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Map4Moloa.a tax # 4490110130006000 6565c Koolau Rd

o From: jack gardner <[email protected]>

To: [email protected]

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Subject: Map4Moloa'a tax # 4490110130006000 6565c Koolau Rd Date: Tue, Jun 22, 20102:55 pm

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ShookJs this going to help get things rollin'_Moloa'a tax # 4490110130006000 6565c Koolau Rd

jack_gardner © art direction p_o:-box_2417 oceanside_C8 92051_2417 808_651_3608.J)h 760_804_9146_fax art [email protected]

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OPUMP INSTALLATION PERMI'D-\ Jack Well, Well No. 1120-56 \wi

Note: This permit shall be pro17linentlv displayed at the site until the work is completed

. 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 Jack Well (Well No. 1120-56) at TMK (4) 4-9-011:013-6, 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 § 13-168-15, 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 49 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 ofthis 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. 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 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 of this perm~t.,

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14. Special conditions in the attached cover transmittal letter are incorporated herein by reference. --Date of Approval:

Expiration Date:

August 20, 2010 August 20, 2012

~LAURA H. THIELEN, Ch~.rperson Commission on Water Resource Management ~

co .'~

I have read the conditions and terms of this permit and understand them. I accept and agree to meet these con~ons ,~~ rei prerequisite and underlying condition of my ability to proceed and understand that I shall not commence work untm ana4,Jiil 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 starf g om the permit date of approval.

Installer's Signature: C-57, C-57a, or A License #: C-29578 Date: b--tD ~ tI Printed Name: Michael L1uellen 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

o NEIL ABERCROMBIE

GOVERNOR OF HAWAII WILLIAM J. AI LA, JR

CHAIRPERSON

STATE OF HAWAII DEPARTMENT OF LAND AND NATURAL RESOURCES

COMMISSION ON WATER RESOURCE MANAGEMENT P.O. BOX 621

HONOLULU, HAWAII 96809

May 18,2011

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

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

NEAL A. PALAFOX, M.D.

WILLIAM M. TAM OEPUTY DIRECTOR

1120-56.ccwc

Mr. Jack Gardner P.O. Box 2417 Oceanside, CA 92051

Dear Mr. Gardner:

Certificate of Well Construction Completion for Well No. 1120-56 (TMK (4) 4-9-011:013-6)

We are pleased to inform you that the Well Construction work permitted for the Jack Well (Well No. 1120-56) 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. If the well is not in use it must be properly capped.

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

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

5. In the event the benchmark in the concrete base of the well is altered in any way, an updated version of the Well Elevation page of the Well Completion 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/cwrmlresources~ermits.htm.

Because ground water in Hawaii is a public trust, and adverse effects at one well may affect other water resources, any violation of the above conditions or any other provision of the Hawaii Administrative Rules may be subject to fines of up to $5,000 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 (808) 587-0218.

CI:ss

c: Kauai Water Well

Sincerely,

WILLIAMM. TAM Deputy Director

NEIL ABERCROMBIE GOVERNOR OF HAWAII

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

Dear Mr. Lluellen:

o




May 18,2011

Well Completion Report Part I for Well No. 1120-56

WILLIAM J. AILA JR. CHAIRPERSON

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

DONNA FAY K. KIYDSAKI, P E. LAWRENCE H. MilKE, M.D., J.D.

NEAL A. PALAFOX, M.D.

WILLIAM M. TAM DEPUTY DIRECTOR

1120-56.wcrl.acc

We received your Well Completion Report Part I for the Jack Well (Well No. 1120-56) on February 17,2011 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.

CI:ss

c: Jack Gardner

Sincerely,

WILLIAMM. TAM Deputy Director

o MEMO and ROUTE SLIP (ver. 5/11/10)

o 12/13/10

I WCR 1 Check for Well No. 1120-56 (GW regulation route)

1. From Roy 1 (initial)

Initial entry in to we I Index Ingrid's spreadsheet updated needed/done

Pump Tests Check

Step-Drawdown Test: followed WCPI Stds analysis attached

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~t ~/' UKfo gpm no test required

Constant Rate Test: followed WCPI Stds analysis attached

[Y'" 0 ~o gpm no test required 0 IY""

Potential Well Interference: 0 0 '\

Potential Stream Impacts: 0 0 If yes, stream name(s):

Additional Testing or Data Required: 0 0 (~\ \ <

Pump Test Comments Attached: 0 ~

Proposed Pump Capacity is OK.: 0 0 ..../'

()..\.I\ 'I-\M VC\M~J::, 2. Well Log Check Geology Code for Well Index: ~ Fm Name: f'"O !:J'eremy _~----1initial)

3. Construction Check<£har~yan L",

Yes

data complete , followed Special Cond & elevations ~ location unchanged from WCPIPA? ~

If yes, is SMA, CD, TMK changed? 0

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

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---2 COUNTY COMMENTS (DWS/SMA)

3 DOH COMMENTS 4 DLNR COMMENTS (LD/OCCUDHP)

5 WCR 1 Accept

6 WELL CONST. COMPLETION CERTIFICATE -...:..../_' _

1 . .uSGSMAP UPDATED • 8 PARCEL CHECK

9 WELL DATABASE INPUT CHECK 10 PUMPTESTWORKSHEer 11 WELL At-Built CHECK PRINT

4. Roy ::fa 5. Susan H.UJ\

6.~Rg~ 7. Charl;yl yan ~cc:

(initial)

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pvc plastic Schedule 40 Schedule 80 other

positive displacement other

steel public steel non public

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

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stainless steel ASTM A409 other


Search Results o Page 10f2

Assessed values reflect tax :rear 2010 for all islands. Taxes reflect tax :rear 2009.

Search criteria: TMK Taxke:r 4-4-9-11-13

PUBLIC RECORD DATA Taxkey Subdiv [Condo Tnr Address Owner [Lessee Bds Bths Land area Liv area Last 5ale Instr

r .4-4-9-11-13 Moloaa & F 6565 BLATT FMLY 0 0 190.09 ac o 11/17/2008 DEED $4 Kaapuna Hui KOOLAU IRREVOC TR Lands

r ..1'4-4-9-11-13-1 MOLOAA F 6565-C FREEMAN FMLY 0 0 7.14 ac 0 VALLEY KOOLAU, REVOC TR/ETAL

Apt 1 r_4-4-9-11-13-2 MOLOAA F 6565-C MOLOAA 0 0 5.24 ac 0

VALLEY KOOLAU, VALLEY ONE Apt 2 LLC/ETAL

r .,4-4-9-11-13-3 MOLOAA F 6565-C TRIBBLE, 0 0 5.09 ac 0 VALLEY KOOLAU, RICHARD M &

Apt 3 JODI A/ETAL r .4-4-9-11-13-4 MOLOAA F 6565-C MOLOAA 0 0 5.71 ac 0


r ,,4-4-9-11-13-5 MOLOAA F 6565-C MOLOAA 0 0 5.89 ac 0 VALLEY KOOLAU, VALLEY ONE

Apt 5 LLC/ETAL r ,-4-4-9-11-13-6 MOLOAA F 6565-C GARDNER, 0 0 4.11 ac 0

VALLEY KOOLAU,JACK A & Apt 6 TERESA/ETAL

r .. 4-4-9-11-13-7 MOLOAA F 6565-C WRIGHT, CARL 0 0 8.81 ac 0 VALLEY KOOLAU, L & SANDRA

Apt 7 E/ETAL r "4-4-9-11-13-8 MOLOAA F 6565-C WOOD, 0 0 5.79 ac 0

VALLEY KOOLAU, LISA/ETAL Apt 8

r ... 4-4-9-11-13-9 MOLOAA F 6565-C WOODS, 0 0 9.70 ac 0 4/26/2010 QD $ VALLEY KOOLAU, VALERIE

Apt 9 r .4-4-9-11-13-10 MOLOAA F 6565-C ALGOSA 0 0 21.84 ac 0

VALLEY KOOLAU, MASTERS Apt 10 TR/ETAL

r "4-4-9-11-13-11 MOLOAA F 6565-C ANDERSON, 0 0 4.08 ac 0 4/26/2010 QD $ VALLEY KOOLAU, MAXIMILIAN J Y

Apt 11 r '-4-4-9-11-13-12 MOLOAA F 6565-C MAAS, CRAIG H 0 0 1.84 ac 0

VALLEY KOOLAU, REVOC TR/ETAL Apt 12

r ,-4-4-9-11-13-13 MOLOAA F 6565-C MOLOAA 0 0 5.19 ac 0 VALLEY KOOLAU, VALLEY ONE

Apt 13 LLC/ETAL r .4-4-9-11-13-14 MOLOAA F 6565-C MOLOAA 0 0 4.20 ac 0


r ,.4-4-9-11-13-15 MOLOAA F 6565-C ANDERSON, 0 0 5.60 ac 0 5/13/2010 QD $ VALLEY KOOLAU, MAXIMILIAN J Y

Apt 15 r .4-4-9-11-13-16 MOLOAA F 6565-C JAY, TERRY E 0 0 11.00 ac 0

VALLEY KOOLAU, TR/ETAL

http://web08.hawaiiinformation.com/REsearch/HIS/Search/search PUB.asp?NOCACHE=1279137865875 7114/2010

•

o o lIuelien [email protected]

04/21/2011 03:39 PM

To Charley. F [email protected]

cc

bcc

Subject Re: jack Well

History: ~ This message has been replied to.

so do I need to send in another sketch?

-----Original Message-----From: Charley.F.lce <[email protected]> To: lIuellen808 <[email protected]> Sent: Thu, Apr21, 20112:41 pm Subject: Re: jack Well

You've given a pretty good picture of the problem. Use the storage container, although it could be moved in the future. We also recommend (for the future?) that photos show the setting with as many landmarks as possible. We know land gets cleared, trees go down -- even roadways get widened or realigned. Can't be helped. The more we have to work with, the less likely the well will be lost some day.

[email protected]

04/21/2011 01 :59 PM To Charley.F.lce@hawaiLgov

cc Subject Re: jack Well

yes the lot is oddly shaped and the road snakes around it with alot of drop ofts etc and is quite brushy to manuver through, so what can I do to make it more clear? There is a strorage container 61' away I could reference ... and Koolau Rd is 75' away The common road which is not used or clearly defined insitu is 460' away form well. Some of the measurement I had to trust the owner. Shook

-----Original Message-----From: Charley.F.lce <Charley.F.lce@hawaiLgov> To: lIuellen808 <[email protected]> Sent: Thu, Apr 21,2011 9:42 am Subject: Re: jack Well

It was the sketch you made, showing distances from roads, and we couldn't figure out what roads you meant, so we wanted something more definitive.

