day& par ~r or 15 saNics conrAClions) and if !he wall "'lIfer fs usee! fOr drinl<ing. 1fro prlltal8 owner 5hOuId _I for tNlclericilDljicl.tI ana CheM,cal pr8liBnee bofOi'll Inilialina &uch Ulillllnd roU~lICIIy monitor the water gualilv lIIl!I1IiIftsr. Howev~ If futura oIlInnea use from tN& 1iOUn:e ,ncrsa_ \Q meot 1I1e pUbliC __ &~m CIIItInlliOn lhan DireQor of Heaflll appmlllll iii requlRKI 811m to Implementation.

If the \/lOa IS used 10 IiUIIP=both 1lCIIIIbJ8 and non-potBllla PLltpQS8l; In a single 5Y1Mm, UIe IISeI' shall alimiMle ~naction8 and bacl<1\oW eonne<:llOtls by ir:IoPy Mpat'lili/li potable ;uJU nOn-poIatllO splBrnri by lin air VOP Of' an apPRMKI backtlow preventor, ana by eJeI!fI)- labeling alll1Ofl::POlII IpiQOIS with _ming eillflllO prevent iPlldver1enl consuMPtion of non--potable water. Badcftow pteYenlion allYlces ShOulO be l1lulii1ely InspecUICI and ta&tad.

It aces not appeilr that Ihle well 'NIP be II&8d foI" c:onswnptlve purpDliBli IIfld 18 no! subjeCt to Sate Orinillng Water RagulatiQRe.

For the appli~m" Information. a &OI'ree t>f possible Wil&taWBtltr contaminatiOn [ )15 [ J Ia liCIt 10CII1ed near the propoeed well Sita (InformallOll attachlld).

An NPOES permll b required.

Othor ralevanl DOH ruleslnJgulatione, infotmllllOn, or RICDl11Il1encllllions aRI altadled.

No commtJntslobjactiomi

Contact Person: St.uart YiUQada Phone: 586-4l58

Signed: --:;!!§'~ Date: 03/12/02

· 'Mar-'t2-0Z 10:Z9am From-HI DEPT O~,~EALTH 808-586-43TO T-OOO P,OZ/OZ F-181

2-1121-01 Kauai

The Department of Health, Safe Drinking Water Branch bas the following additional comments for the Well ModificationlPump Installation Permit Application for the Nancy Irene Well (Well No. 2-1121-01 Kauai):

Please be advised that the Department of Health has experienced drinking water and groundwater contamination by submersible pumps containing mercury. Specifically, the failure of the seals of the pumps allowed mercury to leak out into the well shaft resulting in contamination of the well and the water served by the well. If you intend to install a submersible pump, please review your pump specifications to be sure that the submersible pump{s) you propose to use does not contain materials which could result in either groundwater contamination or drinking water contamination.

3/11/02

c o .~ ,

BENJAMIN J. CAYETANO GILBERT S. COLOMA·AGARAN GOVERNOR OF HAWAII

TO:

FROM:

SUBJECT:

.A 10: 32


COMMISSION ON WATER RESOURCE MANAGEMENT :.' =~:: P.O. BOX 621 • :.':' .

HONOLULU, HAWAII 96809 :~.,

March 1, 2002

Harry Yada, Acting Administrator

Land Division dAifJ 1. Linnel T. Nishioka, Deputy Director Commission on Water Resource Management ,

Well Modification/Pump Installation Permit Application Nancy Irene (Well No. 1121-01)

CHAIRPERSON



HERBERT M, RICHARDS, JR.

LlNNEL T, NISHIOKA DEPUTY DIRECTOR


We would appreciate your comments on the captioned application with regard to the programs, plans, and objectives specific to your division. Please respond by returning this cover memo form by March 20, 2002. If we do not receive comments or a request for additional review time by this date, we will assume you have no comments.

Please find the attached maps to locate the proposed well. If you 'have any questions about this permit application, request additional information, or request additional review time, please contact Lenore Nakama of the Commission staff at 587-0218.


RESPONSE:

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

t2l

[ 1

pqc

[ ]

[ 1

f~

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

A water lease/permit has been obtained by the applicant through lease no. _________ _

This well project [ ] require!idx] does not require a COUP. If a COUP is required it [ ] has [ 1 has not been approved and [ ] is [ ] is not currently active.

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

No objections

Othercomments:original source of private title is Grant 4112 issued prioi1 to statehood in 1959.

Contact Person: Gary Martin Phone: 587-0421

Signed:~",,-/~_'_"'_' _r-_h_~_.,e;L ___ . ____ _ MAR - 6 20C2 Date: ________ , . ..)

· ...

Mar-Or-2002 08:43am From-DEPT OF HEALTH ENVIRONMENTAL MNGMT 8085864352 T-9rD P.D02/002 F-999

~

GILBERT S. COLOMA-AGARAH -

TO:

FROM:

SUBJECT:

STATE OF HAWAII

..,. ... ,... fl', -s L .' '. ~ -. t.· ..,

DEPARTMeNT Of LAND AND NATURAl REsouRCeS COMMISSION ON WATER RESOURCE MANAGEMENT

P.O. BOXIIl1 ItONOLlA.U. HAWAII 9Ii808

March 1. 2002

Honorable Bruce S. Anderson. Director Department of Health

'.M~ ,.. t' DlTH J. CHING ~'J u~ .' :vroNW. DelACRUZ

B C.NISHIM T M. RICHARDS. JR.

UNNEL T. NIliHI~ """"'''''''.,. ..

Attention: Dennis Tulang, Wastewater Branch William Wong, Safe Drinking Water Branch Or. Keith Kawaoka, Hazardous Evaluation and Emergency Response Alec Wong, Clean Water Branch, J{C

Gilbert S. Coloma-Agaran, Chairperson ._-- i_'n 1 Commission on Water Resource Managemen~v '

Well Modification/Pump Installation Permit Application N@ncv Irene (Well No. 1121-01)


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 returnin~ this cover memo fo"" by March 20. 2002. If we do not receive comments or a request for additiona review time by this date. we wUJ 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.

LN:ss Attachment!s )

RESPONSE:

11

11

[ I

[ J

II

[ I

~ 11

This well qualJ1lus ae " ~urce which wiU _ ali a sautee at potable waler 10 • public Wldor ,,~tern (detinad "Ii &ervillg 25 Of more JI09IlIu st IBGSI60 days PI!( year or hili 15 Qr mora sesviCII cannecfiO/'lS) andlllusl receiw OireclOr of Heallh BPPfO\/iII R to 115 usa to comply wttn tiawaii Admlnilifrillive RuleS (HAR). TIIIO 11. ChapWr~O. RLIIee RBlalinglll Potable walltr S,stems. §11- - •

TniS weB CIon IlQl ~Iify 80; OJ o;ource serving a public _lOr 8)'l!1Om (IMIJVeII 18&5 than 25 psopIe or mara paoJlle at lanl80 day& i )MIIIr or 161181V1co connei;tion&) ilnd if the wei walM IS used for dtltiklng. 1111 priVllle OWIlIIr &hould I8&t for bilClsriCiloaical and mamlCii pre&lII'I09 befale Inl1ladna ,uch U&It and routinaly' manitor Ihe water 'luaUt)' 1horeafter. ~ IffulUre planneil we from thi8 eource l/lIlIlIII&aIi to meet 1110 pUblic; water "Y5tem d~1Iiticn tI1III'I DiUlClot of HeaRn apptOltailS requlAICI Brier to Implementation.

If Ine IN8Illa ui8d to &UppIy bOIt'I potable and non-pcxable purposn In a eingla liy&18m. Iha IJ&fJI' lihilll erminalll cmss-eoM8Clion& and backflow conrMIGtklllU by ~)'I;icag'y &BpoualiRg potable and non-potablo Sysleml by ell air gap Of an applO\l8d backf10w ~nter. and by cI\HIrty JabelinA all nMi/OlIIl)Ie ~ with w;aming Signs to prevent Inadvertent con'lI/IIpIIOn of non..polll~ walar. ~ prevention devQJli &hauJa be RIIIIInoly IM~ and 1OI>ted.

It ClOII8 not pppaar that this well \ilia be IISOCI fw c;o/llump!ive JIWPOIiB& and i& not &ubj8l;t to Saro DMkIna Walet ~ClGuJa1ionl.

For tnl appllCllflt'1i information, a soutee 01' poe8tble _e~ eontamlnatloo [ )Ia [) Ia not lOcated neat 1h8 propoHCI well Site tlnftlnnlllian attacnecl).

All NPOES pcrmit 1$ teqllired.

OIhur relevant DOH rules/reGUlation •• lnfoMIItlIon. or I'llClllllmandalion& 01111 attached.

