lae amana - higp · falko-koolau well 7 (well no. 1221-15) at tmk (4) 5-1-003:006, kauai, subject...

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Lae Amana

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Oasis Water Systems

10/30/2009 10:08 AM

Hi Charley-

o To Charley F Ice

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Subject Falko Well 7 - Executed permits

Attached please find the executed permits for the Falko Well 7 for your files. Hardcopy to follow. Aloha, Betsy Lis Oasis \yater Systems, Inc. 826-1854

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FaikoWell7Weil Permit. pdf FaikoWell7 Pump Permit.pdf

o o WELL CONSTRUCTION PERMIT

Falko-Koolau Well 7, Well No. 1221-15 Note: This permit shall be prominently displayed at the construction site until the work is completed

In accordance with Department of Land and Natural Resources, Commission on Water Resource Management's Administrative Rules, Section 13-168, entitled "Water Use, Wells, and Stream Diversion Works". this document pelmits the construction and testing of Falko-Koolau Well 7 (Well No. 1221-15) at TMK (4) 5-1-003:006, Kauai, subject to the Hawaii Well Construction & Pump Installation Standards (HWCPIS - February 2004) which include but are not limited to the following conditions:

2.

3.

4.

5.

6.

7.

9.

10

II

12.

13

14.

15.

16.

17.

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

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

The well construction permit shall be for construction and testing of the well only. The pennittee shall coordinate with the Chairperson and conduct a pumping test in accordance with the HWCPIS (the latest pump test worksheet can be obtained by contacting Commission staff or at www.hawaii_gov/d1nr/cwrm/resources_permits.htm). The permittee shall submit to the Chairperson the test results as a basis for supporting an application to IJlstall a pennanent pump. No permanent pump may be mstalled until a pump IJlstallatlon permit IS approved and Issued by the Chairperson. No Withdrawal of water shall be made for purposes other than testing without a Certificate of Pump Installation Completion. The permitted pump capacity described on the pump installation pennlt may be reduced In the event that the pump test does not support the capacity.

In basal ground water, the depth of the well may not exceed one-fourth (1/4) of the theoretical thickness (41 times initial head) (lfthe basal ground water unless otherwise authorized by the Chairperson. If it can be shown that the well does not tap basal ground water then this condition may be waived after consultation with and acceptance by CommiSSion staff However, in no instance can the well be drilled deeper than one-half (1/2) of the theoretical thickness without Commission approval.

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

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

The proposed well construction shall not adversely affect existing or future legal uses of water in the area, including any surface water or established instreanl flow standards. This penn it or the authorization to construct the well shall not conslltute a detennination of correlative water rights.

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

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

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

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

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

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

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

The pennittee, Its successors, and assigns shall indemnify, defend, and hold the State of Hawaii harmless from and against any loss, liability, claim, or demand for propertv damage, personal injury, or death arising out of any a. ct or omission of the applicant, assigns, utticers, employees, contractors, and agents under this pennit or rdating to or connected with the granting of this pemlit

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

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

Date of Approval: October 3,2009 Expiration Date: October 3,2011

LEN, Chairperson ater Resource Management

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

Driller's Signature:~ C-S7 License #: C-214S7 Printed Name: Betsy Lis Film or Title: Oasis Water Systems, Inc.

Please sigll hotlr copies of tlris permit, retu", olle copy to tire Commissioll office, alld retaill tire other for your records.

Attachment

c o PUMP INSTALLATION PERMIT

Falko-Koolau Well 7, Well No. 1221-15 Note: This permit sllall he prominently displayed al the site Ullti/ tlte 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 Falko-Koolau Well 7 (Well No. 1221-15) at TMK (4) 5-1-003:006, Kauai, subject to the Hawaii Well Construction & Pump Installation Standards (HWCPIS - February 2004) which include but are not limited to the following conditions:

I. The Chairperson to the Commission on Water Resource Management (Commission), P.O. Box 621, Honolulu, HI 96809, shall be notified, in writing, at least two (2) weeks before any work covered by this permit commences and staff shall be allowed to inspect installation activities in accordance with § 13- J 68-15, Hawaii Administrative Rules (HAR).

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

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

4. The pump installation permit shall be for installation of a 100 gpm rated capacity, or less, pump in the well. This permanent capacity may be reduced in the event that the pump test data does not support the capacity.

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

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

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

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

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

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

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

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

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

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

Date of Approval: Expiration Date:

October 3, 2009 October 3, 2011

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

1n,,,Il,,', Signa,,,,,, ,..-~ C,57, C,57a, 0' A Lk,nre #, C-21457 Dalo, IO/JOtn Printed Name: Finn or Title: Oasis Wat~.~ Systeam, Inc.

Please sign bolh copies of this permit, return one copy 10 the Commission office, and retaill the other for ),our records.

Attachments

WELL CONSTRUCTION PERMIT fo (, ycU ( Falko-Koolau Well 7, Well No. 1221-15 f, \e.;~,

Note: This permit shall be prominently displayed at the construction site until I Nt ~ In accordance with Department of Land and Natural Resources, Commission on Water Resource 0 '-~ I\._ " Section 13-168, entitled "Water Use, Wells, and Stream Diversion Works", ~is d~cument pe ~~'-I If Falko-Koolau Well 7 (Well No. 1221-15) at TMK (4) 5-1-003:006, Kaual, subject to the ___ .. ___ .. ________________ ~ l ___ p Installation Standards (HWCPIS - February 2004) which include but are not limited to the following conditions:

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

17.

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


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

In basal ground water, the depth of the well may not exceed one-fourth (1/4) of the theoretical thickness (41 times initial head) of the basal ground water unless otherwise authorized by the Chairperson. If it can be shown that the well does not tap basal ground water then this condition may be waived after consultation with and acceptance by Commission staff. However, in no instance can the well be drilled deeper than one-half (1/2) of the theoretical thickness without Commission approval.

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

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

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

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

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

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

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


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

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

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

This permit shall apply to the location shown on the application only. If the well is to be relocated, the permittee shall apply for a new well construction/pump installation permit In accordance with § 13-1 68-12(f), HAR.

Special conditions in the attached cover transmitta1letter are incorporated herein by reference.

