state of hawaii department of land and natural … · 2012-06-14 · from: david chai subject:...

.. o o LINDA LINGLE LAURA H. THIELEN

GOVERNOR OF HAWAII

Mr.limMair 112 Puako Beach Drive Kamuela, HI 96743

Dear Mr. Mair:

STATE OF HAWAII DEPARTMENT OF LAND AND NATURAL RESOURCES

COMMISSION ON WATER RESOURCE MANAGEMENT P.O. BOX 621

HONOLULU, HAWAII 96809

August 26, 2009 /

Certificate of Pump Installation Completion for Yellow Tang Well- Well No. 5552-02, (TMK 6-8-033:001)

CHAIRPERSON

SUMNER ERDMAN NEAL S. FUJIWARA

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

KEN C. KAWAHARA, PE. DEPUTY DIRECTOR

5552-02.cpi

Weare pleased to inform you that the Pump Installation work permitted for the Yellow Tang Well Well (Well No. 5552-02) is complete and acceptable and welcome you as a new member to the community of well owners and ground water users in Hawaii. This certificate of pump installation completion allows you to commence pumping your well for reasonable & beneficial water use.

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

1. If the well is not in use it must be properly capped.

2. 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(t), HAR, prior to any well sealing or plugging work.

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

4. 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 www.hawaii.gov/dlnr/cwrmlforms.htm.

,,,,-"'''','''_ .... _ .. _----------------

I

o Q l\.1r. Jim Mair August 26, 2009

5 . Your approved pump has a capacity of 60 gpm at a head of 93 ft. In the future, pump replacements of equal or lesser capacity will not require an additional permit from the Commission, but will require the submission of a Well Completion Report Part II by the licensed pump installer. If the pump replacement is greater than the existing pump, you will need to apply for a new pump installation permit.

6. The landowner shall cause the well operator to maintain the installed meter or other appropriate means for measuring and reporting withdrawals and water levels, and appropriate devices or means for measuring chlorides and temperature. These data shall be measured monthly and reported to the Commission on a annual basis, on forms provided by the Chairperson (attached), in accordance with § 13 -168-7, HAR. Blank water use report forms are also available at www. hawaii.gov/dlnr/cwrm/resources-'permits.htm

7. The proposed use shall not adversely affect existing or future legal uses of water in the area, including any surface water or established instream flow standards. The authorization to drill a well and/or install a pump shall not constitute a determination of correlative water rights. The landowner and well operator are notified that the quantity of water taken from the well and/or the pump capacity could be reduced by the Commission in the future.

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 Ryan Imata of the Commission staff at 587-0255 or toll-free at 974-4000 (Hawaii), 274-3141 (Kauai), 984-2400 (Maui), or 1-800-468-4644 (Lanai & Molokai).

Sincerely,

? K~J:::j~P.E Deputy Director

RI:ss Encl: Water Use Report Forms

c: Hawaii Department of Water Supply

o o LINDA LINGLE LAURA H. THIELEN

GOVERNOR OF HAWAII CHAIRPERSON




August 26, 2009 /


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

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

KEN C. KAWAHARA, P.E. DEPUTY DIRECTOR

5552-02.cwc

Mr. Jim Mair 112 Puako Beach Drive Kamuela, ill 96743

Dear Mr. Mair:

Certificate of Well Construction Completion for Well No. 5552-02 (TMK 6-8-033:001)

We are pleased to inform you that the Well Construction work permitted for the Yellow Tang Well (Well No. 5552-02) 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, an)' violation of the above conditions or any other provision of the Hawaii Admimstrative Rules may be subject to fines of up to $5,000 per day. The Commission needs your help and asks that you to do your part in utilizing this shared resource. We prefer to work with you in meeting the goal of protecting our ground water resources together.

If you have any questions, please contact Ryan Imata of the Commission staffat 587-0255.

RI:ss

c: Hawaii Department of Water Supply

Sincerely,

W.U~L ~ KEN{"JJ:::J,P.E.

Deputy Director

/

LINDA LINGLE GOVERNOR OF HAWAII

Mr. Derrick Moreira Derrick's Well Drilling P.O. Box 2187 Keeau, HI 96749

Dear Mr. Moreira:

o o




August 26, 2009

Well Completion Report Parts I & II for Well No. 5552-02

LAURA H. THIELEN CHAIRPERSON


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

LAWRENCE H. MilKE, MD., J.D.


We received your Well Comfletion Report Parts I & II for the Yellow Tang Well (Well No. 5552-02) on October 24, 2008 and acknowledge that they are complete.

This completes your obligation under the well construction and pump installation permits. Certificate of well construction and pump installation completion will be issued to the well operator/landowner and you will receive a copy. These certificates transfer responsibility of specific aspects of well usage and maintenance from you to the well operator/landowner.

If you have any questions, please contact Ryan Imata of the Commission staff at 587-0255 or toll-free at 974-4000 (Hawaii), extension 70255.

Sincerely,

Wf'tM r:fv KEN C. KAWAHARA, P.E.

Deputy Director

RI:ss

c: Jim Mair

I

o o

Results

o o Derrick Moreira <[email protected]>

To Ryan R Imata <Ryan.R.lmata@hawaiLgov>

cc

Hi Ryan,

10/24/2008 08:27 AM Please respond to

moreira [email protected]

bcc

Subject Fw: Meyer Well Salinity

Please see the message below from David Chai regarding the ppm count for the Yellow Tang well #5552-02. please call me.

Thank you, Cynthia --- On Fri, 10/24/08, David Chai <[email protected]> wrote: From: David Chai <[email protected]> Subject: Meyer Well Salinity To: "Derrick Moreira" <[email protected]> Date: Friday, October 24,2008,8:24 AM

Hi Cynthia,

This is just to confirm that the Meyer well sample was 31 ppt (parts per thousand) according to my YSI mod

David Chai

MEMO and ROUTEcaUP (ver. 09/09/08) 0 I WCR 1 Check for Well No. 5552-02 (regulation/survey route)

1. From CharleY/Den~ 2. Pump Tests Check Diane England. ___ _

Step-Drawdown Test:

Constant Rate Test:

followed WCPI Stds analysis attached


Potential Well Interference:

Potential Stream Impacts:

Additional Testing or Data Required:

Pump Test Comments Attached:

Proposed Pump Capacity is OK.:

(initial)

Yes

0 0

0 0

0

0

0

0

0

No

0 0

0 0

0

0

0

0

0

3. Well Log Check Geology Code for Well Index: .....,.-_ Fm Name:

09/30/08

1\ 4. Construction Check Mitch Ohye \ (initial)

IjI- No R. Torres __ (initial)

If no, describe deficiency

data complete ( y(' 0 followed Special Cond & elevations,,~ 0 well database updated. ~ 0

Latitude Longitude

(,,- c . '. NAD27

NAD83

\ !