No con'lMenlSlOlljectlOll8

Contact Pe~on: A ( e V- (;J61 f\-'j Phone: ~"-£f-3e9

Date;----o;;3-+-[ l~{.-lJ_}'--_ Signed: Q .. h.IVi0BTj

Mar-OT-lOOl 08:43am From-DEPT OF HEALTH ENVIRONMENTAL MNGMT 8085864352 T-9TO P.OOI/002 F-999

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

1. For Well .. Drilling Activities

Any discharge to State waters of treated process wastewater effluent associated with well drilling activities is regulated by Hawaii Administrative Rules, Title 11, Chapter 55, Appendix I, effective September 22, 1997. 'Treated process wastewater effluent covered by this general permit includes well drilling slurries, lubricating fluids wastewaters, and well purge wastewaters. This general· permit does not cover well pump testing. The applicable Notice of Intent Forms and filing fee shall be submitted at least thirty (30) days before the start of discharge to the' Department of Health, Clean Water Branch at 919 Ala Moana Boulevard, Room 301, Honolulu, Hawaii 96814-4920 or P.O. Box 337B, Honolulu, Hawaii 96801-3378. Inquiries may be directed to the Clean Water Branch at (808) 586-4309 or by fax at (808) 586-4352.

2. For Well Pump Testing

The discharger shall take all measures necessary to prevent the discharge of pollutants from entering State waters. Such measures shall include, if necessary, containment of the initial discharge until the discharge is essentially free of pollutants. If the diSCharge is entering a stream or river bed, best management practices shall be implemented to prevent the discharge from disturbing the clarity of the receiVing water. If the discharge is entering a storm drain, the discharger must obtain written permission from the owner of that storm drain prior to discharge. Furthermore, best management practices shall be. implemented to prevent the discharge from collecting sediments and other pollutants prior to entering the sto"rl drain .

. JS/cr

...

BENJAMIN J. CAYETANO GOVERNOR Of HAWAII


Dear Mr. Goldberg:




March 1, 2002





LlNNEL T. NISHIOKA DEPUTY otRECTOR

1121-01 Nancy Irene.ack2

Well Modification/Pump Installation Permit Application for Well No. 1121-01

We acknowledge receipt, on February 21, 2002, of your completed Well Modification/Pump Installation permit application and filing fee for the Nancy Irene (Well No. 1121-01). You can expect your application to be processed within ninety (90) days from this date.

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

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

LN:ss

c: Joseph Kobayashi

o BENJAMIN J. CAYETANO

GOVERNOR OF HAWAII GILBERT S. COLOMA-AGARAN

CHAIRPERSON

TO:

FROM:

SUBJECT:




March 1, 2002


William Wong, Safe Drinking Water Branch




L1NNEL T. NISHIOKA DEPUTY DIRECTOR

Dr. Keith Kawaoka, Hazardous Evaluation and Emergency Response Alec Wong, Clean Water Branch. J{C

Gilbert S. Coloma-Agaran, Chairperson ._ .. i ~'AJ 1. Commission on Water Resource Managemen~v '



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 March 20. 2002. If we do not receive comments or a request for additional review time by this date, we will assume that you have no comments.


LN:ss Attachment(s)

RESPONSE:

[ I

[ I

[ I

[ I

[ I

[ I

[ I [ I

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

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

If the well is used to supply both potable and non-potable purposes in a single system. the user shall eliminate cross-connections and backflow connections by physically separating potable and non-potable systems by an air 9ap or an approved backflow preventer, and by clearly labeling all non-potable spigots with waming signs to prevent inadvertent consumpllon of non-potable water. Backflow prevention devices should be routinely inspected and tested.


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

An NPDES permit is required.

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

No comments/objections

Contact Person: _________________ _ Phone: ____________ _

Signed: ___________________ _ Date: ______ _

o BENJAMIN J. CAYETANO

GOVERNOR Of HAWAII GILBERT S. COLOMA-AGARAN

TO:

FROM:

SUBJECT:




March 1, 2002

Harry Yada, Acting Administrator

Land Division cf;({J' 1. Linnel T_ Nishioka, Deputy Director Commission on Water Resource Management I ,


C~IRPERSON






We would appreciate your comments on the captioned application with regard to the programs, plans, and objectives specific to your division. Please respond by returning this cover memo form by March 20, 2002. If we do not receive comments or a request for additional review time by this date, we will assume you have no comments.

Please find the attached maps to locate the proposed well. If you -have any questions about this permit application, request additional information, or request additional review time, please contact Lenore Nakama of the Commission staff at 587-0218.


RESPONSE:

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

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

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

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

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

[ ] No objections

[ ] Other comments:

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

Signed: ___________________ _ Date: _______ _


GILBERT S. COLOMA-AGARAN

TO:

FROM:

SUBJECT:



Don Hibbard, Administrator Historic Preservation


March 1, 2002

Linnel T. Nishioka, Deputy Director ~, .. AJ 1. Commission on Water Resource Management !v ' Well Modification/Pump Installation Permit Ap icatio Nancy Irene (Well No. 1121-01)

CHAIRPERSON






We would appreciate your comments on the captioned application with regard to the programs, plans, and objectives specific to your division. Please respond by returning this cover memo form by March 20. 2002. If we do not receive comments or a request for additional review time by this date, we will assume you have no comments.



RESPONSE:

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

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

[ 1 No objections

[ 1 Other comments:

Contact Person: __________________ _ Phone: ____________ _

Signed: ___________________ _ Date: ______________ _

OOCU'-'ENT

F YR APP

S 02 326 - -- ---- -- ---- -- ---- -- ---

REf'o"ARKS:

Ll 0 DE~TMENT OF LAND fJK) NATURAL RESOVRCES

r-.o • ED WORKSHEET . . U<\C OR ATTACH DATE 2/28/02

0

C ----

SRC/ COST OBJ CTR

1026 0752 ---- -------- -------- -------- ----

LINE (1)

LINE (2)

LINE 0) LINE (4)

'l'YTO THE ORDER

PROJECT PH ACT N-'OlNT

' (1) 25.00 ------ -- ---

(2) ------ -- ---

0) ------ -- ---(4) ------ -- ---

TOTAL 25.00

Well No. 1121-01

OASIS WATERS SYSTEMS, INC 1()'96 P.O. BOX 535

KILAUEA, HI 96754-0535

lDLIVf2. '\ W t:N-r~ F, \/6 -e¥

Memo

I: ~ 2 ~:\O ~O 281: 000 2'" 2~ 5 ?1;8u'

NAME/DESCRIPTION (W~ I~PUT) Oasis Water Systems, Inc. ---------~---------

------------------------------------------.,..---------------

21; 5 5



Dear Mr. Goldberg:

-




February 14, 2002



CLAYTON W. DELA CRUZ. BRIAN C. NISHIDA



1121-01 Nancy Irene.ack

Well Construction/Pump Installation Permit Application for Well No. 1121-01

We have received your Well Construction/Pump Installation permit application to modify the construction of the Nancy Irene Well (Well No. 1121-01). However, your application is incomplete. Matters which must be addressed before we accept your application as complete are as follows:

1. Please submit the $25.00 filing fee.

As discussed in a February 12, 2002 telephone conversation with my staff, we have filled in the blank portions of the modification application (Le., line items 5 through 8) in accordance with the initial well construction/pump installation permit application that was submitted for this well on June 13, 2000. We have also cancelled the pump installation permit that was issued on July 10, 2001 as of the January 28, 2002 receipt date of this modification application.

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


LN:ss

c: Joe Kobayashi

/" Sincerely, I )

P ~~-~~ / i'--i' ·~->o ') l) ~1~ \ !jql~\ G ) '---.-/ I F',_-._

LlNNEL T. NISHIOKA Deputy Director

.....

c o State of Hawaii COMMISSION ON WATER RESOURCE MANAGEMENT Department of Land and Natural Resources APPLICATION FOR PERMIT

Well Construction and/or Installation Instructions: Please rint in ink or type and send completed application with attachments to the Commission on Water Resource Management, P.O. Box 621, Honolulu, Hawaii 96809. Application must be accompanied by 5 copies and a non-refundable filing fee of $25,00 payable to the Dept. of Land and Natural Resources. The Commission may not accept incomplete applications. For assistance, call the Regulation Branch at 587-0225. For further information and updates to this application form, visit http://www.state.hi.us/dlnr/cwrm.

For Official Use Only:

-; ?. ',~; ~

r,n LU I~II . 09

I ~. "

~hone: ~~ -:2 t61

Fax: E-mail: _______________________ _

(b) D LAND OWNER: ..... ,~~'-'-'--'=-----__ Mailing Address:

Contact Person: _______ _ Phone: ________ _

Fax: E-mail: _______________________ _

(c) fCONTRACTOR: Phone: ________ _

Mailing Address:

Fax: K2 t-07 _ Lic#: ~ (circle onElCg C-57a, or A)

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

2. WELl NAME, f!fl;ocy ~ L Address &.-_ f- ~

Island:

-~ : ---;:-'-\ -,--Zone Sec Plat Parcel

- \ Tax Map Key:

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

3. PROPOSED WORK: D C~truct New Well D Install New Pump'

(check all that apply) ~Odify Existing Well' D Modify Pump'

D Abandon/Seal'

's;/te Well No.: II?-. \ .- 0 ) (if unknown, please call Commission at 587-0225)

I12'ririlled D Dug D Shaft D Tunnel 4. CONSTRUCTION:

Is this well part of a battery of wells? DYes ~o (Please describe)

5. PROPOSED PUMPING RATE: 'to • 3D gallons per minute

6. PROPOSED USE: (check all that apply)

D Municipal (including hotels, stores, etc.)

