COMMISSION ON WATER RESOURCE

t" '. (

COMMISSION ON WATER RESOURCE MA~AGEMENT , (11/04) -

FROM: ROY DATE: JAN 18 2.005

TO: INIT, TO: INIT:

BAUER, G. CHING, F. DANBARA, S. FUJII, N. GOODING, K. HARDY, R. ft-HIGA. D.

_)'CE, C. -t It-J1ATA, R.

IZU, Y. KUNIMURA, I.

NAKAMA. L. NAKANO, D. OHYE, M. SAKODA, E. STAHL, K. SUBIA, S. SWANSON, S. UYENO, D. YODA, K. YOSHINAGA, M.

SUSPENSE DATE:

FOR: PLEASE:

Approval See Me Signature Review & Comment Information Take Action

Type Draft Type Final

~ile Xerox __ copies

o o NOTICE TO START DRILLING

DATE: 01114/2005

This is to inform you that we would like to start well construction on GAPP WELL, Well No. 3786-01 and would like to use the test pump as the permanent pump prior to final pump installation permit issuance. Fill free to call me at 808- 987 -8100 or home 808 -966- 6398.

Rod Diamond Well Driller/ Contractor BC23379

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-- o WELL CONSTRUCTION PERMIlQ Gapp Well, Well No. 3786-01

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

In accordance with Department of Land and Natural Resources, Commission on Water Resource Managemenfs Administrative Rules, Section 13-168, entitled 'Water Use, Wells, and Stream Diversion Works", this documentrermits the construction and testing of Gapp Well (Well No. 3786-01) at 15-1014 Pilikai, HPP, Hawaii, TMK 1-5-060: 076, subjec to the Hawaii Well Construction & Pump Installation Standards (February 2004) which include but are not limited to the following conditions:

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

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

The well construction permit shall be for construction and testing of the well only. A minimum 11/4-inch diameter monitor tube shall be permanently installed, in a manner acceptable to the Chairperson, (0 accurately record water levels. The permittee, well operator, and/or well owner shal coordinate with the Chairperson and conduct a pumping test in accordance with the Standards (a pump testing worksheet is attached). The permittee, well operator, and/or well owner shall submit to the Chairperson the test results as a basis for supporting an application to install a permanent pump and withdraw water for use. No permanent pump may be installed until a pump installation permit is approved and issued by the Chairperson.

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

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

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

The proposed well construction shall not adversely affect existing or futuro 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 determinalion of correlative water rights.

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

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

The well construction Q.ermit application is incorporated into this permit by reference and is subject to the Hawaii Well Construction & Pump Installation Standards (Februal)' 18, 2004; HWCPIS). If the HWCPIS are not followed and as a consequence water is wasted or contaminated, a lien on the property may result.

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

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

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

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

Date of Approval: January 3, 2005 January 3, 2007

PETER T. YOUNG, Chairperson Expiration Date: 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 driller have signed, dated, and returned the permit to the Commission. I also understand that non-compliance with any permit condition may be grounds for revocation and fines of up to $5000 per day/ rt' g from ,e pllIrmit date of approval. ./

Permittee's Signature: , Ii ;j Date: I" / {' -() s c:::J

Printed Name: Firm or Title: ______ ~_~::;..,.' C __ -) ___ CJ'1_· ____ _

Driller's Signature:

S:-: ~

~9£-~~~,"",,'"--"--- C-57 License # :'&t:S'S7Q , -: ~te: Et !~/$"" Printed Name: j?r,,1Adt K /2;'& A<'r14 Firm or Title: --i.O.,p..( ,c..<'<.IIVl ........... "4 ... CL....--...::. _____ ---,,-__

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

Attachment c: USGS

Department of Health! Safe Drinking Water, Wastewater, and Clean Water Branches Hawaii Department of Water Supply Rod Diamond

FROM: RYAN

QMISSION ON WATER RESOURCE MANAGEMENO ROUTE SLIP FOR PERMIT ISSUANCE

DATE: __ .....!(_~ __ I_~ ___ SUSPENSE DATE:

TO: INIT. TO: INIT. FOR: PLEASE:

BAUER, G. NAKAMA, L. Approval CHING, F. NAKANO, D. Signature DANBARA, S. -3-OHYE, M. 3 Information ~\ FUJII, N. SAKODA, E. -- /

\ ~ 10· o( GOODING, K. STAHL, K.

NY -1-HARDY, R. !E -2-SUBIA, S.

HIGA, D. SWANSON, S. ICE,C. UYENO, D.

-4- IMATA, R. YODA,K. IZU, Y. YOSHINAGA, M. KUNIMURA, I.

WELL NUMBER S 7 Sc,# () \ JlI WELL CONSTRUCTION

WELL NAME

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

COMMENTS: Due Date ~3 3 SDWB Date \ \ y\" 4 WWB Date \ '\.. 5 CWB Date ,\ t ~ TO BE SENT TO APPLICANT

6 HEER Date ~ 7 LD Date -4-8 HP Date ~ 9 PUMP TEST ~.,....."

·,~~~~.t_'PRtNrQ~r·<\~:;ijd FOR OFFICE USE ONLY

o PUMP INSTALLATION

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

COMMENTS: Due Date 3 SOWS 4 WWB 5 CWB 6 HEER 7 LD 8 HP 9 WCRII FORM

10 WURFORM

Date Date Date Date Date Date

'" <,· •.•.• ;v .. "''"'V'if!!liTitiif''·W·_· ... R .... 'S .. HE' ·c·T'· ."+11/",<(-· ", ~""<"/ ~'l':l '< ~~~:!?~rtwq~'-"H'~ ~'.. YV}~Jh\:tt*t¥1t"+¥

TO BE SENT TO APPLICANT

FOR OFFICE USE ONLY

See Me -1-Review & Comment

Take Action Type Draft

-2-Type Final -4- File

Xerox copies

.....