\

~:~ "> .':) 11"">

5. Charley/Den. ___ ~_ _-= __ (initial) take action based on above analysis

ATTACHMENTS FOR PUMP INSTALLATION PERMIT (2x):

1 COVER LETTER 1= 2 COUNTY COMMENTS (DWS/SMA)

3 DOH COMMENTS

4 DLNR COMMENTS (LD/OCCUDHP)

5 WCR 1 Accept

6 WELL CONST. COMPLETION CERTIFICATE

~ not necessary - only WCP og

} To be sent to driller/pump installer

<------ To Landowner

} Staff internal checks

6. Roy (initial) check (Entered WCR 1IWCCC accept date into database) 7. Susan Hoagbin (initial) finalize 8. Ken (initial) signature 9. Mitch initial) Entered PIP issue date if attached/required 10. Charley/De e/Ryan ile

State of HaW~i 0 COMMISSION ON WATER RESOURCE MANAGEMENT Department of Land and Natural Resources

For Official Use Only: /

/

WELL COMPLETION REPORT - PART I Well Construction DB SEP 29 A 9; 30

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

1. State Well No.: 5552-02 Well Name: Yellow Tang Well Island: ~H;;;.aw;.;.;ll1;;;;·i~ __ _

2. Address: 112 Puako Beach Drive, Kamuela, ill 96743 Tax Map Key: _6-.;;...;;,8-0....;.:;..:33;.;;:00:..;;...:;.1 _____ _

3. Drilling Company: Derrick's Well Drilling & Pump Services, LLC

4. Drilling method used during contruction: 181 Rotary 0 Percussion 0 Other (describe)

5. Date Well Construction (drilled,cased,grouted) completed: 9/25/2008 Attach completed DrIller's Log monthlday/year

6. Was the subject well cored? 0 Yes 181 No

7. Step-Drawdown Test completed? 0 No 181 Yes Attach step-Drawdown Test fonn (12117197 SDPTD Form)

Constant Rate

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

Chloride: 6544 ppm, Temperature: 77.9 OF

mean sea Subtract the depth to the water level.

12. As-built section filled in completely Iii

CRPTD

13. Photograph of well and concrete pad showing benchmark on concrete pad attached Kl 14. GPS coordinates provided in degrees, minutes, seconds 1fI 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:

Derrick's Well Drilling & Pump Licensed Driller (print) .....;..Se.:..rv..",..;;.c....;ie..,;.s,-, L ___ L..,;.C ________ _

D~~ C-57 Lie. No. C-28001 -----------

Date 9/26/2008 Signature

e· -0

12. AS-BUILT vo- SECTION (Please attach as-built if different ~ram provided below)

" Hole Diameter: 12 in. Elevation at top of casing ~ ft .• (to nearest 0.01 ft.)

. -___ --h-- Minimum of 2' Radius & 4" Thick Concrete Pad

Bench mark elevation:

3S.6 ft .• msl* o (Survey to 0.01 ft.)

~ (Estimated)

Grouting method

o Positive Displacement (if annular space is less than two inches. attach photo oftremie)

~ Other

Total Depth

.2.Lft.

Solid Casing Material:

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

Annular space between

hole and casing (1.5" for positive displacement. 3" for other methods) __ 3_in.

Rock or Gravel Packing

31 ft

_'--__ ft. msl*

(item 11 from page 1)

*msl = mean sea level

1M1iF-'''--I"-'''''Ir.-~~''' Elevation: 38 ft .• msl* DSurveyed ~Estimated

Please refer to the HAWAll WELL CONSTRUCTION AND PUMP INSTALLATION STANDARDS

to ensure that your as-built is in compliance with applicable standards.

Solid Casing: (?; 90% x (Ground Elev.-Water Level Elev»

Length: 51 ft. Nominal ~iameter: 6 in. Wall Thickness: .2S0 in. Bottom Elevation: -13 ft .• msl*

Open Casing: • Perforated 0 Screen

Length: 10 ft. Nominal Diameter: 6 in. Wall Thickness: ---.lot..-:"2.,-SO:------- in. Bottom Elevation, ..... : __ .... -2""3'--____ ft .• msl*

Open Hole:

Length: 10 ft.

Diameter: 6 in.

Bottom Elevation: -33 ft .• msl*

Carbon Steel: compliant with (check one or more): 0 ANSIIAININA C200 0 API Spec. 5L 0 ASTM A53 0 ASTM A 139

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

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

ABS Plastic conforming to ASTM F4S0 and ASTM 01527: (check one) 0 Schedule 40 0 Schedule SO

PVC Plastic conforming to ASTM F4S0 and (ASTM 017S5 or ASTM 02241): (check one): ~ Schedule 40 0 Schedule SO 0 Schedule 120

Thennoset 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 AININA 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 ANSIIAININA C200 0 API Spec. 5L 0 ASTM A53 0 ASTM A 139

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

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

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

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




o Glass Fiber Reinforced Resin Pressure Pipe conforming to AININA C950



'A ''''''" A r-__ .. "' .. n''' .. ",, ___ '" _.I. ~

5552-02 Yellow WELL NUMBER: Tang Well

Depths (ft.) Rock Desaiption

_0_ to ~ Soft Cinders

~ to ~ Soft Cinders

......1lL- to ~ Medium Rock

~ to ~ Hard Blue Rock

....§L to _7_1 _ Soft Cinders

to

to

to

to

to

to

to

to

to

to

to

to

Remarks:

o DRILLER'S LOG

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

WtI.«LeveI CI- Dates Depths(Il) Rock Description WeI.«LeveI CI- Del.es

~ to

~ to

~ to

~ to

~ to

~ __ to _

__ to __

to

to

__ to __

to

to

to

to

to

to

__ to __

__ to_

weR1 Fonn 6/12/07 Page 3 of 5

--------------------------_ ... _--------------------

MEMO and ROUTE fiup (ver.9/09/2008) o

09/30108

WCR 2 Check for Well No. 5552-02 (survey to regulation memo)

1. From Charley/Deni / ~

2. Pump Tests Check' special condition of PIP? Yes/No) D. England ___ (initial)

Step-Drawdown Test:


Aquifer Pump Test:

o o

followed WCPI Stds 0 T & S analysis attached 0

Potential Well Interference: 0 Potential Stream Impacts: 0

Additional Testing or Data Required:

Pump Test Comments Attached:

Proposed Pump Capacity is OK.:

o

o

o

o o

o o

o o

o

o

o

If no, describe deficiency

0<70 gpm no test required

0<50 gpm no test required

stream names:

3. Pump Installation Check Mitch Ohye f , :\~~-' I \/ (initial) R. Torres __ (initial)

Yes No If no, describe deficiency

data complete followed Special Cond & Elev.

well database updated

CJ 0 o . 0 0/ 0

4. Charley/ Deni~;.;~y~a:.:.n:...~~~ ___ (initial) take action based on above analysis

ATTACHMENTS FOR ACCEPTANCE: 1WCR2 ACCEPTANCE LETTER

2PUMP INST. COMPLETION CERTIFICATE

3METER INSTALL. REPORT (IF NECCESSSRy) __ _

l' To be sent to drilter

J To be sent to landowner/operator

} Staff internal checks

5. Roy (initial) check(Entered WCR 2/PICC accept date into database)

6. Susan Hoagbin (initial) finalize

7. Ken (initial) signature

8. Faith Ching (initial) enter into WUR database

9. Charley/ Deni@yan~le

o 0 State of Hawaii For Official Use Only:

COMMISSION ON WATER RESOURCE MANAGEMENT Deparbnent of Land and Natural Resources WELL COMPLETION REPORT - PART II Pump Installation

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 Construdion and Pump Installation Standards or call the Regulation Branch at 587-0225. For updates to this form or additional information, please visit our website at http://www.state.hi.usldlnrIONrm/

DB Sf? 29 A 9: 3 0

1. State Well No.: 5552-02 Well Name: Yellow Tan~ Island:Hawaii

2. Address: 68-1115 Honokaope Place, Hawaii Tax Map Key:6-8-033:001

3. Pump Installation Company:Derrick's Well Drillin~ & Pum£ Services, LLC

4. Date Pump Installed: 9/26/2008 monthldaylyear

5. PERMANENT PUMP INFORMATION

Pump Type, Make, Serial No.: Grundfos, Submersible, A06110004-P10725517

Rated Capacity: 60 gpm at head of: 93 ft. Motor Type, H.P., Voltage, rpm: Franklin, 2HP, 230V, 3450RPM

Pump type (check one):

o Deep Well Turbine o Rotary o Propeller 181 Submersible o Rotary-Displacement o Reciprocating o Centrifugal o Rotary-Gear o Impulse

6. Method of flow measurement:

181 Flowmeter Manufacturer Master Meter Model no. 6900384 Size 1-112"

o Other, explain and attach schematic

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

8. Attach the rating curve for the installed pump.

Attach photograph of well clearly showing the benchmark on the concrete pad, the well head, and the 9. method of flow measurement.

10. Well Owner Company Jim Mair Contact Jim Mair

Address 112 Puako Beach Drive, Kamuela, ill 96743

Phone 885-4190 Fax

11. Land Owner Company Same Contact Same

Address Same

Phone Same Fax

12. Remarks

Derrick's Well Drilling & C-57/C-57a1A Lic. No.C-28001 Pump Installation Contractor (print) pumn Services I I C

Signature 0~~ Date 9/26/2008

o o 7 • AS-BUILT PUMP SECTION (Please attach as-built if different from diagram provided below)

Bench mark elevation surveyed to nearest 0.01 ft. =

39 ft. mean sea level

~ •. :: : . .; ........ ~: . ... ~ .. ~ : .. ; .. " .. :: .... ;

SWL 37'

Elevation of top of chase tube n/a ft. mean sea level

Pump intake depth = 50 ft. (referenced to bench mark)

Chase tube depth = nla ft . .jf-_-/-_ (referenced to bench mark)

If airline installed, bottom of airline elevation = 48 ft. mean sea level

WCR2 Form 2126107 Page 2 of 2

Attach photos of completed well and concrete pad

o

NAD83: Latitude: 19 degrees 55 min 58 sec Longitude: 155 degrees 52 min 55 sec

o

EXAMPLE

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

weR1 Form 6112107 Page 4 of 5

06110004 60820-4

H (ft)

120

100

80

60

40

20

o o 60S20-4

Liquid temperature = 32 OF

%~ _____ 1~0~ __ ~2~0~ ____ ~30~ ____ ~4~0 ____ ~5~0 ______ 6~0~ ____ ~70~ __ ~Q~(~US~gp~m~) P2

(HP) 3

0.5

o

Printed from Grundfos CAPS GRUNDFOS·~ 1/1

9..MISSION ON WATER RESOURCE MANAGEME9 ROUTE SLIP FOR PERMIT ISSUANCE 6/25/08

FROM: RYAN

CHENG, C. CHING, F. CHONG,R. DANBARA, S. ENGLAND, D. FUJII, N.

-1-HAROY,R. Ii -2-HOAGBIN, S.

ICE,C. IMATA, R.

-3-KAWAHARA, K.==

DATE: 7/22/08

KIMURA, J. KUNIMURA, I. LEROUX, E.

MILLS,D. ~ OHYE, L.

-4-0HYE,M. SAKOOA, E. SWANSON, S. UYENO, D. YODA, K.

--YOSHINAGA, M.

SUSPENSE DATE:

Approval -3-Signature

4 Information

WELL NUMBER 5552-02 WELL NAME Yellow Tang

application type BOTH J 1 WCP COVER lETTER -Z 2WCP ~/ 3 WEll CHECK PRINTOUT ~

proposed well section issu~

4 PIP COVER lETTER 5 PIP

COMMENTS: 6 SOWB 7 WWB 8 CWB 9 lO

10 HP

date rec'd

ifj issues?

11 lUC 12 OCCl ~ ~~}cr=:....---------13 SMA ~SMA.'~J~I_' ____________ _ 14 BWS

NOTES: DRILLER

TMK

phone fax cell

PUMP CAPACITY WELL OWNER LANDOWNER COMMENT DEADLINE

Derrick Moreira Derrick's Drilling and Pump Service 28002 P.O. Box 2187 Keeau 982-7627 982-7698

o

6-8-033:001 60

Jim Mair Jim Mair

HI

5/5/08

96749

PLEASE:

See Me -1-Review & Comment

Take Action Type Draft

-2-Type Final --File --Xerox copies

if checked, send to applicant

\

LINDA LINGLE GOVERNOR OF HAWAU

Ref: 5552-02.pip

Mr. Derrick Moreira

o o




Derrick's Drilling and Pump Service P.O. Box 2187 Keeau, HI 96749

Dear Mr. Moreira:

Pump Installation Permit Yellow Tang Well (Well No. 5552-02)


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

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

KEN C. KAWAHARA, PE. DEPUTY DIRECTOR

July 30, 2008

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 11:

Special Conditions

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

2. 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.

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

Please sign both permit originals and return one 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 Ryan Imata of the Commission staff at 587-0255.

Sincerely,

~d,;~~L WL .RAH. T LEN "1. _. C lrperson

Enclosure

c: Jim Mair (with applicable comments - DOH WWB, CWB) USGS HawaiiDWS

o PUMP INSTALLATION PERMI9 Yellow Tang Well. Well No. 5552-02

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

In accordance with Department of Land and Natural Resources, Commission on Water Resource Management's Administrative Rules, Section 13-168, entitled "Water Use, Wells, and Stream Diversion Works", this document permits the pump installation for Yellow Tang Well (Well No. 5552-02) at TMK 6-8-033:001, Hawaii, 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.

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 60 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 60 days after completion of work. This form can be obtained by contacting staff or on the internet at www.hawaiLgov/dlnr/cwrm.

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 any related staff submittal approved by the Commission are incorporated into this permit by reference. This permit is also subject to the HWCPIS. 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.

10. 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.