J4' Domestic (individual, noncommercial water system)

D Industrial

Does this well serve 25 or more people at least 60 days per year or have 15 or more service connections? 0 YeS~NO

D Irrigation (crop)

D Military

7. (a) PROPOSED AMOUNT OF WITHDRAWAL:

b METHOD OF FLOW MEASUREMENT:

OTHER IMPORTANT INFORMATION:

D Flowmeter

D No. of Acres:

D Other (explain):

gallons per day

Open-pipe D Weir D Or~ice D Other(explain)

8. LEGAL REQUIREMENTS: If required, these permits!!Jj[g be obtained before the Commission can /egally issue a permit.

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

~ Not Required If required, date approved _____ _

Environmental Impact Statement (EIS) or Environmental Assessment (EA) To determine if an EIS or EA is necessary, call OEOC at 586-4185

~ Not Required If required, date published in OEOC bulletin _____ _

Special Management Area Permit (SMAP) To determine if an SMAP is necessary: on Oahu, call 527-5374; on Hawaii, call 961-8288; for Maui county, call 270-7235; on Kauai, call 241-6677.

l' Not Required If required, date approved _____ _

9. REMARKS, EXPLANATIONS:

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

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

I Landowner 5 ftrv\Q (print legibly)

Signature

Date

....,.~'--~"-:"'-'-.yL....L='-'-'. (print legibly)

For official use only Latitude

Longitude

Signature

Date

Aquifer System No.

State Well No.

C","do, 0 ","5 uJ~ (p~int legibly) ~ )?j Signature

Date 1- \1-02-

wI S, ~ '0\~\ V"\ ','

/

\

13. AS-BUILT CL SECTION (Please attach as-built if differentQ diagram provided below)

':2../'4 U 'f ( Hole Diameter: I j in. Elevation at top of casing --LL...!...:.. ft., msl* ~ i . .L . I -'--'---' (to nearest 0.01 ft.)..l..j:'::. ------=:~.. Minimum of 2' Radius & 4" Thick Concrete Pad

rB-e-n-c-h-m-a-r-k----, :~.::~:.·~4j ( Ground Elevation: 3'~ ft., msl

elevation: - //~q. -G": :.o":'T-·~·T--cyk --;;r~ Please refer to the

'21.iJ::f ft., msl* (Survey to nearest 0.01 ft.)

I

/.'. ~.~::I ··.·4·.

Cement Grout: ?- 40 ft. :!:."~ ,. HAWAII WELL CONSTRUCTION AND

; : PUMP INSTALLATION STANDARDS (min. 70% of distance from ';.:' ,',I>' :;-

;':' Ql to ensure that your as-built is in compliance

ground elevation to top of '. iIi with applicable standards. water surface or 500 ft., whichever isless.)

.. Qi "::1 >

0'. Ql ....I

0 ..

~' . .' :. ~ 'I

~

' . : "

* -- Solid Casing: (290% x (Ground Elev.-Water Level Elev))

[.(.-


.... •••• r;..

.;.:' ',';',

: o'

;.:' ~ Length: .3 5 7 ft .

:) in.

'. .. '0 .. :> ." Ql

~ , iIi

'0 '. c:

'. :J o' e

Nominal Diameter: ~ in.

Wall Thickness: e;;""{6 in.

Bottom Elevation: -45 ft., msl

Rock or Gravel Packing: Q. x

~ ft. Material:

Total Depth ~ 0

0 Ol Open Casing: 0 Perforated o Screen

I o Crushed Basalt

510 ft. 1\1 Length: ____ ---..:~ _______________ ft.

\

o Rounded Gravel Nominal Diameter: _________________ in.

~-------------~--i ~~r- Wall Thickness: in.

I .L

Water Level Elevation:

7 B ft. msl* Bottom Elevation: _______________ _ ft., msl

Open Hole:

I Length: _---J,\"""5:::,.5=-______ ft.

. _1 Diameter: ___ ILy-l--:-::::----..,--___________ in .

Bottom Elevation: __ ---.:.\_9 ........ 5«--____ ft., msl


Solid Casing Material: Carbon Steel: compliant with (check one or more): 0 ANSI/AINWA C200 0 API Spec. 5L

And compliant with (check one or more): 0 ASTM A242 0 Type E 0 Type S

LA53

o Grade B

o ASTM A139

o Other

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

Open Casing Material:

'., Filament Wound Resin Pipe conforming to ASTM 02996

LJ CentrifugaiJy Cast Resin Pipe conforming to ASTM 02997




D FEP Fluorocarbon Tubing conforming to ASTM 03296

Carbon Steel: compliant with (check one or more): [J ANSI/AINWA C200 '.: API Spec. 5L [] ASTM A53 == ASTM A 139

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

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

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

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



:, Reinforced Plastic Mortar Pressure Pipe conforming to ASTM 03517

~I Glass Fiber Reinforced Resin Pressure Pipe conforming to AINWA C950

:J PTFE Fluorocarbon Tubing conforming to ASTM 03296

D FEP Fluorocarbon Tubing conforming to ASTM 03296

MEMO and R~UTE SLIP o I WCR 1 Check for Well No. 1121-01 (survey to regulation memo)

1. Pump Tests Check Glenn Bauer ____ ,(initial) Yes No - -

Step-Drawdown Test:

followed WCPI Stds 0 0 analysis attached 0 0 proposed pump cap O.k. 0 0

Aquifer Pump Test:

followed WCPI Stds 0 0 T & S analysis attached 0 0

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

analysis attached o o

If no, describe deficiency

Stream Surface Water Impacted: o o .- If yes,' identify most probable stream

1 I ,

2. Construction Check Mitch Ohye 1'( ,,, .. ,' (initial) , Yes No / -

data complete !D followed WCPI Stds ,0 ~" well database updated ?"'.

o o o

~ '1 ~ I.' . \

If no, describe deficiency

\

06/21/01

----Hv ..... )'--- (initial) take action based on above analysis

ATTACHMENTS FOR PUMP INSTALLATION PERMIT). 1 COVER LETTER _

2PERMIT~ \/ 3 DOH COMMENTS

4LAND DIV. COMMENTS

5WCR2FORM

4. ROY~ (initial) check 5. Kathy\:' // (initial) finalize 6. Linnel t v..,. \ " (initial) signature 7. Charley/Lenore/Ryan File

__ not necessary - only WCP.

To be sent to applicant

, , ,



Dear Mr. Goldberg:




JUL 1 0 2001

Pump Installation Permit Nancy Irene (Well No. 1121-01)


BRUCE S. ANDERSON ROBERT G. GIRALD BRIAN C. NISHIDA DAVID A. NOBRIGA


lINNEl T. NISHIOKA DEPUTY DIRECTOR

1121-01.pip

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.

The permittee, well operator, and/or well owner are responsible for all conditions of the permit. This includes ensuring that the pump installation contractor submits a completed Part II of the Well Completion Report form (enclosed) within sixty (60) days after the pump installation work is completed. Be advised that you may be subject to fines of up to $1000 per day for any violations of your permit conditions starting from the permit approval date.

Please sign and have the landowner sign both permit originals and retum one for our files. A copy of the Well Completion Report (Part II) and a copy of your water use report form are enclosed for your use.

IMPORTANT - Pump installation shall not commence until a fully signed permit is returned to the Commission. Except for the monthly water use report form, please provide copies of all the information in this packet to your pump installation contractor.

Finally, this letter is notice that we have accepted your Well Completion Report - Part I as complete as of June 14, 2001.

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

Enclosure c. Joseph & Suzanne Kobayashi

Aloha, . ''1 ,D· ./\ A '/X I Ii p' . /1 n '\ 1\' "'-"1 It! ,.!,,-~ J il . V (' r- f l~~. V . ( i :

"-_/ GILBERT s. COLOMA-AGARAN J Chairperson

/

PUMP INSTALLATION PERMI~ Nancy Irene, Well No. 1121-01 .."

" 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 Nancy Irene (Well No. 1121-01) at Koolau Road, Kauai, TMK 5-1-3:1, subject to the Hawaii Well Construction & Pump Installation Standards (1/23/97) which include but are not limited to the following conditions:

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

2. The pump installation permit shall be for installation of a 30 gpm capacity, or less, pump in the well.

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

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

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

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

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

8. The permit may be revoked if work is not started within six (6) months after the date of approval or if work is suspended or abandoned for six (6) months, unless otherwise specified. The work proposed in the pump installation permit application shall be completed within two (2) years from the date of permit approval, unless otherwise specified. The permit may be extended by the Chairperson upon a showing of good cause and good-faith performance. A request to extend the permit shall be submitted to the Chairperson no later than three (3) months prior to the date the permit expires. If the commencement date is not met, the Commission may revoke the permit after giving the permittee, well operator, and/or well owner notice of the proposed action and an opportunity to be heard.