LINDA LINGLE GOVERNOR OF HAWAII

o o

STATE OF HAWAII DEPARTMENT OF LAND AND NATURAL RESOURCES

COMMISSION ON WATER RESOURCE MANAGEMENT P.O. BOX 621

HONOLULU, HAWAII 96809

PETER T YOUNG CHAIRPERSON

MEREDITH J. CHING CLAYTON W DELA CRUZ

JAMES A. FRAZIER CHIYOME L. FUKINO, M.D.

LAWRENCE H. MilKE, M.D., J.D. STEPHANIE A. WHALEN

YVONNEY IZU OEPUTY DIRECTOR

January 6, 2005

Ref:3786-01.wcp

Mr. John Gapp P.O. Box 1128 Pahoa, HI 96778

Dear Mr. Gapp:

Well Construction Permit Gapp Well (Well No. 3786-01)

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

Special Conditions

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

This permit does not authorize work for your permanent pump installation. Approval and issuance of your pump installation permit is contingent upon completed application and information provided to and accepted by Commission staff as required in the Well Construction & Pump Installation Standards (February 2004) and any special conditions performed under this permit. However, a permanent pump may be installed prior to the permanent pump installation permit issuance in accordance with the Commission's April 15,1998 Declaratory Ruling No. DEC-ADM98-G5, which states that:

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

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

/

-Mr. John Gapp Page 2 January 6, 2005

o o

Please sign and have the contractor sign both permit originals and return one for our files. Also, copies of the aquifer pump test worksheet and the well completion report form are enclosed for your use.

IMPORTANT - Drilling work shall not commence until a fully signed permit is returned to the Commission. Please provide all the information in this packet to your well drilling contractor. The permittee, well operator, and/or well owner are responsible for all conditions of the permit. This includes ensuring that the well construction contractor, or other party who constructs the well(s), submits a completed Part I of the Well Completion Report form (enclosed) within sixty (60) days after the well construction work is completed. Be advised that you may be subject to fines of up to $5000 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 or tollfree at 974-4000 (Hawaii), 274-3141 (Kauai), 984-2400 (Maui), or 1-800-468-4644 (Lanai & Molokai), extension 70255.

Sincerely,

Wf'rl"i 1't

Peter T. Young Chairperson

Enclosures

c: Rod Diamond

- OWEll CONSTRUCTION PERMITO Gapp Well. Well No. 3786-01

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

In accordance with Department of Land and Natural Resources, Commission on Water Resource Management's Administrative Rules, Section 13-168, entitled 'Water Use, Wells, and Stream Diversion Works'~ this document permits the construction and testing of Gapp Well (Well No. 3786-01) at 15-1014 Pilikai, HPP, Hawaii, TMK 1-5-000: 076, subject to the Hawaii Well Construction & Pump Installation Standards (February 2004) which include but are not limited to the following conditions:

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

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

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

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

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

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

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

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

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

The well construction p-ermit application is incorporated into this permit by reference and is subject to the Hawaii Well Construction & Pump Installation Standards (February 18, 2004; HWCPIS). If the HWCPIS are not followed and as a consequence water is wasted or contaminated, a lien on the property may result.

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

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

The permittee, its successors, and assigns shall indemnify, defend, and hold the State of Hawaii harmless from and against any loss, liability, claim, or demand for property damage, 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.

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

Date of Approval: January 3, 2005 January 3, 2007

PETER T. YOUNG, Chairperson Expiration Date: 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 driller have signed, dated, and returned the ~rmit to the CommISSion. I also understand that non-compliance with any permit condition may be grounds for revocation and fines of up to $5000 per day starting from the permit date of approval.

Perm'ittee's Signature: _____________ _ Date: ______ _

Printed Name: Firm or Title: _______________ _

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

Printed Name: Firm or Title: _______________ _

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

Attachment c: USGS

Department of Health! Safe Drinking Water, Wastewater, and Clean Water Branches Hawaii Department of Water Supply Rod Diamond

o o PETER T. YOUNG

CHAIRPERSON

'lOu\\ NO~ 23 A \0: 20


JAMES A FRAZIER CHIYOME L FUKINO, MD

LAWRENCE H. MilKE, M.D, J.D. STEPHANIE A WHALEN

,, ,,-, [" STATE OF HAWAII '., '~, ':;,Ct: S DEPARTMENT OF LAND AND NATURAL RESOURCES

,·.cOMMISSION ON WATER RESOURCE MANAGEMENT P.o. BOX 621


November 22, 2004

,'.' CC:-y , co.;;,

.... ,..,

YVONNE Y. IZU DEPUTY DIRECTOR

0 ' -~

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c..)

TO: Dede Mamiya, Administrator Land Division

. :P ~-l

FROM:

SUBJECT:

Yvonne Y. Izu, Deputy Director 11 Commission on Water Resource Management

Well Construction/Pump Installation Permit Application Gapp Well (Well No. 3786-01)

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

.~;:

,-

en . . c...l

1 0

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 January 3. 2005. If we do not receive comments or a request for additional review time by this date, we will assume you have no comments.

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

RI:ss Attachment(s)

RESPONSE:

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

10l A water lease/permit is not required of this applicant.

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

iol This well project [ 1 requires kidoes not require a COUP. If a COUP is required it [ 1 has [ 1 has not been approved and [ 1 is [ 1 is not currently active.

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

[ 1 No objections

:lol Other comments: Original source of private title is Grant No. 1013 issued prior to statehood in 1959.

Contact Person: ___ ---I,;G ... alo,l;r~y'---ll.lMl4la .. r.t .. i"'];I,-------- Phone: SS7-0t,21

Signed:_-~A;~-'::"'-T-~~----'--- Date: 0 EC 2 2 2Wi4

)

FROM: ROY

TO:

BAUER, G. CHING, F. DANBARA, S. FUJII, N. GOODING, K. HARDY, R. HIGA, D.

~/ICE, C. IMATA, R. IZU, Y. KUNIMURA, I.

