o Q COMMISSION ON WATER RESOURCE MANAGEMENT ROUTE SLIP FOR WEll COMPLETION REPORT ACCEPTANCE 10/24/08 FROM: RYAN DATE: . .....:....::..:.=:...:..=.=--10/27/08

o Q

COMMISSION ON WATER RESOURCE MANAGEMENT ROUTE SLIP FOR WEll COMPLETION REPORT ACCEPTANCE 10/24/08

FROM: RYAN DATE: 10/27/08 . .....:....::..:.=:...:..=.=--_____ SUSPENSE DATE:

TO: INIT. TO:

CHENG, C. CHING, F. CHONG,R. DANBARA, S. ENGLAND, D. FUJII, N. -4-

KIMURA, J. KUNIMURA, I. leROUX, e. MILLS, D. OHYE,L. OHYE, M.

INIT.

Approval -3-Signature -4-lnformation

Sl -1-HARDY, R. 110 --SAKODA, E. +--2-HOAGBIN, S. == SWANSON, S. -'--ICE, C. UYENO, D. IMATA, R. __ --YODA, K.

-3-KAWAHARA, K. YOSHINAGA, M. --WELL NUMBER 3688-19 WELL NAME Homer's Adasea

application type BOTH 1 DRILLER ACKNOWLEDGE ty 2CWC ~ 3 CPI v 4 WELlCHECK ~ 5WURFORM ~

NOTES: DRILLER Rod Diamond

Diamond Construction and Water Well Drilling 23379

TMK

phone fax cell

PUMP CAPACITY WELL OWNER LANDOWNER

HCR#3 Box 14073 Keeau HI 96749 966-4129 966-4129 987-8100 <7 \~<) __ o'-\.-(,;- O",C?)

~~Mt- \-kM~ !I&-~

PLEASE:

See Me -1-Review & Comment

Take Action Type Draft

-2-Type Final File Xerox copies

I c o LINDA LINGLE LAURA H. THIELEN

GOVERNOR OF HAWAII

Mr. Mark Heritage Aloha Water Company HCR 3 Box 11074 Keeau, HI 96749

Dear Mr. Heritage:

STATE OF HAWAII DEPARTMENT OF LAND AND NATURAL RESOURCES

COMMISSION ON WATER RESOURCE MANAGEMENT P.O. BOX 621

HONOLULU, HAWAII 96809

November 12,2008 /

Certificate of Pump Installation Completion for Homer's Adasea Well (Well No. 3688-19) (TMK 1-5-045:029)

CHAIRPERSON

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

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

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

KEN C. KAWAHARA, P.E. DEPUTY DIRECTOR

3688-19.cpi

We are pleased to inform you that the Pump Installation work permitted for the Homer's Adasea Well (Well No. 3688-19) is complete and acceptable and welcome you as a new member to the community of well owners and groundwater 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(f) prior to any well sealing or plugging work.

3. In the event that the well operator andlor 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 o Mr. Mark Heritage Page 2 November 12,2008

5 . Your approved pump has a capacity of 16 gpm at a head of 365 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 monthly 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/cwrmlresources -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.

8. In the event that your installed pump is less than 70 gallons per minute, and no elevation survey has been completed, you may be required to do one in the future.

Because groundwater 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/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), extension 70255.

Sincerely,

RI:ss Encl: Water Use Report Forms

c: Hawaii Department of Water Supply Diamond Construction and Water Well Drilling

o o LINDA LINGLE LAURA H. THIELEN

GOVERNOR OF HAWAII CHAIRPERSON




November 12,2008 I


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


3688-19.cwc

Mr. Mark Heritage HCR 3 Box 11074 Keeau, HI 96749

Dear Mr. Heritage:

Certificate of Well Construction Completion for Well No. 3688-19 (TMK 1-5-045:029)

We are pleased to inform you that the Well Construction work permitted for the Homer's Adasea Well (Well No. 3688-19) is complete and acceptable and welcome you as a new member to the community of well owners and groundwater 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) 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 www.hawaii.gov/dlnr/cwrmlforms.htm.

Because groundwater 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,OOO/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 togeth~r.

If you have any questions, please contact Ryan Imata ofthe Commission staff at 587-0255.