[email protected]

04/20/2011 05:53 PM To Charley.F.lce@hawaiLgov

cc Subject jack Well

•

what was the problem withthis well ,I thought we located it on the map. thanks Shook

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lIuellen [email protected]

04/21/2011 01 :59 PM

To [email protected]

cc

bcc

Subject Re: jack Well

History: if/J This message has been replied to.

yes the lot is oddly shaped and the road snakes around it with alot of drop offs etc and is quite brushy to manuver through, so what can I do to make it more clear? There is a strorage container 61' away I could reference ... and Koolau Rd is 75' away The common road which is not used or clearly defined insitu is 460' away form well. Some of the measurement I had to trust the owner. Shook

-----Original Message-----From: Charley.F.lce <Charley.F.lce@hawaiLgov> To: lIuellen808 <[email protected]> Sent: Thu, Apr 21,2011 9:42 am Subject: Re: jack.Well

It was the sketch you made, showing distances from roads, and we couldn't figure out what roads you meant, so we wanted something more definitive.

[email protected]

04/20/2011 05:53 PM To [email protected]

cc Subject jack Well

what was the problem withthis well ,I thought we located it on the map. thanks Shook

Charley F Ice/DLNRIStateHiUS

03/03/2011 09:57 AM


cc

bcc

Subject Jack Well sketch

Just to wrap up: now that we have your confirmation of the Google Earth image of the well location , we're wondering how your well sketch was derived, as it doesn't seem to line up with the image. The nearest road is plausibly 150 feet away, if we jimmy the location of the well, and depending on where you measure the road, but we aren't sure what is the "common road" that's 560' away, at right angles. The nearest roads we see you could measure at right angles to the well location are respectively about 120' and about 360'. Using your sketch dimensions, the well location is way off in the trees away from the buildings and roads.


02/17/2011 07:02 PM


cc

bcc

Subject Re: Jack Well location

yes that is very closeif not exac~ thanks

-----Original Message-----From: Charley.F.lce <[email protected]> To: lIuellen808 <lIuellen808@aol,com> Sent: Thu, Feb 17, 201111:21 am Subject: Re: Jack Well location

I was hoping you'd mark it it and return. Each time I call it up, I can zoom in differently, and the position of the pin and description can change, as you'll see in the attachment. If I interpret your description correctly, the well would be midway between two circular features on the landscape. Does "Shook's Description" look about right?

[email protected]

02/17/201110:33AM To Charley.F.lce@hawaiLgov

cc Subject Re: Jack Well location

Charley, the well head is just left of the well# as printed on the map/photo. Shook

-----Original Message-----From: Charley.F.lce <[email protected]> To: lIuellen808 <lIuellen808@aol,com> Sent: Thu, Feb 17, 201110:28 am Subject: Re: Jack Well location

Sorry about that!

lIuelienBOB@aol com

02/16/2011 07:02 PM To [email protected]

cc Subject Re: Jack Well location

when I open image alii get is your name and address ...... ? shook

-----Original Message-----From: Charley.F.lce <[email protected]> To: lIuellen808 <[email protected]> Sent: Wed, Feb 16, 2011 10:49 am Subject: Jack Well location

I'm attaching a zoom-in of the Google image with a pin at the GPS location you sent, for your verification. Sorry it's a little blurry. I can't really tell how to compare that image with your parcel plot showing the well in relation to roadways. Can you circle a better location

· (5t-oJt') N(Jf~'~·.-h ;}lr ,.

lIuelien [email protected]

02/17/2011 10:33 AM


cc

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Subject Re: Jack Well location

Charley, the well head is just left of the well# as printed on the map/photo. Shook

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1.-2-1) ~ l' G. I (I "

151 () 2-0' 3D. '<{~ I'

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lIuelien [email protected]

01/26/2011 12:04 PM


cc

bcc

Subject Re: Jack Well wcr1 (1120-56)

Error? Me? ........ Iooks that way +45 is correct. Now could I have 'blind well driller' for 100$? Thanks ,Shook

-----Original Message-----From: Charley.F.lce <[email protected]> To: lIuellen808 <[email protected]> Sent: Wed, Jan 26, 2011 10:36 am Subject: Re: Jack Well wcr1 (1120-56)

As to the water level, you indicated it as 35, but depth to water (from 150) as 105 (which would be +45)-just an arithmatic error? Which is correct?

[email protected]

01/25/2011 07:47 PM To Charley.F.lce@hawaiLgov cc


Charley, the GPS is N 22 11.099 W 159 20.501 I must have misfiled and hence can't find my copy. If I remenber correctly the well was 160' deep and static water level at 100 maybe you could give me my numbers until I find it . shook

-----Original Message-----From: Charley.F.lce <[email protected]> To: lIuellen808 <[email protected]> Sent: Tue, Jan 25, 2011 10:59 am Subject: Jack Well wcr1 (1120-56)

Please double-check the depth to water -- I think you miscalculated -- I can fix if you'll give me the corrected number. Also, no lat-Iong coordinates!


01/25/2011 07:47 PM

.......... , .... ~.....,


cc

bcc


CharleY,the GPS is N 22 11.099 W 159 20.501 I must have misfiled and hence can't find my copy. If I remenber correctly the well was 160' deep and static water level at 100 maybe you could give me my numbers until I find it . shook

-----Original Message-----From: Charley.F.lce <[email protected]> To: lIuelienSOS <[email protected]> Sent: Tue, Jan 25,2011 10:59 am Subject: Jack Well wcr1 (1120-56)

Please double-check the depth to water -- I think you miscalculated -- I can fix if you'll give me the corrected number. Also, no lat-Iong coordinates!

.. o 0 State of Hawaii COMMISSION ON WATER RESOURCE MANAGEMENT Department of Land and Natural Resources

WELL COMPLETION REPORT - PART I Well Construction

For Official UseOn.IJ:., (,r', ", ' \.r'"}'

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2Dm ~!OV 16 AN 10: 44 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 587-4225. For updates to this form or additional information, please visit our website at http://www.state.hLusldlnr/CNmll

1. State Well No.: li20-6(p Well Name: __ ~_~ ________ Island: KAuA-1 Koo~ i2d Tax Map Key: 1:- 1-1/-1 :3 - (.

/(Au4i v.J~ WltJl 2. Address:

3. Drilling Company:

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

5. Date Well Construction (drilled, cased, grouted) completed: / /- 7 - /0 Attach Completed DrIller's Log monthIdaylyear

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

7. Step-Drawdown Test completed? ~ No 0 Yes Attach Step-Drawdown Test form (12117197 SDPTD Form)

8.

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

Chloride: ,19 ppm, Temperature: r.'i. "1 OF

mean sea subtract the depth to the water level.

12. As-built section filled in completely t!il

IJI No 0 Yes

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

14. GPS coordinates provided in degrees, minutes, seconds lSI. 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) C-57 Lic. No. ~ - ;J..' sze Signature Date /1-/0 -/0

WCR1 Form 6112107 Page 1 of 5

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

Hole Diameter' lOin Elevation at top of casing L b~., msl* l r (to nearest 0.01 ft.) ~ Minimum of 2' Radius & 4" Thick Concrete Pad

~-:;:? ~~ r Ground Elevation: 1.5b ft., msl o Surveyed j! Estimat Benchmark T:"'~':~

~ .4. .~.

"'''-, elevation: ///,lM\ 't> •• 'ffm' 'f='

:'.~: . . . >" Please refer to the

/";)"0 ft., msI*

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l'20 ~-: ~-: .!! HAWAII ~LL CON§TRUCTIQN AND Cement Grout: ft. :.!' ;. ~. w

ed

o (Surveyed to (min. 70% of distance from .;".. .. : ?",,: Gl PUMP INSTALLATION STANDARD§ .:: ;. > nearest 0.01 ft.) ground elevation to top of .:t! CD to ensure that your as-built is in compliance .~:~: .~ :;:: ....J

$(Estimated) water surface or 500 ft., •••• 1:..:

j with applicable standards. whichever is less.) ',0' .. '

t---' .4. '.'''0' ~ .: ~ .: • 4 ;. ~ . , . '. :> Solid Casing: (;:: 90% x (Ground Elev.-Water Level Elev» Annular space between '~'.: !::.:. ~uting method: hole and casing (1.5" for .:-:;. '. , di ,,/0 Positive ,;,;.

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

"tI

5S{ displacement (if c:: for other methods): ~.~::~

::I Nominal Diameter: in. annular space is ~/

,':: : e ~in.

~'.: ... £!- Wall Thickness: in. less than two .-- :.'~'. :"~'. >< inches, attach !.:.:

I ~ Bottom Elevation: lD ft., msl

photo of tremie) - r-

I 0

Rock or Gravel Packing: a> o Other 1\1

30 ft. --, Open Casing: jj1l""Perforated Material: o Screen

o Crushed Basalt Length: 2....0 ft. o Rounded Gravel 6g~ V Nominal Diameter: £, in.

" W~evel Elevation: I rg Wall Thickness: ~ in.

-10 ~ ft.msI* Ii- Bottom Elevation: ft., msl Total Depth -'-- f---

J~O ft. (item 11 from page 1)

Open Hole: VA Length: ft.

(-t4J '\ Diameter: in.