COMlvdSSION ON WATER RESOURCE MANAGl:nlJENT

DATE: DEC - 1 2004

INIT. TO:

NAKAMA, L. NAKANO, D. OHYE, M. SAKODA, E. STAHL, K. SUBIA, S. SWANSON, S. UYENO, D. YODA, K. YOSHINAGA, M.

INIT:

SUSPENSE DATE:

FOR:

Approval Signature Information

(11/04)

PLEASE:

See Me Review & Comment Take Action Type Draft Type Final File Xerox __ copies

UNDAUNGLE OOYERNOR OF W.WAII

Date:

To:

Attn:

From:

Subject:

o I_~ 1" ~.,. • t ......

~-- ..... t.-.-- "-"

• ~TATE OF HAWAII p.\ \ . rlEPARTMENT OF HEALTH

P.O. BOX 3378

HONOLULU. HAWAII 96801

Wastewater Branch

o

919 Ala Moana Blvd. Room 309 Honolulu~ Hawaii 96814-4920

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

STATE MESSENGER DELIVERY

r(-~-oc,l

Commission on Water Resource Management Department of Land & Natural Resources

SR8:wa;~ffl- ( ~(J'd~tw ~U~) Lori Kajiwara Ph 586-4290 direct line Planning & Design Section Fax 586-4300

CHlYOIE L FllKlHO, M.D. DIRECTOR OF HEAl.1H

In reply, please refer to: EMD/WB

Email: [email protected] watercommissionfax.wpd sam As of January 8, 2003

Please find enclosed the application of the above subject project.

STATE MESSENGER DELIVERY

o o NOV 2 6 2004

LINDA LINGLE PETER T YOUNG CHAIRPERSON GOVERNOR OF HAWAII

TO:

FROM:

SUBJECT:




November 22, 2004

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

William Wong, Safe Drinking Water Branch

MEREDITH J. CHING CLAYTON W. DELA CRUZ

JAMES A. FRAZIER CHIYOME L. FUKINO, M.D

LAWRENCE H. MilKE, M.D., J.D STEPHANIE A. WHALEN

YVONNEY IZU DEPUTY DIRECTOR

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

Peter T. Young, Chairperson 11 Commission on Water Resource Management



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 January 3. 2005. 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)

RESPONSE:

[ 1

[ 1

[ 1

This well qualifies as a source which will serve as a source of potable water to a public water system (defined as servin\! 25 or more people at least 60 days per year or has 15 or more service connections) and must receive Director of Health approval 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 non-potable spigots with waming signs to prevent inadvertent consumption of non-potable water. Backflow prevention devices should be routinely inspected and tested.

[ 1 It does not appear that this well will be used for consumptive purposes and is not subject to Safe Drinking W~~egUlation~

~ For the applicant's information, a source of possible wastewater contamination ~ [1 is not located near thEfPi9~sed we~e 11\ (information attached). MO(j ~ ~.~ rq 'J)

',) C) ·11 [ 1 An NPDES permit is required. : .' :'.~ ,:J' 111 . " b( Other relevant DOH rules/regulations, information, or recommendations are attached. utptiCl tOJll<.f!:fn tol r:..~) )( No comments/objections I J; ):2 OJ?~ co. ntact perso'C5ft~ Phone ~(p ~¥ - .J

Signed: _~ Date: 1(-J1'~~Lf ~

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

--o

STATE OF HAWAII DEPARTMENT OF HEALTH

P.O. BOX 3378 HONOLULU. HAWAII 86801

Wastewater Branch

o

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

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

CHlYOIE L "'MIllO, lUI. DlRKtOR CW HEIoLlH

In .-ply. pIMu ..... EMD/WB

A septic tank file has been found and the following information is provided. In general, the Department of Health has reviewed and approved of the plans based on the information submitted as verification that a treatment individual wastewater svstem (lWS) such as a septic tank was constructed and authorized to be used for wastewater disposal from a building/dwelling.

Tax Map Key number

Address

Septic Tank File #

Applicant Name

Submit Plan Date

Plan Approval Date

Inspection Date

System Approved for Use Date

SPA Date

System / Disposal Via

Use For

Designed By

Percolation Rate / Capacity

o ) I - 5 -0(00 010

fJ1>'b E2 -o7Q

Ih/in / 1000 84/l04.[

Wastewater Branch Engineer PO Section (Oahu)

For further information, you may also call the Wastewater Branch neighbor island engineers:

[ ] Mr. Dane Hiromasa at the Kealakekua Health Center, Kona at (8080322-1507

y< Mr. Jerry Nunogawa at the Hawaii District Health Office, Hilo at (808)933-0401

[ ] Mr. Joe Tateyama at the Kauai District Health Office at (808)241-3323

[ ] Mr. Roland Tejano at the Maui District Health Office at (808)984-8232

cesspool faxes.wpd sam rev October 10, 2003

\ 1~O-04 09:44am From-DOH/Safe Dr:n~inl Water BralH;h 8085864351 A • ~ T-272 P. 002 F-959

~ RECEWEO SAfEDRfNKmG WATER BRANCH

LINDA LINGLE NOV 26 2004 PETER T. YOlJNG v,....,\tIfoe~r,) .... Gcv~ono~ riAI'YAl1

TO:

FROM:

SUBJECT:

STATE OF HAWAII DE?ARlMENT OF lAND AND NATURAJ.. ~e$OU~ES


HONOLI,JLI,J. HAWAII 96809

November 22, 2004

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

MEREorrH J. CHING CLAYTON W. DELA CRUZ

JAII.1EOS A. FRAZH,R CHIYOME L. FUKlIIIO. M.D

LAWRENCE H. MilKE, M.D .• J.D. STEPHANIE A. WHALEN

YIIONNE Y. IZL; D!:P'JT"'t DlJI,CCTOR

William Wong, Safe Drinking Water Branch Dr. Keith Kawaoka, Hazardous Evaluation and Emergency Response Alec Wong, Clean Water Branch




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 b~JanUary 31 2005. If we do not receive cornments or a request for additional review time y 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 infonnatfon, or request additional review time, please contact Ryan Imata of the Commission staff at 587-0255.