Date of Approval: October 3, 2009 ~A AUJlA, H. THIijLEN, Chairp~n ~3: Expiration Date: October 3, 2011 ~ ~omlnission on Water Resource~an&iem~

I :XOfTl I have read the conditions and terms of this permit and understand them. I accept and agree to meet these conditions as a ~ereS~.atld underlying condition of my ability to proceed and understand that I shall not commence work until I have signed, dated, .. re e permit to the Commission. I understand that this permit is not to be transferred to any other entity_ I also understand that:i5n-c . ce with any permit condition may be grounds for revocation and fines of up to $5,000 per day starting from the permit date of aPlM'ovatn~

•• '3:-'

~ ~~~ Driller's Signature: ~ C-S7 License #: C-214S7 Date: Ie) :xJ/t11 Printed Name: Betsy Lis Finn or Title: Oasis Water Systems, Inc.

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

Attachment

PUMP INSTALLATION PERMIT Falko-Koolau Well 7, Well No. 1221-15

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


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 (HAR).





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

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


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


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


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




L LEN, Chairperson ~(") ater Resource Management. (.1)5;

- 0--. z: CA I have read the conditions and terms of this permit and understand them. I accept and agree to meet these coiltiOm::O ~ prerequisite and underlying condition of my ability to proceed and understand that I shall not commence work un.1 I ali! Cj pump installer have signed, dated, and returned the permit to the Commission. I understand that this permit ft!i)not:h ~ transferred to any other entity. I also understand that non-compliance with any permit condition may be grounds flUij"evo~ and fines of up to $5,000 per day starting from the permit date ofapproval. ::II: »~o

~t'\ ~~ C-57, C-57a, or A License #: C-21457 Date: lo/i~~

\ ~ Installer's Signature:

Printed Name: Betsy Lis Firm or Title: Oasis Water Systeam, Inc.


Attachments

'. LINDA LINGLE

GOVERNOR OF HAWAII

Ms. Betsy Lis Oasis Water Systeam, Inc. P.O. Box 507 Hanalei, HI 96714

Dear Ms. Lis:

c

STATE OF HAWAII DEPARTMENT OF LAND AND NATURAL RESOURCES

COMMISSION ON WATER RESOURCE MANAGEMENT P,O, BOX 621

HONOLULU, HAWAII 96809

October 13, 2009

Pump Installation Permit Falko-Koolau Well 7 (Well No. 1221-15)

LAURA H, THIELEN CHAIRPERSON

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

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

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

KEN C, KAWAHARA, PE, OEPUTY DIRECTOR

Ref: 1221-15.pip

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

Special Conditions

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

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

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

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

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

Sincerely,

Enclosure

c: Falko Partners, LLC USGS KauaiDWS

C PUMP INSTALLATION PERMI('j Falko-Koolau Well 7, Well No. 122115

Note: Tlris permit slrall be prominently displayed at tire site until tire work is completed


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 (HAR).





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

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


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


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


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




EN, Chairperson ater Resource Management

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

Installer's Signature: C-57, C-57a, or A License #: C-21457 Date:

Printed Name: Betsy Lis Firm or Title: Oasis Water Systeam, Inc.


Attachments

LINDA LINGLE GOVERNOR OF HAWAII

Ms. Betsy Lis Oasis Water Systems, Inc. P. O. Box 507 Hanalei, III 96714

Dear Ms. Lis:


COMMISSION ON WATER RESOURCE MANAGEMENT P.O. BOX 621


I October 13,2009

Well Construction Permit Falko-Koolau Well 7 (Well No. 1221-15)

LAURA H. THIELEN CHAIRPERSON

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

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

KEN C. KAWAHARA, P.E. DEPUTY DIRECTOR

Ref: 1221-15.wcp

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

Special Conditions

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

2. Your request for a variance to drill deeper than one-fourth the theoretical thickness of an unconfined aquifer is approved.

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

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

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

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

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

c: Falko Partners, LLC (with applicable comments - DOH SDWB, WWB, CWB, HEER) USGS Kauai DWS

(

"..... ........,

'-" ...." / WELL CONSTRUCTION PERMIT

Falko-Koolau Well 7, Well No. 1221-15 Note: This permit shall be prominently displayed at the construction site until the work is completed

In accordance with Department of Land and Natural Resources, Commission on Water Resource Management's Administrative Rules, Section 13-168, entitled "Water Use, Wells, and Stream Diversion Works", this document permits the construction and testing of Falko-Koolau Well 7 (Well No. 1221-15) at TMK (4) 5-1-003:006, Kauai, subject to the Hawaii Well Construction & Pump Installation Standards (HWCPIS - February 2004) which include but are not limited to the following conditions:

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

II.

12.

13.

14.

15.

16.

17.

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


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

In basal ground water, the depth of the well may not exceed one-fourth (1/4) of the theoretical thickness (41 times initial head) of the basal ground water unless otherwise authorized by the Chairperson. If it can be shown that the well does not tap basal ground water then this condition may be waived after consultation with and acceptance by Commission staff. However, in no instance can the well be drilled deeper than one-half (1/2) of the theoretical thickness without Commission approval.

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

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

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

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

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

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

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


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

If the well is not to be used it must be prorerly capped. If the well is to be abandoned during the course of the project then the permittee must apply for a well abandonment permit in accordance with § 3-1 68-12(f), HAR, prior to any well sealing or plugging work.

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

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

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

Date of Approval: October 3, 2009 Expiration Date: October 3, 2011

EN, Chairperson ater Resource Management

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

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

Printed Name: Betsy Lis Firm or Title: Oasis Water Systems, Inc.


Attachment

QMMISSION ON WATER RESOURCE MANAGEME9 ROUTE SLIP FOR PERMIT ISSUANCE 5/19/05

FROM: CHARLEY .R. 9;./ QI5ftl' 01 DATE: II trtHtrri/ilvtvtlttr SUSPENSE DATE: _______ _

KUNIMURA, I. NAKAMA,L. NAKANO, D.

Approval Signature

-3-lnformation

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

-3-0HYE,M. SAKODA, E.

-2-SUBIA, S. -1-HARDY, R.

HIGA,D. ICE,C. IMATA, R.