RI:ss

c: Hawaii Department of Water Supply Diamond Well Drilling

------------- -

Sincerely,

AHARA,P.E. eputy Dire tor

/i

LINDA LINGLE GOVERNOR OF HAWAII

Mr. Rod Diamond

o o




November 12,2008

Diamond Construction and Water Well Drilling HC#3 Box 14073 Keeau, HI 96749

Dear Mr. Diamond:

Well Completion Report Parts I & II for Well No. 3688-19

LAURA H. THIELEN CHAIRPERSON



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


We received your Well Comple)i'0n Report Parts I & II for the Homer's Adasea Well (Well No. 3688-19) on April 10, 2008 and acknowledge that they are complete.

This completes your obligation under the well construction and pump installation permits. Certificates of well construction and pump installation completion will be issued to the well operator/landowner and you will receive a copy of each. 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), 274-3141 (Kauai), 984-2400 (Maui), or 1-800-468-4644 (Lanai & Molokai), extension 70255.

Sincerely,

~~t~~ C. KA AHARA, P.E.

D puty Dire or

Rl:ss

c: Mark Heritage

/

o o

Results

Well Depth Theoretical Thickness of Aquifer 82 1/4 Aquifer Thickness 20.5 Depth of Well below Sea Level ·10 okay Section 2.2

Well Casing Minimum Wall Thickness

Material pvc plastic Minimum Thickness per standards no requirement . Wall ThICkness Provided .. o no sta.ndard Section2.4(b)

Minimum Length of Solid Casing 90% of ground to top of aquifer 95.4

... l,.~mgth. Of$olidr:86ingp~.vidfid.·· ::.·.·i:: ... ·::;;·; ... ·;· ,: ~.;;i;.108 . oUJ,~.·i .~ •... i······;·G.··· ..... .:i .. i··i S~!:)"'2:4(c) 11 casing Ms.tf1l'iaJ .... .' . Scheaolei'4Q ........ 'Y"~ ' . ....

II'I;i~Omplfihc' '. '"

.. ~ion2.4(d):y (for pvconll· .... ch~ for20pt limitJ. ::i.;.:' " okay'':; ;, '. section 2.4(d)

Annular Space Depth of Grouting

Calculated Depth of Grouting 1.4 Depth of Grouting provided 83 okay··· Section 2.6(c)

Minimum Annular Space required 2 Thickness of Annular Space 1.75 okay Section2.6(d)

MEMO and ROUTE i.IP (ver. 04/03/2008) 0 04/22/08

I WCR 1 Check for Well No. 3688-19' (survey to regulation memo)

1. Pump Tests Check Diane England ~/ (initial)

Yes No

Step-Drawdown Test: followed WCPI Stds 0 0 !co gpm no test required analysis attached 0 0

Constant Rate Test: followed WCPI Stds 0 0 ~ gpm no test reqUired' analysis attached 0 0

Potential Well Interference: 0 ~ Potential Stream Impacts: 0

Additional Testing or Data Required: 0 6' Pump Test Comments Attached: , / Proposed Pump Capacity is OK.: 0

2. Well Log Check Geology Code for Well Index: Fm Name: ~ Va fLs. D. England-tl£onitial)

3. Construction Check Mitch Ohye _.....:.....:; __ (initial) Yes / No

data complete £ 0 followed Special Cond & elevations~' // 0 well database updated 7 0

R. Torres __ (initial) If no, describe deficiency

(!),.r· "~I'

~/

Latitude Longitude

NAD27 \ q ~) i

./':1., Jb NAD83 ~ r i '. , i

rz ____ (initial) take action based on above analysis ~n 7 ~ 1C k ,-.

ATTACHMENTS FOR PUMP INSTALLATION PERMIT (2x): ~ not necessary - only WCP o~ 1 COVER LETTER £ } C/ 2COUNTY COMMENTS (DWS/SMA) 3DOH COMMENTS To be sent to driller/pump installer 4DLNR COMMENTS (LD/OCCUDHP)

5WCR 1 Accept

6WELL CONST. COMPLETION CERTIFICATE <------ To Landowner

} Staff internal checks

5. Roy (initial) check (Entered WCR 1IWCCC accept date into database) 6. Susan Hoagbin (initial) finalize 7. Ken (initial) signature 8. Mitc~ g) (initial) signature (Entered PIP issue date if attached/required) 9. Cha y/Ryan He

o WELL CONSTRUCTION PERMIT

Homer's Adasea Well. Well No. 3688-19

o

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 Homer's Adasea Well (Well No. 3688-19) at TMK 1-5-045:029, Hawaii, subject to the Hawaii Well Construction & Pump Installation Standards (HWCPIS - February 2004) which include but are not limited to the following conditions:

I.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

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

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 submit to the Chairperson the test results as a basis for supporting an application to install a permanent pump. No permanent pump may be mstalled until a pump installation permit is approved and issued by the ChaIrperson. No withdrawal of water shall be made for purposes other lhan testing without a Certificate of Pump Installation Completion. The permitted pump capacity described on the pump installation permit may be reduced in the event that the pump test does not support the capacity.