Rl:ss Attachment(s)

RESPONSE:

[ J

[ I

II

ThiS well quaiitiss as a source which will seNe as a source of powble weier to a public wat~r System (<lelioed as servln!ilZ$ or more people 3t less! 60 days p1lf year or I18s 15 or more service COrlTleCllonS) and must receiVE! Director of Health approval g~or to Its use to comply with Hawal, Administrative Rules (HAR), Title 11, Chapter 20. Rules Relatirl9 to PolaO!e Water Systems. §11-2 - .

This well does: not qualify as a ~ou(ce SGrViog a public water system (serves less than 25 people or mere pe9~1e !!t least 60 days per year or 15 selVice connections) and If 1M well water Is used fordnnking. me p'nvale owner ShOuld testfor bsctenelDgICBI and cherrucal presence befol't?: ;oltl;;lling .. uch 1,1 .... and routinely monitor the water quBlllv thereafter. How/wet. if futore plaonect USe from thi$ source .ncreaseS to meet t~.e pl,lblic water :system definition then Oirec1or of Health a~prOvai is req\llred ~rior to IIrplementstion.

11 the well is used 10 supply both pOl$ble and non-potable purposes in a single ~Y!ltem. the uoorshall eliminate cross-coonectioros and baCllllow connections by physically seoarstlng potable and non·pOlabl~ systems by an sir gap or an approved backflow preventer. and by clearly Ii£ooling 311 non-POlable spigots witn warning signs 10 prevent inadvertenl consumption of nan-potable water. BaGkfbw prevention devic6s ~hOul" be routinely inspeclt'd 0~CI t"'$ted.

It does not appear tho!t this wall will be used for consumptive purposes ano Is nDt 5I.lb]ec:t to Safe Drinking Walet Regulations.

For the applic;;Int'$ infonnation. a source of possible wastewater co~tamlnliltiQn []Is [] is not lo~ted r·ear tne pro~~eo well site (infOrmation attached).

( 1 An NPDES permit is required.

[ 1 l 1 No GOmm<:I"I~(objection8

Contact Person: ~a~ Signed; cb/ tlf1.1hy

Phone; _..::::.5=86"---'4=2=58~_

Date;_+tt'It1"'"~~ ....... ...-:;-_ NOV 26 2004

HOI)-30-2004 10: 11m'l FR><: 8085864351 10: DLHR CWRt"l PRGE: 002 R =9T~

F rom-DEPT OF HEALT"ENVI RONMENTAL MNGMT 8085864352 T-670 P.002/002 F-039

~ PI'TI'R T. YOUNG

LlA ~I,1AtRPf.iFl.~Ofll

MI'REOITH J CfjlNG CLAYTONW DEL,r..CRUl

TO:

FROM:

SUBJECT:

STATE OF HAWAII

·04 tj\\

NOV 26

OE?ARTMENT OF I.ANOANO NATURA~ RE;SOURces COMMISSION ON WATER RESOURCE MANAGEMENT

pO 80)(621 HONDLUI.U, HAWAII 86809

November 22,2004

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


•. JAMES A. FRAZieR A 8 :QA CHIYOME L. Fl.lI<INO. ~.O lA.WR"'NC~ H. MilKE. M O. "D

STEI'HANIe A WHALEN

YVONN= Y IZLJ at."u~Y DtKtCTtlri





We would appreciate your comments an 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 b~January 3, 2005. If we do not receive comments or a request for additional review time y this date, we will assume that you have no comments.


RI:ss Attachment(s)

RESPONSE:

11

[ 1

[ 1

[ 1

! 1

T~is well qualifies as a source which wUI serve as a source or potable wllter to a public wllter system (aerinea as servillQ 25 or m~re peoPle al1ea6t 60days per year or hils 16 or more service connectionS) and myst receive Olreclor of Health approval ,f-~gr to 11s use 10 comply wllh Hawa;i Aarninistrative Rules (HAR). Tille 1', Chapter 20, Rule" Relating te Potable Water Systems, §11-2 - .

This well aeell not qualify aa a ~curce serving a public water system (serves less than 25 people or more people at least 60 cays per year or 1 e; service connection'» and it the well wafer is used for drinking, the private owner should test for bacteriological ana cllemlcaJ pre5e~0!I before Inlllatlng ~ueh use and routinely monitor the water gualltY thereafter. HOwe'le~\ It tuture ~anned use from this source InOr't!lases to meet the pub~c water system definition then Olr~or of Healtn approval i~ requlreQ ~to Implementation.

If the ""1011 is u~d to sypply pclh potable and non-potablS purposes in a single sys;"m, the user sha:1 elimin!l\e cross-conneCllons ano packflow eonnections by pnysical!y lIeparating potable and non-potable systems by an air gap or an approvea l)aeKftOw prevQnter, and rtf clearly labeling aU non-potable splgQts with warning signs to prevent Ina(lller1em ,onswnptlon of non-potable wau:r. Backfiow prevention devlt;c:!; :shouJa be i'Olo4tlnely InaptOctall IIna tested.

It dot;$ nOl appear that this well will be Uljed for consumptive purpoaea end is not subject to Sate Drinking Water Regulation,.

For thl!! apPlicant's Information. iii source of pollljible wal;tew~ter contQfT1ll1ation []i& [] is not located near me ProPOl;e\I .veil site (information attached).

[ 1 An NPDI=S parmil is reClUlred.

(y Other relevant DOH rules/regulations, information, or recommendations are atlaCl'lM.

""[l No commentSlClbJ8ctiOnt .1 Contact Person: Ntk V. ~ Phone: t;fb-C?M21 Signed W.![j)~ Date LI{~ DY:r-I\2-

HCIU - 29 - 2004 08: 05Rr'1 FRX:8085854352 ID: DLHR (l.~RM PRGE:012 R=97%

i ",..