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

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

11. Special conditions in the attached cover transmittal letter are incorporated~reln ~~~eference. n ""-\Lf" .' } /1 ./\~)

Date of Approval:

Expiration Date:

June 14,2001 June 14, 2003

( I ". ;.( /t\,-,,l! I \ /'''/\ / I \, /'-.. '>-..J ) ",--"\,,,,,-,!, '>.J ~ I -..--

. \ GILBERT S. COLOMA-AGARAN, Chairperson

Commission on Water Resource Management

I have read the conditions and terms of this permit and understand them. I accept and agree to meet these conditions as a prerequisite and underlying condition of my ability to proceed and understand that I shall not commence work until I and the pump installer have signed, dated, and returned the permit to the Commission. I also understand that non-compliance with any permit condition may be grounds for revocation and fines of up to $1000 per day starting from the permit date of approval.

Permittee's Signature: Date: ____ _


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

Printed Name: Firm or Title: _______________ _


Attachments c: USGS

Department of Healthl Safe Drinking Water & Wastewater Branch Kauai Department of Water Supply Joseph & Suzanne Kobayashi

/

I \

Well No.

Well Name

Applicant

1121-01

Nancy Irene

kobayashi

o


Island

Aquifer System

Aquifer Sector

KAUAI

LIHUE

KILAUEA

data 0 Date of Review 6/25/01 Reviewer RRI

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

Proposed Use

Proposed Withdrawal


Domestic

8000

17



Ground Elevation

Cement Grout

Rock Packing

Hole Diameter

Total Depth

Estimated Head



ft., m.s.1.

ft., m.s.1.

ft.

ft.

in.

ft.

ft., m.s.1.

3198 ft.

Solid Casing

Material

Designation

Length

Diameter

Wall Thickness

Casing

Material

Designation

Length

Diameter

W~JF Thickness

Openings

Open Hole

Length

Diameter


Well Depth




Well Casing


Material

County or Non-County Minimum Thickness per standards


Minimum Length of Solid Casing

90% of ground to top of aquifer


Casing Material

Annular Space

Depth of Grouting




PVC

3198 ft.

799.5 ft.

198 ft.

non-county 0.280 in.

0.000 in.

210.6 ft.

470 ft. Sch40

163.8 ft.

240 ft.

3.5 in.


(disregard if the well is not basal)

too small (refer to HWCPIS Section 2.4 cJ (disregard this if this is a non-county well)


okay (refer to HWCPIS Section 2.4 e)

If the cell above reads #NlA, reference HWCPIS)

okay (refer to HWCPIS Section 2.6 c)


Page 1

State of Ha~ii Q COMMISSION OTWATER RESOURCE MANAGEMENT Department of Land and Natural Resources

WELL COMPLETION REPORT - PART I Well Construction

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

1. State Well No.: 1121-01 Well Name: Nancy Irene

Address: Koolau Rd. Tax Map Key: 2.

3. Drilling Company: 0 ~~") s W AA<,J\.... S'lSM \N c... , If drilled, type of Rig: Rotary 0 Percussion

For Official Use Only:

Island: Kauai

5-1-3:1

4.

5. Date Well Construction (drilled,cased,grouted) completed: 3 - to- 0 \ Attach Driller's Log (7/26/99 DL Form) monthldaylyear

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

.('". ') L.

6. Initial water-level encountered ;:235 ft. below ground Date and time of measurement: 2-2.8.-01 161M

7.

8.

Step-Drawdown Test completed?

Constant Rate Aquifer Test completed?

Parameters prior to pump test:

v'O.D Yes

~ DYes

month/daylyear time

Attach Step-Drawdown Test form (12117/97 SDPTD Form)

Attach Constant Rate Aquifer Test form (12117/97 CRPTD Form)

9. Water-level: _'1~6r:' L· ___ ~. -~~~·~' .. ·, .. aMli'iQ'iWViiWlliQiL~.~ Date and tim~ of measurement:

10. Chloride: _5~V ......... ______ ppm

11. Temperature: -7-1--1~------ OF

Date and time of sampling:

Date and time of measurement: \

month/~~lyear time

month/daylyear time


13. Attach plot plan and surveyor's stamped elevation report.

14. If a pump is not ~Ianned to be installed, please describe (below i?_~e r~m~tks section) how well is secured to prevent unauthOrized access (example: lockable cover, thread11juPlln9" etc.)

15. Remarks: !

I. j

/

Licensed Driller (Pri~~ft-l/; Signature -:iI~","",,4../y::=' ~-~~:.s;:-=j!Itt}.'-.lIi~:;"';~F==-------:""

I !

C-57 Lic. No. ~2c:=...L.\4----l.k-"5_7.L..... ____ _

Date """b;:,..l--..:~~-....;:O::....l.lo......-___ _

Surveyor (print) Se..c.. A- \1 A-C~ L.P.L.S. Lic. No. __________ _ please attach stamped report

Signature Date __________ _

Permittee (print)

Signature Date ___________ _

weR1 Form 512100

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

'3\'-\.'1 Elevation at top of casing ___ ft., msl*

13 in.

(to nearest 0.01 ft.)

Bench mark elevation:

Minimum of 2' Radius & 4" Thick Concrete Pad

Ground Elevation: 3,?., ft., msl

Please refer to the

~ft.,msl* (Survey to nearest 0.01 ft.)

Cement Grout: '7-""""'"''''':--''. (min. 70% of distance ground elevation to top of water surface or 500 ft., whichever is less.)

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

, (~


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

TotalOepth


3 in.

Rock or Gravel Packing: ><

Length: ~70 ft.

Nominal Oiameter: C. in.

\/Vall Thickness: SoL"'- l{"C) in.

Bottom Elevation: -)5b ft., msl

510 ft. _~ft. Material:

Open Casing: e Screen

e Crushed Basalt o Rounded Gravel

Water Level Elevation:

78 ft. msl*

Length: YD Nominal Oiameter:

Wall Thickness:

Bottom Elevation:

Open Hole:

ft.

b in.

Sc...lA. \{O in.

-14~ ft., msl

Length: ____ < __________ ft.

Oiameter: _____________ in.

Bottom Elevation: _________ ft., msl


;rjw ,-t!e:!e/Y 3 ('--"~ , I '- ;"

Solid Casing Material: Carbon Steel: compliant with (check one or more):O ANSI/AWWA C200 e API Spec. 5L e ASTM A53 e ASTM A 139

And compliant with (check one or more): 0 ASTM A242 0 Type E 0 Type S e Grade BO Other


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

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




e Glass Fiber Reinforced Resin Pressure Pipe conforming to AWWA C950



Open Casing Material: Carbon Steel: compliant with (check one or more): 0 ANSI/AWWA C200 e API Spec. 5L 0 ASTM A53 0 ASTM A 139



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): .,schedule 40 0 Schedule 80 0 Schedule 120







• J .. c o

· . FILE No.437 04/13 '01 AM 10:09 ID:Joseph Kobayashi "....,.

, 1 Attmy. FAX:80S 822 9436 ,..., PAGE

~ ..."",

.«'';'~-'':'''ofA'' State of HawaII For Oflclal U .. Olll)':

COMMIlIiON ON WATER RESOURCE MANACIEMENT De"artm.nt of ~nd and Natur •• RHoul'OM

WELL COMPLETION RIPORT - PART I WIll co.uotIon

1. Stitt Will NO.! 1121.01 Well Nlml: MinGY lren. IlItnd; . ..!..K!l!!.~IJIlc:..I __ _

2. Addreta: ..IKooI=oI:.;.:::.-=-u..:..:Rd:.:.-________ ~ __ - Tax Map K'Y: .... 5-'-1,;..;-3:t.1,.;1.:....-____ _

3. Ol1l11ng Company:

4. If drilld, tyPI of Rig: 0 Rotary 0 Percunlon

5. c.t. Wei' ConltNc:t1on (drlNtd,CMed,grwted) campleted; Attaob DftII ..... L-og 17 .... CIt. ~ ~

Ift.rIfIIf/fItt to ,.. ...... IQ. ". ,..,.. log _ PfWIIItW, ",.... ."""" willi "'ill ,.".,.

I. Inltta' wlller..t.vel ~nt.-.d ft. below grounG em and tim. of m.fUrtrMnt monlMI;;.t;Wi em;

1. Step.OmvdownT •• toompltt.d? 0 No 0 y" AUIIoII"p~TMtfonn(111f7mJ"'TI)FomtI

8. Conltlnt Rite AqIAIfw TMt ooml'leted? 0 No 0 Yea Altwh Conewm ..... A4ulflt T_fgrm (1&1f7'" Cltl'J'D /IFoIm)

Pal1lmltn prior 10 pump • .r. $ W"'4!eve1: ft. above mel Date and time gf measurement:

10. Chloride: • ppm 11. T,,"PIF'Itu~: ________ ·F

Oett end tim. of umpllng:

o.te and tlml 01 rnUlUrtmtnt:

12, PIli In II ...... ". aotIon Oft the othe, ald. of thla ,tiNt.