WELL NUMBER 1221-15

~ WELL CONSTRUCTION

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

Falko-Koolau Well 7

ATTACHMENTS FOR WELL CONSTRUc;.TION PERMIT: 1 COVER LETTER ~ 2 PERMIT (2x) ../

COMMENTS: --

! =B ~.'. 5 CWB 6 HEER 7 LD 8 HP 9 OCCL

10 SMA 11 WELL CHECK PRINTOUT

18C PUMP INSTALLATION

TO BE SENT TO APPLICANT

FOR OFFICE USE ONLY

ATTACHMENTS FOR PUMP INSTALLAl)ON PERMIT: 1 COVER LETTER ~ 2 PERMIT (2x) ~

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

10 SMA 11 GLENN'S WORKSHEET

TO BE SENT TO APPLICANT

FOR OFFICE USE ONLY

PLEASE:

See Me -1-Review & Comment

Take Action Type Draft

-2-Type Final 4 File

Xerox copies

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

Data Input

yes no

steel stainless steel

o

pvc plastic abs plastic thermoset plastic other

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

positive displacement other

steel public steel non public

steel ANSIIAWWA C200 API Spec. 5L ASTM A53 ASTM A139 ASTMA606 other

#N/A

0.28

stainless steel ASTM A409 other

pvc plastic Schedule 40 Schedule 80 other


Mr. Ian Costa, Director Planning Department County of Kauai

o


COMMISSION ON WATER RESOURCE MANAGEMENT po. BOX 621


4444 Rice Street, Ste. A473 Lihue, Hawaii 96766

September 3,2009 COUNTY OF "; . Jr: ~

l)9 Sf? -8 p 3 :28

PLANNiNG f Dear Mr. Costa:

Special Management Area Use Permit Requirements for Well Construction/Pump Installation Permit Application

FalkolKoolau Well #7 (Well No. 1221-15)


SUMNER ERDMAN NEAL S. FUJIWARA

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


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

We would appreciate your comments on the captioned application with regard to the SMA permitting requirements specific to your division. Please respond by returning this cover memo form by October 3, 2009. 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 Charley Ice of the Commission staff at 587-0218.

CI:ss

RESPONSE:

[ ] This well project [ ] requires ~oes not and [ ] is [ ] is not currently active.

require a SMA. If a SMA is required it [ ] has [ ] has not been approved

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

¥ No objections Oth" ,"mm~t',~~ \ .\ \ lti ,.f'; ~

Contact Person: ___ ,,_ \j ~~0J\8.tI ___ 1\ ___ .()JJJ __ ,~---=--\ ____ _

[ ]

Signed:----+cr--\-=--->.i---------

Phone: -------

Date: _'---->,0 \ ~__'_+\ ~_=_+R _ \ \ \

SEP-30-2009 08:18 From:DOWSi=1FE WATER BRAHH 8085854351 To:808 587 0219

\

LINDA LlNG~1 1l0vefllNCrl\ OF' ttM

TO:

RECEIVED SAFE DRINKING WATE~~J~~~~N

Stp

STATE OF HAWAII DEPARTMENT OF lANO AND NATVRA~ RI:SOURCES

COMMISSION ON WATER RESOURCE MANAGEMENT po. eox 921

HOIl/OLLJLU. HAWAII 8i&l3

September 3, 2009

c.""",r"OaDN

9 IYV\", SUMNER ERDMAN (11\ f;;i NEAL S, FUJIWARA

CI1 r;.H.I'fO~,L, FUKlNO, M,O. ·1 in Genera)~ ~ tl2)-IS-\ Q = lz.,b o0!ft·. I use = ~ov>'I(,,~1ic 1/ _ . [~ I . 1.11110;1 t:t I KM~w. "'1 locatlOn = vv'" ," I • I ." , , ;'>/l.(/I""",,,, ~\tAe;, 1.~e1owl(j(Clline I grd. elev.::::: oz.:?>? i . (p II

Honorable Chiyome L Fukino, M.D., Director II well dla. ~ "l. r;-c Department of Health well depth ';J '" Attention: Tomas See, Chief, Wastewa.ter Branoh I'T) '\18(' O~ 'I~ W0w 0)111 ~~,

VStuart Yamada, Chief, Safe Drinking Water Branch I y(1 • ~ ,. Alec Wong, Chief, Clean Water Branch L .... r..

fROM: c.. ",Laura H. Thielen, Chairperson We. ~L--Dr. Keith Kawaoka. Office OfH3Z

1Md valuation and mergency Response

\.vv Commission on Water Resource Management SUBJECT: Well Construction/Pump Installation Permit App cation

Faiko/KQglau Well #7 (WelJ No. 1221~15) '1'1'h~: (11 :;, I ' 3; ~

Transmitted for your review and comment is a eepy of the captioned Well ConstructionlPuOlp Installation pennit application.

We would appreciate your comments on the captioned application for any conflicts or inconsistencies with the programs; plans, and objectives specific to your departme:nt. Please resDon.p ~ . returnin,g this cover memo form bl October 3,2009. Ifwe do not recejve 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 pennit application, request additional information, or request additional review time, please contact Charley Ice of the Commission staff at 587-0218.

Cbs Attachment 8

RESPONSE: h~~ av·. ~ilA-.# 3,]2 q('7/04 C~ ~ 'tvr This W"~I~ ·.r:~"uroe·~ 1.11 willletV"as a SOIJrO. of p"'abl. w.ttrto ap"bhc wO\ •• oyot.m (~fj""d .. • ""'''S 25 'I' "''''. p

lflh. well is ",.

Date: 1/27,1vj

SEP-30-2009 08:21AM FAX: 8085864351 ID:DLNR CWRM

SEP-30-2009 08: 18 From:DOWSAFE WHER BRANH 8085854351 To:808 587 0219

\ '-

CWRM App.lica tion Source: Falko/Koola:1,l Well #7 (State We~~ No. 1221-15)

Safe Drinking Water Branch Engineering Section

1. Please clarify if this \~ell will be a source for the Kahuaina water System.

P.2--A

2. This well mal qualify as a source that serves a regulated public water system. Federal and state regulations define a public water system as a system that serves 25 or more individuals at least 60 days per year or has at least 15 service connections. All public water system owners and operators are required to comply with Hawaii Administrative Rules, Title 11, Chapter 20, Rules Relating to Potable Water Systems.

3. All new public water systems are required to demonstrate and meet minimum capacity requirements prior to their establishment. This requirement involves demonstration that the system will have satisfactory technical, managerial and financial capacity to enable the system to comply with sate drinking water standards and requirements.

4. Projects that propose development of new sources of potable water serving or proposed to serve a public water system must comply with the terms of HAR 11-20-29. This section requires that all new public water system sources be G:tpp:t:'oved by the Director of Health pyior to its lise. Such approval is based primarily upon the submission of a satisfactory engineering report, which addresses the requirements set in Section 11-20-2:J.