Noy:-29-2~ 08:14am From-DEPT OF HEALT",ENVIRONMENTAL MNGIAT 8085864352

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

I. For Well-Drilling Activities

/'.... T-670 P001/OOZ F-039 .......,

~ny discharge to State w~t~rs o! treated pr~cess wastewater effluent a~soci2ted :with well drilling actiyities is 'egulated by Hawaii Administrative Rules, Title 11, Chapter 55, Appendix I, effective September 22,19.97. rreated process wastewater effluent covered by this general permit includes well drilling slurries, lubricating nuids wastewaters, and well purge wastewaters. This general· permit does nat cover well pump testing. The applicable Notice of Intent Forms and filing fee shall be submitted at least thirty (30) days before the start of discharge to the· Department of Health, Clean Water Branch at 919 Ala Maana Boulevard, Room 301, Honolulu, Hawaii 96814-4920 or P.O. Box 3378~ Honolulu, Hawaii 96801~3378. Inquiries may be directed to the Clean Water Branch at (808) 586-4309 or by fax at (808) 586-4352.

2. For Well Pump Testing

The discharger shall taKe all measures necessary to prevent the discharge of pollutants from entering State waters. Such measures shall include, if necessary, containment of the initial discharge until the discharge is essentially free of pollutants. If the discharge is entering a stream or river bed, best management practices shall be implemented to prevent the discharge from disturbing the Clarity of the receiving water. If the discharge is entering a storm drain, the discharger must obtain written permission from the owner of that storm drain prior to discharge. Furthermore, best man::lgement practices shall be implemented to prevent the discharge from collecting sediments and other pollutants prior to entering the stolT!' drain.

JS/cr

.-._ .. -_ .. ------- ._----Post-it· Fax Note

t-mu-29-2004 08: 05Rr'1 FRX: 8085864352 IO: DLNR C[...JR~1 PRGE: 011 R=9r;

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

Data Input

Well Number 3786-01 Well Name GappWell Ground Elevation 41 Cement Grout 35 Grouting Method other Hole Diameter 12 Total Depth 45 Estimated Head 1 Public Water Supply Well? no Solid Casing Material pvc plastic plastic Solid Casing Specification Schedule 40 Solid Casing Length 40 Solid Casina Diameter 6 Solid Casing Wall Thickness "~ 'loU:U<

Open Casing Length 5

Results

QISSION ON WATER RESOURCE MANAGEMENO ROUTE SLIP FOR NEW APPLICATIONS

FROM: RYAN DATE: 17-NOy-04 SUSPENSE DATE:

NAKAMA, L. 1 Approval BAUER,.G. CHING, F. FUJII, N.

-1-HARDY, R.

HIGA,D. HIRANO, E. ICE, C.

NAKANO, D. NISHIOKA, L.

-3-0HYE,M.

SAKODA, E. -2-SUBIA, S.

-1-Signature \iJ 3 Information

,\/110,,01

-4-IMATA, R.

IZU, Y.

SWANSON, S. UYENO, D.

--YODA,K.

~

KUNIMURA, 1.- YOSHINAGA, M.-

./ WELL NUMBER 31 B& - <::l I WELL NAME Gapp

o WELL CONSTRUCTION o PUMP INSTALLATION

ATTACHMENTS FOR APPLICATION PROCESSING - Both applicant & staff generated 1 TRANS. LETTER V"'" 2 CWRMMAP vi 3 APPL. FORM (5COPIES) ~

4 USGS MAPS (5 COPIES) ~

5 TAX MAPS (5 COPIES) ./

6 PARCEL OWNER VERIF. ~ MLS PRINTOUT 7 CONTRACTOR VERIF. -T DCCA LICENSE SCREEN PRINTOUT

8 ALL INFO FILLED IN ~ 9 BACKGROUND CHECK

10 $25 FEE DEPOSIT SLIP ---.:!..,I-11 DHP & SMA check v'

FOLDER: I CZI MADE NEW FILE FOLDER, ATTACHED o FILE FOLDER ALREADY MADE, IN FILE CABINET

INCOMPLETE ACTION DATES:

DATE ACTION

24-Nov-04

PLEASE:

See Me -1-Review & Comment

Take Action Type Draft acknow letter

-2-Type Final w/elec.signat., label file folder -4-File

Xerox copies

J

)

__ ~Ne..;;..;e;..;;d...;.;w...;.;el.;..;1 o;..;.;w..;.;.ne;.;.r..;.;.na;;;;..m;.;.;;e.;..;. _-:::-__ (_cJ......;.._~ ____ --fpw<-=....x.._'fl<;_---'J. 1/1 vi-____________________________ ~/~I !11!,q


Mr. John Gapp P.O. Box 1128 Pahoa, HI 96778

Dear Mr. Gapp:

o




November 22, 2004

PETER T YOUNG CHAIRPERSON


JAMES A. FRAZIER CHIYOME L. FUKINO, M.D.

LAWRENCE H. MilKE, MD, J.Q STEPHANIE A. WHALEN

YVONNE Y. IZU DEPUTY DIRECTOR

3786-01 ,doc

Well Construction/Pump Installation Permit Application for Well No. 3786-01

We acknowledge receipt, on November 8, 2004, of your completed Well Construction/Pump Installation permit application and filing fee for the Gapp Well (Well No. 3786-01). You can expect your application to be processed within ninety (90) days from this date.

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

If you have any questions about your permit application, please contact 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) extension 70255.

RI:ss

c: Rod Diamond

Sincerely,

tv."r!-1 1't

YVONNE Y. IZU Deputy Director

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

o o LINDA LINGLE

GOVERNOR OF HAWAII PETER T. YOUNG

CHAIRPERSON

TO:

FROM:

SUBJECT:




November 22,2004

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



JAMES A FRAZIER CHIYOME L. FUKINO, M.D

LAWRENCE H. MilKE, M.D, J.D STEPHANIE A WHALEN

YVONNE Y IZU DEPUTY DIRECTOR


Peter T. Young, Chairperson 1'1 Commission on Water Resource Management



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 January 3, 2005. If we do not receive comments or a request for additional review time by this date, we will assume that you have no comments.