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

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

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

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

The Well Completion Report Part I shall be submitted to the Chairperson within sixty (60) days after completion of work (please contact staff or visit www.hawaii.gov/dlnr/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 ~eference. 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 IDroperty may result. Any variances from the HWCPIS shall be approved by the Chairperson prior to invoking the variance. -C" .1 _"

The work proposed in the well construction permit application shall be completed within two (2) years from the daf~-'of Permit aPP.fOlf~, unle~{ltherwise specified. The permit may be extended by the Chairperson upon. a showing of good cause and good-faith performance. A reqilest to ext93' the permit. shall be submItted to the ChaIrperson no later than the date the permIt expIres. ,. , 1

'., -- \ 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 th~n the permittee milst apply fOL 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 indenmify, defend, and hold the State of Hawaii harmless from and against"any loss, liabilii±';~laim, or\ci~\nand for property damage, personal injury, or death arising out of any act or omission of the applicant, assigns, officers, employees, contractors, lIiKHtgents UJ1.® 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'jor a new well ~structionlpump installation permit m accordance with Hawaii Administrative Rules § 13-1 68-12(f). . .. " c::> Special conditions in the attached cover transmittal letter are incorporated herein by reference.

Date of Approval: March 10,2008 Expiration Date: March 10,2010

J?w:LAU - \ r Com ter 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: ~ t2.r

f/ C-57 License #: C-23379 Date: .5 ' Z" " ~r

Printed Name: Rod Diamond ~~~~~~----------------------------------

Diamond Construction Firm or Title: and Water Well Drilling

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

Attachment

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

State of HawQ 0 COMMISSION ON WATER RESOURCE MANAGEMENT Department of Land and Natural Resources WELL COMPLETION REPORT - PART I

For Official Use Only:

'''"' \l ';:' :1 f, \. ,~ . - 1...

Well Construction "" " Instructions: Please print in ink or type and send completed report (with altactmeIb, if appItabIe) to Commission on WaJer Resource Mallagemellt, P.O. Box 621, Honolulu, Hawaii 96809. The Commission may not accept incomplete reports. This form shaI be submitted within 60 days of the completion of wor1<. For assistance, please consult the Hawaii Weft Constructioo and P~ Installation standards or cal the Regulation Branch aJ 587.f 0226. For updaJes to this form or additional information, please visit our website aJ httD:llwww.staIe.hi.usldInr/cwrmI '

• I 30

.. , " .... ,!

1. State Well No.: 3688-19 Well Name: Homer's Adasea Island: Hawaii 2. Address: He 3 Box 11074, Keaau, HI 96749 Tax Map Key: 1-5-045-029 3. Drilling Company: Diamond Drilling and Pump

4. Drilling method used during construction: ~ Rotary 5. Date Well Construction (drilled, cased, grouted) completed: 3-25-08 RII out attached Drille(s Log

MonIhIDa)ItYear

In addition to the dnllet"'s log. if a geologic log was prepared. please submit with this form.

6. Was the subject well cored? DYes • No

7. Step-Drawdown Test completed? • No DYes Attach Step-Orawdown Test Form (12117197 SDPTD Form)

8. Constant Rate Aquifer Test completed?

Water Level Data:

• No D Yes Attach Constant Rate Aquifer Test Form (12117197 CRPTD Form)

Reference Point Depth to WaJ.er level Date /Time of Elevation WaJer (ft.) ft. above msI Measurement

9. 10.