II. 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.

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

Date of Approval: Expiration Date:

July 11, 2008 July 11,2010

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:

Printed Name: Derrick Moreira

C-57, C-57a, or A License #: C-28001 Date:

Derrick's Drilling and Pump Firm or Title: Service

~~~-----------------

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

Attachments


Ref: 5552-02.wcp

Mr. Derrick Moreira

o o




Derrick's Drilling and Pump Service P.O. Box2187 Keeau, ill 96749

Dear Mr. Moreira:

Well Construction Permit Yellow Tang Well (Well No. 5552-02)



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



July 30, 2008

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 13:

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 for our files. For copies of the aquifer pump test worksheet, please call staff or visit www.state.hi.us/dlnr/cwrmlfonns.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 Ryan Imata of the Commission staff at 587-0255.

S~incerely,c. ~a-wtv L-Cv LA .RAH. T LEN ""r Ch lrperson

Enclosures

c: Jim Mair (with applicable comments - DOH WWB, CWBS) USGS HawaiiDWS

/

o o WELL CONSTRUCTION PERMIT

Yellow Tang Well, Well No. 5552-02 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 Yellow Tang Well (Well No. 5552-02) at TMK 6-8-033:001, Hawaii, subject to the Hawaii Well Construction & Pump Installation Standards (HWCPIS - February 2004) which include but are not limited to the following conditions:

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

II.

12.

13.

14.

15.

The Chai1J!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.

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 rump test worksheet can be obtained by contacting Commission staff or at www.hawaii.gov/dlnr/cwrmlforms.htm). The permittee shal sulimit 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 pumll installation permit is approved and issued by the Chliirperson. 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.

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.bawaii.gov/dlnr/cwrmlforms.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 any related staff submittal approved by the Commission are incorporated into this permit by reference. This permit is also subject to the HWCPIS. 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 Chrurperson upon a shOWIng of good cause and good-fruth 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) prior to any well sealing or plugging work.

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

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

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

Date of Approval: July 11, 2008 Expiration Date: July 11,2010

EN, Chairperson iss ion on Witter Resource Management

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

Driller's Signature: C-57 License #: _C:::::--=2:..::::8.:::;00::..::1~ __ _

Printed Name: Derrick Moreira Firm or Title:

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

AttacIunent

Date: -------Derrick's Drilling and Pump' Service

/' !

o o

Results

Jun-za-~109 ~:26am

TO:

FROM:

SUBJECT:

From-DEPT OF HEA~-" ENVIRONMENTAL MNGMT 8085864352 T-756 P.004/006 F-502

STATE OF HAWAII DePARTMENT OF LAND ANI:! NATURAL RESOURCES

COMMISSION ON WATER RESOURCE MANAGEMENT P.o. BOX 621

HONOLULU. HAWAII 9S(l09

June 12, 2008

Honorable Chivome L. Fukino, M.D., Director Depanment o(Health Attention: Director's Office

Tomas See, Chief, Wastewater Branch Stuart Yamada, Chief, Safe Drinking Water Branch ~lec Wong, Chief, Clean Water Branch

Laura H. Thielen, Chairperson 'f1 Commission on Water Resource Management

Well Construction/Pump Installation Permit Application Yellow Tang Well (Well No. 5552-02j

2B~~~~~o~~10:24R~ MEREOITH J. CHIN~ JAMES A. F~I"Fl NEAL S. FUJIWARA ~

CHIYDME L. FUKINO. M.O. • DONNA FAY I(.KIYOSAKI, P.E LAWRENCE H. MilKE. M.D., J.D.

KEN C. KAWAHARA. P E. OEP .... T'( c"AeCTI),oi

Transmined 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 applicadon for any conflicts or inconsistencies with the programs. plans, and objectives specific to your department. Please re.'i ond b rcturninf this cover memo form by Julv 1l~ 2008. Tfwe do not receive comment~ or a request or additiona review time by this dale, we will assume that you have no comments.

Please find the attached maps to locate the proposed well. If yon have any questions about this permit application, request additional information, or requesT additional review time, please contact Ryan Imata of the CommissIOn staff at 5&7-0255.

RI:ss Attachment(s )

RESPONSE:

[ 1

[ 1

r 1

( 1

[ 1

J r l

Thi, well q"alifi ••• s •• "'.-cC whioh Will ,elve 'IS" SOIl«C of pOJabk wat"r to a p"bl,c wilt'" Sy,.om (a..£lned~ •• orviQI'i 25 ar m(>1'~ p¢Ople at leasr 60 d~ys JWIr Y0;1r Of J~&s 1 S ot '-hl(c safVIC;U cam'Ld:clioIH) and .usr ~Cdl"'tI Pm~clor ()J:' HtI.:dth ,*pprOVi:1J ~ (0 l[;!i mit:! to oomply with Hawaii Admillisluilive ftule~ (N!<R), T\tI~ 11, Cll~p~or 20, Rul •• 1t.I"ting ~o Po\;lb]c W.lc!r !:lY~l~m~, § 11·~() .. 29.

T'llis IN<lIl does 110[ q\\alify as a SOllrct serving a public warcr gyst~m (6lll'VQ~ l~ss tl,&n25 poople '" rno", !",cple ~11.~~t 6U 4RY~ per year or 15 service cunn~ollon~) ~n<l ifU,. well wal~r i. Il~"" fOI <Inll~ing, 1/1. pl'''"I. own<r.hollld I~t fCl b~ot~noloSlcal and o/l~mical pr.sence llcforo initiuillg """Ii II'" and rolltincly monitor Ih. w.lIOr qlllllilY thorcaIWr. How~v.r. if f1lturc planned usc from Ihis Ilc>~(ce iJlcrCS8(!S ra IllC':': Die pubhc w~t .... y~l.m dofinihon the" DifBtIOt af Hualrh approval is rOQuirud 1lriru: to i,.plcillulilatioli.

Ifrh~ ",ell i. lJactitO supply bOlh pornblclI!ld non-potable purposes in a sinl!lr s)islcm. the uSer gh~11 ~li!l'uil;!.te ttMS-CCIlliuttien. atu! b'lokt\(lw cOilnemon' by pilY3ically separating pctablc and nOIl-polab!c systems by an ait ~ap Or an appro,"", backnuv. prev.n .... , ""d hy clQrlrly labclin8 all nonpt)lab~d spiSQts ""jIlL watniliS sisus [0 pi(;Vc(a[ lnadvet'lLln[ COIISLlI'llptlOIl uf nOn .. pOl~b]t3 watF"r BoackOow prdv~nljon clf;vi~e;o; ~hould b~ rominely illSPCc[C'd ,aIld''':!:lluQ.

LI does nOI .ppe ... rhal Ihls well will bc uo,d fat C(llISUIII]llivc ~u"",.~, ODU .. nol .. \bJocl 10 s~f. Dnnkms W"'O. Rdg1llal1oQ~.

Filt rhe applican~s UifQ(marioll. a ilOwCC of pc.ssibk ", •• I(;Water COlltaUlluanOn Iii> II i. nallo(~.O<J n",*r l!te prcpo><d w<1I ~ItC (inlormnlion attached).

OIhcr rcl~vam DOH r~I~~llcelillnon., mt~rm«hon, or recomlm'ndmioos arc nrtllChcd

