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Lear Well Well No. 1122-05 TMK (4) 5-1-002:010, Kauai

Prepared by CWRM Printed 27-04-2009

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o o LINDA LINGLE LAURA H. THIELEN

GOVERNOR OF HAWAII CHAIRPERSON

STATE OF HAWAII DEPARTMENT OF LAND AND NATURAL RESOURCES

COMMISSION ON WATER RESOURCE MANAGEMENT P.O. BOX 621

HONOLULU, HAWAII 96809

October 19, 2009 /

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

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

KEN C. KAWAHARA, P.E. DEPUTY DIRECTOR

1 1 22-05,ccwc

David and Sandy Lear P.O. Box 1283 Verdi, NY 89439

Dear Mr. and Mrs. Lear:

Certificate of Well Construction Completion for Well No. 1122-05 (TMK (4) 5-1-002:010)

We are pleased to inform you that the Well Construction work permitted for the Kane Well (Well No. 1122-05) is complete and acceptable and welcome you as a new member to the community of well owners and ground water users in Hawaii.

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

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

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

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

4. In the event that the well operator and/or landowner chap.ges, the Commission shall be notified prior to the change.

5. In the event the benchmark in the concrete base ofthe well is altered in any way, an updated version of the Well Elevation page of the Well Com'pletion Report Part I shall be submItted to the Commission. If a licensed surveyor had estImated the original benchmark elevation then a licensed surveyor must establish the new benchmark elevation. The Well Elevation portion of the Well Completion Report Part I can be obtained by contacting Commission staff or at our website at www.hawaii.gov/dlnr/cwrm/resources-permits.htm.

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

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

CI:ss

c: Kauai Department of Water Kauai Water Well

Sincer ly,

LINDA LINGLE GOVERNOR OF HAWAII

Mr. Michael Lluellen Kauai Water Well P.O. Box 431 Anahola, HI 96703

Dear Mr. Lluellen:

o




October 19,2009

Well Completion Report Part I for Well No. 1122-05

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, M.D., J.D.

KEN C. KAWAHARA, PE DEPUTY DIRECTOR

1122-05.wcrl.acc

We received ypur Well Completion Report Part I for the Kane Well (Well No. 1122-05) on October 2, 2009 and acknowledge that it is complete.

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

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

Sincerely,

CI:ss

c: David and Sandy Lear

MEMO and ROUT~ SLIP (ver. 07/21/09) 0 10/09/09 /

~\tL wi1J. I WCR 1 Check for Well No. 1122-05 (regulation/survey route)

1. Fror(§harl~yan ~ (initial) l~ .(.Sojr-

2. Well Log Check Geology Code for Well Index: Q.\tL-.Fm Name: j(o/M. 0/t~ D. England~initial)

3. Pump Tests Check Diane England <f3I1./ (initial)

Yes No

Step-Drawdown Test: followed WCPI Stds analysis attached

Constant Rate Test: followed WCPI Stds analysis attached

o o

o o

o o

o o

~gpm no test required

~m no test required

Potential Well Interference: D-rp Potential Stream Impacts:

Additional Testing or Data Required:

o .~ o ~

Pump Test Comments Attached: o l( Proposed Pump Capacity is OK.: 1 0

4. Construction Check Mitch Ohye 1\ /1 (initial) I Yes No

data complete g: 0 followed Special Cond & elevations ~ 0

R. Torres ----,L!(initial)

If no, describe deficiencl w-fv-Jl ~<f"

n t L, well database updated ~ 0 location change significant? '0 ,¢'

(SMA, CD, TMK)

NAD27

NAD83

.~ ..

Latitude

\ .'

CChar~/Ryan C. (initial) take action based on above analysis 'C

Longitude

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

2 COUNTY COMMENTS (DWS/SMA)

3 DOH COMMENTS

4 DLNR COMMENTS (LD/OCCUDHP) ~ 5 WCR 1 Accept ~

__ not necessary - only WCP or BOTH.

} To be sent to driller/pump installer

6 WELL CONST. COMPLETION CERTIFICATE ../ <------ To Landowner 7 USGS MAP UPOATEO } a PARCEL CHECK

9 WELL OAT:. 'ABA. '. SE INpUT CHECK Staff internal checks 10 PUMP TEST WORKSHEET 11 WELL As--Built CHECK PRINT

6. Roy ~ (i • .J. check (Entered WCR 1IWCCC accept date into database) 7. Susan Hoagbin ~ (initial) finalize 8. Ken (initial) signature 9. Mitch (initial) Entered PIP issue date if attached/required 1 oCQ.harle?yan File

1J blillili MI t t in: jei'1tt "It.I1It ~#&'.,.

,

State of HaQii o 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.usldlnr/rmrm/

For Official Use Only:

RECEIVED COH~ISS!m1 ON WATER

RESOURCE [u.,\NAGn1EN (

2001 OCT -2 PH 12: 0" J/

1. State Well No.: l/~,;z, .. o~ Well Name: • . __ ...:./(j....:...;..A=1'l....::..=E."---_ Island: kA-wtr-i __ ~KtIt,.CAp~uM~A'--4i24r_:==:a_ __ , .c.:;.,JYk~}C1~AL-i _ -_-__ Tax Map Key: 6--1 - 002._ 1:>/0 2. Address:

3. Drilling Company: K Pfu.f\-; W~ Wc.l I 4. Drilling method used during construction: Ji Rotary 0 Percussion 0 Other (describe)

5. Date Well Construction (drilled,cased,grouted) completed: q - Z ~-o'l Attach Completed Driller's Log monthldaylyear

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

7. Step-Drawdown Test completed? Ilf No 0 Yes Attach Step-Drawdown Test form (12117/97 SDPTD Form)

8. Constant Rate Test ,..n.",nll ... t.c.rf?

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

Chloride: 1 Co ppm, Temperature: ", I OF

to mean sea subtract the depth to the water level.

12. As-built section filled in completely ti

No 0 Yes

13. Photograph of well and concrete pad showing benchmark on concrete pad attached ~

14. GPS coordinates provided in degrees, minutes, seconds,;zf

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

16. Remarks:

Licensed Driller (print)

Signature

C-57 Lic. No. L c - 2. 9s-78 Date t:f - >0- CJ~

WCR1 Form 6112107 PafJf' 1 of 5

o o 12. AS-BUIL T WELL SECTION (Please attach as-built if different from diagrem provided below)

Hole Diameter' I Z. in Elevation at top of casing 072- ft., msl* l r 1 (to nearest 0.01 ft.) ~ Minimum of 2' Radius & 4" Thick Concrete Pad

-:-;-;.:? ~ r Ground Elevation: olV ft" msl o Surveyed ;fEstimate Bench mark ·1.-:';'.>. ... ~ . .r;: elevation: I~\ '\>.- ,\>.- 11;7&\ 11;7&\ .....

>" Please refer to the ::i', "",.,

..D.!L ft., msl* l~~ ft . >' • .' . ..9! HAWAII W~Lb. CQN§TRYSiTIQIj &:10 Cement Grout: :. f· :. ~. w

o (Surveyed to (min. 70% of distance from :~.:.: . " 'ii PUMP IljSTALLATION STANDARQ§ c. •••

ground elevation to top of -.:\>" :-: ;. > to ensure that your as-built is in compliance nearest 0.01 ft.) ';.:' ~:;:: ~

11 (Estimated) water surface or 500 ft., ..... ... with applicable standards. .... ~. whichever is less.)

'\>., '\>.- .!! '. " .~: " ~ - ',t>.o

,'. . '. :.f! .: :: .

Annular space between :~.:.: ,; Solid Casing: (~ 90% x (Ground Elev.-Water Level Elev» ~uting method: :~.~ J!

hole and casing (1.5" for -.: r: W lZQ Positive .;.:. ;.:. Length: ft.

positive displacement, 3" ~ .::;:. ~

displacement (if c:

~ for other methods): .... '\>.- ~ Nominal Diameter: in. . .... e annular space is V • A •• • 4 ••

~ ~'':4 ~'. :4 Q. Wall Thickness: in. less than two --in. '~ .. ~:'

:';'0 >< yeo inches, attach ~.:.: ~ Bottom Elevation: ft., msl 0

photo of tremie) - f-

I ~ 0

Rock or Gravel Packing: en o Other ~Oo AI

3~ ft. :i~ h I Open Casing: ,i5 Perforated o Screen Material:

.Il! Crushed Basalt ~] Length: 3'0 ft. o Rounded Gravel ~ li?g? Y Nominal Diameter: ~ in.

v

[;9i 1-Wall Thickness: in. Water Level Elevation:

qffs g Bottom Elevation: '"/..Zo ft., msl ft. msl* Total Depth -~ '---2J!)O ft. (item 11 from page 1)

Open Hole:

~ Length: -"'"

ft.