Initial encountered during drilling (this should also be filled in on the driler's log)

Just prior to casing installation After casing installation (this information should be before any pump tests are performed with casing installed)

Ground= 106.4 tlmsl - 108.4 Ground=I06.4tlmsl 108.4 If this refer-eore point is not the bmdunark, the difference between the bencbmark and this

= 2 3-24-08 am 2 3-24-08 am

11. Chloride: 33 ppm. Temperature: 71 *F pointis: 0 tl 108.4 2 3-24-08 am 12. As-built section filled in completely 13. Attach photograph of well and concrete pad showing benchmark on concrete pad. 14. GPS coordinates provided in degrees, minutes, seconds

If a pump is not planned to be installed, please describe (belOW in the remarks section) how well is secured to prevent 15. unauthorized access (example: lockable cover, threaded coupling, etc.) 16. Remarks:

Licensed Driller Rod Diamond C-57 Lie. No. Be 23379 --------------------------------------- --------------------

Date: =================== Signature flkk£2..J

--------~-----------------------------4-7-08

weR1 Fonn 6112107 Page 1 of 5

o o 13. As-BUIL T WELL SECTION (PietnIe 8lfItch u-buiIt if diffetent tom diagnmI ptOVIded below)

Elevation at lop of casing 109.4 ft., msI* (to nearest 0.01 ft.)

8 in.

Minimum of X Radius & 4" Thick Conaete Pad

Ground Elevation: 108 ft., msI Bench mark elevation:

108.4 ft. msI* (Surveyto~ 0.01 ft.)

Grouting method: o Positive

displacement Jii[0ttler

Total Depth

118 ft.

Solid Casing Material:

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

Annular space between hole and casing (1.5" for positive displacement, 3" for other methods):

1.5 in.

Rock or Gravel Packing:

35 ft "'"'M'""ateria/---"· -=:- .

N Crushed Basalt

o Rounded Gravel

water Level Elevation: _2 __ ft. msI*

Please ..-.r to the HAWAJlWELLCOHSTRUC11ON AND PUMP INST6LLADQNITANPAROS to ensure that your M-built is in compliance

with applicable SIandards.

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

Length: 1 08 ft.

Nominal Diameter: 4 . 5 inches in.

wall Thickness: Schedule 40 in.

Bottom Elevation: -0- ft., msI

Open casing: 0 Perforated o Sa"een Length: ____ --"'l..:..O _____ ft.

Nominal Diameter: 4 5 inches in.

WaD Thickness: Schedule 40 in.

Bottom Elevation: -10 ft., msl

Open Hole:

Length: ____ ---LN~/..L..A.L_ ___ ft. Diameter: ____________ in .

. Bottom EIevation: ________ ft., msI

Carbon Steel: compliant with (check one or more): 0 ANSI/AWWA C200 0 API Spec. 5L 0 ASTM A53 0 ASTM A139

And compliant with (check one or 11IOIe): 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)

ASS Plastic conforming to ASTM F480 and ASTM 015Z7: (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

Thennoset Plastic: (check one) 0 Filament Wound Resin Pipe conforming to ASTM D2996

o CentrifugaUy Cast Resin Pipe conforming to ASTM 02997

o Reinforced Plastic Mortar Pressure Pipe conforming to ASTM 03517

o Glass Fiber Reinforced Resin Pressure Pipe conforming to AWWA C950

o PTFE Fluorocarbon Tubing conforming to ASTM 03296

o FEP Fluorocarbon Tubing conforming to ASTM 03296

Open Casing Material: Carbon Steel: compliant with (checkoneorl1lOle): 0 ANSIIAWWA C200 0 API Spec. 5L 0 ASTMA53 0 ASTM A139

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


ASS Plastic conforming to ASTM F480 and ASTM 015Z7: (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

Thennoset Plastic: (check one) 0 Filament Wound Resin Pipe conforming to ASTM D2996

o Centrifugally cast Resin Pipe conforming to ASTM 02997





weR1 Form 1011B1rJ4 Page 2 of 5

o o

o DRILLER'S LOG o WELL NUMBER: 3688-19

Depths (ft.) s Rock Description, Watsr Level, Chlorides PPM Dates

0 to 118 Basalt, Water @106.4 ft. Chlorides 33 PPM 3-24-08

to

to

to

to

to

to

to

to

to

to

to

to

to

to

to

to

Remarks:

weR1 Form 10118104 Page 3 of 5

o o

21'

~O Well

i 120'

Latitude: N19 d~gr~~s 36 min. (.254)x60=15s~c /

Longitude:W 15-ld~g1ws 58 min. (.852)x60=51 S~C.·

I 11th Ave. HPP Dead End

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

weR1 Form 10118!f)4 Page 4 of 5

Well Elevation Site Photo

Benchmark Elevation est. 108.4

I certify that the eleyation shown aboye: 1) Was done in accordance with acceptable slUTeying practices 2) Is accurate to the nearest 0.01 ft. ~) Is referenced to mean sea leyei