5. The engineering report must identify all potential sources of contamination and evaluate alternative control measures, whi~h could be implemented to reduce or eliminate the potential for contamination, including treatment of the water source. In addition, water quality analyses tor all regulated contaminants, pertormed by a laboratory certified by the State Laboratories Division of the state of Hawaii, must be submitted as part of the report to demonstrate compliance with all drinking water standards. Additional parameters may be required by the Director for this submittal or additional tests required upon his or her

CWRJIl 'Nell AppliC(3tion Standard COmr.lent~ (SDWB) Verso 6/1/07

SEP-30-2009 08:22AM FAX: 8085864351 ID:DLNR CWRM PAGE:002 R=94%

SEP-30-20m 08: 18 FrOff!:DOWSAFE WATER BRAHH 8085854351 To:808 587 0219

" ....

6.

7.

8.

review of the information submitted.

All public water system sources must undergo a source water assessment, which will delineate a source water protection area. This process is preliminary to the creation of a source water protection plan for that source and activities which will take place to protect the drinking water source. Projects proposing to develop ew public water systems or proposing substantial modifica ~ons to existing public water systems must receive app oval by the Director of Health prior to construction 0 the proposed system or modification. These projects 'nclude treatment, storage and distribution systems of pu lie water systems. The approval authority for project owned and operated by a County Board or Department of Water or Water Supply has been delegated to them. I

i I

All public water systems must ~e operated by certified distribution system and water reatment plant operators as defined by Hawaii Administrati e Rules, Title 11, Chapter 11-25 titled; Rules Pertainin to Certification of Public Water System -2£era.tors.

9. All projects which propose the use of dual water systems or the use of a non-potable water system in proximity to an existing potable water system to meet irrigation or other needs must be carefully design and operate these systems to prevent the cross-connection of these systems and prevent the possibility of backflow of water from the non-potable system to the potable system. The two systems must be clearly labeled and physically separated by air gaps or reduced pressure principle backflow prevention devices to avoid contaminating the potable water supply. In addition backflow devices must be tested periodically to assure their proper operation. Further, all non-potable spigots and irrigated areas should be clearly labeled with warning signs to prevent the inadvertent consumption on non-potable water. Compliance with Hawaii Administrative Rules, Title 11, Chapter 11-21 titled; Cross-Connection and Backflow Control is also required.

10. All projects which propose the establishment of ~ potentially contaminating activity (as identified in the Hawai~i Source Water Assessment Plan) within the source water protection area of an existing source of water for a

C~~ Well Application Stdndard Comments (SDWB) Verso 6/1/07

SEP-30-2009 08:22AM FAX: 8085864351 ID:DLNR CWRM PAGE:003 R=94%

SEP-30-2009 08:18 From:DOWSAFE WATER BRAHH 8085854351 To:808 587 0219

,

public water supply should add~ess this potential and activities that will be implemented to prevent or reduce the potential for contamination of the drinking water source.

11. For further information concerning the application of capacity, new source approval, operator certification, source water assessment, backflow/cross-connection prevention or other regulated public water system prog~ams, please contact the Safe Drinking W~ter Branch Engineering Section at 586~4258.

Underground Injection Control (Ule)

12. The siting of a drinking water source below the Ule line affects the allowed potential for new injection well construction. New injection wells will then be prohibited within setback areas defined in Chapter 11-23. If this drinking water source will serve a regulated public water system, the applicant will be required to inform surrounding landowners of this proposed action because it will affect the injection well development potential of the properties within the 6etb~ck area.

13. Questions about UIC may be directed to Chauncey Hew at 586-4258.

CWRM Well Application Stdnd~rd Somments (SDWB) llers. 6/1107

SEP - 30 - 2009 08: 22RI'1 FRX:8085864351 ID:OLHR CWRM PRGE:004 R=94%

LINDA LINGLE GOVERNOR OF HA WAH

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STATE HISTORIC PRESERVATION DIVISION 601 KAMOKILA BOULEVARD, ROOM 555

KAPOLEI, HA WAIl 96707

September 22, 2009


BOARD OF LAND AND NA ruRAL RESOURCES COMMISSION ON WATER RESOURCE MANAGEMENT

RUSSELL Y. TSUJI FIRST DEPUTY

KEN C. KAWAHARA DEPUTY DlREcroR - WATER

AQUATIC RESOURCES BOATING AND OCEAN RECREATION

BUREAU OF CONVEYANCES COMMISSION ON WATER RESOURCE MANAGEMENT

CONSERVATION AND COASTAL LANDS CONSERVATION AND RESOURCES ENFORCEMENT

ENGINEERING FORESTRY AND WILDLIFE HISTORIC PRESERVATION

KAHQOLA WE ISLAND RESERVE COMMISSION LAND

STATE PARKS

MEMORANDUM Log No: 2009.3887 Doc No: 0909NM35

TO: Ken C. Kawahara, Deputy Director Commission on Water Resource Management

FROM: Nancy A. McMahon, Deputy Administrator and Deputy State Historic Preservation Officer State Historic Preservation Division

Jbfl~~ Subject: Chapter 6E-42 Historic Preservation Review-

Well Construction (Falko-Koolau Well #71221-15) Pilaa, Hanalei, Kaua'i Island, Hawai'i TMK: (4) 5-1-003: 006

Thank you for the opportunity to review this permit.. The project is for a new well.

We determine that no historic properties will be affected by this project because: IZI Intensive cultivation has altered the land ~ o o o o

Residential development/urbanization has altered the land Previous grubbing/grading has altered the land An accepted archaeological inventory survey (AIS) found no historic properties SHPD previously reviewed this project and mitigation has been completed Other:

Please call me at (808) 692-8015 if you have any questions or concerns regarding this letter.