Diameter: in. ~---- -

*msl = mean sea level Bottom Elevation: ft., msl

Solid Casing Materiali 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 or A606 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): Ji'Schedule 40 0 Schedule 80 0 Schedule 120

Thermoset Plastic: (check one) 0 Filament Wound Resin Pipe conforming to ASTM 02996

o Centrifugally Cast Resin Pipe conforming to ASTM 02997

o Reinforced Plastic Mortar Pressure Pipe conforming to ASTM 03517

o Glass Fiber Reinforced 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 A 139

And compliant with (check one or more): 0 ASTM A242 or A606 0 Type E 0 Type S 0 Grade B 0 Other

Stainless Steel: (check one): 0 ASTM M09 (production wells) 0 ASTM A312 (monitor wells)


PVC Plastic conforming to ASTM F480 and (ASTM 01785 or ASTM 02241): (check one): 1 Schedule 40 0 Schedule 80 0 Schedule 120




o Glass Fiber Reinforced Resin Pressure Pipe conforming to AWWA C950



WCR1 Form 6112107 Page 2 of 5

d

o DRILLER'S LOG

o WELL NUMBER: k l t.-2- ..... 05';n addition to the driller's log, if a geologic log was prepared, please submit with this form

Depths (ft.) Rock Description Water Level CI- Dates Depths (ft.) Rock Description water Level CI- Dates

__ -==- !"!-of _to _______ _

-=lto!fE- 41#( _-_ ~ i -8-:fJ't _to ______ _

1Lto 11.0 '8L"'~ $R - ~ 1-9-01 _to _______ _

I'Ll tolK' t1tu~e"JA. ~- _to ___________ _

l~to/B1 '8W1vc.J{ - _to ___________ _

;6.0J:lr C~tV'V>~ 87/3iL 1-/~-o1 _to ___________ _

J 1~ to J!!} t>~1v ~ !7 f' ~ 1::i.fiJ? _to __________ _

_ to ___________ _ _to __________ _

_ to ___________ _ _ to __________ _

_ to ___________ _ _to ___________ _

_ to ___________ _ _to ___________ _

_ to __________ _ _to ___________ _

_ to ___________ _ _to ___________ _

_ to ___________ _ _to ___________ _

_ to ___________ _ _to _______ _

_ to _______ _ _to _______ _

_ to _______ _ _to __________ _

_ to ___________ _ _to ___________ _

Remarks:

WCR1 Form 6112107 Page 3 of 5

o o ... ".' ,.

o 0 WELL CONSTRUCTION PERMIT

Kane Well, Well No. 1122-05 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 Kane Well (Well No. 1122-05) at TMK (4) 5-1-002:010, 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.

The Chail'£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).

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

The well construction permit shall be for construction and testing of the well only. The permittee shall coordinate with the Chairperson and conduct a pumping test in accordance with the HWCPIS (the latest 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 Instalration 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 De 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 stop 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/cwrmlresourcesJlermits.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.

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

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

If the well is not to be used it must be proyerly 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.

15. 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.

::0 16. 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 Wel"s~ump

installation permit m accordance with §13-168-12(f), HAR. :I' 03:

17. Special conditions in the attached cover transmittal letter are incorporated herein by reference. 58 §5:! Z C':;cn::p IT! CJ'2 ,."

:rO~ Date of Approval: June 5, 2009 W LAU H. THIE EN, Chairper~ =~~ Expiration Date: June 5,2011 'C..... Com ission on ter Resource f\lfima&fi?

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

Driller's Signature: C-57 License #: C-29578 Date:6 -22 .,......O? Printed Name: Michael Lluellen Firm or Title: Kauai Water Well

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

Attachment

Vl OJ

( . .::... QI



Dear Mr. Lluellen:

o




June 17,2009

Pump Installation Permit Kane Well (Well No. 1122-05)


MEREDITH J. CHING NEAL S. FUJIWARA

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


KEN C. KAWAHARA, P.E. DEPUTY DIRECTOR

Ref: 1122-05 pip.doc

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.

2. Attached for your information are copies of the Department of Health's (DOH's) review comments. Please review the requirements related to discharge of emuent 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

The permittee is responsible for all conditions of the permit. This includes ensuring the submission of a completed Well Completion Report Part n 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.

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

If you have any questions, please call Denise Mills of the Commission staff at 587-0251 or toll-free from Kauai at 274-3141, extension 70251.

Enclosure

c: David & Sandy Lear (with applicable DOH comments) USGS Kauai Department of Water

/

, -

".....,

VpUMP INSTALLATION PERMIIO Kane Well, Well No. 1122-05

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 Kane Well (Well No. 1122-05) at TMK (4) 5-1-002:010, Kauai, subject to the Hawaii Well Construction & Pump Installation Standards (HWCPIS - February 2004) 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 (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 50 gpm rated capacity, or less, pump in the well. This permanent capacity may be reduced in the event that the pump test data does not support the capacity.

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

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

7. Well Completion Report Part II shall be submitted to the Chairperson within 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 staff submittal approved by the Commission are incorporated into this permit by reference.

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

11. 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 goodfaith 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 ofthis permit.

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

Date of Approval: Expiration Date:

June 5,2009 June 5, 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.

Installer's Signature: C-57, C-57a, or A License #: C-29578 Date: -------

Printed Name: Michael Lluellen Firm or Title: Kauai Water Well

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

Attachments

/



Dear Mr. Lluellen:

o o




June 17,2009

Well Construction Permit Kane Well (Well No. 1122-05)


MEREDITH J. CHING NEAL S. FUJIWARA

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


KEN C. KAWAHARA, P.E. DEpuTY DIRECTOR

Ref: 1122-05 wcp.doc

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's) review comments. Please review the 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.

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 is allowed for 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.

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

If you have any questions, please call Denise Mills of the Commission staff at 587-0251 or toll-free from Kauai at 274-3141, extension 70251.

Sincerely,

Enclosures

c: David & Sandy Lear (with applicable DOH comments) USGS Kauai Department of Water

/

-' . o o WELL CONSTRUCTION PERMIT

Kane Well, Well No. 1122-05 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 pemits the construction and testing of Kane Well (Well No. 1122-05) at TMK (4) 5-1-002:010, 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 Chail"£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).

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

The well construction permit shall be for construction and testing of the well only. The permittee shall coordinate with the Chairperson and conduct apumping test in accordance with the HWCPIS (the latest pump test worksheet can be obtained by contacting Commission staff or at www.hawaii.gov/dlnr/cwrm/resources.JIermits.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 ilian 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 enviromnent, to schedule work to avoid periods of high rainfall, and to revegetate any cleared areas as soon as possible.

In the event that historically significant remains such as artifacts, burials or concentrations of shells or charcoal are encountered during construction, the permittee shall stop work and immediately contact the Department 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/cwrm/resources_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.

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

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

If the well is not to be used it must be 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-I2(f), HAR, prior to any well sealing or plugging work.

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

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

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

Date of Approval: June 5, 2009 Expiration Date: June 5, 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 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-57 License #: C-29578 Date:

Printed Name: Michael Lluellen Firm or Title: Kauai Water Well

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

Attachment

/

Well Construction/Pump Permit Application t) Review Tracking ,

" 0 J

Well No.: (122- --0 S Well Name: ----Z:;;~=Vl:...:.e--=-______ _

Review start date: 4/ :?o I 0 j

Comment deadline: l~ 15/0Cf I ,

Comments Attach Comments Reviewer Received (YIN) Date to Permit (YIN)

DLNR

Land Division, Morris Atta V-- 4/~/O'1 No Historic Preservation Division V II (I,( CUt" q No

LUC (Dan ua'v fI

Office of Conservation & Coastal Lands IS::arn

Inl..Ju, , .... 0

DOH (Hon. C.L. Fukino) ~ ~~7 ...Li..-.. v

YVWB - T)I'omas See V 5( M~j o'f N~ SDWB - Stuart Yamada V S VUnlJJOf Vt:v CWB - Alec Wong V- ii M~rA 'IuJ HEER - Kawaoka V /3M.J 04 N,<

C&C or ..... , ..... w, v

Honolulu BWS 0Nayne Hashiro)

Dept of Planning & Permittina (~I~ IJ

Ka '::l0' ... ,canning (Costa)

•

'.