RI:ss Attachment(s)

RESPONSE:

[ 1

[ 1

[ 1

[ 1

[ 1

[ 1

[ 1 [ 1

This well qualifies as a source which will serve as a source of potable water to a public water system (defined as servin!) 25 or more people at least 60 days per year or has 15 or more service connections) and must receive Director of Health approval 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 Hearth approval is required prior to Implementation.

If the well is used to supply both potable and non-potable purposes in a single system, the user shall eliminate cross-connections and backflow connections by physically separating potable and non-potable systems by an air gap or an approved backflow preventer, and by clearly labeling all non-potable spigots with waming 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 [l 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.

No comments/objections

Contact Person: _______________ _ Phone: ______ _

Signed: __________________ _ Oate: _______ _


TO:

FROM:

SUBJECT:

o o




November 22, 2004

Dede Mamiya, Administrator Land Division




PETER T. YOUNG. CHAIRPERSON


JAMES A. FRAZIER CHIYOME L. FUKINO, M.D

LAWRENCE H. MilKE. MD , J.D STEPHANIE A. WHALEN


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 January 3, 2005. If we do not receive comments or a request for additional review time by this date, we will assume you have no comments.


RI:ss Attachment(s)

RESPONSE:

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

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

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

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

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

[ 1 No objections

[ 1 Other comments:

Contact Person: ________________ _ Phone: _________ _

Signed: _________________ _ Oate: ______ _


TO:

FROM:

SUBJECT:

o o




November 22,2004

Melanie Chinen, Administrator Historic Preservation




PETER 1. YOUNG CHAIRPERSON


JAMES A FRAZIER CHIYOME l. FUKINO. M.D

LAWRENCE H. MilKE, M.D , J.D STEPHANIE A WHALEN


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 Januag 3, 2005. If we do not receive comments or a request for' additional review time by this ate, we will assume you have no comments.


RI:ss Attachment( s)

RESPONSE:

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

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

[ 1 No objections

[ 1 Other comments:

Contact Person: ________________ _ Phone: ____________ _

Signed: ___________________ _ Date: _______ _

Department of Commerce & (5sumer Affairs - State of Hawaii - PVL(:)CENSE CLAS... Page 1 of 1

Department of Commerce and Consumer Affairs PwfeHlorkl1 dod vo<:atlonalllCNHln9 DIvISion

J)rofessional and Vocational IJcensing Search

LICENSE CLASS SCREEN

Please click a link listed below to display the other screen.

There were 2 specific license classes on this licensee!

***** LICENSE CLASS FOR THIS LICENSEE ***** LIC: CT -23379 RODNEY K DIAMOND

CLASS CODE CLASS TYPE EFFECTIVE 10/12/01 06/30/04

RESTRICTED B GENERAL BUILDING

C57 WELL

<-Back New Search->

STATUS

EMPLOYEES LIST I I EMPLOYERS LIST II INSURANCE/BONDI I LICENSE CLASS

Copyright 2002 Professional and Vocational Licensing Division

Hawaii State homepage II DCCAII Professional and Vocational Licensing Division

http://www.ehawaiigov.org/serv/pvl?_f=n&_ a=LC&licno=233 79&lictp=CT &off=O&nm... 11118/2004

Search Results o o Page 1 of 1

Copyright ©11/18/2004 by Hawaii Information Service

Assessed Values reflect tax year 2004

• PUBLIC RECORD DATA Taxkey Subdiv/Condo TnrAddressOwner/LesseeBdsBths Land areaLiv area Last Sale Instr Price

r 3-1-5-60-76 Hawaiian F PILIKAI GAPP, 21,780 sqft 0 8/26/2003 DEED $30,000 Paradise Park MAUREEN M

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

http://webrel.hawaiiinformation.comlre4IHIS/Searchlsearch_PUB.asp?NOCACHE=110...11118/2004

DARTMENT OF LAND AND NATURAL RESOQES DOCUMENT NO . .. UAC OR ATTACHED WORKSHEET DATE· 11/8/04

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

S 05 326 C 1026 0752 (1 ) $25.00 Donald S. Rullo

" " " " " " (2) $25.00 Buddy L. & Sons Construction, Inc.

" " " " " " (3) $25.00 Michael Houston RobertsonJames Kurose

" " " " " " (4) $25.00 Carolyn Hendershot

" " " " " .. (5) $25.00 Drainpipe Plumbing and Solar, LLC

" " " " .. " (6) $25.00 Robert Duley

(7)

(8)

(9)

(10)

TOTAL $ 150.00

REMARKS: LINE (1) Opihale-Rullo Well, tmk: 8-7-13:6/89 LINE (2) Kilohana Waena Sudivision, tmk: 3-9-004:015 LINE (3 Keauhou-Robertson, tmk: 7-7-026:014 LINE (4) Hendershot, tmk: 1--016:063 LINE (5) GAPP, tmk: 1-5-060:76 LINE (6) Duley Well, tmk: 1-5-53:11 LINE (7) LINE (8) LINE (9) LINE (10)

,. State of4i.W8ii 0 For 0.181 Use Ollly:

• COMIIISSKlN ON WATER RESOURCE MANAGEMENT Department of Land and Natural Resources APPLICATION FOR PERMIT

~ SF \.t II.WeII ConstructIon and/or 0 Pump Installation h4 ~'''ll B

instructions: PIea8e prirt In ink or tp and .. nd completed appIcaIIon with allachrnants k) the CommI88ion ~ i "'" w A 10: 3 9 on W8I8r RaeowaI Mllragemen, P.o. Box 621, Hono ............ 96808. AppkaIon nut be aecon,.,.-ied by 5 oopies and a mn-ntfundable ftl11a fee d S2UO pa)8ble k) the Dept. of Land and Nattnl ResoLlC8S. The ComIrission may not accept i~ appIcaIorI5. For assistance, caIIlhe Regulation Branch at 517..m. f' ("'.' ';, \ ,0 I' " •.. 1"" ,