~ Bottom Elevation: ft., msl p'sQ f *msl = mean sea level

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

And compliant with (check one or more): 0 ASTM A242 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) ABS Plastic conforming to ASTM F480 and ASTM 01527: (check one) 0 Schedule 40 0 Schedule 80 PVC Plastic conforming to ASTM F480 and (ASTM 01785 or ASTM 02241): (check one): ;(Schedule 40 0 Schedule 80 0 Schedule 120 Thermoset Plastic: (check one) 0 Filament Wound Resin Pipe conforming to ASTM 02996

o Centrifugally Cast Resin Pipe conforming to ASTM D2997 o Reinforced Plastic Mortar Pressure Pipe conforming to ASTM 03517 o Glass Fiber Reinforced Resin Pressure Pipe conforming to AWWA C950 o PTFE Fluorocarbon Tubing conforming to ASTM 03296 o FEP Fluorocarbon Tubing conforming to ASTM 03296

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

And compliant with (check one or more): 0 ASTM A242 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): .,t1"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 D3296


>'-1:<- .'

o o DRILLER"S LOG

WELL NUMBER: IJ 20- S=, In addition to the driller's log, if a geologic log was prepared, please submit with this form

Depths (ft.) Rock De8aiption WaIIM Level CI- Dates Depths (ft.) Rock De8aiption WallMLeveI CI- Dates

~to3- ?_iL? _,1-(-10 - to - ----..ito ,- S~~~lb _ 11-1-/1) _to_ ----£to '/[" Ct!i~ - 11-'111 to ---- - - ----

lJ"to~~ 1/ .1/-11 _to_ ---- ----7() tJlo 'L~f.t,J{ - _ IJ..-o{D to - - ----J 10 to JJS: aiNPNU. I!£ L/8 IJ-t,.,D - to - ----

JJ~ toll/~ ~?t.J(. t0~ ~ 11-5-10 - to - ----I '1'S" to I'JO C;,,~ lOS .!1L 11-'''/0 - to - ----ISO to I/,() &\lA. foJL los ~e /1-1,.10 to ---- - - ----_to_ ---- - to - ----- to - ---- - to - ----

- to - ---- - to - ----

- to - ---- - to - ----

- to - ---- - to - ----_to_ ---- - to - ----_to_ ---- - to - ----

- to - ---- - to - ----

- to - ---- - to - ----

Remarks:

weR1 Form 6112107 Page 3 of 5

~~--------------~~------------------.~~' ~-------------

I r

I

I , 1

l , \ , t!

\ \ I

~ tl

-5 ~ '"

I

Attach photos of completed well and concrete pad

---7"'" ·w ELL--ti 1/ :t.c:J6 6

NAD83: Latitude: _ degrees _ min _ sec Longitude: _ degrees _ min _ sec

EXAMPLE PROPERlY UNE

Lat: 19"36'45" wru. Long: 154°51'18"

15' ;' '~

; -; HOUSE -; ;

~ ~ :/, -;

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

Provide Latitude and Longitude of well referenced to NAD83 to nearest second


o 0 ~ State of Hawaii li~~ COMMISSION ON WATER RESOURCE MANAGEMENT § t ~) 1 Department of Land and Natural Resources \~

WELL COMPLETION REPORT - PART I 2011 NOV 1 6 AM 10: 4 Well Construction

InstnJc:ti0n8: Please print in ink or type and send c:on.,aeted report (wiIh atIactimenIs, if applicable) to the CommIssIon on water Resource Management, P.O. Box 621, HonoIlJu, HawaII.96809. The Commission may not accept Incomp/efe reports. ThIs form shall be submilIed within 60 days of the ~ of work. For assistance, please consult the HawaIl WeI ConsIruction and Pump InsIaIaIion SbnIards or cal the Regulation Branch at 587-0226. For updates to this form or additional infioliilalion, please visit our website at http://www.state.hI.usldlnrlcwnnI

1. State Well No.: 020-6(, Well Name: __ ~--=-/k.-_K. ______ Island: ~A-i 2. Address: KooLA.... 124 Tax Map Key: .f.- 1-//-13 -l. 3. Drilling Company: ~i (,J~ Wvl 4. Drilling method used during construction: J;j!(Rotary 0 Percussion O,Other (describe)

5. Date Well Construction (drilled,cased,grouted) completed: I/- 7-10 Attach CompIeI8d DriIIar"s Log ~

6. was the subject well cored? 0 Yes &I No

7. Step-Drawdown Test completed? ~ No 0 Yes AtIach S1ap-OrIIwcIaIw Test form (12/17197 SDP7D FonD) ~.

8. Constant Rate uiferTestcom 111 No 0 Yes AtlachConstantRata

Water Level Data: 9. Initial encountered during drilling this should also be tBJed in on the driIIer's

10. Just . r to casI installation

11. After casing installation (this information should be before any pu11p tests are performed with casing insIaIIed)

Chloride: .18 ppm, Temperature: ,if. ?oF

Ground = msI If this refemnce point is not the benchmaIk, the ditferela between the belldwnark and this point is:

ft.

II-r-/~

/I_~ -If)

noIB: for aU eIavations IfIfetenced 10 mean sea level, taIce the gmund elevation (SIII'IIfJy8d oreslimated if surt/fly not tequited at Ibis lime) and subbact the depth 10 the water level.

12. As-bullt section filled in completely '&

13. Photograph of well and col1Cl8te pad showing benchmark on concrete pad attached fti

14. GPS coordinates provided in degrees, minutes, seconds I5l

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) C-57 Lie. No. ~- :z..'~Z8

Signature Date /1-/0-/0


o 12. As-BUIL T WELL SECTION (PIeesB aItach as-built if diffenmt #'tom diagram pIOVided below)

r Hole Diameter: lOin. Elevation at top of casing ,msI*le- t (to neateSt 0.01 It) L"-:::;- Minimum of X Radius & 4- Thick Conaete Pad

-.:d Y~ r Ground ElevatIon: 1Sf:) ft.,msI o Surveyed _

Bench rnartt ~-

.~-".'; "::~ ::'.:~. ., elevation: ~~,,",'

r~:' •.. //Jmo.\ ,;""'"

I-:J'O ft., msI*

~-.4:.· ... ~: Ii Please refer to the Cement Grout: l'3C2. ft.

.'. HAB6I weu. CONSTRUCTION AND ::; /;1 il o (Sulveyed to (nin. 70% of distance from ~:.: ..... PUMP INSTAllATION IIANDARDS neaJeSt 0.01 ft.) ground elevation to top of .: ...

'J~ ~ to ensure that your ~ is in compliance

~::. ,/If'{Estimated) water Slriace or 500 ft., :~.? :.A,: ... with appicabIe SIandards.

whic:hewr is less.) > •• I f- :.": :.~7: .'. .'. ::; :. ~. •

~~: Annular space between ·t··~ A.:.: ~ Solid C8sing: (~90% x (Ground EJev.-WaIer Level EJey» hole and casing (1.5" for :: ~ ill 1-10 Positive fA ~::: length: ft. positive displacement, 3- -0

'1fI ........ !5 dlsplaoement (If for other methods): ..... Nominal Diameter: in. /" '~:' :~.

~ annular space is .' . ~'.:.

3 .. ,.. Well Tbidmess: in. less than two in. I---' :,,"1 :. !o- x .

inches, attach

~I; :... ",,: #. Botl8rn Elevation: lO ft., msI

photo of tremIe) - ~; 0

Rode or Grawe! Packing: CJ)

o Other /U

30 ft. ,...., Open casing: ~ o Saeen Material:

~ -..

2-D

I o Crushed Basalt Length:

1, ft.

V o Rounded Gravel Nominal Diameter: in. "i<'(

>~ I W8II Thickness: e!!::!I. in. I water Level Elevation:

-+ -lO 3S- ft. msI* Bottom Elevation: ft., msI

Total Depth -'

J~O It (dem 11 from page 1)

U Open Hole: VA L.engIh: It

l Diameter: in. t Bottom Elevation: ft., msI

"msI = mean sea level

Solid Casing Matedal: carbon StBaI: campIiant with (check one or 17JOI'e): 0 ANSUAWINA C200 0 API Spec. 5L 0 ASTM A53 0 ASTM A139

And compliant with (chedroneorl7JOl8): 0 ASTM A242 or A606 0 Type E 0 Type S 0 Grade B 0 Other

Stafnle8e Steel: (check one): 0 ASTM M09 (production wells) 0 ASTM A312 (monitor wells) ABS PIaeIIc confofming to ASTM F480 and ASTM 01527: (check one) 0 Schedule 40 0 Schedule 80 PVC Plastic COllformillg to ASTM F480 and (ASTM 01785 or ASTM 02241): (checIc one): jlf"ScheduIe 40 0 Schedule 80 0 Schedule 120 Thennoeet PlastIc: (checIc one) 0 Filament WcuId Resin Pipe COIIformiIIg to ASTM D2996

o Centrifugally cast Resin Pipe conforming to ASTM 02997 o Reinforced PlastIc Mortar Pressure Pipe conforming to ASTM 03517 o Glass Fiber Reinforced Resin PretISUf1! Pipe conforming to AWNA C950

o PTFE Fluorocarbon Tubing confonnIng to ASTM D3296

o FEP Fluorocarbon Tubing confonning to ASTM D3296

Open Casing Material: carbon Steel: compliant with (check one or 11lOI8): 0 ANSUAWINA C200 0 APt Spec. 5L 0 ASTM A53 0 ASTM A139

And compliant with (check one or 11lOI8): 0 ASTM A242 or A606 0 Type E 0 Type S 0 Grade B 0 Other Stalnfess Steel: (checIc one): 0 ASTM A409 (production wells) 0 ASTM A312 (monitor wells)

ABS PlastIc oonforming to ASTM F480 and ASTM 01527: (checIc one) 0 Schedule 40 0 Schedule 80

PVC PIaeIIc oonformillg to ASTM F480 and (ASTM 01785 or ASTM 02241): (check one): )!fScheduie 40 0 Schedule 80 0 Schedule 120 ThenncIeet Plllstlc: (check one) 0 Filament WOund Resin Pipe conforming to ASTM 02996

o Centrifugally cast Resin Pipe confonning to ASTM 02997 o Reinforced Plastic Mortar PA!IS8Ure Pipe conforming to ASTM 03517 o Glass FIber Reinforced Resin Preasure Pipe confonning to AWINA C950

o PTFE Auorocarbon Tubing confonning to ASTM 03296 o FEP Auorocarbon Tubing conforming to ASTM D3296

WCR1 Form 6/12/07 Page 2 of 5

o o DRILLER'S LOG

WELL NUMBER: "20- ,..., In addition to the clrillers log, if a geologic log was prepa19Cl, please submit with this fonn

Dephs (ft.) Rock DIIa'Iption watar Level CI- Dates

~to3.... 7_iL? __ _ 11-1/-10

~to.2 S~~ ~l; ____ JI-1-1)

~toj[c't.Af~ _-__ "_I-I1l_" 'I, to 70 ~ ____ "_'1.J/._"1I

7fJ Jlo ~~ - _ I~~ I/O to /1) 4J~1rI« I!£ LJ8 N::.bD

I Jfj toltk' ~?.k. J0~ ~ 11-5-10

I~tol,o ~~ lOS: ~/'-''-IO /50 to I{'() Q."A IDJL los 16 1/-t,.ItJ

_ to ___________ _

_ to ___________ _

_ to ___________ _

_ to ___________ _

_ to __________ _

_ 10 ___________ _

_ to ___________ _

_ to ___________ _

_ to ___________ _

Remarks:

_to ___________ _

_10 __________ _

_10 ___________ _

_10 ___________ _

_10 ___________ _

_to __ ....... _______ _

_to ___________ _

_to __ ---:-________ _

_to ___________ _

_ to ___________ _

_to ___________ _

_to ___________ _

_10 ___________ _

_to ___________ _

_to ___________ _

_to ___________ _

_to ___________ _

_to ___________ _

WCR1 Fomr 6/12107 Page 3 of 5

f

I I

v I

Attach photos of completed well and concrete pad

o a

,

~----------------~ I ~W:: _degrees_min - sec I _ Longitude: _ degrees_min_ sec

EXAMPLE

Lat: 19"36'45" WEll !,.ong: 154"51'18"

20"

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

Provide Latitude and Longitude of well referenced to NAD83 to nearest second

WCR1 Fotm 6112107 Page 4 of 5

Lc.t 2-~O 11' 5.",4"

15'" Zo 3D. DiJ

3ro"""-~ T~'kok (f)or~.s)

LINDA LINGLE GOVERNOR OF HAWAII


Dear Mr. Lluellen:

o·




September 3,2010

Pump Installation Permit Jack Well (Well No. 1120-56)

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, MD., J.D.