JUH-03-20f19 09: 22 Fr om: DOW SAFE v.JATER BRANH 8085864351 To:808 587 0219 P.1/6 tJ ...

LINDA liNGLE

RrCfiVEO SAFE DRUHHNG WA1IR BRfl&!f'\!.J

11.1M8'qA 1'1 TrilElEN QCII~A"alll or ~"WAII

STATE OF HAWAII

IIA't 4 2009 "'''"","SON ., . ~ Me:R~I)ITH J. OHING

" "". JI'MI<S A F~AZII!R,

~ NEAll!!. FUJIWAR'"

M ~_ CHIYOME l. FUKlNO, M.D DO!oJI\IA I'AV K KI,(OSAKI. P E

CJ1 L"'~ENee H MIlKE M.O, JD.

:frrfJ.-- KEN C KAWAHARA. P E. DeFIJTY tIIRECTOR

/

I)I:M~TM~NT OJ! LAND ANti IIIATUAAL ~S:SOU"CI:S COMMISSION ON WATER RESOURCE MANAGEMENT [;. General: ~, '\'2.2·- O?-

Q = ~-o ~L~

TO:

FROM: .t SUBJECT:

PO SaXG21 HONOLUlU. HAWIUI 9880~

April 30 l 2009 use ;;;; 1>6Y"'lf?, L •

location -).~w;;. ~..&iiJf~( . f..avp.., .,41ll.u~ Q~

Honorable Chiyome L. Fukil1o, M.D., Director (above·~ti'"&N 'Ii',UIC line Department of Health C /' I Attention: Tomas See, Chief. Wastewater Branch I grd. elev. = ~ 7 (."I

$tuart Yamada, Chief, Safe Drinking Water Branch I well dia = 4- " Alec Wong, Chief. Clean Water Branch . ~ , Dr. Keith Kawaoka, Office of Hazard Evaluation and E, well d~Wh F . ~ ~k ,f

Laura H. Thielen, Chairperson 1Wt:.tp! WtflU, It.v· itt1~" '''i· '

Commission on Water Resource Management

Well Construction/Pump Installation Pennit ApplIcation . ~ Well (Well NQ. 1122-05), TMK (4) 5-1-002:010 j4r\l,...

Transmitted for your review and comment is a copy of the captioned Well Construction/Pump Installation permit application. The maps a.tta.ched to the permit application show the proposed well location.

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 returninr tbis cover menlO form by June 5, 2009. If we do not receive comments or a request for additiona review time by this date, we will assume that you have no comments.

If you have any questions about this permit application, request additional infonnation, or request additional review time, please contact Denise Mills of the Commission staff at 587-0251.

DEM:ss Attachments

RESPONSE; [I This well quahfles as a sourc.e ",,-Illeh Will serve as s sour",e of potable w~1.Cr to a p\)blic water system (defined 35 serving 25 Qr metre pcoplt

at least Gil days pcr year or has 15 or more ~erv'ce cOl'lnec.tlQI'Is) ~<l m\lst recejve Dirrotor of Health approval prior to its us~ to com.ply wlm Hawaii Administrative Rules (HAR), Title J I, Chapter 20, Rules Reillting to Potable Wal~ Systems, § 11 ,20·29

)(( This wdl docS not qualIfy as II. source serving a publi~ water system (serves less than 25 p~ople or more people at I~ast 60 days rer year or . I j ~rvjcc connections) and if the well water is used for lItinking, the private owner sbould test for bacteriological and ~hemica presence

before jnl~i:attng s\lclll,ls~ anti routinely monitor the water quality tbereafter. However, if future planned use from thiS source increase~ 10 meet the public wate, system definition then Dire'lOr of Health apPrOVal is reqUired D!1ru: to implementatiOn

I 1 If the well i$ us.d to mpply both potable and non-potable purposes m a single S)'Slent. the USer ,hall ehminak IOlUSs-eonnections and bacldlow conncocliOlls by phY~Hc8l1y separating potable and non-potable systems by an air gap or an approved bllcldlow preventer, and by clearly I abo:li ng all non-potable spigots with warning SIgnS to prevent inadvertent COJlSumption of non-potable water Saddlow prc:vention devices should "co rOlltmcoly in~pectect and tested.

[1 It does 1101 $ppCar tllal this well will be used for consumptive purpo~es and IS nol subject to Safe Drinking Water Regulations

r J for rne applicant'S information, a source ofposslbl~ wilSt~WALIlr contamination I Jis I II is Dot located near tne proposed well site (lnfurmation atla<:hed)

(1 An NPDES p~rnllt is r~ql.lJrccl

(1 Otoor relevant DOH rulcsir£guilltjons. information, or r~commruclalions art attached.

(J In the event that the locatIOn of 1!'1t: well cl1angcs \Jut tS stIll WIthin the parcel (\csc,ibed 011 thIS "PplicatJon, our division cOI1slders the comm~/lts to stIll be applicable.. and we do not need \0 rcvie-.- the new IOtation.

(l No comments/objectiOns

JUN-03-2009 09:22AM FAX: 8085864351

Phone: $tSb -4:-zt8 Date: .s,l2~j/dj

10: DLNR CWRr'1 PAGE: 001 R=94%

JUN-03-2009 09:22 From:DOWSAFE WATER BRANH 8085854351 ~ ,.. To:808 587 0219

CWRM Application Source: Lear Well (USGS No. 1122-05) TMK (4) 5-1-002: 010

Safe Drinking Water Branch (SOWB). - Engineering Section

No comments

SDWB Underground Injection Control {UIC) Section

P.2/6

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

JUN-03-2009 09:22RM FRX:8085864351 ID:DLNR CWRM PRGE:002 R=94%

JUN-03-2009 09:22 From:DOWSAFE 1.ICjTER BRAHH 8085854351 To:808 587 0219

....... ; -

WARNING! As the owner of a privately-owned well, you shOlild NOT assume that water from your well is sa1e for consumption. It is your responsibility to make sure that your well water is safe to drink. The only way to do this is to have your well regularly tasted for bacteriological and chemical contaminants.

There are no regulations controlling water quality in private wells selVing individual residences as there are for public water systems (public or privately owned utilities supplying water to 25 or more people or 15 service connections). In other words, there are no enforceable limits for contaminants and no requirements for regular testirlg. Private wells are often found if"I rural areas, where many activitia:s such as onsUe wastewater disposal can contaminate the ground water.

U.I_ ENVlRQNMEt:UN- PR9TE£TION AGENCY (gpA) RECOMMENDATIONS

The EPA recommendS that privata well owners test their weU water each year for suctl contaminants as Total Coliform Bacteria, Nitrates, as well as any other conta,minants that may be of concern in your area. More frequent testing may be appropriate if you suspect a problem. EPA also suggests that you consider testing for pesticides. organic Chemicals. and heavy metals be10re using it for the first time. Please refer to the EPA website on Private Drinking Water Wells at h~tp:J/www.epa.go'v'/5a.fewater/priyatewells/faq,htm!

OTJ1EA CONTAMINANTS

water testing can be very expensive. It is important that you spel1(1 time to identity wha1 other potential contaminants may be of concern. Please refer to the EPA website on Private Drinking water Wells at btig:i/www.epa.gov{§afewaterlDdvatewellslwhatyoucaodo.html for more Mlpful information. Be aware of what and how you use and aispose of household and garden chemicals. Also determine the location of nearby septic tanks or cesspools. and agricultural or Industrial activities in the area. General information on known chemical contamination of ground wa1er in Hawaii can also be found at the OOH webSite www.,hawaii.gov/health/enyiroom~ntal/Water/sdWblconm§psjpdf/coomapSQ5.l22f

LABOBATORtES

Local commeroiallaboratories can be found in the yellow pages of the telephone boOk lJnder "laboratories, Analytical." Whenever pOSSible, utilize a labOratory that is certified or approved 10r the specifiC drinking water tests and carefully follow their instructions for collecting. storing, and transporting the samples. Just be sure to ask the lab to use EPA approved methO(jg for drinking water analysis. A list of labs certified or approved by me Department of Health can be found at "!fNW. hawaii .govlhealth/eovironmwtal/watertsdwb/sdwbJpdf/!estjog%2QLabs . pdt . As lab certification status changes constantly, confirm their status when you contact the lab. Please note that the list is limited to currently regulated contaminants in public water systems.