ForfLrtherilobmalon and ...... k) Ilia 8pf)Ic:!Iion form, WIlt hIIp:J/www .. IId8.Ii .... ~. ,:-: - "i" " ),1,\ I r-: APPLICANT INFORMATION: (F110lJ all thrae.1f appIcabIa, and place a check next., the primary col1aCt)" ' . :.! : r! ~ 1. (8) 0 WELL OWNER: ------------------ Contact Person: _______ _ POOne: ____________ _

Mallng AddI8SS:

Fax:

(b) )( LANDOWNER: l"ohtl\ G, o...'P..~ MallngAddress: f) a 6Qp( 1'\ L <l

E~t ____________________________ ~--~~-

contact Person: .... J.u.o=k=V\.~:---_ pOOne:<JfI-Q3b 5tdI r PAHOA !tiL QG77f'

Fax: E-mail: ____ ..",... __________________ _

(c) tit CONTRACTOR: ~l.pc:l,-~~.da.Q£lIL.._

WELL & PUMP INFORMATION: (Plaase In In the diagram on the back of !tis form.)

2. WELL NAME: GAP (> Island:

Address I~'-' IQIt! PIL/kA1 dHT~Map Key: I S - ObO: ---':!! ...... '-Zone Sec Plat

AtIach: <a) portion of 8 7.5-Mioote Series USGS topograptic map (scala 1:24,000) with _I location labeled and Include the .. me of the ql8d nap (b) a property tax map, showing well kx:alion refentnced to es1ablshed property boundaries

3. PROPOSED WORK: Jt Construct New Wei ~ InItaI New PU11)"

(check all that apply) 0 Modify Eldsting Weir D Modify Punp* f ~ % 5vJ P U~ : + o AbandonlSear t? d. f\. *State Wen No.: (If urMown. please caU Comm! to; «0 V fc..1"\ OI\J

4. CONSTRUCTION: brI Oriled D Dug 0 Shaft 0 Tunnel H-ctf (30'/ ,I.{ 0 7~ Is this well part of a battery of wells? DYes ~No (Please describe) v lc..t;.l) W; q b 7 '{9

5. PROPOSED PUMPING RATE: ~ t)gallons per minute ~,

6. PROPOSED USE: (check all that apply)

o Muric\paI(includIB41 hoIaIs,saea. etc.)

)( Domestic (lndhAdI.IIl. noncoll1lTl8fdal water s)1Stam)

D Industrial

Does this well SeMI 25 or more people at least 60 days per year or haw 15 or more service connections? 0 Yes" No

o hlgation (crop) No.ofAaes:

o MiItafy 0 OIher (ellplaln~ 7. (a) PROPOSED AMOUNT OF WITHDRAWAL: ____ ---:..1.._?_O ___ gallons per day

(b) METHOD OF FLOW MEASUREMENT: K Fk7MnelllrD Open-pipe D Weir D Orifice D OIher(ellplaln)

OTHER IMPORTANT INFORMATION:

8. LEGAL REQUIREMENTS: "tequil8d, these permits _ be obtained before the Commission can legally issue B permit. Conurvalion DIatrIct U .. Pennlt (COUP) To 1100 out If a CDUP Is necessary, call DLNR Land Dillision at 587-0414 )( Not Required If requll8d, date approved ____ _

Envtronmentallmp..:t 8tatIInerIt (Ell) or Envtronmental AM ... ment (EA) To detllrmlne If an E IS or EA Is necessary, caD OEQC at ~185 Jlt Not Required If required, date plblshed In OEQC bullt1ln ____ _

Special ~ Ante P"",lt (SMAIl) To detIIrmIne if an SMAP Is necasaary. on oahu, caR 527-6374; on Hawaii, call 961-8288; for Maul county, call 27Q-7235; on Kalal, call 241-86n.

t( Not Required If reqLir8d, date approved ____ _

9. ARCHEOLOGICAL REQUIREMENTS; To tnd out If an archeological ~ Is requll8d: on oahu, call Elaine Jo~ne at 692-8027; on HawaII, call MaryAnra Malgrat at 327-3690, for Maul coulty, cal Cslhy Dagher at 692-8023, on Kaual, cal Nancy McMahon at 742-7033.

jf Not Required If rvquil8d, pIaaae attach letter tom DLNR Iistorlc PntSerWlIIon

10. REMARKS, EXPLANATIONS:

(If more space is needed. please attach additional sheet) 1 ::t:"

NOTE: Sigring below indicates the aigraDiea underslllrd am ....,. that the IrIonnalon proWded on Dis appIcaIon 18 accurate arm true to the beat . '(',' af their knowledge. FlIther, the signatories undefstand thit approval of un appIcation 8Uachel the following standard condHlonB: 1) the propoeed work Is to be COfI1)IeIed within Mo (2) )188I'S of the approval data; 2) the con1raClOr shall slbmlt to the Commlaeion a wall cornplatlon'abandonmert report wltlin 80 da)e ... the COfI1)Iadon data of the permlttBd work; 3) morthly water ... data shal be stbmltted to the ComrrUsIon; 4) such approval shall not constitute a detannlnaUon of conelatiw water rights and shall not gU81'8n1ae the punp capacity or fWn uae ~ to the permitted punp capacity, 5) in the ewrt that the applcallon Is not COfI1)Ieted correctly, any permit may be suspended until the Ian I. brought In to COfI1)Iance, and any work done wtila the permit Is In suspension may result In I,.. of ~ to~19'fO'daY' A J Well Owner Landowner _ /:, L- - 1 /? (prIrt legibly) (prirt legibly) U j Sig nat Ll'e Signatll'e oJ.t rJ &. 6-f\ Date Date ~ - f)...~ .... d Date

For dficlal use only Latitude _______ Aqlifer System ttl. Longitude State Wei ttl.