13. ~tcIch plot plan Ind IYNeyor's atlrnped elevation report

14, If e pump I,not planned to balnlt1llled, pie •• dMOrlbo (below In tM rtmll'kl fICtion) how weill. a80Urecf to prtvent unauthorized aGOftl (exlmple: Ioekable COV.,., thl'llCllCI coupung, etc.)

16, JIIt.mark,:

LIHnMCI Driller (Print) __________ _ C-67 Lie. No. _______ ~_

81pture 0 .. ___ ~ ____ _

lurv.yor(prtnt) ~=:::J~----~------ L.P.L,S. lie. No. _______ --: __ pIN. tItfIoh""',.wr

SIgnature

Perml ..... (print)

SI"".ture

oate __________________ _

8LLBsz:e9::J9

1

, \

c o

WELL NUMBER: \ \'1\ -0 \

DRILLER'S LOG (7/26/99 DL Form)

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

--.1Lto~ ~D>V->~ \teo.. C\Ay $0\ \ _to_2C.~J-D( litom ~e~ ~\~ ~(J( s-\-rCA\cSo ___ '_( __ _

\31 tom Q:,W)\e.IA. ~\veJ4c~ ~ \Jv~~G~<- \\

\16to135 ~e& W~~ ~c\( ~k~ ~~Jh( ?--';A~-ol_ d35tom ~AC\-u(LeJ ~\ueJl-OC\~ to\]J160-<-~ l\ (Wi) ~031] ~~c:\Jh( \JvL~kR.- ~{&.-k S- \-D\ mto3b5 ~uAd-uCLeJ} ~'ue- ~~to_ \ \

31S-to~ ~\ve.- ~tQc \-( <\.- Y:I ,,~C\.-U~ \LocJ-c 3-).-0 l LJ35-to!:)% £:,\UL ~c\~ _to_ ~\ ~to5Q£ Wt.4~UL- ~c~ '\- ~JI\~~lItec9- ~c\-c 3-5--6{ wz.. 5~to5iO ~ \v~ ~c\c _to_ \ ~ _to ________ _ _ to ______ _ _ to ________ _ _ to ______ _ _ to ________ _ _ to ______ _ _ to ________ _ _ to ______ _ _ to ________ _ _ to ______ _

_ to ________ _ _ to ______ _

_ to ________ _ _ to ______ _

Remarks:

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

~;~~ '-' n

1--~·\C '0 I ELEV =314.40'

I ,

~ CASING

4" CO NCRETE SLAB

\ ~ELEV =312.4 0'

· . . . . · . . . . . · . ~ .. . ~ .. · ~ .. . ~ .. . . . . . . .. . . . . . .

· . · · . . . · . . . . · . . . · . . . . . . . . . . GR · . . .. . . · . . . . . . . · . . . · . . · . OUND

I I I I I I I I

I I I I I I I I I 1

WELL ELEV A TION

WELL #1121-01

OWNER:JOSEPH KOBAYASHI

T.M.K.( 4 )5-1-37:01

(liN ANCY IRENE") ~--

PETER N. TAYLOR

LICENSED PROFESSIONAL LAND SURVEYOR No.9149

ENCH MARK USED: WELL SITE #1120-27 HAVING AN ELEV ATIION OF 311.38'

02/20/2001 17:00 8088280778 - ... _-.. ··----0; .... ~ ... o

Oasis Water Systems, Inc.

Feb. 20 2001 /

State Of Hawaii . Water Commission ATT: Lenore Nakama

Dear Lenore,

P.O BOX 535 KILAUEA, HI 96754

Phone: 808-828-6876

Fax # 808-587-0219

Please be advised that Oasis Water, Inc. License No. C-21457. We will begin work on the Aqua Par Vida Well # 1120-31 & the Nancy Irene Well # 1121':01 in the next few weeks. -Sincerely,

Steve Goldberg Oasis Water inc. C-21457

PAGE 01

02/20/2001 17:02 8088280778 ". .. "

FILE No.1B8 OS-'Cl ·~O AM Of ~ ID:)ogeph KobaYl1!'<hi H'Ctrm'. FRi'::80B/"~ 8436 ,- ....., ·'ILL CONSTRUCTION PERMIT (

bloCk '[lP' Will. win tlo. 112141 '

PAGE 01

PAGE 2 !


REF:CWRM-SS


Dear Mr. Goldberg:




JUL 1 8 2000

Well Construction Permit Nancy Irene Well (Well No. 1121-01)

TIMOTHY E. JOHNS CHAIRPERSON



LINNEL T. NISHIOKA DEPUTY DIRECTOR

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

Special Conditions

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

2. The wall thickness of well casing shall be selected in accordance with good design practices applied with due consideration to conditions at the site of the well and shall be sufficient to withstand antiCipated formation and hydrostatic pressures imposed on the casing during its installation, grouting, well development, and use.

3. All wells (excepting salt-water wells, artesian wells, and temporary monitor wells designed for immediate or short-term monitoring purposes and subsequent abandonment/sealing) shall be constructed with a casing string having a minimum length of solid caSing equal to 90 percent of the depth measured from the ground surface to the top of the selected aquifer.

4. To prevent surface contamination, the annular space of all cased non-artesian wells (except monitor wells designed for immediate and short-term monitoring purposes and subsequent abandonment) must be sealed with grout from the ground surface to a minimum depth of 500 feet or 70% of the vertical distance between the ground surface and the top of the aquifer selected for exploration, long-term monitoring, or development, whichever depth is less.

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

c Mr. Steve Goldberg

JJeg, e 2000

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

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

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

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

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

Aloha,

~' /1

, '1'~ ~/'

. I / .U~-1\-TIMOTHY E. JOHNS" '- j Chairperson

Enclosures

o WELL CONSTRUCTION PERMQ Nancy Irene Well, Well No. 1121-01

I

In accordance with Department of Land and Natural Resources, Commission on Water Resource Managemenfs Administrative Rules, Section 13-168, entitled "Water Use, Wells, and Stream Diversion Wprks", this document permits the construction and testing of Nancy Irene Well (Well No. 1121-01) at Koolau Rd., Kauai,TMK 5-1-~:1, subject to the Hawaii Well Construction & Pump Installation Standards (1123197) which include but are not limited to the following conditions:

c; - \ - :". \ 1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

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

The well construction permit shall be for construction and testing of the well only. A minimum 11/4-inch diameter monitor tube shall be permanently installed, in a manner acceptable to the Chairperson, fo accurately record water levels. The permittee, well operator, and/or well owner shal coordinate with the Chairperson and conduct a pumping test in accordance with the Standards (a pump testing worksheet is attached). The permittee, well operator, and/or well owner shall submit to the Chairperson the test results as a basis for supporting an application to install a permanent pump and withdraw water for use. No permanent pump may be installed until a pump installation permit is approved and issued by the Chairperson.

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

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

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

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

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

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

The well construction permit application is incorporated into this permit by reference and is subject to the Hawaii Well Construction & Pump Installation Standards (January 23, 1997; HWCPIS). If the HWCP1S are not followed and as a consequence water is wasted or contaminated, a lien on the property may result.

The permit may be revoked by the Commission if work is not started within six (6) months after the date of app'roval or if work is suspended or abandoned for six (6) months, unless otherwise specified. The work proposed in the well construction permit application shall be completed within two (2) years from the date of permit approval, unless otherwise specified. The permit may be extended by the Chairperson upon a showing of goOd cause and good-faith performance. A request to extend the permit shall be submitted to the Chairperson no later than three (3) months prior to the date the permit expires. If the commencement date is not met, the Commission may revoke the permit after giving the permittee, well operator, and/or well owner notice of the proposed action and an opportunity to be heard.

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

The permittee, its successors, and assigns shall indemnify, defend, and hold the State of Hawaii harmless from and against any loss, liability, claim, or demand for property damage, P.8rsonal injury, or aeath arising out of any act or omission of the applicant, assigns, officers, employees, contractors, and agents under this permit or relating to or connected with the granting of this permit.

Date of Approval: July 14, 2000 July 14, 2002

TIMOTHY E. JOHNS, Chairperson Commission on Water Resource Management Expiration Date:

I have read the conditions and terms of this permit and understand them. I accept and agree to meet these conditions as a prerequisite and underlying condition of my ability to proceed and understand that I shall not commence work until I and the driller have signed, dated, and returned the permit to the Commission. I also understand that non-compliance with any permit condition may be grounds for revocation and fines of up to $1000 per day starting from the permit date of approval.