RESUh1§

Once the lab provides you with the test results, you will be in a better position to determine if your well water is safe to drink or what contaminant you need to treat for. Generally. you should compare the results with Federal (www.epa.QQv/safewater/mcl.html) and State (www·hawS!ji. gov/healtb/environmentallwater/sdwbJsdWblpdtiState'1/..,20MCL.od1) drink;ing wate r standards, Where your test results are greater than the State or Federal maximum contaminant levels. your well water should be considered as ynsafe for consumption.

P.Y6

JUN-03-2009 09:22RM FAX: 8085864351 ID:OLNR CWRM PRGE:003 R=94%

Me y. 13. 2009 10: ~OAM DOH-HEER OFFICE 208-536-7537

LlNDALlNG~E aO'IWI.NOA. OF HAIN.AIJ

TO:

BEC[IVEO. DEPAR1MEHTOFHEAL

, lOn' M~Y -u A I() '3

HEER OfFICE STATE OF HAWAII

DEPARTMENT Of LAND AND NATURAL RESOURCES COMMISSION ON WATER RESOURCE MANAGEMENT

P.O. 90)(621 HONOLULU. WlWAIl 96809

April 30, 2009

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

~o. 2433 P. 2

LAURA H. THIELEN

MEREOITH J. CHING .lAMl;;S A, FflAZlER NEAL S. FUJIWARA

CHI'fOME l. fUKINO. M.D. DDi':NAFAY K. KlYOSAI<I, P.!;.

LAWRENCf:: Ii MIIKl::. M.D., J.D.

KEN C. KAWAHARA P.E. ot:JI"uTY DlR~c:rOR

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

vtJr. Keith Kawaoka, Office of Hazard Evaluation and Emergency Response

Laura H. Thielen, Chairperson 1w~t(i ,L, FROM: ~

SUBJECT:

Commission on Water Resource Management

Well Construction/Pump InstallatIOn Permit Appilcation Lem' Well (Well No. 1122-05), TMK(4) 5-1-002;010

"'KrutL Transmitted for your review and comment is a copy ofthe captioned Well Construction/Pump

Installation permit application. The maps attached to the permit application show the proposed well location.

We would appreciate your comments on the captioned application for any conflicts or inconsistencies with the programs, plans, and objectives specific to your depaltment. Please respond.!!l: returning this cover memo form by June S, 2009. If we do not receive comments or a request for additional review time 6y this date, we will assume that you have no comments,

If you have any questions about this permit application, request additional information, or request additional review time, please contact Denise Mills of the Commission staff at 587-0251.

DEM:ss Attachments

RESPONSE; [] Tilis weli -qualifies !lS ~ sOllrce which will !erve lIS a SOurCe ofpol.llble Wilier to a public w~ter ~yslem (defined as serving 25 ~r more pCIOple

Ilt least 60 days per year Or has 15 Or mOre ~crvicy connections) and must receive Director of Health Ilppronl prior to ils use to comply wilh Hawaii AdminislraliVl:- Rules (HAR), Title 11, Chapter 20, Rules Relaling to »ota!JIc Water Systems, § 11-20-29,

[J Thi~ well do~s not qualifY as a SOllfce serving a public water system (serves less than 25 people Or mare people alJellSt 60 days per year or 15 s=rvice cOlUlcctions) /\lId iftne well water is used for drinking, thc privale ownet should test for bac(criQfogic~1 and chemical presence befcre initiating such Uje and routinely monitor tllewater qunlitythereafter. However. iffutu!e planned use froin this source incrci\5es to meelthc public water system definition then Director of Health approval is required priQ .. to implementation.

[] If the well is Ilsed to sLlpply bilth potable ~nd non-potable purposes ill a single sY&lem, the \lStr shall eliminate cross-oonnections and backt10w connectionS by phy~ic.lly separating potable and Iloa·potable systemg by 811 air gap or an approved backflow pre'i>enter, arId by clearly labeling all non-potable spigots with waming signs to prevent inadveltent COllSLlDlptioll of non-potable WlIler. Backflow prevention devices shiluld be rOLltinely ilJjp~ted and tested.

[] It doel nol appear that this well will be used for comumplive purposes and is not subject 10 Safe Drii1l<illg Water Regulaliolls.

[1 For the appliont's infonnlllion, a source of possible wastewater cQntammll.lion (Iii I (1 is not located near the proposed well site (inf(lfmlliion f1Ual!hed).

(1 AIl NPDES permit is required

(] Oliler releYanl DOH roiesiregillations,inforrnation, Or recommendations are attached.

[1 hi the event tirat the locaticn of the wdl changes bul is still wililin the puce) described (lJl this application, our division considers the commonu 10 still be applIcable, ami we do not need 10 review lhe new location.

~ No comrnenlslobJection~

Contact Person: ~ &.~ ~iO"nprl· ~'" \." .... II·A 9,.JIM 0 or-

t1R'( -13 -2009 10: 49R~1 mx: 808 586 7537

Phone; 58: f, -0 ?> 7

ID:DLNR CWRM PRGE:002 R=95%

o o LINDA LINGLE LAURA H. THIELEN

GOVERNOR OF HAWAII CHAIRPERSON

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

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.

DEPUTY DIRECTOR

TO:

FROM: ~

SUBJECT:

DEPARTMENT OF LAND AND NATURAL RESOURCES COMMISSION ON WATER RESOURCE MANAGEMENT

PO BOX621 HONOLULU, HAWAII 96809

April 30, 2009

Honorable Chiyome L. Fukino, M.D., Director Department !,Jf Health Attention: "rom as See, Chief, Wastewater Branch

Stuart Yamada, Chief, Safe Drinking Water Branch Alec Wong, Chief, Clean Water Branch Dr. Keith Kawaoka, Office of Hazard Evaluation and Emergency Response

Laura H. Thielen, Chairperson 1WL!. tp. ~ Commission on Water Resource Management

Well Construction/Pump Installation Permit ApplIcation Lear Well (Well No. 1122-05), TMK (4) 5-1-002:010

Transmitted for your review and comment is a copy of the captioned Well ConstructionlPump Installation permit application. The maps attached to the permit application show the proposed well location.

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 June 5, 2009. Ifwe do not receive comments or a request for additional review time by this date, we will assume that you have no comments. __

~ .. -If you have any questions about this permit application, request addifional information, or request

additional review time, please contact Denise Mills of the Commission sta~~t 587-0251.

DEM:ss Attachments ; ~)

RESPONSE: [1 This well qualifies as a source which will serve as a source of potable water to a public water syste.lU (defined as serving 25 or moreloPle::o

atIeast 60 days per year or has 15 or more service connections) and must receive Director of Helifl)i;approval.D[ior to its use to co rrlg WIth HawaII AdmmlstratIve Rules (HAR), TItle II, Chapter 20, Rules Relatmg to Potable Water sYstems, §1l:30-29. ~:3:

[I This well does not .qualify as. a source serving. a public water system (serves less than 25 people ~re peepiiUlt least 60 days perl or ;ii! 15 servIce connectIOns) and If the well water IS used for drInkmg, the prIvate owner should test f'tj(;~actenologltal and chemIcal pr ce n (1)::0 before initiating such use and routinely monitor the water quality thereafter. However, if future pTanned use from this source increasl' to rrl~~ meet the public water system definition then Director of Health approval is required prior to implementation. CIt :xC,."

""1>%-[I If the well is used to supply both potable and non-potable purposes in a single system, the user shall eliminate cross-connections an~ %C~

backflow connections by physically separating potable and non-potable systems by an air gap or an approved backflow preventer, y ~ZO clearly labeling all non-potable spigots with warning signs to prevent inadvertent consumption of non-potable water. Backflow pre ion C)::IE 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. _ ~ ., Z::D

[I For the applicant's infonnation, a source of possible wastewater contamination (lis / [I is not located near the proposed well site -4 (infonnation attached).

[I An NPDES pennit is required.

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

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

No comments/objections

Contact Person: Lori Vetter, Eng. on Kauai 241-3323 ------------------------------------------

Signed:~~' 0'V1 ~ Date:

:x: ~ t- :r: U") -Jo <z co W <'!

::c Ct.: u.. C' e:: 0 CL a:: I- l..IJ :z: I- ::r W .. ~ ::::E ~; .- Ii t- uJ :>-

~.;.,. a:: .... a:: - < (J? e=

.- . E 0- «

<: tlJ3: f!