I ~ -0 N W

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:;0 1"1"1("') (.1)0 03: C::J: ;0-~-)U'J::O '. (J)1T1 r-,-C") -:~ of'Tl -~z-~;,.

s ep, 14, L (I 0 9 1,0: ~ 9 AM DOH-HEER OFFICE E08-536-7537 p, 6

UNOAUNGLE COV~ItN:)A C' "AWNI

TO:

FROM:

REC(IVED DEPARTMENT OF rfEA

zon SEP -q P I: 0 HEtR OFJ.'"/rrSTATE OF HAWAII

P!;PA~~1Jift ...... a .... "" which will .

o LINDA LINGLE

GOVERNOR OF HAWAII R E eEl V E.I{;J~! ~PE!~~;LEN f 0\ \ I f\ n Ii , I C'L"{'rIRI \~.~.~ ) ~:t f;' ~ ~ERDMAN

NEAL So FUJIWARA CHIYOME L FUKINO, M.Do

DONNA FAY K~IYOSAKI, PE , ~ SEP - 8AwAN

, t •. ... .



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

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

STATE OF HAWAII KEN C. KAWAHARA, P.E.

DEPARTMENT OF LAND AND NATURAL RESOURCES



September 3, 2009

DEPUTY DIRECTOR

Honorable Chiyome L. Fukino, M.D., Director Department 0f Health I ~g Attention: .. komas See, Chief, Wastewater Branch ~~

TO:

Stuart Yamada, Chief, Safe Drinking Water Branch ~ c~ Alec Wong, Chief, Clean Water Branch -0 g ~~ Dr. Keith Kawaoka, Office of Hazard valuation and mergency Respgnse '''-(")

J--C) 3': 0 f'TI

FROM: C. ,Laura H. Thielen, Chairperson ~ • "\ ~%-£NUL!. lltM :I ~~~ - ~~ .. :X-" "YV Commission on Water Resource Management SUBJECT: Well Construction/Pump Installation Permit App FalkolKoolau Well #7 (Well No. 1221-15)

cation en f'I1l'W1 .... z::u .... Transmitted for your review and comment is a copy of the captioned Well Construction/Pump

Installation permit application.

We would appreciate your comments on the captioned application for any conflicts or inconsistencies with the programs, plans, and objectives specific to your department. Please respond by returning this cover memo form by October 3,2009. Ifwe do not receive comments or a request for additional review time by this date, we will assume that you have no comments.


CI:ss Attachment(s)

RESPONSE:

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

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

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

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Pennit ID: 19430 IWS Type: i Septic Tank .,;] Assigned To: i Legacy File#: 2767 Island: i Kauai v.1 Soul"Ce: WWB

eHawaii ID: 0 Status: L:,::.r:~_~' ,d vi Description: 1

I Project Information I I Review Information I L~~s~~. M Mill~; - .. -

- -"--" ~J Engineer: Wj Submit Date: 14/12/1994 ..... _ ...............

TMK: 1451003006 1 • Reviewed: 14/12/1994 IWS may be within 1,000 ft. of a potable plan Approved: 4/12/1994 well

Street Address: 17480 KOOLAU RD. 1 No Final Approval Lt..:

Sb-eet Address 2: 1 1 Inspection Date:

Suite I Apt.: 1 1 Final Approval:

City: IKILAUEA 1 Tennination Date: 11/12/2009

State: Hawaii

Zip Code: 1 I I Pa~ment Information I Payment Type: I vi Check Number: I 1 Amount: 1 Check Date: 1 1 Payor: 1 1

1~'IUIIII!Ual~1 1111I~'IIIIHIlI Added By: phsieh 2/26/2007 10:52 AM Last Modified: Ivetter 1/12/2009 3: 56 PM

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From-DEPT OF HEALTH ENVIRONMENTAL ~NGMT 9095964352 T-547 P.003/005 F-679

LlNPA LINGI-E OOVE,:lIllORafrVIWl.Jl

LAU~ H. TH!e~EN CI"fJlIItPE;~$QN

TO:

STATE OF HAWAII DEPARTMENT OF LAND AND NATllAAL ~eSOURCES

COMMISSION ON WATER RESOURCE MANAGEMENT P.o. Box621

HONOLLfLU, HA.WAlI ElSS09

September 3,2009

Honorable Chiyome L. Fukino, M.D., Director Depanment of Health Anention: Tomas See, Chief, Wastewater Branch

Stuart Yamada, Chief, Safe Drinking Water Branch JAlec Won~ Chief; Clean Water Branch

SUMNER ERDMAN NeAL S. FUJIWARA.

CHIYOME~. FUKINO, MD. OONNA FAY K. KIYOSAICI, P,E

LAWRENCE "1, MilKE. M,D. J.n

t ~UQob.d.

In th; l!v~nllh'" \h~ lo~~lion Qf tilt:! w~lI Q])lIIlBC>' bUll. mil withm t~ paccel di!.Sctibed 011 Ibis 4'piJoati(Jn. our divisioo con3idcrs tbB eOllllTlOn!. Ie .nil be appli".bl •• 11114 WII dQ nQl need ro r~vi .... Ihe rI~ loOltiion.

[ 1 No ~omm.llt.lcoj",,~ons

Contact Person: __ "':::'~L:!:.....--~.;;...--=L-,-• ..;~_' __ ~ ___ _

Signed:----f-a--+--""'~~-{f'-

09-l0-2ut9 Ot29pm From-DEPT OF HEALT~ ENVIRONMENTAL UNGMT 8085864352 T-547 P.001/005 F-679

Fax to: Company:

Fax No.:

",.... FAX TRANSMITTAL

State of Hawaii Department of Health Environm.ental Managem.ent Division

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

Fax No.: (80S1586-4352

Mr. Ryan Imata I~Charley Xc;) Ms. Denise Mills Conunission On Water Resource Management Department of Land and Natural Resources 587-0219

Date: -:;. lO . 03 Fax from: Joanna L. Seto ~

Total Pages~ incl. cover: 2+3

Subject: Well ConstructionJPump Installation Permit Application(s) Well N o(s). I 2. Z. I - IS! 5" I 3 j - 0 Z. 5 g ,'2.. - 0, . ;

The Depanment of Health, Clean Water Branch (CWB) has the following comments:

1. For Well-Drilling Activities

Any discharge to State waters of treated process wastewater effluent associated with well drilling activities is regulated by Hawaii Administrative Rules (HAR). Title II. Chapter 55, Appendix I, effective October 22, 2007, and compiled June 15,2009. Treated process wastewater effluent covered by this general pennit includes well drilling slurries. lUbricating fluids wastewater, and well purge wastewater. This general permit does not cover well pump testing. The applicable Notice of Intent (NOl) Forms and filing fee shall be submitted at least 30 calendar days before the start of discharge to the:

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

The CWB-NOr Fonns are available online at http://www.hawaii.gov/health/environmentaltwater/cleanwater/forms/genl-index.html. Inquiries may be directed to the CWB at (808) 586-4309 Or by fax (808) 586-4352.