Surveyor License No. Date

weR1 Form 10118104 Page 5 of 5

o MEMO and ROUTE SLIP (ver.04/03/2008)

o I WCR 2 Check for Well No. 3688-19 (survey to regulation memo)

1. Pum Tests Check s ecial condition of PIP? Yes 'No D. England ~ Yes No no, describe ~y

Step-Drawdown Test:

followed WCPI Stds analysis attached

Aquifer Pump Test:

followed WCPI Stds T & S analysis attached

Potential Well Interference:

Potential Stream Impacts:

Additional Testing or Data Required:

Pump Test Comments Attached:

Proposed Pump Capacity is OK.:

o o

o o

o

o

o

o

t\ ;,J

o o

o o

o

£."0 gpm no test required

/ 0<50 gpm no test required

stream names:

04/22/08

2. Pump Installation Check Mitch Ohye i \.' (initial) R. Torres __ (initial)

data complete followed Special Cond & Elev.

well database updated

No If no, describe deficiency

3. Charl€yan) ____ (initial) take action based on above analysis

ATTACHMENTS FOR ACCEPTANCE: 1WCR2 ACCEPTANCE LETTER

2PUMP INST. COMPLETION CERTIFICATE

3METER INSTALL. REPORT (IF NECCESSSRy) __ _

4WUR

=1 To be sent to driller

J To be sent to landowner/operator

} Staff internal checks

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

5. Susan Hoagbin (initial) finalize

6. Ken (initial) signature

7. Faith Ching (initial) enter into WUR database

8. ChareRY~ile

+ OMP INSTALLATION PERMIT 0

Homer's Adasea Well, Well No. 3688-19 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 Homer's Adasea Well (Well No. 3688-19) at TMK 1-5-045:029, 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.

11.

12.

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.

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


The pump installation permit shall be for installation of a 25 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.

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

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.

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.

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

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.

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.

C3 The permittee, its successors, and assigns shall indemnify, defend, and hold the State of Hawaii harmlessfr~m and ~~inst any loss, liability, claim, or demand for property damage, personal injury, or death arising out of any act or omission ~the applTt, assigns, officers, employees, contractors, and agents under this permit or relating to or connected with the granting o~is perniitl

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

Date of Approval: March 10,2008 March 10,2010

j).v.LAU Expiration Date: \ Com

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: Rod Diamond

C-57, C-57a, or A License #: C-23379 Date: '5 - f? t(.. tJY/ Diamond Construction and

Firm or Title: Water Well Drilling


Attachments

/

State of HawS 0 For Official Use Only:

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

-i;;;;;;;;;;;F;;;;Prini'p;u:1m;;i;p~l;-n~stap;;-;lI:;at;rio;n;;r;;;;~;;;;:n;:ih;;d::;;0f;i:ibi:);-;i:C~::t~~AFRIO Instructions: Please print in ink or type and send completed report (wiIh altachmenls, if appIiI;aIE) to the on Water Resource Management, P.O. Box 621, Honolulu, Hawaii 96809. The Commission may nat accept incomplete reports. This form shall be submitted within 60 days of the completion of work. For assistallce, please consult the Hawaii Well Construction and Plmp hlSIaIIatioI. standards or call the Regulation Branch at 587.e225. For updates to this form or additional infonnation, please visit our website at http://www.state.hi.usldlnr/cwrml.

29

Hawaii 1. State Well No.: 3688-19 Well Name: Homer's Adasea Island: ==========================~----~==~======~ 2. Address: HC 3 Box 11074, Keaau, III 96749 Tax Map Key: 1-5-045-029

3. Pump Installation com:.pa=n~y..:..: -==================--"-__________________ , 4. Date Pump Installed: 3-24-08

-----=~~~/~~-r-----

5. PERMANENT PUMP INFORMATION ~-~=----~~~-------------------

Pump Type, Make, Serial No.: SUB 1 GRUNDFOS 1 16S20-18

6.

Rated Capacity: 16 gpm at head of: 365

Motor Type, H.P., Voltage, rpm: FRANKLIN 12 lIP 1230 V/3450 RPM Pump type (check one):

o Deep Well Turbine

X Submersible

o Centrifugal

Method of flow measurement:

o Rotary o Propeller

o Rotary-Displacement o Reciprocating

o Rotary-Gear o Impulse

ft.