". >-Q ,

'j CI)

: . ~, ~ I: l.:J :.~.:.

;, .. V-' ~~.

~;:. g::_. W -.....

.. o o RECEIVED

LINDA LINGLE GOVERNOR OF HAWAII R~OMH~~SfON aMlilATlfiaAALA FUKINO. M.D.

c.SOUf\VE MANAGEifttOOOFHEALTH

2089 HAY -8 PH 2: '3 STATE OF HAWAII

DEPARTMENT OF HEALTH P.O. BOX 3378


Wastewater Branch 919 Ala Moana Blvd. Room 309 Honolulu, Hawaii 96814-4920

Phone (808) 586-4294 Fax (808) 586-4300

STATE MESSENGER DELIVERY

In reply, please refer to: EMD/WB

Date: 0 £). O€J .. oq To: Commission on Water Resource Management

Department of Land & Natural Resources State of Hawaii

Attn:

From:

Subject:

Lori Morikami, Planner Planning & Design Section water commission route.wpd sam as of 06-21-2007

Ph 586-4294 Fax 586-4300 Email: [email protected]

Well Construction/Pump Installation Permit/Water Use Permit for

Well No. ---="'\.!.-\ ~_'_-_oS __ l.wJv __ W_-a----,' _____ _

Well No. _l j:_1-_?J_~_O_4-__ Mru1~_a _lO--'-lM-----'t1 ___ _

Well No. __________________ _

Well No. ___________________ _

Please find enclosed the application of the above subject project.

STATE MESSENGER DELIVERY

Q5-11-2009 11:11am From-DEPT OF HEAlT~ENVI RONMENTAL IilNGMT 9095964352 T-990 P.Q04/004 F-999

"..

LINPAI-INGU< :;;Q\le ...... a~ 0" rt.l.\llrAf!

TO:


COMMISSION ON WATER RESOURCE MANAGEMENT .. a BOX521

1'I0NO"ULU, HAWAII 95809

April 30, 2009

Honorable Chiyome 1. Fukino, M,D., Director Department of Health Attention: Tomas See, Chief, Wastewater Branch

" .

LAI.IRA H. THIELElI OHA!Rfi'cRa:ON ~r

~"REPITH J. CHING • ~~ JA",ES A. FAAZIER A. ~ NEAL S Fi,lJIWARA U I

CHIYOME L FUKlNO, M.D. !:lONNA FAY K. KIYOSAKI, P,E.

LAWRENCE joj MilKE, M.O .. J.D.

KEN C, KAWAHARA, P.~. DI:.puT\" Q,IREeT:'JH

r.tuart Yamada, Chief, Safe Drinking Water Branch -~Alec Wong, Chief, Clean Water Branch

Or. Keith Kawaoka, Office ofI-Iazard Evaluation and Emergency Response

Laura H. Thieien, Chairperson 1~(!.tp.·~ Commission on Water Resource Management

FROM: ~

SUBJECT: Well Construction/Pump Installation Penn it App cation Lear Well (Well No, 1122-05) TMK (4) 5-1-002:010

Transmitted for your review and comment is a copy of the captioned Well Construction/Pump Installation permit application. The maps attached to the permit application show the proposed well location,

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 h): rcturninJ! this cove .. nti!lttll form by June 5, 200~, If we de not receive comments or a request for additional review time by tliis date, we will assume that you have no comments,

If you have any questions about this permit application, request additional infonnation, or request additional review time, please contact Denise Mills of the Commission staff at 587-0251.

DEM:ss Attachments

RESPONSE: [I ThiS wtll qUlIliu"li ~~ a ~O\.lrcc which will serve as II source of {lot~ble water to a public v.<1lllr sy~km (d~fineQ as serving 25 or more people

II11easl60 days per year Of has 1501' more savicc connections) and ml.lst tecei'll'" Dircctor of Hcalili approval prior to lIS \lSC to comply with Hawaii Adtrtitlisltati vb RI"~!l a-IAR). Title II, Chaplet 20, Rules Relatins to Potabl. Waler Systems, $11-20-29_

[] This well does nO! qualify a,; iii sOurce sewing a public water sYStem (~.,,-y.1l1'$s than 25 people or more people M least 60 days fer year Of 15 service connections) and ifth., well w'It"r is used for drinking, the private OWO<;:f should test for bacl.,rioloSlt;lilllllld chemica presenc~ befote initiating ;;uch u.e IIIld routinely monitor lhe watetqllality Ihefeilftcr. However, if furure plann~d us~ from Ihis SOufCE: inCreases to mem tile pLlblic wal~r system definitiollthetJ DireclOr of Health IIPprovai is rcquu'ed prior Lo implt:mentation,

[] If the well is used w supply both pOl:abk !tlld non-PQ~ble purposes in a single Sy~tem, th~ usor shall eliminate cross-connections and ba~l;:tl(lw ~onneclions by physically separating pOlable anil mm-potable systems by an air IOIIP or an approved backtlow prcventer. and by clearly labeling aIlllon-polable spigolS wilh w,uning signs to prevetJt inadvertent cOllsl.1mptioll OfllO!l.,potable wafer, Backtlow prevtlll:ion dev ices shollid be routinely inspected and tested,

r 1 It does nor ilppear thalthi~ well will k used for ooli~umrtive purposes ltnd I~ not subject [(j S'lfe Drirlk:in8 Wa.ter R~gulatjons_

[] For the applicant's intormarioll. a ~olm:~ OfPO~51ble waSTeWater contamination Ilis I II i~ not located near tnt proposed well sire (infonnatioTi attached),

[] An J'PDES permit is required.

(~ Other relevant DOH lUit;:~rcsullltions, informatioil, Or rtoilmmtndations are attached.

[1 In Ihe cvc::nt thllt the location ofth~ wdl changes bllt is still within th( parcd d~SCiib(ld on Lhis applicll[ion, our divi~iol\ COll:lil1er~ the cOmm~m~ to still be applicable. and we do nOt need III review the now lOCatiOn.

r.l No commems/objecticms

Contact Person: _..;:,c:h"--.::;.~.;:....._~' ......:L=-. _____ ~~~ __ ~_~~ Signed; ___ -F}fn-+-_a,;_~ __ '1i--ioJ""~;;;....;.. ____ _

(T

Phone: ft3~ -4:)D~

Date: 21t- O~

t1AY -11 - 2009 11: 12At1 FAX: 8085864352 ID:DLNR CWRM PAGE:004 R=96\

,," 05-11-2009 11: 11 am

Fax to: Company:

Fax No.:

From-DEPT OF H~ ENVIRONMENTAL ~GMT 8085864352 o T-990 P.OOI/004 F-999

FAX TRANSMITTAL State of Hawaii Department of Health Environmental Management Division

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

Fax No.: (808) 586-4352

Mr. Ryan hnata I Mr. Charley Ice~~;e ~ Commission On Water Resource Management Department of Land and Natural Resources

Date; ~ II I t.co9 Fax from: %anna L. Seto ~

587-0219 Total Pages, incI. cover: 2+ z..

Subject: Well Construction/Pump Installation Permit Application(s) Well No(s). l"Z. 2.,- 04. \\ u..-05

•

The Department of Health. Clean Water Branch (eWB) 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 11. Chapter 55, Appendix: I, effective October 22. 2007. Treated process wastewater effluent covered by this general permit includes well drilling slurries, lubricating fluids wastewater. and well purge wastewater. This general pennit does not cover well pump testing. The applicable Notice ofIntent (NOl) FOTIns 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-NOI Forms are available online at htu?:/ /V\lWW .hawaii. gov lhealthJenvironmental/water/cleanwater/fonns/genl-index.html. Inquiries may be directed to the CWB at (808) 586-4309 Or by fa.'l( (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 storm drain prior to discharge. Furthennore, best management practices shall be implemented to prevent the discharge from collecting sediments and other pollutants prior to entering the storm drain.