LENORE N. OHYE ACTING DEPUTY DIRECTOR

Ref: 1120-56.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 at 274-3141 (Kauai), extension 70218.

Sincerely,

~.~~ Chairperson

Enclosure

c: Jack Gardner USGS KauaiDWS

PUMP INSTALLATION PER~ Jack Well, Well No. 1120-56

Note: This permit slrall be prominently displayed at tire site until tire 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 Jack Well (Well No. 1120-56) at TMK (4) 4-9-011:013-6, 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 §13-168-15, 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 49 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. If the 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 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.

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

Date of Approval: Expiration Date:

August 20, 2010 August 20, 2012

c"r L~. ~L~rperson Commission on Water Resource Management

I have read the conditions and terms of this permit and understand them. I accept and agree to meet these conditions as a prerequisite and underlying condition of my ability to proceed and understand that I shall not commence work until I and the pump installer have signed, dated, and returned the permit to the Commission. I 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


Attachments



Dear Mr. Lluellen:

o o


COMMISSION ON WATER RESOURCE MANAGEMENT PO BOX621


September 3,2010

Well Construction Permit Jack Well (Well No. H20-56)

LAURA H THIELEN CHAIRPERSON


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

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


Ref: 1120-56,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.

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/cwrm!forms.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 Charley Ice of the Commission staff at 587-0218 or toll-free at 274-3141 (Kauai), extension 70218.

Sincerely,

~lA-.D~ ~ LAURA H. THIELEN I

Chairperson

Enclosures

c: Jack Gardner (with applicable comments - DOH SDWB, WWB, CWB) USGS KauaiDWS

o 0 WELL CONSTRUCTION PERMIT

Jack Well, Well No. H20-56 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 Jack Well (Well No. 1120-56) at TMK (4) 4-9-011:013-6, 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.

S.

6.

7.

8.

9.

10.

11.

12.

13.

14.

IS.

16.

17.

The ChaiTP-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-IS, 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/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 (114) 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 (112) 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/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.

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

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

If the well is not to be used it must be properly caf:,ped. If the well is to be abandoned during the course of the project then the permittee must apply for a well abandonment permit in accordance with §13-168- 2(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 m accordance with § 13-168-12(f), HAR.

Special conditIOns in the attached cover transmittal letter are incorporated herem by reference

Date of Approval: August 20, 2010 Expiration Date: August 20, 2012

~ LAURA H. THIELEN, Chairperson Commission on Water Resource Management

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

Driller's Signature: C-57 License #: C-29578 --~--~-----------

Date:

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


Attachment

o ~ WELL CONSTRUCTION PERMIr

Jack Well, Well No. 1120-56 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 Jack Well (Well No. 1120-56) at TMK (4) 4-9-011:013-6, 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.

8.

9.

10.

II.

12.

13.

14.

15.

16.

17.

The Chai'P-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/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 (114) 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 lie 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/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 § 3-168-12(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 m accordance with §13-168-12(f), BAR.

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

Date of Approval: August 20, 2010 Expiration Date: August 20, 2012

'rperson Commission on Water Resource~na~'&ient

c::::t ,-','

I have read the conditions and terms of this permit and understand them. I accept and agree to meet these conditions as a eareq~~~ an.d underlying condition of my ability to proceed and understand that I shall not commence work until I have signed, dated, a~ retUJ:lied ."e permit to the Commission. I understand that this permit is not to be transferred to any other entity. I also understand that ~-col1\pJi2t~~ with any permit condition may be grounds for revocation and fines of up to $5,000 per day starting from the permit date of aJllUJ>val.,:~, ':.~ ';

Driller's Signature: rWJ C-57 License #: C-29578

Printed Name: Michael L1uellen Firm or Title:


Attachment

qOMMISSION ON WATER RESOURCE MANAGEQT ROUTE SLIP FOR PERMIT ISSUANCE 5/19/05

'7 if- fl..tl 0. ~ 0 DATE: 71#1#/:h:i#hfJfJ# SUSPENSE DATE: FROM: CHARLEY

KUNIMURA, I. NAKAMA, L. NAKANO, O.

Approval --Signature -3-lnformation

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

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

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

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

WELL NUMBER 1120-56

~ WELL CONSTRUCTION

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

Jack Well

ATTACHMENTS FOR WELL CONSTRU56TION PERMIT: 1 COVER LETTER ./ 2 PERMIT (2x) ::::::2:

COMMENTS: 3 SOWB

+ 4 WWB 5 CWB TO BE SENT TO APPLICANT

6 HEER 7 LO 8 HP 9 OCCL

10 SMA FOR OFFICE USE ONLY

fin. PUMP INSTALLATION

ATTACHMENTS FOR PUMP INSTALLA,ION PERMIT: 1 COVER LETTER ~ 2 PERMIT (2x) ~

COMMENTS: --3 SOWB 4 WWB 5 CWB TO BE SENT TO APPLICANT

6 HEER 7 LO 8 HP 9 OCCL

10 SMA FOR OFFICE USE ONLY

PLEASE:

See Me -1-Review & Comment

Take Action Type Draft

2 Type Final 4 File

Xerox copies

Results

Well Depth Theoretical Thickness of Aquifer 1/4 Aquifer Thickness Depth of Well below Sea Level

Y'Lell Casina Minimum Wall Thickness

Material Minimum Thickness per standards Wall Thickness Provided

Minimum Length of Solid Casing 90% ofground to top of aquifer LenfJ!I'Lof solid casing Provided

Casing Material (for pvc only - check for 200' limit)

Annular Space Depth of Groutin9_

Calculated Depth of Grouting Depth of Grouting provided

Minimum Annular Space required Thickness of Annular Space

yes no

steel stainless steel

o

7380 1845

80 okay Section 2.2

[pvc plastic no requirement

0.25 no standard Section 2.4(b)

54 140 okay_ Section 2.4 c)

Schedule 40 in compliance Section 2.4 ~ okay Section 2.4 (d)

42

140 okay Section 2.6(c) 1.5

3 okay Section 2.6(d)

pvc plastic abs plastic thermoset plastic other


positive displacement other

steel public steel non public

steel ANSIIAWWA C200 API Spec. 5L ASTM A53 ASTM A139 ASTM A606 other

#N/A

0.237

stainless steel ASTM A409 other


c o

LINDA LINGLE CIGYIIIIIOa or"MAII

LAURA H. THIELEN -WILLIAM D.IW.FOUR, JR,

TO:

FROM:

SUBJECT:

STATE OF HAWAII DEPARTMENT OF LAND AND NATURAL REsOURCES

COMMISSION ON WATER RESOURce MANAGEMENT P.o. BOX 1121 .

HONOLUW. HAWAI lII8OI

July 20,2010

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

SUMNER ERDMAN HfALa. FUJIWARA

CHIYOME L FUlGNO; M.D. DONNA FAY ItIClYOSAlCl, P.E.

LAWRENCE H. MIIICE; M.D .• J.D.

LENORE H. OHYE ....... lIIPVIY_.

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

Laura H~ Thielen, Chairperson ~.~ ~L. ~ Commission on Water Resource Management , .

Well ConstructionlPump Installation Permit Application Jack Well (Well No. 1120-56) TMK (4) 4-9-011:0]3-6

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

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

CI:ss Attachment(s)

RESPONSE: II

II

I I

" I)

~

This weI qualifies u. source which will_ ... IGurce ofpolUie WIler to. public water aystem (deli ....... ..mna 25 or 111_ ~ at I .... 60 days per)'W'CII' baa IS or 11lOI'II amlcc _li_) lIIICI.ut -=elva Direclor of Kealth IIIProYIlmw: 10 ii, use 10 comply with Kawlii Admillislrati .. Rules (HAR). Title II. Chapter 20, Rule. Relalina to Potable W_ Systellll, 111-20.29.

This wen dacI not Clualify as • .-co MrVin,1 ~blic wiler .ystem (.eMS leu than 25 people or more people .. Icut 60 days per ~ or IS IOVice _ctiOIlS) and ilih. Well_or fI unci for "'in .. the pri""", ___ ul'leal for bacleriolaslcal .. d Chemical ...-= befen initillina'uch \lie and routinely monitor Ihe water fl.ualily lhireafter. Hawe_. if ftsture pIaaned use 60111 this Murat incn!uft to _ the public waler IYIIem dellnltlan lhen DiRctor of Health appIDVII d required JUW: to implenlentation.

I (Ibe well illllOd to supply both )lDlab1e and IIDII-potable PurpDlulD a sin811 syMem. the _ shall eliminate ctoIHOftDections IIUI bukO_ conoecti_ by phJslcally HpIfIIin. potable IlUllIOJIojIotabIe 'Yl!ems by 1ft mr sap or U appIIIVld badcflaw prewDIer.lDd by clearly labelina all nonpacible lP.iaats wilh wamm8 .i .... to p:evenl inadvertent COIIIUrnptioll iI nan-patable water. Backl\ow JlflWlltion deYicc. should be routinely inspacted IlllCltemiL

II .... nat lllpea'that this well wUI be \lied for collSllmpliwe PwpDlCS and ill nollubjecllo SlIfe Drinkin, Water Re/llllalioDa.