X Flowmeter Manufacturer Master Model no. PT92194 Size % in. ------ --~~-~

o Weir o Open Pipe 0 Orifice· 0 Other*, explain below

7.

8.

9.

10.

*attach schematic

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

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 method of flow measurement.

Well Owner: Mark Heritage / Donna Chalmers HC 3 Box 11074, Keaau, III 96749 966-9608 / 966-4452

11. Land Owner: Same

Pump Installation Contractor (print) Rod Diamond

Signature

C-S7/C-S7a/A Lic. No. Be 23379

Date 4-8-08 WCR2 Form 2123105 Page 1 of 2

'. 7. AS·BUIL T pUMQcnoN (Please attach as-built if different from dQ provided below)

Bench mark elevation surveyed to nearest 0.01 ft. = 108. ft. mean sea level ---::t

~ 1111 = 011_1111 = 011 .~---"'t....-.

Elevation of top of chase tube NI A ft. mean sea level

.. f

.... ....... l.. ..

Pump intake depth = 116 ft. (referenced to bench mark)

Chase tube depth = NI A ft. (referenced to bench mark)

If airline installed, bottom of airline elevation =

NI A ft. mean sea level

WCR2 Form 2123105 Page 2 of 2

-~RO~CECURVES o 16GPM o MODEl16S

'-OW RANGE: 10 -20 GPII

2300 OUTLET SIZE: 11/ .. • NPT

16S10&-7&DS (10 HP) . .. "2"~ l. ~I-

~.,

2100

2000

1900

1800 , "

1700 g18S7H8DS n f/J Ii PI

:fd:

[t ~/. fi~. })j. ~:~"

1600

1500

1400 'fj::: 1300

fl1200 ii 1100 ~~m 1000 r i:~& 900 ~~~?

Fl16S5N8

800 ~~~ 700

800 ~16S20-18

.. .-

500

400 816S15-14 (1'12 or

ij~ .

I 1:116510-10 1 Hr

M"_

r:ir -""".:

i~?~ ~~~.,

!i ~f:.-.· :-;::i :·.-.~7

300'

200

100

~16S07-8 PI. HP . -C/16S05-5 (1/2 HP

o o 2 4

, Ji.~:

---J..-' : . . ,

6 8 10

=.~ RPM ~ GI ... _.-: ...... I-GIIHUI ___ .... I-

.......... I-~.---

;.

- ':

-~

~ r----....

CAPACITY (GPM)

12 14 18 18 20

%~ ?tPf>t .. ,~ ~~ At>A-~ AdIi_ CIJIIiaa to ISO .... ,.. tEl __ A ...... at 1>_.2 feeL

,jffl'

I ,I ·:1 I

~:~~.----.. --------.. --------.. ----------------------------------------------------------------------------------------------... ,~~~ 4-17

o o "

~ISSION ON WATER RESOURCE MANAGEMENO ROUTE SLIP FOR PERMIT ISSUANCE 11/14/07

FROM: RYAN

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

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

ICE,C. IMATA, R.

-3-KAWAHARA, K.==

DATE: 3110108

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

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

SUSPENSE DATE: _______ _

Approval Signature

-3-lnformation

PLEASE:


Take Action Type Draft

-2-Type Final -4-File

Xerox copies

WELL NUMBER 3688-19 WELL NAME Homer's Adasea

application type BOTH 1 WCP COVER LEITER ---b'--:-2WCP ~ 3 WELL CHECK PRINTOUT ---y-

4 PIP COVER LETTER 5 PIP

COMMENTS: 6 SDWB 7 WWB 8 CWB 9 LD

10 HP 11 LUC 12 OCCL 13 SMA

NOTES: DRILLER TMK PUMP CAPACITY WELL OWNER LANDOWNER COMMENT DEADLINE

~

V vi

=1Z

~t n I

Rod Diamond -0- ,,<;·'-\.S:'71 {) -'t. S'

~J r.-tVt ~~ ~

'\VlM/l>(w-- ~ Tr~ r-:'~ ~ ~ d 0; 1)A/l'1-wJ .-

W tA~d ~i tUJ~40 ~<~ / H> ~d r e -1;frr..ei.,

f'JD ~ +0, ~ ;u+-fvv (tZ -- veN 1.B1...V ,

~ Vt{ (\d ~ / Ii) I i) 'i>

~~~~

lV~-~~, c/

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


Mr. Fred Page

o o




March 19, 2008

Fred Page Drilling International P.O. Box 1434 Pahoa, HI 96778

Dear Mr. Page:



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



Cancellation of Well ConstructionlPump Installation Permit for Well No. 3688-19

This is confirmation of your acceptance of the cancellation of the Well Construction/Pump Installation Permits for the Homer's Adasea Well (Well No. 3688-19) on March 10, 2008.

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.