MAY -11 - 2009 11: 11 A~1 FAX: 8085864352 I D: DLHR CVJF:M PAGE: 001 R=96~;

\

05-1 H009 11: 11 am From-DEPT OF HE~ ENVI RONIAENTAL LolNGt.4T 8085864352

~ Mr. Ryan !mala / Mr. Charley Ice I Ms. Denise Mills Commission On Water Resource Management

o T-990 P.002/004 F-999

FAX TRANSMITTAL Page 2

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

By HAR, Title 11, Chapter 55, Appendix C, effective October 22~ 2007, an NPDES pennit or Notice of General Permit Coverage is required before the start 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 NOI (see Comment No.1, above) shall be submitted 30 calendar days before the start of construction activities.

nAY -11 - 2009 11: 11 At"1 FAX: 8085864352 ID: DU·1R CWR~'1 PAGE:002 R=96%

LINDA LINGLE GOVERNOR OF HA WAIl

c


STATE HISTORIC PRESERVATION DIVISION 601 KAMOKILA BOULEVARD, ROOM 555

KAPOLEI, HAWAII 96707

May 6, 2009


BOARD OF LAND AND NATURAL RESOURCES COMMISSION ON WATER RESOURCE MANAGEMENT

RUSSELL Y. TSUJI FIRST DEPUTY

KEN C. KAWAHARA DEPlITY D1REC'rOR- 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

KAHOOLA WE ISLAND RESERVE COMMISSION LAND

STATE PARKS

MEMORANDUM LOG NO: 2009.1978 DOC NO: 0905WT21

TO:

FROM:

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

Nancy A. McMahon (Deputy SHPO),

Archaeology and Historic Preservation Manager ~ t? ~ok..

! ..--..

SUBJECT: Chapter 6E-8 Historic Preservation Review- !! Well ConstructionIPump Installation Permit Application, Lear Well (Well No. llt!! 05) West Waiakalua Ahupua'a, District of Kilauea, Kaua'i, Hawai'i TMK: (4) 5-1-002: 010

We are in receipt of the permit application we received on May 5, 2009

We determine that no historic properties will be affected by this project because:

[gI Intensive cultivation has altered the land D D D D D

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:

In the event that historic resources, including human skeletal remains, are identified during the construction activities, all work needs to cease in the immediate vicinity of the find, the find needs to be protected from additional disturbance and please contact the State Historic Preservation Division at (808) 692-8015.

Please call Wendy Tolleson at (808) 692-8024 if you have any questions or concerns regarding this letter.

Cc: Denise Mills, Water Commission

r.", , r I r-?l\j . .'- .

.. z: c >-

!":- I: ;:',c -":::':t •• m,...., I\) CII:::s: UI ...


TO:

FROM:

SUBJECT:

c "Rf'crlvto

L ,:\ND DIVISION


MEREDITH J. CHING JAMES A FRAZIER NEAL S. FUJIWARA

CHIYOME L FUKINO, M.D.

lUfA APR 30 p DONNA FAY K KIYOSAKI, P.E. 3: fWRENCE H. MilKE, M.D., J.D.

lEN C. KAWAHARA, P.E. STATE OF HAWAII DEPUTY DIRECTOR

DEPARTMENT OF LAND AND NATURAL RESOURC!ES.", r ':, . '_, COMMISSION ON WATER RESOURCE M~AtS~M,ENT~ :',: .,j ,':-_.

PO BOX 621 ::', -'" ,)/'1 S HONOLULU, HAWAII 96809 :,1 r. , ' : - (. ~ '. .' ':. -I i -

, • J !

April 30, 2009

~:t:.:::::s:~:~Ury Diroctor !wt Kawl! L-Commission on Water Resource Management l Well ConstructionlPump Installation Permit Appl cation J..,dr Well (Well No. 1122-05), TMK (4) 5-1-002:010 ~

KG\f\(

Transmitted for your review and comment is a copy of the captioned Well Construction/Pump Installation permit application. The maps attached to the permit application show the proposed well location.

We would appreciate your comments on the captioned application with regard to the programs, plans, and objectives specific to your division. Please respond by returning this cover memo form by June 5, 2009. Ifwe do not receive comments or a request for additional review time by this date, we will assume you have no comments.


DEM:ss Attachments

RESPONSE: I [ ] A water lease/permit is required of this applicant and an application for such will be requested by 0

division. ;oc

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

~C' (fto gl :::O(j)-::o g~~

[ ]

[ ]

[ ]

:x,0rtl ),.:%:2 ..,..o~

A water lease/permit has been obtained by the applicant through lease no. _________ ..... __ . ~~o

== ~!4

k~

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

No objections

Other comments: Original source of private title is( Land Commission Award 8859-8: 40 issued between 1845 and 1855.

Contact Person: Ga ry Ma rt i n Phone: 527-0421

Signed /d-..-. 7 ~ Date: IViMY -; 200~ ---------''---

~

"

(. .:

,. I I

z: ~ , "':l

~ ;:~; :" --""i' " 0.: • . :g • t.

J-.

History:

o [email protected]

05/04/2009 11 :44 AM

To Denise.E.Mills@hawaiLg9 cc

bcc

Subject lear well app.

~ This message has<~~en i-;plied to.

Denise, david lear requesed that his well be named, " KANE". If it is not too late to do so , could you add this to the process? Thanks Shook

Shopping for Mom? Save yourself a little time and money on AOL Shopping.

FROM: DENISE -----------------

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

-1-~~~~.R. ~~ -2-HOAGBIN,S. _

ICE, C. IMATA, R.

-3-KAWAHARA,K.==

WELL NUMBERll ).~-VS

[g'" WELL CONSTRUCTION

COMQSION ON WATER RESOURCE MANAGEMENT 0 ROUTE SLIP FOR NEW APPLICATIONS

DATE: 21-Apr-09

KUNIMURA, I. 5 Mills, D.

NAKAMA,L. § 4 OHYE, M.

SAKODA, E. SWANSON, S. UYENO, D.

--YODA,K. YOSHINAGA, M.-

SUSPENSE DATE:

Approval -3-Signature -4-lnformation

WELL NAME ~ ~:OYit , ~UMP INSTALLATION

28-Apr-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

WUP Number NA

D WUPA

ATIACHMENTS FOR APPLICATION PROCESSING - Both applicant & staff generated 1 TRANS. LETTER V 2 PERMIT PROCESS TABLE ~

3 CWRMMAP v-4 APPL. FORM (11 COPIES)

5 USGS MAPS (11 COPIES)

6 TAX MAPS (11 COPIES)

7 PARCEL OWNER VERIF.

8 CONTRACTOR VERIF.

9 ALL INFO FILLED IN

10 BACKGROUND CHECK

11 $25 FEE DEPOSIT SLIP

12 DHP/CDUP/SMA pre·screen

FOLDER:~

? lO ,1 /pu;t f7/L -Ylo J1.ee~ fW nv.ve

~MLS PRINTOUT ---I,..:::::. DCCA LICENSE SCREEN PRINTOUT

~ . ~~

v-V-(SMA map printout http://gis.hicentral.com/website/parcelzoning/viewer.htm.,or INGRID'S SMA/CD MAP)

--(LUC map printout http://luc.state.hLus/luc_maps.htm., or INGRID'S SMA/CD MAP)

~ MADE NEW FILE FOLDER, ATIACHED D FILE FOLDER ALREADY MADE, IN FILE CABINET

INCOMPLETE ACTION DATES:

DATE ACTION

plot 1. 1 ,residence. U /Iu't i ~~ 5 ~: 01'\. ~U~hIA"';~rn. tU"t.{ra~ try MYl. t~.L~ -,

\{q{l~ '/tvt",,-0' v..lM 1M- ~VIAL 'Tfwl~ -- d;/{-· .,(~t' Ut'lAt 2.


/I

Mr. Michael Lluellen Kauai Water Well P.O. Box431 Anahola, HI 96703

Dear Mr. Lluellen:

o o


COMMISSION ON WATER RESOURCE MANAGEMENT PO BOX621


April 30, 2009



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

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

KEN C. KAWAHARA, PE. DEPUTY DIRECTOR

1122-05 wcpipa.ack.doc

Well Construction/Pump Installation Permit Application for Well No. 1122-05 ~, 'l\'~

We acknowledge receipt, on April 20, 2009, of your completed Well ConstructionlPump Installation permit application and filing fee for the'.Pe(r Well (Well No. 1122-05). You can expect your application to be processed within ninety (90) days from this date. The attached table shows the permit process, responsible parties, and deadline requirements for drilling or modifying a well and for installing, modifying or replacing a pump.

By this acceptance letter, we are also providing notice to the well operator and landowner that water cannot be pumped for purposes other t~an testing until a certificate of well construction completion and certificate of pump installation completion letter are issued to the well operator and landowner. Additionally, the permitted pump capacity described on the pump installation permit may be reduced ifthe results of a pumping test do not support the proposed 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 stream flows in the vicinity of the well location. Please be aware that you could be required to remove the pump and install a smaller pump at the Commission's discretion before any water can be withdrawn from the well for purposes other than testing.