2. For Well Pump Testing

The discharger shall take all measures necessary to prevent the discharge of pollutants from entering State waters. Such measures shall include, if necessary, containment of 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. lfthe discharge is entering a storm drain, the discharger must obtain written pennission from the owner of the stonn 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 storm drain.

SEP-10-2009 04:27PM FAX: 8085864352 ID:DLNR CWRM PAGE: 001 R=96;~

09-10-2019 O~29pm From-DEPT OF HEALT~ ~NVIRONMENTAL ~NGMT

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

8085864352 T-547 P.002/005 F-679

"'-'" FAX TRANSMITTAL

Page 2

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

By HARt Title 11, Chapter 55, Appendix C. effective October 22,2007, and compiled June 15,2009, an NPDES pennit or Notice of General Pennit Coverage is required before the :;tart of the construction activities that result in the disturbance of one (1) or more acres of total land area, including clearing, grading, and excavation. The total land area includes a contiguous area where multiple separate and distinct construction activities may be taking place at different times on different schedules under a larger common plan of development or sale. An NO! (see Comment No.1, above) shall be submitted 30 calendar days before the start of construction activities.

SEP-10-2009 04:27PM FAX: 8085864352 ID:DLNR CWRM PAGE:002 R=96%

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

FROM: CHARLEY -----------------

CHING, F. FUJII, N. GOODING, K.

-1-HARDY, R. i, HIGA,D.

-2-HOAGBIN, S. . o' 5 ICE, C.

IMATA, R. -3-KAWAHARA,K.=::::

DATE: 27-Aug-09

KUNIMURA, I. NAKAMA,L.

-4-0HYE,M. ,';j -SAKODA, E. L-SWANSON, S. UYENO, D. YODA,K. YOSHINAGA, M.-

SUSPENSE DATE:

1 Approval -3-Signature -4-lnformation

3-Sep-09

PLEASE:

See Me -1-Review & Comment

Take Action Type Draft acknow letter

-2-Type Final, label file folder, update People.db 5 File

Xerox copies

WELL NUMBER 1 ~1 ...- f£" WELL NAME Falko/Koolau No.7 wUP Number NA '~ WELL CONSTRUCTION )(1 PUMP INSTALLATION D WUPA

ATTACHMENTS FOR APPLICATIO~OCESSING - Both applicant & staff generated 1 TRANS. LETTER .

2 PERMIT PROCESS TABLE ~ 3 CWRM MAP . ./ •

4 APPL. FORM (11 COPIES) ~ 5 USGS MAPS (11 COPIES) =z.z 6 TAX MAPS (11 COPIES) ../ I"

7 PARCEL OWNER VERIF. Z MLS PRINTOUT 8 CONTRACTOR VERIF. ~ DCCA LICENSE SCREEN PRINTOUT 9 ALL INFO FILLED IN ./

10 BACKGROUND CHECK

11 $25 FEE DEPOSIT SLIP

12 DHP/CDUP/SMA pre-screen 7--r (SMA map printout http://gis.hicentral.com/website/parcelzoninglviewer.htm.,or INGRID'S SMA/CD MAP) --(LUC map printout http://luc.state.hLus/luc_maps.htm., or INGRID'S SMA/CD MAP)

FOLDER: D MADE NEW FILE FOLDER, ATTACHED D FILE FOLDER ALREADY MADE, IN FILE CABINET

INCOMPLETE ACTION DATES:

DATE ACTION


Ms. Betsy Lis Oasis Water Systems, Inc. P.O. Box 507 Hanalei, HI 96714

Dear Ms. Lis:

c




September 3,2009



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

LAWRENCE H. MilKE, MD, J.D.

KEN C. KAWAHARA, P.E. OEPuTY DIRECTOR

1221-15. wcpia.acc

Well Construction/Pump Installation Permit Application for Well No. 1221-15

We acknowledge receipt, on August 20,2009, of your completed Well ConstructionlPump Installation permit application and filing fee for the Falko/Koolau Well #7 (Well No. 1221-15). You can expect your application to be processed within ninety (90) days from this date.

We note your request for a variance to drill deeper than a basal aquifer would normally allow, as experience shows this is not a basal aquifer. We anticipate approving drilling down to a total depth similar to those drilled for the earlier Falko Wells.

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

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

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

CI:ss Attachment

c: Falko Partners LLC


TO:

c o




September 3, 2009

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

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



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

KEN C. KAWAHARA, PE. DEPUTY DIRECTOR

Dr. Keith Kawaoka, Office of Hazard valuation and mergency Response

FROM: c.. I Laura H. Thielen, Chairperson "VV Commission on Water Resource Management SUBJECT: Well Construction/Pump Installation Permit App


W~ 1lWJ--cation


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 October 3, 2009. Ifwe do not receive comments or a request for additional review time by this date, we will assume that you have no comments.

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

CI:ss Attachment( s)

RESPONSE: [ 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 II, Chapter 20, Rules Relating to Potable Water Systems, §11-20-29.

[ I 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.

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

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

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

[ I An NPDES permit is required.

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

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

[ I No comments/objections

Contact Person: Phone: -------------------------------------------- -----------------Signed: __________________ _ Date: ----------------


TO:

FROM:

SUBJECT:

c o



Morris Atta, Administrator Land Division


September 3, 2009

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

Well Construction/Pump Installation Permit Ap FalkolKoolau Well #7 (Well No. 1221-15) T



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




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 October 3,2009. Ifwe 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 Charley Ice of the Commission staffat 587-0218.

Cl:ss Attachment( s)

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. __________ _

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

[ ] No objections

[ ] Other comments:

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

Signed: ___________________ _ Date: --------


TO:

c o




September 3, 2009

Dr. Puaalaokalani Aiu, Administrator



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


KEN C. KAWAHARA, PE. DEPUTY DIRECTOR

FROM:

SUBJECT:

Historic Preservation t Ken C, Kawahara, P.E., Deputy Director ~ec rA,L Commission on Water Resource Management

Well Construction/Pump Installation Permit Appl' ation FalkolKoolau Well #7 (Well No. 1221-15) TMK: (4) 5-1-003:006


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 October 3,2009. 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 or request additional review time, please contact Charley Ice of the Commission staff at 587-0218. If you require additional information regarding specific information that can be provided by the applicant, please contact the applicant directly at the contact information provided on the application form.