~~~~t::-Deputy Director

RI:ss

c: Mark Heritage


Ref: 3688-19.pip2

Mr. Rod Diamond

o o




Diamond Construction and Water Well Drilling HCR#3 Box 14073 Keeau, ill 96749

Dear Mr. Diamond:

Pump Installation Permit Homer's Adasea Well <Well No. 3688-19)


MEREDITH J. CHING JAMES A FRAZIER NEAL S. FUJIWARA

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


KEN C. KAWAHARA P.E. DEPUTY DIRECTOR

March 19,2008

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.

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

Please sign both permit originals and return one for our files.

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

Finally, this letter is notice that we accept your completed application on March 10,2008.

If you have any questions, please call Ryan Imata of the Commission staff at 587-0255.

~SinCerelY' , ~~ L-L l!RA H. TIpLEN C alrperson

Enclosure

c: Mark Heritage (with applicable comments - DOH SDWB, WWB, CWB) USGS HawaiiDWS

- t""\ PUMP INSTALLATION PERMI~ -rIomer's Adasea Well, Well N o. 368~

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 Homer's Adasea Well (Well No. 3688-19) at TMK 1-5-045:029, Hawaii, subject to the Hawaii Well Construction & Pump Installation Standards (HWCPIS - February 2004) which include but are not limited to the following conditions:

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

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 25 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.hawaii.gov/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.

11. 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:

March 10,2008 March 10,2010




C-57, C-57a, or A License #: C-23379 Date: -------Diamond Construction and

Firm or Title: Water Well Drilling


Attachments


Ref: 3688-19.wcp2

Mr. Rod Diamond

o o




Diamond Construction and Water-Well Drilling HCR#3 Box 14073 Keeau, HI 96749

Dear Mr. Diamond:

Well Construction Permit Homer's Adasea Well <Well No. 3688-19)



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



March 19,2008

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


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/cwrmlforms.htm.

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

Finally, this letter is notice that we accept your completed application on March 10, 2008.

If you have any questions, please call Ryan Imata of the Commission staff at 587-0255.

S~:~ {W~=~TH~~~L--,

Enclosures

c: Mark Heritage (with applicable comments - DOH SDWB, WWB, CWB) USGS HawaiiDWS

/

o o WELL CONSTRUCTION PERMIT

Homer's Adasea Well. Well No. 3688-19 Note: This permit shall be prominently displayed at the construction site until the work is completed


I.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

The ChailJ!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.


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 sutimit 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 pumJ> installation permit is approved and issued by the Clulirperson. No withdrawal of water shall be made for purposes other than testing without a Certificate of Pump Installation Completion. The permitted pump capacity described on the pump installation permit may be reduced in the event that the pump test does not support the capacity.

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

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 1 shall be submitted to the Chairperson within sixty (60) days after completion of work (please contact staff or visit www.hawaii.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 Chairperson upon a showing of good cause and good-faith performance. A request to extend the permit shall be submitted to the Chairperson no later than the date the permit expires.

If the well is not to be used it must be prorerly capped. If the well is to be abandoned during the course of the project then the permittee must apply for a well abandonment permit in accordance with § 3-l68-12(f) prior to any well sealing or plugging work.

The permittee, its successors, and assigns shall indenmify, 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 §13-168-12(f).