In the event that rlie location afthe w¢lI ohanges bllt is .tlll within the parcel described on rhi. applicari()fl. OLl' di.i.",,, (:I>",i&' .. Ihe COm!1l"nl~ 10 ~hll be npphcDble. Rnd ",..., do not n.,od to re".iflw tho ne'\.V looation

( 1 No tomn\~"I~lobjt"riil\\S

Contact Person: ~ L.;. )<40

Signed: ~~

JU~~ - 20 - 2008 08: 098M Ff=1X:8085864352

Phone: t6~. tJ'§o 9 Date: (V ZO .. 00

ID:DLNR CWRM P8GE:004 R=97%

Jun~ZO~008 ~8:25am From-DEPT OF Ht) ENVI RONI.'CNTAL IANGfilT 8085864352 o T-756 P.OOI/006 F-502

FAX TRANSMITTAL State of Hawaii Department of Health Environmental Management Division

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

Fax No.: (808) 586·4352

Fax to: Qir. Ryan~ Mr. Charley lee Company: Commission On Water Resource Management

Department of Land and Natural Resources Fax No.: 587-0219

Date: (p . -z..o ~ 06

Fax from: Joanna L. Seto 11 Total Pages. incl. cover: ~

Subject: Well Construction/Pllmp Installation Permit Application(s) Well No(s). jG,61'" ""I 555'2-01-) 1 ft;5 +-01 ~ ,,55'- i{

The Department of Health. Clean Water Branch (CWB) has the following comments:

1. For Well-Drilling Activities

Any discharge to State waters of treated process wastewater effluent associated with well drilling activities is regulated by Hawaii Administrative Rules (liAR), Title 11, Chapter 55, Appendix I. effective October 22, 2007. Treated process wastewater effluent covered by this general pennit includes well drilling slurries, lubricating fluids wastewater, and well purge wastewater. This general permit does not cover well pump testing. The applicable Notice oflntent (NOl) Forms and filing fee shall be submitted at It;ast 3D calendar days before the start of discharge to the:

Department of Health Clean Water Branch 919 Ala Moana Boulevard. Room 3D 1 Honolulu. Hawaii 96814-4920

The eWB-NO! Forms are available online at h:m>:!lwww.hawaii.govlhealth/environmentallwater!cleanwater/forms/genl-index.html. Inquiries may be directed to the eWB 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 pollutanls. 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 pennission from the owner of the storm drain prior to discharge. Furthennore, best management practices shall be implemented to prevent the discharge from collecting sediments and other pollutants prior to entering the stonn drain .

.JUN-20-2008 08:08RM FRX:8085864352 ID: DLNR CWR~1 PRGE:001 R=96%

Jun-.201008 1!8:25amc

··From-DEPT OF HO ENVIRONMENTAL IIIGMT

Mr. Ryan !mata / Mr. Charley Ice Commission On Water Resource Management

8085864352 ~ T-756 P.002/00S F-502

FAX TRANSMITTAL Page 2

3. For Construction Activities Distuibing One (1) or More Acres ofTota! Land Area

By HAR, Title 11, Chapter 55, Appendix C, effective October 22, 2007, an NPDES permit or Notice of General Permit Coverage is required before the stan of the constrUClion 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 to the start of construction activities.

JUN-20-2008 08:08RM FRX:8085864352 ID:OLNR CWRM PRGE:002 R=97%

o o LINDA LINGLE LAURA H. THIELEN

GOVERNOR: OF HAWAII CHAIRPERSON

TO:

FROM:


COMMISSION ON WATER RESOURCE MANAGEMENT' P.O. BOX 621


June 12, 2008

Morris Atta, Acting Administrator Land Division

Ken C. Kawahara, P.E., Deputy Director 1 Commission on Water Resource Management

% (1)>00 ~C!t"'; l>;v "1,'1 ;;:t:z>;--l Orel "T!::;" ...,

:x:t"flr »<nJ> °z ~§3o =n~ ",

(I)

MEREDITH J. CHING JAMES A FRAZIER NEAL S. FUJIWARA

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


I r

i; l> z::O OI'Tr

WI O~ « » ~"" -0 • 0 Z

# 0

SUBJECT: Well ConstructionlPump Installation Permit Application Yellow Tang Well (Well No. 5552-02) TMK 6-8-033:001

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 July 11,2008. 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 Ryan Imata of the Commission staff at 587-0255.

RI:ss Attachment( s)

RESPONSE:

[ ] A water lease/pennit is required of this applicant and an application for such will be requested l@ur division. ("'il

. -'"'!" S-A water lease/pennit is not required of this applicant.~: ~

"./"'1 - " [Xl(

[ ]

[ ]

[ ]

A water lease/penn it has been obtained by the applicant through lease no. ------:·~4ti~·.·,-iI1IC&;.---(.Q---· :i Other relevant Land Division rules/regulations, infonnation, or recommendations are ltta~d. ~ rn

XX]

). - ....., ~)~. '-,.I No objections ~.;; ••

;;~::;! C)

Other comments: Original source of private title is Land Cciimlssio~ward 4458: 4 issued between 1845 amd 1855.

Contact Person: Gary Mart i n Phone: 587-0421

Signed:--,~"--,,,oL...:.---=---+-_~ _____ · ____ _ .. .!UN 1 8 2008

Date: _______ _

, ....

o o LINDA LINGLE

GOVERNOR OF HAWAII LAURA H. THIELEN

CHAIRPERSON

TO:

FROM:

16 AM 8 1ft STATE OF HAWAII

DEPARTMENT OF LAND AND NATURAL RESOURCES COMMISSION ON WATER RESOURCE MANAGEMENT

P.O. BOX 621 HONOLULU, HAWAII 96809

June 12, 2008

Honorable Chiyome L. Fukino, M.D., Director Department of Health Attention: .pirector's Office

Jr omas See, Chief, Wastewater Branch Stuart Yamada, Chief, Safe Drinking Water Branch Alec Wong, Chief, Clean Water Branch

Laura H. Thielen, ch~irperson 1 Commission on Water Resource Management


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

KEN C. KAWAHARA, P.E DEPUTY DIRECTOR

SUBJECT: Well ConstructionlPump Installation Permit Application Yellow Tang Well (Well No. 5552-02)

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 returning this cover memo form by July 11,2008. If we do not receive comments or a request for additional review time by this date, we will assume that you have no comments.

Please find the attached maps to locate the proposed well. If you have any questions about this permit application, request additional information, or request additional review time, please contact Ryan Imata of the Commission staff at 587-0255.

RI:ss Attachment(s)

,"': 3: rn RESPONSE: 'c~ 'fl n

(i"V" -' [ I

[ I

[ I

This well qualifies as a source which will serve as a source of potable water to a public water system (defined as serving 2~~ Q-e people m'lfast 60 ~ days per year or has 15 or more service connections) and must receive Director of Health approval prior to its use to comRl:tWilli Hawaii AdministrativeL Rules (HAR), Title II, Chapter 20, Rules Relating to Potable Water Systems, §11-20-29. :.: ••. ? _ -..... ::z: .. \11 This well does not qualifY as a source serving a public water system (serves less than 25 people or more people at least 60 kYs JE:year or l~rvice CJ connections) and if the well water is used for drinking, the private owner should test for bacteriological and chemical presenoelb'lfere initiatillg·such use and routinely monitor the water quality thereafi,er. However, if future planned use from this source increases to meet the pu~ ~r system W:fInition then DIrector of Health approval IS reqUIred pnor to ImplementatIOn. ~:':A' --