WCPPA Form 7117103

o o 10. PROPOSED WELL SECTION (PIeaae attach schematic If different from di8f118m provided belowj

Hole Olamel8r: 1'7- in.

Elelation at top of casing -L. ft.. mar MirimLlllof2' Radilll & 4" TtickConcrete Pad (toCOrDinbenctmark

Total Depth

EI'£ft.

Cemert Grout :as It. (min. 70% of d1s1ance tom ground elevation to top of water aurfaoe or 500 ft.. wtichever is less.)

Amular space between 00Ie and casing (nin.3"):

~ In.

Rock or Gmwl Packing:

10 ft. Material: ~CNIhed Basal D Rounded Grawl

Estimated Water Lew!

Elevation:

__ -,-'_ft. mer

sww)lBd to nearest 0.01 ft.) i . Groll'ld Elevation: t:J ft.. msr

Please refar to the HAWAII WELL CONSTRUCTION AND PUMP INSTALLATION STANDARDS to eran u.t)OlI" as-blil is In compIance

wilt appIcabIa Slandards.

"---t Sold Casing: (~90% x (Ground Elev.-Watar Le .... Elev»

Tolal Length: if 0 tl Noninal ~iameter. __ ~b::::..... _____ In.

Wal Tticknass:. __ .-3%=.L-:-. ~t(c::/),--__ In.

Bottom Elevation: ___ ~O_· 0:..-___ ft .• mer

D Screen Open Casing: ~ PerfondBd

Total Length:. __ --"5.:L-/_~,.-----ft. , I'

NomInal Diameter: ____ .,.=-:-~-:-;~- In.

Wal Tticknass:, _____ f:be...&Jl';...l/!~'()~' _in.

=u Bottom Elevation: __ .!II;?::-.. ____ ft •• mer noIe: Ne/lher benfonile nor mud should be used In

_h_1Arl JrVlA rl"rinn rlrl/linn

Open Hole:

Lengtk--~/R4IhA~-------tl OiamelBr. ____________ in.

BoItom Elevation: ft •• mer

• The approxlmale elevation roost be referenced to mean sea 1e\l81 (msI) at the time of appIcalion filng. Final elell8l1or1l of well components ahal be StbmiUad In the We. Cor\1JleIionIWeU Abandormant reports and referanced to a benchmerk wtich has been estabiahed by a SlI"\I8)Or IC8fII8d by the StaIB.

For non-sal we .. Basal Wells· bottom elevation of wei aholti not be deeper than H4 of aqlifer ttickness or. Bottom Elevation of We. Umit. (Water Elevation. 11 x Water b~yej Eleyation)

ExalT1lle: E.Umated + 2 ft. Water Level Bev ...... Botlom Elevation of Well Linit .. (2 - i1f2l) = -18.5 fl.

Solid Casing Material; Carbon StMl: compUaM with (check one or mOl8): D ANSVAWWA C200 D API Spec. 5L D ASlM A53 D ASlM A 139

And compliant with (check one ormo(8): D ASlMA242 D Type E D Type S D Grade B D Other

Stainless S188I: (chec/c one): D ASlM M09 (production wells) D ASlM A312 (moritor wells)

ASS Plastic conforming to ASlM F480and ASlM 01527: (check one) D Schedule 40 D Schedule 80

PVC Plastic confonni ng to ASlM F480 and (ASlM 01785 or ASTM 02241): (chec/c one): )( Schedule 40 D Schedule 80 D Schedule 120

Thel1l1OMtPlaatlc: (chec/cone) 0 Fllamert Wound Resin Pipe conforming to ASlM 02996

D Certrifugally Cast Resin Pipe conforml~ to ASlM 02997

Open Casing Material:

D Reinforced Plastic Mortar Pressure Pipe conforming toASlM 03517

D Glass Fiber Reinforced Resin Pressll"8 Pipe conforming to AWWA C950

D PTFE Fluorocarbon Tlbing corlorming to ASlM 03296

D FEP Fh.Drocarbon Tlbing conforml~ to ASlM 03296

Carbon SI8eI: compUart with (check one or mOl8): 0 ANSIJAWWA C200 D API Spec. 5L 0 ASlM A53 0 ASlM A 139

And compllart with (check one or more): 0 ASlM A242 0 Type E D Type S D Grade B D Other

Stain .... SIMI: (chec/cone): D ASlMA409 (productionweHs) D ASlMA312 (moritor wells)

ASS Plastic conforming to ASlM F480 and ASlM 01527: (chec/c one) D Schedule 40 D Schedule 80

PVC Plastic conforml~ to ASlM F480 and (ASlM 01785 or ASTM 02241): (check one): )( Schedule 40 D Schedule 80 0 Schedule 120

Thermoset PIaatIc: (chec/c one) D Fliamert Wound ResIn Pipe conforming to ASlM 02996

o Certrifugally Cast Resin Pipe conforming to ASlM 02997

D Reinforced Plastic Mortar Pressure Pipe conforming to ASlM 03517

D Glass Fiber Reinforced Resin Pre8S11"8 Pipe corlorming to AWWA C950

D PTFE Fluorocarbon Tubing conforming to ASlM 03296

o FEP Fluorocarbon Tl.bing conforming to ASlM 03296

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12' x 18' Absorption Bed ______ (See Pg. 18) ,

Distribution Box (See Pg. 17)

N-400 1,000 Gal. Septic - ____ _ Tank (See Pg. 15)

COIUlect to Building Sewer Line. Provide C.O.T.G. at all bends. FOR

Notes:

DEPT O·F HEALTH USE ONLY

'

1. Mamtain ~"/ft. slope on all sewer lines.

2. No planting of trees 4" in diaIneter or larger within 10' ofIWS.

3, All downspouts from the house gutter system shall be directed away from the IWS.

4. * denotes percolation test site.

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Owner: John Gapp Lot Area: 0.50 Ac.;

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Septic Designs Page 10

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