CI:ss Attachment(s)

RESPONSE:

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

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

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

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

Signed: ____________________ _ Date: --------


Mr. Ian Costa, Director Planning Department County of Kauai




September 3,2009

4444 Rice Street, Ste. A473 Lihue, Hawaii 96766

Dear Mr. Costa:

Special Management Area Use Permit Requirements for Well ConstructionJPump Installation Permit Application




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

KEN C. KAWAHARA, P.E. OEPUTY DIRECTOR


We would appreciate your comments on the captioned application with regard to the SMA permitting requirements specific to your division. Please respond by returning this cover memo form by October 3, 2009. Ifwe do not receive comments or a request for additional review time by this date, we will assume you have no comments.


CI:ss

RESPONSE:

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

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

[ ] No objections

[ ] Other comments:

Contact Person: __________________ _ Phone: --------

Signed: ____________________ _ Date: _______ _

~ARTMENT OF LAND AND NATURAL RESOgES DOCUMENT NO.: UAC OR ATTACHED WORKSHEET DATE : August 20 2009 ,

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

S 10 326 C 1026 0752 (1 ) $25.00 Oasis Water

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

TOTAL $ 25.00

REMARKS: LINE (1) Falko/Koolau Well #7 LINE (2) LINE (3 LINE (4) LINE (5) LINE (6) LINE (7) LINE (8) LINE (9) LINE (10)

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To: State of Hawaii Department of Land and Natural Resources Commission on Water Resource Management P.O. Box 621 Honolulu, HI 96809

From: Oasis Water Systems, Inc. P.O. Box 507 Hanalei, HI 96714

Subject: Variance Request for FalkolKoolau Well # 7

o RECEIVED

COMMISSION ON WATER RESOURCE r1t;~IAGEMENT

• AUG 20 .. 9: 28

8119/2009

Due to previous experience drilling water wells in the immediate vicinity of this well, we are requesting a variance to drill past the Y4 thickness of the theoretical basal lens. Please refer to nearby Wells No. 1121-02, 1121-03, 1121-04 and 1121-05, all of these wells had to be drilled deeper to encounter a sustainable yield. Proposed well # 7 is on the same property as those wells, so we suspect we will encounter the same results. Thank you for your assistance in this endeavor.

~ Oasis Water Systems, Inc.

PO Box 507, Hanalei, HI q67J4 p. 808-635-q?qo f.808-82.6-6530 License # C-2.1457 [email protected]

, .

•

. ,\e--ltoF

Iy. f&it .~ " . ~

c 0 STATE OF HAWAU DEPARTMENT OF LAND AND NATURAL RESOURCES COMMISSION ON WATER RESOURCE MANAGEMENT APPLICATION FOR A WELL CONSTRUCTION I PUMP INSTALLATION PERMIT

Instructions: Please print in ink or type and send oomplak!1f appIk:ation wiIh aIIachments to the Commission on water Resource Management. P.O. Box 621, Honolulu, Hawaii 96809. Application must be accompanied by 10 copies and a flOIH8fundabIe fling fee of $25.00 payable to the Dept of Land and Natural Rescuces. The Commission may not accept incomplete applications. For assistance, cal the Regulation Branch at 587-0225. For further information and updates to this application brn, visit htIp:lMww.hawaii.govIdlnr/cwrm.

WELL LOCATION INFORMATION

The fdIcMing must be IIIIta:hed before this appIiaiion is accepted as c:ompIeta:

For Official Use ~EI V ED / COMMISSION ON WAre ~.

RESOURCEr1ANAGEMENT

III AUG 20 AH g: ~ 8

-Portion of7.5-UirUe Series USGS k>pogiaplic map (SC1IIe 1:24,000) willi wall kx:aIion labeled and inc:Iudethe naneofthequad map • Property tax map, showing wall kx:aIion ....... 1Ced to established property botJndIwies • PhotDgiaph offtle ~ wail_ -A schemaIic: diagram showing the wall site, _ road and propcIIIId wall inhastruI::IuAt - For dug walls, attach a gnIdirig ..... willi CRIBS sedion JIft)Iile8 stIIIIIinD e.is\ing and tnsh grades

5. VIt'El.l OPERATOR'S NAIIEICOIIPANY I Well Operab's ConIact 6. LANDOVH:R'S NAMEICOMPANY fal~ P(A(-Me.cS L.L. c.. I~ P,\k\n~('\ So..me

llandownar'S E-mail

PROPOSED WELL CONSTRUCTION PROPOSED PUMP INSTALLATION 7. PIuposed Work 8. ConsmIction Type 10. Proposed Work 11. Proposed Pumping Rate, gpm 13. MeIhod of low meastnment

'a" Construct New \MtII 15l Drilled Dr Install New Pump (gallons per minute) B Flowmeter o Modify Existing \MtII 0 Dug b Replace Pump /00 0 Other (explain) o AbandonISeaI WeI 0 Shaft o Tunnel 12. Proposed Amount of

I----------'--------t V\MhdrawaI, gpd (gallons per day) 9. Is this well part of a batIery ofwells? ~ Yes 0 No 72 000

PROPOSED USE o 15. Municipal (water systems ~ greater than 25 individuals or 15 seMoa COIwledions) 18 16. Domestic Number of Iris to be served: .5

o 17. IndusIriaI (describe) o 18. irrigation (desaIJe crop and 110. of acres) o 19. Military (describe) o 20. Other (describe) OTHER LEGAL REQUIREMENTS If tequired, items 21. 8IId 22. must be obtained before the Commission can legally issue a pennit: 21. Conservation District Use Permit (COUP) o 'NaIl is in Conservation District

o Required, COUP. dale appnMJd o Not Required (attach documentation trorn OCCL) ---o I have not checked wiIh OCCL about whether or not a COUP is required. I understand that checking wiIh OCCL prior to making this

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

]Ii Well is not in ConseMdlon 0istr1d o I have not checked if well is in or out of Conservation Di6trid. IlI1derstand that checking if the well is in a Conservation DsIrict may expedite my

Ieview. I further laldeIstand that issues raised may delay or result in denial of the permit issuanoe, or revocation of thepennitafter it is issued. 22. Special Managemellt AIea Permit (SMAP) o Required, SMA. dale approved o Not Required (attach doaImentation trorn applicable Cotmty""--agency--:-) 'M I have not checked wiIh the county about whether or not an SMA Permit is required. I understand that checking wiIh the County prior to making this

appIicaIion may expedite my review. I further understand that issues raised by this agency may delay or result in denial of the permit issuanoe, or revocation of the p8rmit after it is issued.