For lhe applicl2lt'. Infonnatian, • ICIUfCC of possible wastewater contlllllnltion Ills III. nat located near !he propcllld well ute (information attached)

An NPOES permit I. required.

Other rwleVIIII DOK I1Ile.1reau!lIion .. infOl1llltian, or reCOllUlleUjonilre IIIIChcd

In the even! that the IDClbon oflbe well cIwt,es bul is 11111 Wlthlll the pucel described DI\ this application, our divilion _iden the co_lito llin be appIioable, and we do DDt'need to review the new 10000jOll

II NOHmm~~j=tiollS

Contact Person: _~l.l..t:::!i.~;k..--i.:.w~at:=lLl!~~_

Signed;'_~"L.~:::k:iIo::::":f-===S;~_+ ___ _

Phone: S~ - 4'2SB. Date: 7li/lo

e

CWRM Application Source: Jack Well (State Well No. 1120-56)

Safe Drinking Water Branch Engineering Section

See attached private water wells information sheet.

Underground Injection Control (UIC)

In general, a shallow well, or a well that recharges quickly from local rainfall, should not be used as a potable water source because such a well increases the risk of having unsatisfactory groundwater quality that when consumed may compromise health. Factors that directly influence a well's groundwater quality include wastewater disposal systems (cesspools, septic systems, drainage wells), lawn/garden/crop-growing activities, and even the proximity to the ocean where salt water intrusion may occur.

Well water quality should be initially and periodically tested for its acceptable and intended use, especially if for 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.

CWRM Well Application Standard Comments (SDWB) Verso 6/1/07

, .

~,.. .. \

WARNING! As the owner of a privately-owned well, you should NOT assume that water from your well is safe 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 tested for bacteriological and chemical contaminants.

There are no regulations controlling water quality in private wells serving 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 testing. Private wells are often found in rural areas, where many activities such as onsite wastewater disposal can contaminate the ground water.

u.s; ENVIRONMENTAL PROTECTION AGENCY (EPA) RECOMMENDATIONS

The EPA recommends that private well owners test their well water each year for such contaminants as Total Coliform Bacteria, Nitrates, as well as any other contarrlinailts 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 before using it for the first time. Please refer to the EPA website on Private Drinking Water Wells at http://www.epa.goy/safewater/privatewells/fag.html

OTHER CONTAMINANTS

Water testing can be very expensive. It is important that you spend time to identify what other potential contaminants may be of concern. Please refer to the EPA website on Private Drinking Water Wells at http://www.epa.gov/safewater/privatewells/whatvoucando.htmI for more helpful information. Be aware of what and how you use and dispose 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 water in Hawaii can also be found at the DOH website www.hawaii.gov/health/environmentallwaterlsdwb/conmaps/pdf/conmaps05.pdf

LABORATORIES

Local commercial laboratories can be found in the yellow pages of the telephone book under "Laboratories, Analytical." Whenever possible, utilize a laboratory that is certified or approved for 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 !Jse E:PA approved methods for drinking water analysis. A list of labs certified or approved by the Department of He.alth can be found at www.hawaiLgov/health/environmental/waterlsdwb/sdwb/pdf/Testing%20Labs.pdf.As lab certification status changes constantly, confirm their status when you contacfthe lab. Please note that the list is limited~o currently regulat~d contaminants in public water systems.

RESULTS

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.gov/safewater/mcl.html) and State (www.hawaii.gov/health/environmentallwater/sdwb/sdwb/pdf/State%20MCL.pdf) drinking water standards. Where your test results are greater than the State or Federal maximum contaminant levels, your well water should be considered as unsafe for consumption.

o LINDA LINGLE LAURA H. THIELEN

GOVERNOR OF HAWAII CHAIRPERSON


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

LENORE N. OHYE STATE OF HAWAII ACTING DEPUTY DIRECTOR

Mr. Ian Costa, Director Planning Department County of Kauai

DEPARTMENT OF LAND AND NATURAL RESOURCES COMMISSION ON WATER RESOURCE MANAGEMENT

P.O. BOX 621 HONOLULU, HAWAII 96809

July 20, 2010 CfUNTY OF KAUAr

·,0 Jtl 22 P 4 :27 4444 Rice Street, Ste. A473 Lihue, Hawaii 96766 ,.LANNING DEP-:.

Dear Mr. Costa:

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

Jack Well (Well No. 1120-56)

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

We would appreciate your comments on the captioned application with regard to the SMA permitting requirements specific to your division. Please respond by returning this cover memo form by August 20, 2010. 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 staff at 587-0218.

Sincerely,

~~vD~ i""~~-I ;;.., {,~~. c:;., (~~., :":r

CI:ss

RESPONSE:

~ LAURA H. THIELEN Chairperson

---

~-. i_' ""1 ":.:',' ,~

"- "

:~:~:; ;~; C~J Pl- -~

3:~ MM Z:O -4

[ ] This well project [ ] reqUire~\lctoes not and [ ] is [ ] is not currently ~

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

[ ]

Contact Perso,?-"":' ~~~~!.i-~~:-=:::::t:~:=-~L----- Phone: W· 405D

Signed:_---'~__h/¥-\~~rP-__ ....... ~L..L-"""'IJ'.¥--------- Date: :::awl LD

c

. ,

o "Seto, Joanna L" To <[email protected]> <joanna [email protected] .go v> cc <[email protected]>, "Ledda, Madeleen $Maddie$"

<[email protected]> 08/03/2010 08:37 AM

Hi Roy,

bcc

Subject eWB Comments for Well Nos. 5711-04, 3587-20, 2583-03, 0620-02,5130-04,5030-02 to 04, 1120-56, 1224-05

As requested by Charley's out of office message, the attached Clean Water Branch comments for the subject wells are attached.

Thanks, Joanna

Joanna l. Seto Engineering Section Supervisor Clean Water Branch State of Hawaii Department of Health Phone: (808) 586 - 4309 Fax: (808) 586-4352

Notice: This information and attachments are intended only for the use of the individuals) or entity to which it is addressed, and may contain information that is privileged .. neVor confidential. If the reader of this message is not the intended redpieO'~ any dissemination, distribution, or copying of this communication is strictly prohibited and may be punishable under state and federal

law. If you have received this communication aneVor a:;!f~ts in error, please notify the sender via e-mail immediately and destroy all e;rf:nd paper copies

_i [ __ i -: ~ 20100802.RE_ Review for Comments ['Well Nos. 5711-04,3587·20, 2583-03].pdf 20100802.RE_ Well No. 0620·02.pdf

~ 201 00802.RE_ Well Nos. 5130·04,5030·02 to 04, 1120·56, &: 1224·05.pdf

•

From: To: cc: Subject: Date:

o Seto, Joanna L "charley. f. [email protected]"; Ledda, Madeleen (Maddie);

o

RE: Well Nos. 5130-04, 5030-02 to 04, 1120-56, & 1224-05 Monday, August 02, 2010 5:32:00 PM

Subject: National Pollutant Discharge Elimination System Regulations for the

Well Construction/Pump Installation Permit Application(s) for the Subject Well (5)

Dear Mr. Ice:

The Department of Health, Clean Water Branch (CWB) has the following comments for the subject wells:

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, and compiled June 15, 2009. Treated process wastewater effluent covered by this general permit 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 (NOI) 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-NOI Forms are available online at http://www.hawaii.gov/health/

environmental/water/cleanwater/forms/genl-index.html. Inquiries may be

directed to the CWB at (808) 586-4309 or by fax (808) 586-4352.

c 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. If the discharge is entering a storm drain, the discharger must obtain written permission from the owner of the storm drain prior to discharge. Furthermore, best management practices shall be implemented to prevent the discharge from collecting sediments and other pollutants prior to entering the storm drain.

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, and compiled June 15, 2009, an NPDES permit 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.

Thank you for the opportunity to comment,

Joanna

Joanna L. Seto

Engineering Section Supervisor

Clean Water Branch

State of Hawaii Department of Health

Phone: (808) 586 - 4309

Fax: (808) 586-4352

.--- c

Notice: This information and attachments are intended only for the use of the individual(s) or entity to which it is addressed, and may contain information that is privileged and/or confidential. If the reader of this message is not the intended recipient, any dissemination, distribution, or copying of this communication is strictly prohibited and may be punishable under state and federal law. If you have received this communication and/or attachments in error, please notify the sender via e-mail immediately and destroy all electronic and paper copies.

From: Susan S Hoagbin/DLNR/StateHiUS@STATEHIUS@DOHMAIL On Behalf Of Susan S Hoagbin/DLNR/StateHiUS@DOHMAIL Sent: Wednesday, July 21, 2010 2:51 PM To: Morikami, Lori N; Miyahira, Michael M; Seto, Joanna L; Palmer, Richard Cc: Charley F Ice Subject: Well Nos. 5130-04, 5030-02 to 04, 1120-56, & 1224-05

Please respond to this email request for comments to charleyJ.ice@hawaiLgov.

« File: 5130-04.PDF» «File: 1120-56.PDF» «File: 1224-05.PDF» «File: 5030-02 to 04.PDF »

c "Seto, Joanna L n

<joanna [email protected] v>

08/02/2010 05:32 PM

o To <charleyJ.ice@hawaiLgov>

cc "Ledda, Madeleen $Maddie$" <madeleen [email protected]>

bcc

Subject RE: Well Nos. 5130-04, 5030-02 to 04,1120-56, & 1224-05

Subject: National Pollutant Discharge Elimination System Regulations for the

Well Construction/Pump Installation Permit Application(s) for the Subject Well(s)

Dear Mr. Ice:

The Department of Health, Clean Water Branch (CWB) has the following comments for the subject wells:

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, and compiled June 15, 2009. Treated process wastewater effluent covered by this general permit 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 (NOI) 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-NOI Forms are available online at http://www.hawaii.gov/health/environmental/water/cieanwater/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. If the discharge is entering a storm drain, the discharger must obtain written permission from the owner of the storm drain prior to discharge. Furthermore, best management practices shall be implemented to prevent the discharge from collecting sediments and other pollutants prior to entering the storm drain.

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, and compiled June 15, 2009, an NPDES permit 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 oftotalland 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.