If you have any questions about your permit application, please contact Denise Mills of the Commission staff at 587-0251 or toll-free from Kauai at 274-3141, extension 70251.

DEM:ss Attachment

c: David and Sandy Lear

Sincerely,

~~wf(~,~ g;~ DlreciHJ


o o




April 30, 2009

TO: 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, P.E.


KEN C. KAWAHARA, P.E DEPUTY DIRECTOR

Dr. Keith Kawaoka, Office of Hazard Evaluation and Emergency Response

FROM: f'JrI Laura H. Thielen, Chairperson 1We.tp. ~ ~ Commission on Water Resource Management

SUBJECT: Well Construction/Pump Installation Permit ApplIcation !p«r Well (Well No. 1122-05), TMK (4) 5-1-002:010

\(ttl{ Transmitted for your review and comment is a copy of the captioned Well Construction/Pump

Installation permit application. The maps attached to the permit application show the proposed well location.

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 June 5, 2009. If we do not receive comments or a request for additional review time by this date, we will assume that you have no comments.


DEM:ss Attachments

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.

[] 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.

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

[1 An NPDES permit is required.

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

[1 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.

[1 No comments/objections

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

Signed: ________________ _ Date: ______ _


o o LAURA H. THIELEN

CHAIRPERSON


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


TO:

FROM:

SUBJECT:




April 30, 2009

ra~~i~tvf~~~dministrator 1 1 Ken C. Kawahara, P.E., Deputy Director ~t aMlt LCommission on Water Resource Management

Well Construction/Pump Installation Permit Appl cation yar Well (Well No, 1122-05), TMK (4) 5-1-002:010 ~)ii'(

KEN C. KAWAHARA, PE. DEPUTY DIRECTOR

Transmitted for your review and comment is a copy of the captioned Well Construction/Pump Installation permit application. The maps attached to the permit application show the proposed well location.



DEM:ss Attachments

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:


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


TO:

FROM:

SUBJECT:

o


COMMISSION ON WATER RESOURCE MANAGEMENT po. BOX 621


April 30, 2009

Dr. Puaalaokalani Aiu, Administrator Historic Preservation tL Ken C. Kawahara, P.E., Deputy Director ~)~ Commission on Water Resource Management - r -Well Construction/Pump Installation Permit Application lKc{r Well (Well No. 1122-05), TMK: (4) 5-1-002:010

./

~tW(


MEREDITH J. CHING JAMES A FRAZIER NEAL S. FUJIWARA

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

KEN C. KAWAHARA, PE. OEPUTY DIRECTOR

Transmitted for your review and comment is a copy of the captioned Well ConstructionlPump Installation permit application. The maps attached to the permit application show the proposed well location.


If you have any questions about this permit application or request additional review time, please contact Denise Mills of the Commission staff at 587-0251.

If you require additional information regarding specific information that can be provided by the applicant, please contact the applicant directly.

DEM:ss Attachments

RESPONSE:

[ ] This is a [ ] public (county or state) project I [ ] private project and [ ] willI [ ] could 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:


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

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

Data Input

Well Number 1122-05 Well Name (it I\( J,..eEIf - Kauai Ground Elevation 570 Cement Grout 180 Grouting Method positive displacement Hole Diameter 14 Total Depth 200 Water Level 400 Depth to water 170 Public Water Supply Well? no Solid Casing Material I pvc plastic plastic Solid Casing Specification Schedule 40 Solid Casing Length 180 Solid Casing Diameter 4 Solid Casing Wall Thickness 0.250 Open Casing Length 20

Results

Well Depth Theoretical Thickness of Aquifer U1C1h~ (,Ut( (~ ~4gp 1/4 Aquifer Thickness .~ U ..A'I'&O Depth of Well below~Sea Level :~. '.~ okay Section 2.2

Well Casing ,

Minimum Wall Thickness Material pvc plastic

Minimum Thickness per standards no requirement Wall Thickness Provided .. . .. :.:.

"" ·0;25 no standard Section 2.4(b)

Minimum Length of Solid Casing 90% of ground to top of aquifer 153

. Length of solid casing Provided I: .. ~.:y .. . :. : ::::;.;. :t·t.·: .. : : taO okay Section 2.4(c) Casiilg Material SchedllJe40 ::: .. incompliance Section 2.4(d) (for pvc onlY' - check for 200' limit)

... okay Section 2.4(d)

Annular Space Depth of Grouting

Calculated Depth of Grouting 119 Deeth of Grouting provided 180 okay Section 2.6(c)

Minimum Annular Space required 1.5 Thickness of Annular Space .. 5 okay Section 2.6(d)

Professional and Vocational Licensing (PVL) - powered by eHawaii.gov o 0 Page 1 of 1

Professional and Vocational Licensing (PVL) Search - General Licensee

GENERAL LICENSEE

LIC ID: CT-29578 Active/Inactive: ACTIVE

NAME: MICHAEL R LUELLEN

TRADE NAME:

STATUS: CURRENT, VALID & IN GOOD STANDING

ENTITY: INDIVIDUAL BUSINESS CODE: SOLE OWNER

ORIG LIC DATE: 01/05/2009 EXPIRE DATE: 09/30/2010

CLASS PREFIX: C SPECIAL PRIVILEGE:

RESTRICTION: EDUCATION CODE:

CONDITIONS AND LIMITATIONS:

BUSINESS ADDR: 7111 KOOLAU RD ANAHOLA HI 96703

MAILING ADDR: POBOX 431 ANAHOLA HI 96703

Click here to enter search criteria for prior complaints history -> For prior complaints and disciplinary history, contact licensing and business information center at (808)

587-3295.

License information on this site reflects information in the Professional and Vocational Licensing Division as of April 27, 2009; however, applicatio and forms are subject to standard processing time, and the information here does not reflect pending changes which are being reviewed. The site updated daily, Monday through Friday, except holidays. The State of Hawaii makes no guarantees as to the accuracy of the information accessed, the timeliness of the delivery of transactions, delivery the correct party, preservation of the privacy and security of users and makes no warranties, including warranty of merchantability and fitness fOI particular purpose. User is advised that if the information obtained herein is to be reasonably relied upon, user should confirm the accuracy of su information with the provider thereof.

http://pvl.ehawaii.gov/pvlsearch/app?_a=d&_f=n&lictp=CT&licno=29578&off=&nm=MI... 4/27/2009

I I

o o Page 1 of 1

Copyright 4/27/2009 by Hawaii Information Service

PUBLIC RECORD DATA TMK # 4-5-1-2-10-1

Owner: LEAR, DAVID & SANDRA FMLY TR Tax Payer: LEAR, DAVID & SANDRA FMLY TR Tenure: Fee Simple

Tax Bill: PO BOX 1283, VERDI, NV 89439 USA Annual Tax: $10,846.11 Assessed Value Exemption Size Buildings: 0 Zoning: A

Land: $1,571,900 $0 14.91 ac Dwellings: 0 PITT Code: 500 - Agricultural Total Buildings: $0 $0 o sq ft Subdivision: Waipake Land Use:

Total: $1,571,900 $0 Project: Keala Ranch Census Tract: 401.00 Bedrooms/Baths: 0/0 Lot#:

SALES 5/28/2008 DEED-F $650,000 DOC 08-086237

CONDO MAP #34; PARTIAL INTEREST 50% MOKI MAC LLC, A Company or Corporation(Tenants in Severalty)

4/14/2009 DEED $1,250,000 DOC 09-055113 LEAR, DAVID R, Trustee(Family Trust) LEAR, SANDRA L, Trustee(Family Trust) *DAVID & SANDRA LEAR FAMILY TRUST DATED *OCTOBER 19, 2005 WITH FULL POWER

BUILDING PERMITS FROM REAL PROPERTY TAX

Date I Number I Amount J Status I Purpose

10/18/2001 I 0100002109 I $200 I Open/Old Permit I SHEDS

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

http://webrel.hawaiiinformation.comlREsearchIBase/Lib/ActionMenuPrintModal.htm 4/27/2009

~ARTMENT OF LAND AND NATURAL RESO~ DOCUMENT NO .. UAC OR ATTACHED WORKSHEET DATE A ·120 2009 : ~pn ,

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

S 09 326 C 1026 0752 (1 ) $25.00 . Derrick's Well Drilling

" " " " " " (2) $25.00 Kauai Water Well

" " " " " " (3) $25.00 Oasis Water Systems, Inc.