23. State HistorIc: Preservation Division (SHPm of the Department of Land and Natural Resoun:es o I have consulted wiIh the HPD rega~ ~ impacIs of wei constructiOn actMIies on historic sites. I have aIIached applicable documeIlIatioI.

t-om the HPD. Jii. I have not consuIIIIId wiIh the HPO reganlillg potential impads of well constructiOn activities on historic sites. I IlIlde1s1and that checking wiIh the HPD

prior 110 rnaU1g this appIc;ation may expedite my nMew. I further llI_starld that issues raised by this agency may delay or result in denial of the Permit issuanCe, or revocation of the pi,rmIt after it is issued. . , the history of Pa&t land use is attached.

24. water Use Permit No. (If applicable):

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

NOTE: Signing below indicates that the sigll8toIies understand and swear that the ilfoml8lion provided is aa:unde and true to the best of 1heir 1a1OWledge. Fur1her, 1he sigll8toIies UIIderstaIId that upon permit approval: 1) the proposed work is to be compIeIed within two (2) J88fS of !he approval dale; 2) !he COIIIrador shaI submit to the Commission a well campIeIiorJabandolment report within 10 days after the conlpletion dale of the pennItaed won; 3) in the event that the application is not complelled corredJy, any permit may be suspended until the item is brought in to cOillplianCle, and any work done while the

. permit is in ... , IIIl/Iy result in fines of lID to

\I\CPI AppIicatioiI Form 05l2Ol2OO9

.. I i ,)

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PROPOSED WELL SECTION (Pfease attach schematic if different from dagram provided below)

Hole Diameter: 13 in. Elevation at top of casing J.-3 7 ft., msI* l r

e.6-t. f-,r.::;- Minimum of 'Z Radius & 4" Thick Concrete Pad (to contain benchmark

surveyed to nearest 0.01 ft.) e..&t r7~ ~~ r GroundEIevaIion: ~3$ ft.,~

//~\ .'.~ .~::

'1/1&' '1/1&'

:" .. :: .. .".::.: Please refer to the ;l~ Cement Grout: ft. ;.: ,'. UAWAU WEI·I, CONSTRUCDON AND

(min. 70% of cflStance from :-"~' " .. ~. .~.::. ~. :: PUMP INfiAIJ.ATION nANDARDS ground elevation to top of :: ~ :-:;.

water surface or 500 ft., ~:::. ~:::. to ensure that your as-built is in compliance with

applicable standards. whidIever is less.) ... .~ "0::: .', II' .:

Grouting method: AmuIar space between hole :- ~ :. ~.

~ Solid Casing: (

~-.~: :. ~.

~.s 4. -:. Bottom Elevation: - ft., msI* Rock or Gravel PacIdng: -, r-

i Total Depth a-ft. Open Casing: & Perforated o Saeen 35'0 ft. r-. gO o Crushed Basalt Total Length: ft. V Nominal 0iameIer: " in. o Rounded GraIl8l &~ _'V \?i WaD Thickness: .~O in.

Estimated Water Lew! Bottom Elevation: -n5 ft., msI* -~ I~ Elevation: note: Neither bentonite nor mud should be used in ..s _ '--- 8i [-ft. msI* saturated zone during drilling Open Hole:

(lj Length: ft. Diameter: in.

~ Bottom Elevation: ft., msl*

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

For non-salt water Basal Wets - bottom elevation of well shoUd not be deeper than 1/4 of aquifer thickness or, Bottom Elevation of Well Linit = (Water Elevation _ 41 x Water Let EImtjon ) Exafr1IIe: Estimated + 2ft. WIller Level8ev. - BoItom Elevation of \Nell Lirrit = (2 - ~) = -18.5ft.

Solid Casing Material: Carbon StIIeI: cOlllpliantwith (check one or more): 0 ANSIJAVWVA C200 0 API Spec. 5L }:I(ASTMA53 0 ASTMA139

And compliant with (check one or more): 0 ASTM A242 (or A6(6) .." Type E 0 Type S V Grade B 0 Other Stal ...... StIeI: (check one): 0 ASTM MOO (production weBs) 0 ASTM A312 (monitor weIs) ASS PlastIc cOllfoJmil9 to ASTM F480 and ASTM 01527: (check one) 0 Schedule 40 0 Schedule 80 PVC PlastIc conformil9 to ASTM F480 and (ASTM 01785 or ASTM 02241): (check one): 0 Sd1eduI8 40 0 Sd1eduI8 80 0 Schedule 120 TheI'lllOMt PIastic:: (check one) 0 Aamenl Wot.n:I Resin Pipe conforming to ASTM D2996

o Centrifugally cast Resin Pipe conformil9 to ASTM 02997 o Reinforoed Plastic Mortar Pressure Pipe conformiIl9 to ASTM 03517 o Glass Fiber ReinfoR:ed Resin Presstn Pipe confonniIl9 to AVWVA C950 o PTFE Fluorocarbon Tubing conforming to ASTM D3296 o FEP FU:IrocaIt>on Tubing conforming to ASTM D3296

ODIn Casing Material: Carbon .... : compIianl with (check one or more): 0 ANSUAVWVA C200 0 API Spec. 5l 0 ASTM A53 ltASTM A139

And compliant with (check one or more): 0 ASTM A242 (or A6(6) pr. Type E 0 Type S .,. Grade B 0 Other StainIIu SIIMtI: (check one): 0 ASTM MOO (production weDs) 0 ASTM A312 (monitor wells) ASS PIasIIc COIdonning to ASTM F480 and ASTM 01527: (check one) 0 Schedule 40 0 Sd1eduI8 80 PVC PIIetIc confonning to ASTM F480 and (ASTM 01785 or ASTM (2241): (check one): 0 Sd1eduI8 40 0 SchaduIe 80 0 SchedUle 120 TheI'lllOMt PIastic:: (check one) 0 Aamenl Wot.n:I Resin Pipe conforming to ASTM D2996

o Centrifugally cast Resin Pipe COIlfOltllill9 to ASTM 02997 o Reinroroed Plastic Mortar