Thank you for the opportunity to comment,

Joanna

Joanna L. Seto

Engineering Section Supervisor

Clean Water Branch

State of Hawaii Department of Health

Phone: (808) 586 - 4309

Fax: (808) 586-4352

Notice: This information and attachments are intended only for the use of the individuals) or entity to which it is addressed, and may contain information that is privileged and/or confidential. If the reader of this message is not the intended recipiert, any dissemination, distribution, or copying of this communication is strictly prohibited and may be punishable under state and federal law If you have received this communication and/or attachments in error, please notify the sender via e-mail immediately and destroy all electronic and paper copies

From: Susan S Hoagbin/DLNR/StateHiUS@STATEHIUS@DOHMAIL On Behalf Of Susan S Hoagbin/DLNR/StateHiUS@DOHMAIL Sent: Wednesday, July 21, 2010 2:51 PM To: Morikami, Lori N; Miyahira, Michael M; Seto, Joanna L; Palmer, Richard Cc: Charley F Ice Subject: Well Nos. 5130-04, 5030-02 to 04, 1120-56, & 1224-05

Please respond to this email request for comments to [email protected].

« File: 5130-04.PDF» « File: 1120-56.PDF» «File: 1224-05.PDF» « File: 5030-02 to 04.PDF »

L1NDA LINGLE GOVERNOR OF HAWAII

Date:

To:

Attn:

From:

Subject:

~~ECtJVEO" COr-1~1iSSION ON WATER

RES'OUPCf: !<k\PAGEMENT '. ,,\ ~ t 11'y;d

261DJUL 26 AM II: 42 STATE OF HAWAII

DEPARTMENT OF HEALTH P.O. BOX 3378


.... ,~ast~wat!!rBranch . '.' 919 Ala Moana BlVd. Room 309 Hon'ohllu, Hawaii 96814-4920

Phone (808)5,86-4294 Fax (80S) 586-4300

STATEM·ESSENGER.DElIVERY

10/ d-?--r ~ to

Commission on Water Resource Management Department of Land & Natural Resources State of Hawaii

~ reb.

CHIYOME LEINAALA FUKlNO. M.D. DIRECTOR OF HEALTH

In reply, please refer to: EMD/WB

Lori Morikami, Planner Planning & Design Section

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

water commission route.wpiI sam as of 06-21-2007

. Well. Construction/Pump Installation Permit/Water Use Permit for

Well No. _tJJ_____.W_. _-O_~_---,-.~---.,;.' .a_ .. bJR)_ .......... , ... f!L_ .•. ~ _rl-fUJ1_ .. _.,_ . . __ _

Well No. _O_{_, ~_O_-_O......:...f_·_·kM_.U1_·_..--,-_CV£Pl.;...J......· _'00_.: _. __ _

I J.4-1f-05 ~nnAo+ .f£J)Jt): . . ;

Well No. ___ '1'..:....-___ -.--.:\J~w;::__:_-'tA_._:_. ______ _

Well No. _l.,...-(_~_' _-_6_(t1_~(J_a...,__ckJ-/;t.rG{--"-~-I--_ Please find enclosed the application of the above subject project.

STATE MESSENGER DELIVERY

c

LINDA LINGLE OOYEItNOR OF HAWAII

LAURA H. THIELEN CHAlRPEftBON

TO:

FROM:



HONOLULU. HAWAII 96809

July 20,2010

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

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

CHIYOME L FUKlNO. M.D. DONNA FAY I<. KIYOSAKI. P.E. LAWRENCE H. MilKE. M.D .• J.D.

LENORE N. OHVE A,CTlNO OEPIJ1'Y OtAECTOR

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 ~ tv- ~L. ~ Commission on Water Resource Management ~.

SUBJECT: Well ConstructionlPump Installation Permit Application Jack Well (Well No. 1120-56) TMK (4) 4-9-011:013-6

10000-0 ~o\a~r<d -fnaVrola

<1(0103 Transmitted for your review and comment is a copy of the captioned Well ConstructionlPump Installation permit application.

We would appreciate your comments on the captioned application for any conflicts or inconsistencies with the programs, plans, and objectives specific to your department. Please respond by returnin this cover memo form b Au ust 20 2010. Ifwe do not receive comments or a request for a ItlOna 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: [ J

[ J

[ J

[ J

~ [ J '~

I J

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This well qualifies as a source which will serve as a source of potable water to a public water system (defined as sl!fVing 25 or more people at least 60 days per year or has J 5 or more service connections) and .USI receive Director of Health approvalll!ill!: to its use to comply with Hawaii Administrative Rules (HAR). Title II, Chapter 20, Rules Relating to Potable Water Systems. §11-20-29,

;;0 This well does not qualifY as a source serving a public water system (serves less than 25 people or more people at least 60 days per year or IS ~ rrtC'":l connections) and if the well water is used for drinking, the private owner •• Duld test for bacteriological and chemical presence before initiating.uZLe U) 0 and routinely monitor the water quality thereafter. However, if future planned use from this soun:e increases to meel Ibe public water system defitRn C"):J: then Director of Health approval is required JIIiI!: to implementation. Co.. I' - -,.

c:::: :.3 : ..... : If the well is used to supply both JIOtable and nonl'otable purposes in a single .system. the user shall eliminate cross-connections and backf10w r- (.~) ~;:: ;:.:' connections by phYSIcally separatlftg potable and non-potable systems by an air gap or an approved backtlow prevenler, and by clearly labehng a!loen- ,. ':-:.'. ' ':'.' potable spigots with warning signs to prevent inadvertent consumption of non-potable water. Baekflow prevention device. should be routinely i'8lFled -,. c. '; and tested. '. ....,,, f ,

It does not appear that this well will be used for consumptive purposes and is not subject to Safe Drinking Water Regulations. l:IIt; "c:' :: ..

For the applicant's information. a source of possible wastewater contamination'Ais II i. not located near the proposed well site (information alt~d). ;~ ~ ;~j :. :1:-1 - ,11fT;

One-Stop database screen'Mfo ~:.:o An NPDES permit is required.

Other nol.vant DOH rules/regulations. information. or recommendations are attached.

In the event that the location ofth. well changes but is still within the parcel descnbed 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 iD441 Signed:_-c..lni=--:..-=--' --<-~-,--_··._hfM1 __ \_trn __ tnJJ_~_ Date: ()1" ')-") 110 10

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Application Information

Pennit ID: 36730

Legacy File#: N/A

Assigned To: ,~-=-~;;;-L;;;i-=--=-_=:==~ VI

eHawaii ID: N/ A

Soul"Ce: WWB

Description: lunit 2 ~~~-------------~

Variance ID: 1'----,

1 Project Information 1------------------------------------, Engineer:

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Street Address:

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Suite/Apt.:

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Zip Code:

1449011013

IWS may be within 1,000 ft. of a potable well

16565-C Koolau Road

~IA=na=h=o=la====~--------------~I.HI 196703

Submit Date:

Reviewed:

plan Approved:

No Final Approval Uri

Inspection Date:

Final Approyal:

Tennination Date:

I Payment Information I Payment Type: L~~-~k _==_ ";1 Check Date: 14/23/2007

Check Number: 1404411

~==========~ Payor: IPostal Money Order

Apploval to Build Applove To Use EHception Repolt Inspection Deficiency Repolt

Added By: Ivetter 6/6/2007 2,50 PM Last Modified: Ivetter 5/20/2008 2,14 PM

16/6/2007

16/6/2007 H,m". 16/6/2007 HnH·

HuH· 18/14/2007

15/20/2008

Amount: 1100,00

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Fil'St Name: IJohn ~:;::==========~

Last Name: l~p=ra=Z=ia=l=e=========~ Street Address: 16565-C Koolau Road

Street Address 2: I ~============~ Suite I Apt#:

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I Dwelling Information I lot Size (sq ft.): 18276400

CPR lot: ~ Dwelling Type: INew D~el~';----------Vl

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EXisting IWS:

# of Existing IWS:

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Total Bedrooms: Bedroom

Designed Flow Rate (gpd): '--14_0_0 _____ ~

BUilding Type: i R;~;~~~;~I_=_=~-~-=-=~~_=--vl LCC: IT:] Potable Well widlin 1,OOOft?: IT:]

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, Soil Profile Information ,

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!soil Absorption Information!

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length:

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Total Min. Soil Absorp. Required: li31i sq. ft.

3' Groundwater Setback: EJ Total Soil Absorp. Pro .... ided: liOO sq. ft.

SOIl Absorption Trenches

length: 0 ft

Width: Oft

# of Trenches: 0 3' Soil Replacement: EJ

Seepage Pit

Diameter: 0 ft Depth: 0 ft

Lining Type:

Access Opening: c=J inches

Co .... er Diameter: D ft

6" Inspection Port: EJ

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Charley,

"Palmer. Richard" <richard [email protected]. gOY>

07/26/201002:38 PM

To "Susan S Hoagbin/DLNRIStateHiUS@DOHMAIL" <IMCEANOTES-Susan+20S+20Hoagbin_DLNR_StateHiUS +40DOH [email protected]>,

cc "Charley F Ice" <[email protected]>

bcc

Subject RE: Well Nos. 5130-04, 5030-02 to 04, 1120-56, & 1224-05

The HEER Office has no comment regarding the well permits submitted on July 21,2010.

Regards,

Richard

Richard Palmer, Ph.D.

Environmental Health Specialist

Hazard Evaluation and Emergency Response Office

Hawaii Department of Health

919 Ala Moana Boulevard, Suite 206

Honolulu, Hawaii 96814

(808) 586-4249

(808) 586-7537 FAX

-----Original Message-----

From: Susan S Hoagbin/DLNR/StateHiUS@STATEHIUS@DOHMAIL On Behalf Of Susan S

Hoagbin/DLNR/StateHiUS@DOHMAIL

Sent: Wednesday, July 21, 2010 2:51 PM

To: Morikami, Lori N; Miyahira, Michael M; Seto, Joanna L; Palmer, Richard

Cc: Charley F Ice

Subject: Well Nos. 5130-04, 5030-02 to 04, 1120-56, & 1224-05

Please respond to this email request for comments to [email protected].

«File: 5130-04.PDF» «File: 1120-56.PDF» «File: 1224-05.PDF» «File: 5030-02 to 04.PDF»

o "Morikami, Lori N" <Iori [email protected] ov>

07/22/201010:42 AM

Hello Charley -

o To <[email protected]>

cc

bcc

Subject Wells: 1120-56,1224-05,5130-04,5030-02

Here are our comments for the above mentioned wells.