Permittee's Signature: _____________ _ Date: ______ _

Printed Name: _____________ Firm or Title: ______________ _

Driller's Signature: _____________ C-S7 License #: _____ Date: ______ _

Printed Name: Firm or Title: ______________ _


Attachment c: USGS

Department of Health! Safe Drinking Water, Wastewater, and Clean Water Branches Kauai Department of Water Supply Joseph & Suzanne Kobayashi

Well No.

Well Name

Applicant

1121-01

Nancy Irene

Kobayashi

o


Island

Aquifer System

Aquifer Sector

KAUAI

LIHUE

KILAUEA

data

Date of Review

Reviewer

Proposed Use

o

Proposed Withdrawal


7/13/00

RRI

Domestic

8000

17



Ground Elevation

Cement Grout

Rock Packing

Hole Diameter

Total Depth

Estimated Head



, m.s.1.

,m.s.1.

______ ft., m.s.1.

o ft. -----

------

Solid Casing

Material

Designation

Length

Diameter

Wall Thickness

Casing

Material

Designation

Length

Diameter

Wall Thickness

Openings

Open Hole

Length

Diameter

ft.

in.

in.

ft.

in.

in.

sq.in.ll.f.

ft.

in.


Well Depth




Well Casing


Material

County or Non-County

Minimum Thickness per standards


Minimum Length of Solid Casing

90% of ground to top of aquifer


Casing Material

Annular Space

Depth of Grouting




PVC

Oft.

o ft. -400 ft.

non-county

0.280 in.

0.000 in.

360 ft. Oft.

--~S-ch-4-0

280 ft.

Oft. --~--4in.


too small (refer to HWCPIS Section 2.4 c)

too shallow (refer to HWCP/S Section 2.4 d)

okay (refer to HWCP/S Section 2.4 e)

If the cell above reads #N/A, reference HWCPIS)

not enough

okay

Page 1

(refer to HWCPIS Section 2.6 c)

(refer to HWCPIS Section 2.6 d)

BENJAMIN J. CAYETANO TIMOTHY E. JOHNS GOVERNOR OF HAWAII CHAIRPERSON



LlNNEL T. NISHIOKA

STATE OF HAWAII DEPUTY DIRECTOR

TO:

FROM:

SUBJECT:

DEPARTMENT OF IJI.ND AND NATURAL RESOURCES



,-,1>...,.'_' ,_ '.... __

Dean Y. Uchida, Administrator Land Division .... , . __ . /y-j/ Linnel T. Nishioka, Deputy Director(-1ir~J, () { f'-'" Commission on Water Resource M~~~ment Well Construction/Pump Installation Permit Application Nancy Irene Well (Well No. 1121-01)

Transmitted for your review and comment is a copy of the captioned well application which includes a request for a pump installation permit.

We would appreciate your comments on the captioned with regard to the programs, plans, and objectives specific to your division. Please respond by returning this cover memo form by July 14,2000.



RESPONSE:


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

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


[ ]

[¥ No objections

Other comments: Original source of title is Land Commission Award 6730 issued between 1845 - 1850.

Contact Person: Gary Martin Phone: 587-0421 ----~---------------

Signed: ___ .~~_~_nt:......J''::''~_#---'~'(.::....:~='. _________ Date: 7/7/00 C=' C:Y

c.. ... ;::J C : q ... -I

;> - : 1

~

~ -' . . ,

c.o • )

.I:-~

BENJAMIN J, CAYETANO GOVERNOR OF HAWAII


BRUCE S, ANDERSON ROBERT G. GIRALD BRIAN C, NISHIDA DAVID A. NOBRIGA

HERBERT M, RICHARDS, JR.

STATE OF HAWAII LlNNEL T. NISHIOKA

DEPUTY DIRECTOR

TO:

FROM:

DEPARTMENT OF LAND AND NATURAL RESOURCES COMMISSION ON WATER RESOURCE MANAGEMENT

P,O. BOX 621 HONOLULU, HAWAII 96809


William Wong, Safe ~~n~ilJg W~ter ,~T~?7h

Timothy E. Johns, Chairperson (--"tMe, I. 0 {)f _ \dr Commission on Water Resource M~gJriiertV J'- ~

SUBJECT: Well Construction Permit Application Nancy Irene Well (Well No. 1121-01)

Transmitted for your review and comment is a copy of the captioned well 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 July 14, 2000.



RESPONSE:

[ 1

[ 1

[ 1

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

This well does not qualify as a source serving a public water system (serves less than 25 people or more people at least 60 days per year or 15 service connections) and if the well water is used for drinking, the private owner should test for bacteriological and chemical presence before initiating such use and routinely monitor the water quality thereafter. However, if future planned use from this source Increases to meet the public water system definition then Director of Health approval is required .PJ:!2.[ to implementation.

[ 1

[ 1

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 Qap or an approved backflow pre~r, and by clearly labeling all non-potable spigots with waming signs to prevent inadvertent consumption of non-potable water. Backfl~lJevention ,"" devices should be routinely inspected and tested. ?'? C') (;.:. " d

It does not appear that this well will be used for consumptive purposes and is not subject to Safe Drinking WaJ.~ ~ulations~;: -"" -;" " \' '1

For the applicant's information, a source of possible wastewater contamination [lis [I Is not located near the pro~ well siteC)") (information attached). ',.-:, ;'

\-_.:'



, ,'" Phone: BCJ0 4 2Pl~,~ Date: 1-1-2000

"\ .::.

..

o o BENJAMIN J. CAYETANO TIMOTHY E. JOHNS

GOVERNOR Of HAWAII CHAIRPERSON

TO:

FROM:

STATE OF HAWAII

BRUCE S. ANDERSON ROBERT G. GIRALD BRIAN C. NISHIDA DAVID A NOBRIGA


UNNEL T. NISHIOKA DEPUTY DIRECTOR

DEPARTMENT OF LAND AND NATURAL RESOURCES RECEIVED COMMISSION ON WATER RESOURCE MANAGEMEN1SAFE DRINKING WATER BRANCH

P.O. BOX 621 HONOLULU, HAWAII 96809

JUl' L: 0 C:UUJ


William Wong, Safe Drinisiog Water Branch

Timothy E. Johns, Chairperson ()j:rf;!/ 'J. 6 r~~f' - <~tr Commission on Water Resource ManagemertV ;- ~

JU:~ '[, t LUJJ /1"



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 July 14.2000.


LN:ss Attachment(s)

RESPONSE:

[ 1

[-1/

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

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

[ 1 If the well is used to supply both potable and non-potablesurposes in a Single system, the user shall eliminate.Gr~-conne~ and backflow connections by physically separating potable an non-potable systems by an air ~ap or an approv~~w prev.Jiii?r, and by ""'" clearly labeling all non-potable spigots with waming signs to prevent inadvertent consumption of non-potable \l¢er:' :aackfl~vention ~ devices should be routinely inspected and tested.::-: ~~~ p , .j:', It does not appear that this well will be used for consumptive purposes and is not subject to Safe Drinking Wat~:.J3.~lations. ) [ 1

[ 1

[ 1 [ 1

.' i .,.. c;:1') '1


For the applicant's information, a source of possible wastewater contamination []is [] is not located near the p'ropO~ well site (lnformallon attached). .C "'f" '::P

" '~. C5 l;·<~ "'L •• ~~:~; a CP-';,i --J,

Phone: :;-/ c. ~ 0Zs-s? --------~--~-----------


Date: ~ 3, 2t?tt7o

-" .,... , \



Dear Mr. Goldberg:

-





BRUCE S. ANDERSON ROBERT G. GIRALD BRIAN C. NISHIDA

DAVID A. NOBRIGA HERBERT M. RICHARDS, JR.

LlNNEl T. NISHIOKA DEPUTY DIRECTOR

Well Construction I Pump I nstallation Permit Application for Well No. 1121-01

We acknowledge receipt, on June 13, 2000, of your completed well construction I pump installation permit application for the Nancy Irene Well (Well No. 1121-01). You can expect your application to be processed within ninety (90) days from this date.

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


LN:ss

c: Joseph and Suzanne Kobayashi

Sin~erelY, ()

"~)e\/' 0 ~...cr-, '-../)1 !, CJ ft1 . J. : ',--" ,

LlNNEL T. NISHIOKA Deputy Director



TO:

FROM:




JUi\ L 0 iJ~U


William Wong, Safe DrinjsilJg Water Bran9h

Timothy E. Johns, Chairperson (~e/ /). 6/~~{ \tr Commission on Water Resource M¥~g~ent! }- t






We would appreciate your comments on the captioned application for any conflicts or inconsistencies with the programs, plans, and objectives specific to your department. Please respond by returning this cover memo form by July 14. 2000.


LN:ss Attachment(s)

RESPONSE:

[ 1

[ 1

[ 1

[ 1

[ 1

[ 1 [ 1

This well qualifies as a source which will serve as a source of potable water to a public water system (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 pror to Its use to comply with Hawaii Administrative Rules (HAR), Title 11, Chapter 20, Rules Relating to Potable Water Systems, §11-20- 9.