:,:~;':>J ......

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.

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

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

[ I

¥ An NPDES permit is required. 0 ..J.L ( Other relevant DOH rules/regulations, information, or recommendations are attached. etd.Ct ~Ih I t ~ .s In the event that the location of the well changes but is still within the parcel described on this apMication, our division considers the comments to still be applicable, and we do not need to review the new location.

~ No comments/objections ,

Contact~~n:.~ In i:!m Phone: 32'2"1'I~ Date: (0-17 .. 0 f; Slgned:_~ ___ ~--=,-__ ,-_--,---,,-,I"L--...... I--,-fDn.:---=-__

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• o o Ar11 Q so Fr t (' r: ! V r:: D LAURA H. THIELEN

c. , . CHAIRPERSON GOVERNOR OF HAWAII

PLANhjj~!C~ LT;-'\FlTMENT COUNTY OF H/\WAII' 08 JI.JL I


A In ~.~~I.0ME L FUKINO, M.D.

Mr. Chris Yuen, Director Planning Department County ofRawaii 10 I Pauahi Street Rilo, HI 96720

Dear Mr. Yuen:

IU IJ.~ ltV K KIVOSAKI, P.E 'fiE H. MilKE, M.D., J.D.

S T Ct:!411/"("'/ KEN C. KAWAHARA, P.E. TA E OF HAWAII p ... ;;' 'j . .) • .' 0" t:J#' I DEPUTY DIRECTOR

DEPARTMENT OF LAND AND NATURAL RESOURC{S.I tC'- '., l: I !.I..I rr . COMMISSION ON WATER RESOURCE MANAGEMENT~ ···',r:'/.(t:],

P.o. BOX 621 "'.1 , HONOLULU, HAWAII 96809

June 12,2008

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

Yellow Tang Well (Well No. 5552-02)

Transmitted for your review and comment'is a copy of the captioned Well ConstructioniPump Installation pennit application.

We would appreciate your comments on the captioned application with regard to the SMA pennitting requirements specific to your division. Please respond by returning this cover memo form by JUlt 11, 2008. If we do not receive comments or a request for additional review time by this date, we will assume you ave no comments.

Please find the attached maps to locate the proposed well. If you have any questions about this pennit application, request additional infonnation, or request additional review time, please contact Ryan Imata of the Commission staff at 587-0255.

RI:ss

RESPONSE:

Sincerely,

W.fin 1"L

LAURA H. THIELEN Chairperson

SCANNED

By: ~Nf~'~O

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

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

[ ] No objections

[ ] Other comments:

Contact Person: __ -IE;;........ _I ... m~aIII ...... lu.r-"a>--__________ _ Phone: (808) 961-8288

Signed: ___ s=---b-"'-M---==----=.~"___=. '--'------=-____ _ Date: 6/26/08

COMMQN ON WATER RESOURCE MANAGEMENT 0 ROUTE SLIP FOR NEW APPLICATIONS

FROM: RYAN

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

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

-2-HOAGBIN, S. ICE,C.

-5-IMATA, R. -3-KAWAHARA,K.==

DATE: 7-May-08

KUNIMURA, I. NAKAMA,L.

-4-0HYE,M. SAKODA, E. SWANSON, S. UYENO, D. YODA, K.

SUSPENSE DATE:

, 1 Approval ~ -3-Signature

~ 4 Information

~

--YOSHINAGA, M.-

WELL NUMBER ~~ '1- - 0 -z....

!Z1 WELL CONSTRUCTION

WELL NAME Yellow Tang

~ PUMP INSTALLATION

ATTACHMENTS FOR APPLICATIO~P CESSING - Both applicant & staff generated 1 TRANS. LEITER

2 PERMIT PROCESS TABLE

3 CWRM MAP -;z-4 APPL. FORM (11 COPIES) --;;r-5 USGS MAPS (11 COPIES)

6 TAX MAPS (11 COPIES)

7 PARCEL OWNER VERIF.

8 CONTRACTOR VERIF.

9 ALL INFO FILLED IN

-7 ~ MLS PRINTOUT ~ DCCA LICENSE SCREEN PRINTOUT

14-May-08

PLEASE:

See Me -1-Review & Comment

Take Action --Type Draft acknow letter -2-Type Final, label file folder, update People.db -5-File

Xerox copies

WUP Number

o WUPA

10 BACKGROUND CHECK

11 $25 FEE DEPOSIT SLIP

12 DHP/CDUP/SMA pre·screen

~/ • 1- • \V1 ~ M)t V'W' ~ (h v9

=z{SMA map printout http://gis.hicentral.comlwebsite/parcelzoning/viewer.htm.,or INGRID'S SMA/CD MAP) (LUC map printout http://luc.state.hLuslluc_maps.htm., or INGRID'S SMA/CD MAP)

FOLDER:~ MADE NEW FILE FOLDER, ATTACHED

o FILE FOLDER ALREADY MADE, IN FILE CABINET

INCOMPLETE ACTION DATES:

DATE ACTION


Mr. Derrick Moreira

o


COMMISSION ON WATER RESOURCE MANAGEMENT po. BOX 621


June 12, 2008

Derrick's Drilling and Pump Service P.O. Box 2187 Keeau, HI 96749

Dear Mr. Moreira:

o LAURA H. THIELEN

CHAIRPERSON


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

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

KEN C. KAWAHARA, P. E DEPUTY DIRECTOR

5552-02.ack

Well ConstructionlPump Installation Permit Application for Well No. 5552-02

We acknowledge receipt, on May 5, 2008, of your completed Well ConstructionlPump Installation permit application and filing fee for the Yellow Tang Well (Well No. 5552-02). 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 Ryan Imata of the Commission staff at 587-0255.

Rl:ss Attachment

c: Jim Mair

Sincerely,

Wf7f1 ~

KEN C. KAWAHARA, P.E. Deputy Director


TO:

FROM:

SUBJECT:

o o


COMMISSION ON WATER RESOURCE MANAGEMENT po. BOX 621


June 12,2008

Honorable Chiyome L. Fukino, M.D., Director Department of Health Attention: Director's Office

Tomas See, Chief, Wastewater Branch Stuart Yamada, Chief, Safe Drinking Water Branch Alec Wong, Chief,Clean Water Branch

Laura H. Thielen, Chairperson '11 Commission on Water Resource Management

Well ConstructionlPump Installation Permit Application Yellow Tang Well (Well No. 5552-02)



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




We would appreciate your comments on the captioned application for any conflicts or inconsistencies with the programs, plans, and objectives specific to your department. Please respond by returning this cover memo form by July 11,2008. 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 Ryan Imata of the Commission staffat 587-0255.

RI:ss Attachment(s)

RESPONSE: [ I This well qualifies as a source which will serve as a source of potable water to a public water system (defined as serving 25 or more people at least 60

days per year or has 15 or more service connections) and must receive Director of Health approval prior to its use to comply with Hawaii Administrative Rules (HAR), Title II, Chapter 20, Rules Relating to Potable Water Systems, §11-20-29.

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

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

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

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

[ I An NPDES permit is required.

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

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