(4)

(5)

(6)

(7)

(8)

(9)

(10)

TOTAL $ 75.00

REMARKS: LINE (1) Dusty Well LINE (2) TMK: 5-1-002:010 LINE (3 Mana'Olana Spring Well LINE (4) LINE (5) LINE (6) LINE (7) LINE (8) LINE (9) LINE (10)

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

F~~r·v

Instructions: Please print 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 10 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.hawaii.gov/dlnr/cwrm.

WELL LOCATION INFORMATION 1. STATE WELL NO. (if already assigned) I 2. WELL NAME" .

It t.2-- -D IS 1 ~ ~-f{, "G 14TMK

The following must be attached before this appHcation is accep1ed as complete: • Portion of 7.5-Minute SerIes USGS topogrephic map (scale 1 :24,000) with well location labeled and include the name of the quad map • Property tax map, showing well location referenced to established property boundaries • Photograph of the proposed well site • A schematic diagram showing the well site, ateeIS road and proposed well infrastructure • For dug wells attach a gredlng plan with cross section proftles showing existing and finish grades

Well Operator's MaHing Address Landowner's Mailing Address

~·B 1;2.83 VElWt NV P.Jf'/39

Well Operator's Phone I Well Operator's Fax J Well Operator's E-mail

Landowner's Phone I Landowner's Fax

PROPOSED WELL CONSTRUCTION 7. Proposed Work ~ Construct New Well o Modify Existing Well o AbandonlSeal Well

8. Construction Type er Drilled DOug o Shaft o Tunnel

9. Is this well part of a battery of wells? 0 Yes l2( No

PROPOSED PUMP INSTALLATION 10. Proposed Work [ZI Install New Pump o Replace Pump

11. Proposed Pumping Rate, gpm (gallons per minute)

~"--'S6 ~ ~ 12. Proposed Amount of Withdrawal, gpd (gallons per day)

7"a::o

-APR20 lit 9121/

I landowner's Contact

I Landowner's E-mail

13. Method of flow measurement ,eI Flowmeter o Other (explain)

14. Proposed Surveyor name and license number (a surveyor Is required for all Well Construction Pennlts and may be required for some Pump

Installation Penn Its) ~£-L'::~:"F.£~

PROPOSED USE

o 15. Municipal (water systems serving greater than 25 individuals or 15 service connections)

Z 16. Domestic Number of units to be served: t o 17. Industrial (describe)

o 18. Irrigation (describe crop and no. of acres)

o 19. Military (describe)

o 20. Other (describe)

OTHER LEGAL REQUIREMENTS If required, /tems 21. and 22. must be obtained before the CommiSSion can legally Issue a permit:

21. Conservation District Use Permit (COUP) o Well is in Conservation District

o Required, COUP # date approved o Not Required (attach documentation from OCCL) ----o I have not checked with OCCL about whether or not a COUP is required. I understand that checking with OCCL prior to making this

application will expedite my review. 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.

o Well is not in Conservation District J2f I have not checked if well Is in or out of Conservation District. I understand that checking if the well is in a Conservation District may expedite my

review. I further understand that issues raised may de~ or result in denial of the permit issuance or revocation of the permit after it is issued. 22. Special Management Area Permit (SMAP) o Required, SMA # date approved ___ .,-o Not Required (attach documentation from applicable County agency) [:j( I have not checked with the county about whether or not an SMA Permit is required. I understand that checking with the County prior to making this

application may expedite my review. I further understand that issues raised by this agency may delay or result in denial of the permit iNuance, or revocation of the permit after It Is issued.

23. State Historic Preservation Division (SHPD) of the Department of Land and Natural Resources o I have consulted with the HPO regarding potential impacts of well construction activities on historic sites. I have attached applicable documentation

from the HPO. ~ I have not consulted with the HPD regarding potential Impacts of well construction activities on historic sites. I understand that checking with the HPD

prior to making this application may expedite my review. I further understar.d that inues raised by this agene), may delay or result in denial of the ~ermit issuance or revocation of the permit after it is issued. Additionally, the history of past land use is attached.

Additional remarks, explanations, etc. (a!tech additional sheet if more space is needed)

NOTE: Signing below indicates that the signatories understand and swear that the information provided is accurate and true to the best of their knowledge. Further, the signatories understand that upon permit approval: 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) 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 may result in fines of up to $5000/day.

25. PUMP INSTALLER (MU8t be filled out if application is for Pump Installation)

~~W~! e---2-9'57f3 """ ... bu ....... ame ~ e-s11C-57a1. La ... No. iI:IIafZk ~t~/.w I:~ --01

ig ature '7nt Date

24. WELL DRILLER (MuIK be filled out if application is for Well Construction)

I<4m; 11Arrta..1JJPiJ/ c-){t27B Li~s~ness name , <.. C-57 L~nse ~NO' ~fffl-lr'-··~~-"--_ CI/d,,/twrtJ -6 -or Signalure rint ate

c o

PROPOSED WELL SECTION (Please attach schematic if cHffrJrent from diagram provided below)

Hole Diameter: I i in.

Elevation at top of casing ~., mSI*.'1 I-.L. I ~_ Minimum of 2' Radius &." Thick Concrete Pad (to contain benchmarj( -- ·t-- . surveyed to nearest 0.01 ft.)

C:[,=:,' ~\::l {- Ground Elevation·57o ft msl· ., ~~

Please refer to the lll,---::::~~-=:: ~-;~- ~~~'[ _. ??: 7r -r--'-(min. 70% of distance from '~"~:~' ~:·t I & W ~Il ~ELL ~QNSTRUcrIQN A!::!!U ground elevation to top of

I .. ,.' ':'.:,:;.1 I PUMP ~~T~I.ILAIIQN §IANDARDS

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

whichever is less.) ".' /': applicable standards.

--

Grouting method: Annular space between hole and caSing (1.5" for positive

--.h .~.:;.- <~ , __ _ ::-,-.: .' I Solid Casing: (~90".4. x (Ground Elev.-Water Level Elev»

aPositive displacement, 3" for other displacement methods):

o Other ~ in. .

:( ~:!:I .'. ~'. :.tt

Total Length: 1m ft.

Nomioal Diameter: ~ in.

Wall Thickness: in.

Bottom Elevation: 3tjo ft., msl*

Rock or Gravel Packing:

Total Depth 't...O ft. Open Casing: J2I' Perforated o Screen 'Zd-O ft. Material:

Jlf Crushed BasaH

I o Rounded Gravel

I Estimated Water Level

Total Length: z..o ft.

Nominal Diameter: ~ in.

Wall Thickness: in.

Bottom Elevation: 1.70 ft., msl* I i tion

:

I 00 ft. msl*

note: Neither bentonite nor mud should be used in saturated zone during drilling

I Open Hole:

Length: ft.

Diameter: In. _L~. ____ . __ . _____ ... Bottom Elevation: ft., msl*

* 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 CompletionJWeIl Abandonment reports and referenced to a benchmarj( which has been established by a surveyor licensed by the State.

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

Bottom Elevation of Well Limit = (Water Elevation _ 41 x Water ~el Eleyatjon )

Example: Estimated + 2 ft. Water Leval Elev. - Bottom Elevation of Well Limit = ( 2 - ~) = -18.5 ft.

Solid Casing Material: Carbon Steel: compliant with (check one or more): 0 ANSIIAWNAC200 0 API Spec. 5l 0 ASTM A53 0 ASTM A139

And campUant with (check one or more): 0 ASTM A242 (or A606) 0 Type E 0 Type S 0 Grade B 0 Other

Stain I ... Steel: (check one): 0 ASTM M09 (production wells) 0 ASTM A312 (monitor wells)


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


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

o Glass Fiber Reinforced Resin Pressure Pipe conforming to 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 ANSIIAWNA C20D 0 API Spec. 5l 0 ASTM A53 0 ASTM A139

And compliant with (check one or more): 0 ASTM A242 (or A606) 0 Type E 0 Type S 0 Grade B 0 Other Stain .... Steel: (check one): 0 ASTM M09 (production wells) 0 ASTM A312 (monitor wells) ABS PIa.tic 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

'I




o Glass Fiber Reinforced Resin Pressure Pipe conforming to AVVWA C950



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lear well well no. 1122-05 tmk (4) 5-1-002:010, kauai · certificate of well construction...

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