Hard copies are in the mail. «Well 1224-0S-1 0446. PDF» «WeIl1120-S6-1 0447. PDF»

Aloha, «WeIlS030-02-ID44S.PDF» «WeIlS130-04-ID444.PDF»

Lori Morikami DOH - Wastewater Branch

~ ~

Happy weekend (we are on furlough tomorrow) WeIl1224·05·ID446.PDF WeIl1120·56·1D447.PDF

-m WeIl5030·02·ID445.PDF WeIl5130·04·ID444.PDF

TO:

o


COMMISSION ON WATER RESOURCE MANAGEMENT P.O.8OX621

HOHOlULU,~~1 ~

July 20, 20 10

Honorable Cbiyome L. Fukino, M.D" Director Department of Health Attention: Acting Chief, Wastewater Branch

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

lAURA H. THIELEN --WLLIAM D. BALFOUR, JR. SUMNER ERDMAN NEAl S. FUJIWARA

CHIYOME L. FUICINO, M.D. DONNA FAY K. KIYOSAKl, P.E. LAWRENCE H. MIlKE, M.D., J.D.

LENORE N. OHYE ,u,1'VII000'tJTY0IIIIECT0R

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

FROM: Laura H. Thielen, Chairperson ~ ~-~L ~ Commission on Water Resource Management , .

SUBJECT: Well Construction/Pump Installation Permit Application Jack Well (Well No, 1120-56) TMK (4) 4-9-011:013-6

~0S-0 koo\a~fd -/VU.{t1 ala

<1(0703 Transmitted for your review and comment is a copy of the captioned Well Construction/Pump Installation permit application.


CI:ss Attachment(s )

RESPONSE: r)

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This wen qualifies .... _ which will _ .u a _ of potable water 10 • public water I)'JIem (defined .. serving 25 or more people at last 60 days per year or has 15 or IIIOI'e ~e cooaectiofts) and ..... reui..., Direclor of Health approval JIIiI[ 10 its Ide 10 comply with Hawaii AdminiSlrBtive R ..... (HAIl), Title II, Chapter 20, Rule. Relatilli to Potable Wiler Sy3Iems, 111·20·29.

This well doa J10I q .... ify.s .......... serving a public _er sysInI (serve_ tess than 25 people C< "'''"' people at Icast 60 days per yftr or 15 service connecciOIll) ..... if1he wen wiler iJ used for drinking, the private owner ,bald tell for bacteriological and chemical presenoe before initialine such use and ro.tinely monitor the waller quality thereafter. However, if fUture plaoned use &om this source incrcoasco 10 meet the public w ..... system definition then Director of Health .IpPIOval isl1!qUinod JIIiu: to implemcntalioo.

Ifille well. used 10 'upply bod! potable IUd IIOn-potablc PlIIpOIn in a sinale S)'1Iem, the user shall elimiaalc cro.~ti",," ... d baclctlow connections by physically separalilli potIIble and non-potable systems by an air pp or ... approved b8cI</low preventer, aod by clearly labeling all non· potIIble api(lOts wilh -..i_g si .... to "",VCllt inadvertent ronsumprion ofnon-polable _ Bldflow prevention devices should be routinely inspected and ''''led. . II does not appear that this well will be _d for COIWlJIIplive purposes ..... is nol subject 10 Safe Drinkinl Waler ReguLations.

For the applicant" information, a swrce of possible wastewater comrn.inatio,i'fJ,.u II it no,IOUled near lhe pr~ well site (information attached)

An NPDES permit is required.

Other relevanl DOH rules/regulations, informalion, or nocOftlJllelldaliolll are attached One-Stop database screen info In 1he event that the Iocllion ofllle well cbnae' but is still withon lhe parcel described onlhis application. our division considers the COIIUIICIIls 10 still be applicable, and .... do not need 10 review tlte DeW location

No cornmcnWobjections

Contact Person: Lori Vetter, Eng. on Kauai 241-3323 iD441 Signed:_....c.1n~~1-=.~...:..-_··_h_~_, _ttn_tTdJ __ ~_ Date: 01')-7 (JO 10

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Cesspool Cards ;J Find Cesspool Card

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Septk Tank liquid Volume: <.:11.,:5.,:0..:,0 ____ --11 gal.

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," Inspection Port(s) to g.-ad... [EJ Manhole openings brought to g .. ade: ~ Remari<s:

I Soil Profile Information I

Disposal Type: . Bed Y:

Percolation Rate: ~ ~1inimum Soil Absorption: :UI sq. ft./bd

Total Min. Soil Absol'p. Requi .... d, 636 sq. ft .

3' Groundwater setback. [C]

!Soil Absorption Information\

Length.

width:

3' Soil Replacement: [CJ Total Bed Area: 688 sq. ft.

Total Soil Absorp. Provided: 600 sq. ft.

Length, Oft Width: Oft it of T .... nches: 0 3' Soil Replacement; D

Diamete .. ,O ft Depth, 0 ft

lining Type: V.'

Access Opening: 0 inches

Co ... e .. Diameter: 0 ft

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LAURA H. THIELEN CHAIRPERSON REGE\VEO

NO O\V\S\ON WILLIAM D. BALFOUR, JR SUMNER ERDMAN NEAL S. FUJIWARA

CHIYOME L. FUKINO, M.D.

10\0 JUl 22 A \Q: OS' STATE OF HAWAII

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

TO:

FROM:

SUBJECT:

DEPARTMENT OF LAND AND NAT~m;~J~ .. ~~~~~S COMMISSION ON WAT;:-B~;~~~~I't~~\

HONOLULU, HAWAII 968~n;.:.1 c.. Of n AWA

Morris Atta, Administrator Land Division

July 20,2010

Lenore N. Ohye, Acting Deputy Director ~ ~ . O~~ Commission on Water Resource Management ~

Well ConstructionlPump Installation Permit Application Jack Well (Well No. 1120-56) TMK (4) 4-9-011:013-6


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

We would appreciate your comments on the captioned application with regard to the programs, plans, and objectives specific to your division. Please respond by returning this cover memo form by August 20, 2010. If we do not receive comments or a request for additional review time by this date, we will assume you have no comments.


CI:ss Attachment( s) .... RESPONSE: ~

CD

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

N

A water lease/permit is not required of this applicant. 0'\

> :J:

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[ ]

[ ]

[ ]

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A water lease/permit has been obtained by the applicant through lease no. ________ --.--....-_ W

Other relevant Land Division rules/regulations, information, or recommendations are attached. (1'1 N

No objections

Other comments: Original source of private title is Grant 535 issued before statehood.

Contact Person: ------*'Grf3afI'r~y~Malflll'r'-'Et4i"""nl---------- Phone: 587-0421

A~-M- ~ Signed:_~~~-+ _____ /-T---~-------""'--===-~-- Date: July 26, 2010

.~

II .. UI



Dear Mr. Lluellen:


COMMISSION ON WATER RESOURCE MANAGEMENT po. BOX 621


July 20,2010

LAURA H. THIELEN CHAIRPERSON


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



1120-56.wcpia.acc

Well Construction/Pump Installation Permit Application for Well No. 1120-56

We acknowledge receipt, on June 30, 2010, of your completed Well Construction/Pump Installation permit application and filing fee for the Jack Well (Well No. 1120-56). You can expect your application to be processed within ninety (90) days from this date.

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: Jack Gardner

Sincerely,

Lkb~ LENORE N. OHYE Acting Deputy Director

LINDA LINGLE LAURA H. THiElEN GOVERNOR OF HAWAII CHAIRPERSON

TO:

FROM:


COMMISSION ON WATER RESOURCE MANAGEMENT po. BOX 621


July 20,2010

Honorable Chiyome L. Fukino, M.D., Director Department of Health Attention: Acting 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, MD., J.D.


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

Laura H. Thielen, Chairperson ~ bv- ~L. ~ Commission on Water Resource Management ~.

SUBJECT: Well Construction/Pump Installation Permit Application Jack Well (Well No. 1120-56) TMK (4) 4-9-011:013-6


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 August 20, 2010. 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 staff at 587-0218,

CI:ss Attachment( s)

RESPONSE:

[ I

[ I

[ I

[ I

[ I

[ I

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[ I

[ I

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

This well does not 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 nonpotable spigots with warning signs to prevent inadvertent consumption of non-potable water. Backflow prevention devices should be routinely inspected and tested.

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

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

An NPDES permit is required.

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

In the event that the location of 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.

No comments/objections

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


TO:

FROM:

SUBJECT:



Morris Atta, Administrator Land Division


July 20,2010

Lenore N. Ohye, Acting Deputy Director ~ '\tv . O~~ Commission on Water Resource Management ~

Well Construction/Pump Installation Permit Application Jack Well (Well No. 1120-56) TMK (4) 4-9-011:013-6

,



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


LENORE N. OHYE ACTING OEPUTY DIRECTOR


We would appreciate your comments on the captioned application with regard to the programs, plans, and objectives specific to your division. Please respond by returning this cover memo form by August 20, 2010. Ifwe do not receive comments or a request for additional review time by this date, we will assume you have no comments.


CI: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:

FROM:

SUBJECT:

c




July 20, 2010

Dr. Puaalaokalani Aiu, Administrator Historic Preservation

Lenore N. Ohye, Acting Deputy Director ~ h.-. O~ Commission on Water Resource Management ~

Well Construction/Pump Installation Permit Application Jack Well (Well No. 1120-56) TMK: (4) 4-9-011:013-6



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


LENORE N. OHYE ACTING OEPUTY DIRECTOR


We would appreciate your comments on the captioned application with regard to the programs, plans, and objectives specific to your division. Please respond by returning this cover memo form by August 20, 2010. 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 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

o o



HONOLULU. HAWAII 96809

July 20,2010

4444 Rice Street, Ste. A473 Lihue, Hawaii 96766

Dear Mr. Costa:

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

Jack Well (Well No. 1120-56)


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.



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 August 20, 2010. Ifwe do not receive comments or a request for additional review time by this date, we will assume you have no comments.


Sincerely,

~.\A...vD~ ~ LAURAH. THIELEN

Chairperson

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: --------

"MISSION ON WATER RESOURCE MANAGEME~ ROUTE SLIP FOR NEW APPLICATIONS

FROM: CHARLEY DATE:

FUJII, N.

9-.Jul-10

KUNIMURA, I. NAKAMA,L. UYENO, D.

h--YODA,K. --"!IP YOSHINAGA, M.

-1-HARDY, R.

-2-HOAGBIN, S. 4 ICE,C.