[ I No comments/objections

Contact Person: Phone: ------------------------------------- -----------

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


TO:

FROM:

SUBJECT:

o o




June 12,2008

Morris Atta, Acting Administrator Land Division


Well ConstructionlPump Installation Permit Application Yellow Tang Well (Well No. 5552-02) TMK 6-8-033:001



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

KEN C. KAWAHARA, P.E DEPUTY DIRECTOR


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 July 11,2008. 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 Ryan Imata of the Commission staffat 587-0255.

RI:ss Attachment( s)

RESPONSE:

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

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

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

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

[ ] No objections

[ ] Other comments:

Contact Person: Phone: -------------------- ---------

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


TO:

FROM:

SUBJECT:

o o




June 12,2008

Dr. Puaalaokalani Aiu, Administrator Historic Preservation

Morgan Davis Historic Preservation


Well ConstructionlPump Installation Permit Application Yellow Tang Well (Well No. 5552-02) TMK: 6-8-033:001



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

KEN C. KAWAHARA, P.E. DEPUTY DlRECT9R


We would appreciate your comments on the captioned application with regard to the programs, plans, and objectives specific to your division. Please respond by retnrning this cover memo form by July 11, 2008. If we do not receive comments or a request for additional review time by this date, we will assume you have no comments.

Please find the attached maps to locate the proposed well. If you have any questions about this permit application or request additional review time, please contact Ryan Imata of the Commission staff at 587-0255. 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.

RI: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. Chris Yuen, Director Planning Department County of Hawaii 101 Pauahi Street Hilo, HI 96720

Dear Mr. Yuen:

o o




June 12,2008

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

Yellow Tang Well (Well No. 5552-02)


MEREDITH J. CHING JAMES A FRAZIER NEAL S. FUJIWARA

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

KEN C. KAWAHARA, PE DEPUTY DIRECTOR


We would appreciate your comments on the captioned application with regard to the SMA permitting requirements specific to your division. Please respond by returning this cover memo form by July 11, 2008. If we do not receive comments or a request for additional review time by this date, we will assume you have no comments,

Please fmd 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 Ryan Imata of the Commission staff at 587-0255.

RI:ss

RESPONSE:

Sincerely,

w.f7n 1't

LAURA H. THIELEN Chairperson

[ ] 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: _______ _

_ PM UN , U

Well Background Check Well Construction Pump Installation

Approved Well No. Well Name Applicant Driller Pumplnst. Type Issued Signed WCR1 Accept Issued Signed WCR2 Accept

Yellow Tang Jim Mair C-28001 C-28001 BOTH

Well 1 Pahinahina Property LLC C-28001 C-28001 BOTH

5058-06 YY Investments, YY Investments, LLC C-28001 C-28001 BOTH

6652-01 Puanui 1 KS/BP C-28001 C-28001 BOTH

5058-07 Panattoni Carl D. Panattoni C-28001 C-28001 BOTH

6/18/1992 3587-02 HPP-Newmans Newmans Nursery C-28001 WELL 6/18/1992 5/212008

115/2007 3185-03 Rainbow Serpent Fred Page Drilling Int'l C-28001 C-28001 BOTH 1111912007 11119/2007 4/2812008 11/1912007 11/1912007 4128/2008

9/15/2007 3388-02 Moreira Derrick Well Drilling & Pump S C-28001 C-28001 BOTH 11/28/2007 1212112007 1112812007 12121/2007

~ 10124/2007 5914-01 Broda Edmund Broda C-28001 C-28001 BOTH 1112812007 12/21/2007 1112812007 1212112007

11/5/2007 4958-02 Chai Kona Village Partners C-28001 C-28001 BOTH 11/2812007 1212112007 11/28/2007 1212112007 S".-fl"1j

1/10/2008 2983-03 Hellstern D.L.H. Enterprises LLC C-28001 C-28001 BOTH 3/19/2008 3/24/2008 3/1912008 3/2412008 W7 2/412008 5058-05 Pilara Mary Pilara C-28001 C-28001 BOTH 3/4/2008 3/612008 5/212008 3/4/2008 3/6/2008 5/212008 ~~

2114/2008 3687-56 Kuniyuki Kevin & Dayle Kuniyuki C-28001 C-28001 BOTH 3/412008 3/612008 5/1212008 3/4/2008 3/6/2008 5/1212008

o

Tuesday, May 27, 2008 Page 1 ofl

Search Results o o Page 1 of 1

Assessed Values reflect tax year 2008.

Search criteria: TMK Taxkey 3-6-8-33-1

• PUBLIC RECORD DATA Taxkey Subdiv/CondoTnrAddress Owner/Lessee 8d.s.8tbsLand area Liv area Last Saleln.5t

Oe3-6-8-33-149 Black Sand F 68-1115 MAIR 1994 REVOC TRO 0 1.43 ac 0 3/10/2005 DEE[ Beach HONOKAOPE

PL

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

Copyright ©5/27/2008 by Hawaii Information Service

http://webrel.hawaiiinformation.comlREsearchiHIS/Searchisearch _ PUB.asp?NOCACHE... 5127/2008

Professional and Vocational Licen~g (PVL) - powered by eHawaii.gov

'wi 0 Page 1 of 1

Professional and Vocational Licensing (PVL) Search - General Licensee

GENERAL LICENSEE

L1C ID: CT-28001 Active/Inactive: ACTIVE

NAME: DERRICK'S WELL DRILLING & PUMP SERVICES LLC

TRADE NAME:

STATUS: CURRENT, VALID & IN GOOD STANDING

ENTITY: ORGANIZATION (LIMITED LIABILITY COMPANY) BUSINESS CODE:

ORIG L1C DATE: 06/19/2007 EXPIRE DATE: 09/30/2008

CLASS PREFIX: C SPECIAL PRIVILEGE:

RESTRICTION: EDUCATION CODE:

BUSINESS ADDR: 15-2005 29TH AVE KEAAU HI 96749

MAILING ADDR: POBOX 2187 KEAAU HI 96749

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

587-3295.

License information on this site reflects information in the Professional

http://pvl.ehawaiLgov/pvlsearch/app?_a=d&_ f=n&lictp=CT &licno=2800 1 &off=&run=DE... 5/27/2008

DEQ..MENT OF LAND AND NATURAL RESOURQ DOCUMENT NO .. UAC OR ATIACHED WORKSHEET DATE M 5 2008 ay ,

SRC/ COST F YR APP D OBJ CTR PROJECT PH ACT AMOUNT NAME/DESCRIPTION 0IJANG INPUT)

S 08 326 C 1026 0752 (1 ) $50.00 Derrick's Well Drilling n n n n n n (2) $25.00 Derrick's Well Drilling

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

TOTAL $ 75.00

REMARKS: LINE (1) Well 1 & 2, TMK: 7-2-31:4 LINE (2) Yellow Tang Well LINE (3 LINE (4) LINE (5) LINE (6) LINE (7) LINE (8) LINE (9) LINE (10)

,"

STATE OF HAW~ 0 DEPARTMENT OF L.1IIB AND NATURAL RESOURCES ' COMMISSION ON WATER RESOURCE MANAGEMENT APPLICATION FOR A WELL CONSTRUCTION I PUMP INSTALLATION PERMIT

For Official Use Only:

Instructions: Please print in ink or type and send completed application with attachments to the Commission on Water Resource Management, P.O. Box 621, Honolulu, Hawaii 96809. Application must be accompan;ed by 6 copies and a non-refundabIe fifing fee of $25.00 payable to the Dept d Land and Natufal Resources. The Commission may not accept incomplete applications. For assistance, caR the Regulation Bnmch at 587-0225. For further information and updates to this application fonn, visit hIIp:lIwww.hawaii.govldlnrlcwrm.

r I " , , -.r::L'·; ,

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WELL LOCATION INFORMATION 4.TMK 1. STATE WEll NO. [If already assigned) 2. WELL NAME

Yellow Tang 3. ISlAND

Hawaii 6 8 - 033 : 001 ------following be attached before IJ1is application is accepted as complete (check off if attached):

Portion of 7.5-Mintde Series USGS topographic map (scale 1 :24,000) with welllocafiOn labeled and include the name of the quad map Property tax map, showing well location referellced to established property boundaries PhoIograph of the proposed well site A schematic diagram shoWing the well site, access road and proposed well infIasIrudure

5. WELL OPERATOR'S NAMElCOMPANY

Jim Mair Well Operator's Mailing Address 112 Puako Beach Drive Kamuela, HI 96743

Well OperaD's Fax

PROPOSED WELL CONSTRUCTION 7. Proposed Work

181 Construct New Well o Modify Existing Well o AbandoniSeal WeR

8. Construction Type 181 Drilled o Dug o Shaft o Tunnel

o Well is in Conservation District

and finish 6. LANDOWNER'S NAMElCOMPANY

Same Landowner's Mailing Address Same

10. Proposed Work 11. Proposed Pumping Rate, gpm 181 Instal New Ptmp (gallons per minute) o Replace Pump 60

r-------------------~ 12. Proposed Amount of Withdrawal, gpd (gallons per day)

o Required, COUP t# date approved __ _

o Not Required (attach documentation from OCCL)

Landowner's Contact Same

Landowner's E-mail same

13. Method of flow measurement 181 Flowmeter o Other (explain)

o I have not chec:ked with OCCL about whether or not a COUP is required. I understand that c:hec:king 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.

181 Well is not in Conservation District o I have not checked if wen is in or out Conservation District I understand that checfdng if the wen is in a Conservation District may expedite my review.

I further ~is Special Management Area

181 Required, SMA. 2 date approved _1978.-,-__ o Not Required (attach doclmentation from applicable County agency) o I have not checked with the county about whether or not an SMA Perm~ is required. I understand that checIdng with the County prior to making this

appliCation may expedite my review. I further understand that issues raised by this agency may delay or result in denial of the permit issuance, or of the after it is Issued.

181 I have consulted with the HPD tegarding potential impacIs of well construction activities on historic lies. I have aIIacfIed applicable documentation from the HPO. o I have not consuIed with the HPD tegarding potential impacts ofweH construction ac:tivilies on historic sites. 1 ... 1derstand that checking with the HPO prior to making this application may expedite my review. I further understand that Issues raised this agency may delay or result in denial of the

after attached.

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

NOTE: Signing below indicates that the signatories understand and swear that the inroonation provided is acx:uraIe and true to the best of their knowledge. Further, the signatories understand that upon permit approval: 1) the proposed work is to be completed within two (2) years of the approval date; 2) the contractor shall submit to the Commission a well compIetionIabandonment report within 80 days after the completion date d the permitted work; 3) in the event that the apprlCation is not correctly, permit may be suspended until the item is brought in to compliance, and any work done while the

25. PUMP INSTALLER (Must be filed out if application is for Pump Installation)

Derrick's Well Drilling & Pump Svc ..::.c..,,..:2==8oo::-;:.:::1~-:-:--_=-~ ~.:;: ##'"", C-57fC.57aJA License No. ~ //ur~ Derrick Moreira 4124/08 Signature Print Date

--------~

££ g 9 _l:::~~ -_._-

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o o PROPOSED WELL SECTION (Plea88 attach schematic if diffelent from diagram provided below)

Elevation at top of casing_61_ft., msl*

Grouting method o Positive

displacement

~ Other

Total Depth

65 ft

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

Annular space between

and casing (1.5" for positive displacement, 3D for other methods)

3 in.

Rock or Gravel Packing 25 ft

Material: ~ Crushed Basalt

Elevation:

8 ft. msl*

__ ..;,..-Minimum of 2' Radius & 4" Thick Concrete Pad (to contain benchmark surveyed to nearest 0.01 ft.)

- Ground Elevation: §Q ft., msl* mF~>==ZI-==---

Please refer to the HAWAll WELL CONSTRUCTION AND PUMP INSTALLATION STANDARDS

to ensure that your as-built is in compliance with applicable standards.

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

Total Length: 50 ft. Nominal Diameter: 6 in. Wall Thickness: .280 Schedule 40 PVC in. Bottom Elevation: 1 0 ft., msl*

Open Casing: 0 Perforated 0 Screen

Total Length: 10 ft. Nominal Diameter: 6 in. Wall Thickness: .280 Schedule 40 PVC in. Bottom Elevation: o ft., msl*

note: Neither bentonite nor mud should be uS8d in satUleted zone during drilling

Open Hole:

Length: ____ --'"'nI ... a'--_______ ft.

~iameter: ____________ in.

Bottom Elevation: ft., msl·

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

For non-saIt water Basal Wells - bottom elevation of~. should nat be deeper than 1/4 of aquifer thickness or, Bottom Bevation of Well Limit = (Water Elevation _ 41" w .. rr ..... ;'B1.evmm ) Example: Esllmated + 2 ft. water Level Elev. - Bottom Elewtion of WeD Limit .. ( 2 - ~) • -18.51l

Solid CaSing Material: Carbon Steel: compliant with (check ona or mOle): 0 ANSUAWINA C200 0 API Spec. 5L 0 ASTM A53 0 ASTM A 139

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


ASS 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




o Glass Fiber Reinforced Resin Pressure Pipe conforming to AWINA C950



Open Casing Material: Carbon Steel: compliant with (check one or mole): 0 ANSIIAWlNA C200 0 API Spec. 5L 0 ASTM A53 0 ASTM A 139

And compliant with (check one or mole): 0 ASTM A242 or A606 0 Type E 0 Type 5 0 Grade B 0 Other


ASS Plastic conforming toASTM 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




o Glass Fiber Reinforced Resin Pressure Pipe conforming to AWINA C950



WCPI App. Form 10105104

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state of hawaii department of land and natural … · 2012-06-14 · from: david chai subject:...

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