This well does not qualify as a source serving a public water system (serves less than 25 people or more people at least 60 days per year or 15 service connections) and if the well water is used for drinking, the private owner should test for bacteriological and chemical presence before initiating such use and routinely monitor the water quality thereafter. However, if future planned use from this source Increases to meet the puolic water system definition then Director of Health approval is required m:!2!: to implementation.

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


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



ConmctPerson: ___________________________________ Phone: ______________________ _

Signed: _________________________________________ Date: ______________________ _


TO:

FROM:

SUBJECT:




Dean Y. Uchida, Administrator Land Division /-, . '---'. ),-i') Linnel T. Nishioka, Deputy Director<~}'8;J, U ( \'--Commission on Water Resource M~~~ment Well Construction/Pump Installation Permit Application Nancy Irene Well (Well No. 1121-01)




LINNEL T. NISHIOKA DEPUTY DIRECTOR

Transmitted for your review and comment is a copy of the captioned well application which includes a request for a pump installation permit.

We would appreciate your comments on the captioned with regard to the programs, plans, and objectives specific to your division. Please respond by returning this cover memo form by July 14,2000.



RESPONSE:


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

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


[ ] No objections

[ ] Other comments:

ConmctPerson: __________________ ~Phone: ___________ _

Signed:, _____________________ Date: ___________ _

;:: ~~~ .. ... .. ~ :: ... no ! ga n..o .... 0 g9i~ "

iii .... n..o -< ~ ~ . ~o ... ....

~ .F >' e. f~ .." ... =~g 0 0 ~ -0 l .."

~ " .... ~ &l ~ ~ 0 IT'

0 $ a i Lt1 n..o t\ , .. DJ

i :E 0 .. ~~i

0 .... 0 !=' ..D 0 ;!;~'" 0 3: IEe1 ..

I!- ! ,i!i n..o

..D n..o JI> . ..D Z .." Lt1

• P .... .."

~ 0

IT' .... DJ IT' 'io ....

~ Ii 'io

.... " .. - 0

0 ! f~i .... "h, n..o i 't

i i ~~ •• is' : ~ ~ :8;:s i §

EI> ..... 0 lUi w

• I J\) J •

DEPAAlJ'o1ENT OF I..ftNO fW) Wl-TlAAL RESO\.RCE5

o OOCLt ENTN:). UAC OR ~r.:rAO£O IIORKS

I SRC/ COST , F YR' N'P o OBJ CTR PROJEC PH ACT ",.~

G_ .QQ 999 ~ lQ~§ Q12_ ----- -- --- (1) 25.00

G_ b.9_ 92- 9 !Q~~ 075 ------ -- (2) 25.00 ---G_ 0.9_ 929 9 !Q~~ 075 -- (3) 25.00 ----- ---~ O.9ot I~ ~I~ 075 ------ -- (It) 25.00

W5 --- 25.00

TOTAL 125-:-00

REWlRKS: LIt£ (1) WELLNO 1221-05 (WCPA/PIPA)

LINE (2)

LINE (3)

eOEi.VI<'.........,"" ..... "' .... ,·

."

c~ ~ CII_ :o)ooQ ?:p~)oo

;"~i:P ''-,xn i: ;8:::8n '~i:lz8

)ooz 6)00 ... 0

WELL NO.

WELL NO.

1224-01 (WCPA/PIPA)

1121-01 (WCPA/PIPA,)

~cot;.t;. H, Raut.mann carrie ~, y, l<8ut.mann 18001 0:20,1:>01 P.O. Box 718 KUtluea, HI q&"4

70;, ______ _

ALOHA ASSOCIATES 2000, LLC

ET DATE: 6/ 2/00 2

W<ME /OESCR I PTf ON ' (WNCG I !'PUT)