I MATA , R. -3-KAWAHARA,K.==

WELL NUMBER ( 20 . 5b WELL NAME .Jack

SUSPENSE DATE:

1 Approval 3 Signature

Information

1KJ WELL CONSTRUCTION f5([ PUMP INSTALLATION

ATTACHMENTS FOR APPLICATION P CESSING - Both applicant & staff generated 1 TRANS. LETTER

16-Jul-10

PLEASE:

See Me -1-Review & Comment

Take Action Type Draft acknow letter

-2-Type Final, label file folder, update People.db 4 File & Input Issue Date

Xerox copies

WUP Number na

o WUPA

2 PERMIT PROCESS TABLE

3 CWRMMAPS making 1-mile radius and penciling in on hanging maps 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:

MLS PRINTOUT - DCCA LICENSE SCREEN PRINTOUT

=z: 7----l:lA.. (SMA map printout http://gis.hicentral.com/website/parcelzoning/viewer.htm.,or INGRID'S SMNCD MAP)

(LUC map printout http://luc.state.hi.us/luc_maps.htm., or INGRID'S SMNCD MAP)

o MADE NEW FILE FOLDER, ATTACHED

~ FILE FOLDER ALREADY MADE, IN FILE CABINET

INCOMPLETE ACTION DATES:

DATE ACTION

Search Results o Page 1 of2

Assessed values reflect tax ~ear 2010 for all islands. Taxes reflect tax ~ear 2009.

Search criteria: TMK Taxke~ 4-4-9-11-13

PUBLIC RECORD DATA Taxkey Subdiv [Condo Tnr Address Owner [Lessee Bds Bths Land area Liv area Last Sale Instr

r .4-4-9-11-13 Moloaa & F 6565 BLATT FMLY 0 0 190.09 ac o 11/17/2008 DEED $4 Kaapuna Hui KOOLAU IRREVOC TR Lands

r .4-4-9-11-13-1 MOLOAA F 6565-C FREEMAN FMLY 0 0 7.14 ac 0 VALLEY KOOLAU, REVOC TR/ETAL

Apt 1 r .4-4-9-11-13-2 MOLOAA F 6565-C MOLOAA 0 0 5.24 ac 0


r .4-4-9-11-13-3 MOLOAA F 6565-C TRIBBLE, 0 0 5.09 ac 0 VALLEY KOOLAU, RICHARD M &

Apt 3 JODI A/ETAL r .4-4-9-11-13-4 MOLOAA F 6565-C MOLOAA 0 0 5.71 ac 0


r .4-4-9-11-13-5 MOLOAA F 6565-C MOLOAA 0 0 5.89 ac 0 VALLEY KOOLAU, VALLEY ONE

Apt 5 LLC/ETAL r .4-4-9-11-13-6 MOLOAA F 6565-C GARDNER, 0 0 4.11 ac 0

VALLEY KOOLAU,JACK A & Apt 6 TERESA/ETAL

r .4-4-9-11-13-7 MOLOAA F 6565-C WRIGHT, CARL 0 0 8.81 ac 0 VALLEY KOOLAU, L & SANDRA

Apt 7 E/ETAL r .4-4-9-11-13-8 MOLOAA F 6565-C WOOD, 0 0 5.79 ac 0

VALLEY KOOLAU, LISA/ETAL Apt 8

r .4-4-9-11-13-9 MOLOAA F 6565-C WOODS, 0 0 9.70 ac 0 4/26/2010 QD $ VALLEY KOOLAU, VALERIE

Apt 9 r .4-4-9-11-13-10 MOLOAA F 6565-C ALGOSA 0 0 21.84 ac 0

VALLEY KOOLAU, MASTERS Apt 10 TR/ETAL

r .4-4-9-11-13-11 MOLOAA F 6565-C ANDERSON, 0 0 4.08 ac 0 4/26/2010 QD $ VALLEY KOOLAU, MAXIMILIAN J Y

Apt 11 r .4-4-9-11-13-12 MOLOAA F 6565-C MAAS, CRAIG H 0 0 1.84 ac 0

VALLEY KOOLAU, REVOC TR/ETAL Apt 12




r .4-4-9-11-13-15 MOLOAA F 6565-C ANDERSON, 0 0 5.60 ac 0 5/13/2010 QD $ VALLEY KOOLAU, MAXIMILIAN J Y

Apt 15 r .4-4-9-11-13-16 MOLOAA F 6565-C JAY, TERRY E 0 0 11.00 ac 0

VALLEY KOOLAU, TR/ETAL

http://web08.hawaiiinformation.com/REsearch/HIS/Search/search ]UB.asp?NOCACHE= 127913 7865875 7114/2010

Search Results Page 2 of2

Apt 16 r .4-4-9-11-13-17 MOLOAA F 6565-C MOLOAA 0 0 5.03 ac 0





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

Copyright ©7/14/2010 by Hawaii Information Service

Next Page

http://web08.hawaiiinfonnation.com/REsearchiHIS/Search/search]URasp?NOCACHE=1279137865875 7/14/2010

QARTMENT OF LAND AND NATURAL RESo9cES DOCUMENT NO . .. UAC OR ATTACHED WORKSHEET DATE· June 30 2010 ,

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

S 10 326 C 1026 0752 (1 ) $25.00 Kauai Water We"

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

TOTAL $ 25.00

REMARKS: LINE (1) Jack We" LINE (2) LINE (3 LINE (4) LINE (5) LINE (6) LINE (7) LINE (8) LINE (9) LINE (10)

-r • .

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

IJWtructIorw: Please pOnt in ink or type and send completed appHcation with attachments to the Commission on Water Rettource Management, P.O. Box 621, Honolulu, Hawaii 96809. Application must be accompanied by 10 copies and a non-refundable filing fee of $21.00 payable to the. Dept. of Land and Natural Resources. The CommIseion 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.

Conslnlet New Well o Modify ExIsting Well o Abandon/Seal Well

o 17.lndustr1al fruutl'rih .. \

o 18. Irmlatlfln

019.

o Well Is in Conservation OIstr1ct o Required, COUP fI date approved o Not Required (attach documentation from OCCL) ---

20m JUN 30 PH 12: 39

I.J -parcel

o I have not checked with OCCL about whether or not a COUP is Il!quired. 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 Distr1ct ~ I have not checked If well is in or out of Conservation Distr1ct. I understand that checkirlg

KA...ti t!!~{ C- :14nB U_~ss name , C-57 Ucanse No.

~ <' _~ ~bJ b-}klO ~.t ture ~ ~ Date

'~-o 451 ~~~ ?C9liB Address

~-ql(,~ -Phone Fax

Installation)

~-'Z9~7B C-57/C-57a1A Ucanse No.

=P-:...=::;...----t~k '~1r'" P-g.,l> 1/3/ tlII4ItiA,l/; f,,?l!.3

WCPI Application Form OS/20/2009

o o

PROPOSED WELL SECTION (Please attach schematic if different from diagrem provided below)

Hole Diameter: 10 in.

a a opo ca ng .,m

.j;~ ----- Minimum of 2' Radius & 4" Thick Concrete Pad (to contain benchma 1[--EIev tion tt f si J..1'Z-ft BI* L rk

surveyed to nearest 0.01 ft.) - .. ~J r Ground Elevation: zclo ft., rnsl-,.-. oq •• ····21

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

: ... .; : i; &.:.Of. ___ l 1/1*\\ 'IP"'" WI'A"

I >::' .'.::-. Please refer to the I.~ Cement Grout: ft. ~'-: ,'.

BAW AD WEI.). m~~IBUCTIO~AND (min. 70% of distance from ::i :. ~. '~.'.:

.. ' PUMP mUALLAJm~ UANDARDS ground elevation to top of 4 • .-:: ;. -,'.'" to ensure that your as-built is in compliance with water surface or 500 ft., :;~:~; ~:;~ whichever is leu.) ."'.-

applicable standards.

~'.::: .. ' • .!..-

, .. ,'.

Grouting method: Annular space between hole '::i :; :-: Solid Casing: (~ 90% x (Ground EIev.-Water level Elev»

and casing (1.5" for positive '.\.'.: 4, "

t1' Po8ltlve .:: ;. ::;,

Total Length: ';1J' ft . displacement, 3" for other . ; .~. ;.s displacement rf methods): /~.;:: Nominal Diameter: in . o Other .. :: "

~ .' . . ..

Wall Thickness: in. I----, .. "",4 Y in. :. ~. :: !':

4.," Bottom Elevation: toO ft., mal·

Rock or Gravel Packing: ~ I' ~ Total Depth 40 p( Petforated ft. I Open Casing: o Screen I kQ ft.

c--Material:

I ..z" Crushed Basalt Total length:

~~ ft.

D

o Rounded Gravel / Nominal Diameter: in. <7

Cl ~ Wall Thickness: in.

Estimated Water level Bottom Elevation: go ft., mal·

Elevation: ~'-- iii bb note: Neither bentonite nor mud should be used In

liQ -- -ft. mBl· ~ setursted zone during drilling

~--

Open Hole:

length: ft.

Diameter: in. L~ ___ ~_~ _____ ~_ - ~--- - Bottom Elevation: ft., mal*

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

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

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

Example: E.tlmated + 2 ft. Wllter Level Elev. _ Bottom Elevallon orWell Umlt .. (2 _ 41 ~(2» = -18.5 ft.

Solid CaliDA Mated,l; Carbon StHl: compliant with (check one or more): 0 ANSIIAWlNA 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

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

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

PVC Pt..uc conforming to ASTM F480 and (ASTM 01785 or ASTM 02241): (check one): ¢' Schedule 40 0 Schedule 60 0 Schedule 120

ThennOHt Plutlc: (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 AWINA C950

o PTFE Fluorocarbon Tubing conforming to ASTM 03296

o FEP Fluorocarbon Tubing conforming to ASTM 03296

OD.O CaliDA M.ted,l: Carbon Steel: compliant with (check one or more): 0 ANSIIAWlNA 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

StaIn .... StHl: (check one): 0 ASTM M09 (production wells) 0 ASTM A312 (monitor wells)

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

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

ThermOHt PI_tic: (check one) 0 Filament Wound Resin Pipe conforming to ASTM 02996

o Centrifugally Cast ReBln Pipe conforming to ASTM D2997 o Reinforced Plastic Mortar Pressure Pipe conforming to ASTM 03517

o Gla85 Fiber Reinforced ReBln Pressure Pipe conforming to AWINA C950

o PTFE Fluorocarbon Tubing conforming to ASTM 03296

o FEP Fluorocarbon Tubing conforming to ASTM 03296

WCPI Application Form 0512012009