_~~~~~L ___________ _~~~2~gg~ ___________

-~~~~~~g~~~---------PATRICIA MACDONALD

--UltSlS wAIER SISIEmi. -rNC".------

LINE LINE

(4) WI'LL NO. 1123-05 (WCPI./PIPA: (5) WELL NO. 1324-02 (WCPA/PIPA

~1 1363

'P." fi1ftt..( 1fi2) 2tJCD

~101l1213

" 1057

t9196 IIVMVH 'V3nV"lllt 699~~ W:~ XOS 0 d

IHSYAY80X'N 3NNvzns

~~~t,:I~:I~h9Na~ATER RESOURCE MANAGE~NT For Official Use Only:

Department of Land and Natural Re rces APjlLICATION FOR PERMI 6ell Construction and/or um Installation

Instructions: Please print in ink or type and send completed application with attachments to the Commission nO ·JUN 13 p12: 1 6 on Water Resource Management, P.O. Box 621, Honolulu, Hawaii 96809. Application must be accompanied by 3 copies and a non-refundable filing fee of $25.00 payable to the Dept. of Land and Natural Resources. The Commission may not accept incomplete applications. For assistance, call the Regulation Branch at 587~225. ." ... For further information and updates to this application form, visit http:/twww.state.hi.usldlnr/cwrm. ti'(:",\ ;'i';~;~-:\~j (: 1 \~' • T;~

r ... ,-·· ... r .. : ...... (·'·:'~.-~ ",f_ "',~ •• I APPLICANT INFORMATION: (Fill out all three. if applicable, and place a check next to the primary contact1";: ;;',)1_ _ .. . 'J'.'"

1. (a) 0 ~LL OWNER: SA", ~ , Contact Person: Phone: --------Mailing Address:

Fax: E-mail: _____________ --:..--_____ _

(b) OX-LAND OWNE"'" 3"--IlN ~ StJ2.ItIAJ..e ..w" 4.0.,. ...... 7.0e.) f .. L ,G~ e;-n. "D •• T ItS lei I Contact Person: -~ Phone: '-.! I II' ..... - .. .-Q ,

Mailing Address: r 0 SO.,c~' I(A'-AA- , 11-£ 4p45?"1o.( /ax: r)..l,,'" ,43.{. E-mail: _________________ _

(c) u'cONTRACTOR: QAS\S WA+c.rl- Contact Person: Phone: ______ _

Mailing Address:1'O~ 635 K~ \'-'\1 __ \~ 44----='7,::-:'$'::-:'''t-=----Fax: (j"o~ .. tl* ... 0178 E-mail: _________ _

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

2. :~~~~AM=- t~1ttJgg~C.'I 1~:Ma::: :3 5 --+1_ Zone Sec Plat Parcel

Attach the relevant portion of (a) a 7.5-Minute Series USGS topographic map (scale 1 :24,000) and include the name of the quad map, and (b) a property tax map, showing weillocat~ referenced to established property boundaries.

3. PROPOSED WORK: Iiiif" Construct New Well "- Install New Pump·

(check a/l that apply) 0 Modify Existing Well- 0 Modify Pump·

o Abandon/Sear

·s,e Well No.: _________ (if unknown, please call Commission at 587-0225)

4. CONSTRUCTION: Ilif6rilled 0 Dug o Shaft 0 Tunnel

Is this well part of a battery of wells? DYes ~No (Please desaibe)

5. PROPOSED PUMP INFORMATION: Rated Pump Capacity: -...:~~O~ ... _~~O~ ___ gallons per minute

Pump Type (Check one):

o 9'ep WeH Turbine

Iif"Submersible

D Centrifugal

o Rotary

o Rotary-Displacement

o Rotary-Gear

6. PROPOSED USE: (check a/l that apply)

D ~niclpal (including hotels, stores, etc.)

.t"Domestic (individual, noncommercial water system)

o Irrigation (crop) -----------------------o Military

o Propeller

o Reciprocating

o Impulse

D Industrial

D No. of Dwelling Units:

D No. of Acres:

o Other (explain):

7. (a) PROPOSED AMOUNT OF WITHDRAWAL: 6,000 " gallons per day

(b) METHOD OF FLOW MEASUREMENT: D Flowmeter ~n-Pipe D Weir 0 Orifice D Other(explain)

OTHER IMPORTANT INFORMATION:

8. LEGAL REQUIREMENTS: 0 COUP o SMAP o EIS DEA o Other (explain)

9. REMARKS, EXPLANATIONS:

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

I understand that approval of this application attaches the following standard conditions' 1 \ the proposed wort< is to be completed within two (2) years of the approval date; 2) the contractor shall submit to the Commission a well completion/abandonment report within 60 days after the completion date of the permitted wort<; 3) monthly water use data shall be submitted to the Commission; 4) such approval shall not constitute a determination of correlative water rights and shall not guarantee the pump capacity or future use up to the permitted pump capacity.

"~ ;n,gJl.. A>VI;) ~IJ~

"'" Well Owner *'It. It. landowner KN61J. Y JtI6 JJ1 Contractor ~~~ Signature ~ ~ Signatur~'Ji ~5!Ma:t~' Signature ~ ~ Date 6(1¥~O-=-O_____ Date d./I¥~/) \ Date ''-h-~

For official use only Latitude Longitl,de _., _ .

.. ,,"" ...... _ Aquifer System No. State Well No .

.... ____ • _____ ..... IiI:I.;:_,1.WI!'nI.Th· ... ,-.. ~,"...rtl'\·~-________________________________ ...

WCPIPA Form 512100

IV. r"vrv~&;;u .... a.;. ...... ~&;;'" I lVi'll (t-'Iease arlacn scnemsuc" OfTTerenr Trom olagram provlaea De/oW)

• ~ Hole Diameter: I q . in. (::,

Elevation at top of casing '1o,..,"ft., msl* ~ ... _L_ . ..: Minimufl\ of 2' Radius & 4" Thick Concrete Pad (to contain benchmark -.!.~ surveyed to neaTest 0.01 ft.) L..IcV

"

Total Depth

___ ft.

I

,

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

Annular space between hole and casing (mino3"):

-=h in.

Rock or Gravel Packing:

:-:---:-,..-- ft. Material: o Crushed Basalt o Rounded Gravel

'--______ -;--..J. '

Estimated Water Level

Elevation:

____ ft. msl*

, !

0,

,

• • l .•

/ or

i

_ Ground Elevation: 7' ft., msl*

Please refer to the HAWAII WELL CONSTRUCTION AND PUMP INSTALLATION STANDARDS to ensure thafyour as-built is in compliance


Solid Casing: (~90% x (Gm Elev.-Water Level Elev»)

Total Length: . IT . ft.

Nominal ~iameter: ~w£ in.

Wall Thickness: '?ch lja in.

. Bottom Elevation: , ~~ ...... lIt· fl,msr

/. /.

¥peitoriilted Open Casing: o Screen

Total Length: 00 ft.

~~ in . NominalOiameter: . ~.

. Wall Thickness: . ~ in.

Bottom'Elevation: N"-- fl, msl*

note: Neither bentonite nor mud should be used in

saturated zone during drilling

Open Hole:

I Length: __ --JML::::....(?::::....:....f\J~~=_· ___ fl Diameter: _____________ in.

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

Bottom Elevation: _______ _

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

Bottom Elevation of Well Limit = (Water Elevation _ 41 x Water l~vel Elevation )

Example: Estimated + 2 ft. Water level Elev. --+ Bottom Elevation of Well limit = ( 2 -~) = -18.51t.

Solid Casing Material: Carbon Steel: compliant with (check one or mora):O ANSIlAWWA C200 0 API Spec. 5L 0 ASTM A53 0 ASTM A 139



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

fl,ms/*

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

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






Open CaSing Material: Carbon Steel: compliant with (check one or more):O ANSIlAWWA C200 0 API Spec. 5L 0 ASTM A53 0 ASTM A 139



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

FVC FlasUc cuniurm;ng to;"5 1M F480 ana (ASTM D1'185 or ASrM 02241): (check one): IlfSchedule 40 0 Schedule 80 0 Schedule 120

Thennoset Plastic: (check one) o Filament Wound ReSin Pipe conforming to ASTM 02996

o Centrifugally Cas~ Resin Pipe GQnforrT)ing to ASTM 02997

, 0 Rein(orced'PlasficMortarPressurePipe conforming to ASTM 03517

o Glass Fiber Reihforcetl'ReSin Pre~ure Pipe conforming to AWWA C950



o o " I

•

•

- ......

•

'.

•

; , c 7lJ u R-S73

S'fA,]'J!: 0 .. ' HAWAJ J BIIlU:AlJ Oli' CONV~:YANCfo:~

RI':eORI.HW

Otl:07. AM

Do~ No(g) 7.0nO-05~1]6

I g/CARI. T. WArl'ANASIi; ,

A.(TING t RJi:GISTRAR Oli' CONVli:VANCfo~

CqNV~-:YANCF. 'I'AX: $0. on ,

LAND COURT Itl REGULAR SYSTEM AFTER RECORDATION RETURN BY: MAIL ( X) PICKUP (. )

JOSEPH N. KOBAYASHI P. O. BOX 589 KAPAA, HAWAII 96746

Title or type of Document: Quitclaim Deed

Grantor name(s}:

Grantee name(s} and Address (es) :

TMK: (4) 5-1-3-1

Joseph N. Kobayashi Suzanne Nepute Kobayashi

Joseph N. Kobayashi Suzanne Nepute Kobayashi P. O. Box 589 Kapaa, Hawaii 96746

TO:

, , c o OUITCLAIM DEED

THIS DEED, made this 14th day of April , 2000, by and

between JOSEPH N. KOBAYASHI and SUZANNE NEPUTE KOBAYASHI,

hereinafter called the "Grantor", and JOSEPH N. KOBAYASHI and

SUZANNE NEPUTE KOBAYASHI, husband and wi.fe, whose residence address

is 4639-E Waiakalua Street, Kilauea, Kauai, Hawaii, and whose /

mailing address is P. O. Box 589, Kapaa, Hawaii 96746, hereinafter

called the "Grantee".

H.!TNg's's£;TH:

WHEREAS, JOSEPH N. KOBAYASHI and SUZANNE NEPUTE KOBAYASHI, are

joint tenants as to an undivided one-half (~) interest in the

property described in Exhibit "A", attached hereto and made a part

hereof, having acquired title by Quitclaim Deed dated February 7,

2000, recorded in the Bureau of Conveyances of the State of Hawaii

as Document No. 2000-035884; and

WHEREAS, JOSEPH N. KOBAYASHI acquired title to an undivided

one-half (~) interest, as tenant in severalty, in the property

described in Exhibit "A", attached hereto and made a part hereof,

by Exchange Deed dated March 6, 2000, recorded in the Bureau of

Conveyances of the State of Hawaii as Document No. 2000-038625; and

WHEREAS, the parties desire to hold title to the property

described in Exhibit "A" attached hereto and made a part hereof as

tenants by the entirety.

NOW THEREFORE, for and in consideration of the foregoing

recitals and the sum of TEN DOLLARS ($10.00), receipt whereof is

hereby acknowledged, and the love and affection Grantor, JOSEPH N.

KOBAYASHI, bears toward Grantee, SUZANNE NEPUTE KOBAYASHI, Grantor

c o does hereby remise, release and quitclaim unto the Grantee as

tenants by the entirety, their assigns, and the survivor of them

and his or her heirs, devisees, personal representatives and

assigns, all of their right, title and interest in and to the real

property described in Exhibit "A" attached hereto and made a part

hereof.

TO HAVE AND TO HOLD the same, together with all of the

improvements thereon, and all of the rights, easements,

appurtenances and remainders thereunto belonging or in anywise

appertaining or held and enjoyed therewith, and the rents, issues

and profits thereof, unto the Grantee in the tenancy aforesaid, in

fee simple.

IN WITNESS WHEREOF, the Grantor has executed these presents on

the day and year first hereinabove written.

. KOBAYASHI

2

c STATE OF HAWAII

SS. COUNTY OF KAUAI

On this 14th day of April , 2000, before me personally appeared JOSEPH N. KOBAYASHI and SUZANNE NEPUTE KOBAYASHI, to me known to be the persons described in and who executed the foregoing instrument and acknowledged that they executed the same as their free act and deed.

SHEILA N. SAIKI Notary Public, State of Hawaii

My commission expires: 2-1-2002

3

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EXHIBIT "A"

PORTION OF EXCLUSION 1 OF LAND COURT APPLICATION 1161

Lepeuli, Hanalei, Kauai, Hawaii

Being portions of School Grant 41, Apana 2 to Board of Education and Grant 530 to Abner Wilcox conveyed to the Territory of Hawaii by Elsie H. Wilcox and Mabel I. Wilcox by Deed dated December 4, 1936 and recorded in Liber 1353, Pages 265-271 (Land Office Deed 5540) .

Beginning at the south corner of this parcel of land, at the west corner of Grant 12702 to Koolau Huiia Protestant Church and on the northeast side of Kuhio Highway, the coordinates of said point of beginning referred to Government Survey Triangulation Station "PUU AUAU" being 4342.58 feet North and 5066.96 feet West, thence running by azimuths measured clockwise from True South:-

1.

2 .

3.

4.

130 0 45' 264.52

217 0 11' 320.59

307 0 11' 264.00

337.05

feet along the northeast side of Kuhio Highway;

feet along Lot D-1 as shown on Map 4 of Land Court Application 1161;

feet along Lot D-1 as shown on Map 4 of Land Court Application 1161;

feet along Lot D-1 as shown on Map 4 of Land Court Application 1161 and Grant 12702 to Koolau Huiia Protestant Church to the point of beginning and containing an AREA OF 1. 99 ACRES.

Being the same premises conveyed by the following:

1. Quitclaim Deed dated February 7, 2000, recorded in the Bureau of Conveyances of the State of Hawaii on March 17, 2000 as Document No. 2000-035884; and

2. Exchange Deed dated March 6, 2000, recorded in said Bureau of Conveyances on March 23, 2000 as Document No. 2000-038625.

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