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

Date of Approval: March 10,2008 Expiration Date: March 10,2010


Driller's Signature:


C-S7 License #: C-23379 Date: ------------------- ------------------Diamond Construction

Firm or Title: and Water Well Drilling


Attachment

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

Data Input

~ell Number 3688-19 Well Name Homer's Adasea Greund Elevatien 110 Cement Greut 84 Greuting Methed pesitive displacement Hele Diameter 8 Tetal Depth . 120 Depth to Water 108 calculated head 2 Public Water Supply Well? no. Selid Casing Material pvc plastic plastic Selid Casing Specificatien Schedule 40 Selid Casing Length 110 Selid Casing Diameter 4.5 Selid Casing Wall Thickness 0 Open Casing Length 10

Results

~ell Depth Theeretical Thickness ef Aquifer 82 1/4 Aquifer Thickness 20.5

. Dfjfltb/~ell.belov{Sea t.e.vef" ..... .... ....~;. '.~ .. 10 okay'" •• . ...... Sectien 2:2 .•. Well Casing

Minimum Wall Thickness Material pvc plastiC

Minimum Thickness per standards no. requirement ;' .. ' WalliliitkneesProviCted·.·. .. /; ... /~ .... ........... ......... .. o nOstandam ".:'" Sectien2.4(b) Minimum Length ef Selid Casing

90% ef greund to' tep ef aquifer 97.2 fi.f1.i:tgtl'l df:solidcasin'gProvided ......... ·.·;;i •. ·.i'V...··{r :MO okay~ .. :;.~:i . .. . Section 2;4 q

·CasfJig"Matenaf ~ ~ 'SChedule 40 •. •.... ~ .: .... incompliance . ... Sectien 2.4 d)'e' (foipvcooJk- check for 200'limit) /' .. :. .. ... okay Section 2.4 d).

Annular Space Depth ef Greuting

Calculated Depth of Grouting 75.6 Deptl'lof Groutirlg provided

•• 84 okay Sectien 2.6(c)

Minimum Annular Space required 1.5 Thick/Jess of !J.tm(Har Space. . ·}:~'~.:S.·· ....... : .....• tJ5 okay. . Section 2.6(d)

STATE OF HAWA9 Q DEPARTMENT OF LAND AND NATURAL RESOURCES COMMISSION ON WATER RESOURCE MANAGEMENT

APPLICATION FOR A WELL CONSTRUCTION I PUMP INSTALLATION PERMIT

Instructions: Please print in ink or type and send completed application with attachments to the Commission on Water Resource Management, P.O. Box 621, Honolulu, Hawaii 96809. Application must be accompanied by10 copies and a nonrefundable filing fee of $25.00 payable to the Dept. of Land and Natural Resources. The Commission may not accept incomplete applications. For assistance, call the Regulation Branch at 587-0225. For further information and updates to this application form, visit http://www.hawaii.gov/dlnr/cwrm.

WELL LOCATION INFORMATION 1. STATE WELL NO. Of already assigned) 2. WELL NAME

3688-19 Homer's Adasea 3. ISLAND

Hawaii The following be attached before this application is accepted as complete (check off if attached):

4. TMK 1 ZONE


5 045 SEC PLAT

o Portion of 7.5-Minute Series USGS topographic map (scale 1 :24,000) with well location labeled and include the name of the quad map. o Property tax map, showing well location referenced to established property boundaries. o Photograph of the proposed well site.

A schematic dia ram showin the well site, access road and ro osed well infrastructure if a licable 5. WELL OPERATOR'S NAME/COMPANY Well Operator's Contact 6. LANDOWNER'S NAME/COMPANY

same same Mark Heritage & Donna Chalmers

Well Operator's Mailing Address same

Landowner's Mailing Address HeR #3 Box 11074 Keaau, HI 96749

Landowner's Contact

Same

029 PARC

Well Operator's Phone Well Operator's Fax Well Operator's E-mail Landowner's Phone Landowner's Fax Landowner's E-mail

same same H:966-4452 966-4452 PROPOSED WELL CONSTRUCTION PROPOSED PUMP INSTALLATION 7. Proposed Work. 8. Construction Type 10. Proposed Work. 11. Proposed Pumping Rate, gpm (gallons per minute) 13. Method of flow measurement X Construct New Well. x Drilled. o Modify Existing Well. 0 Dug

X Install New Pump. 25 x Flow meter

O Replace Pump 1--7::-::---:-:----:-:~,___-:---:---::--~,---i 0 Open Pipe

O 0 Shaft. Abandon/Seal Well. 0 Tunnel

12. Proposed Amount of Withdrawal, gpd (gallons per day) 0 Weir

Yes x No

500 0 Orifice o Other

14. Proposed Surveyor name and license number (a surveyor is required for all Well Construction Permits and may be required for some Pum Installation Permits Deferred

PROPOSED USE

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

X 16 Domestic Number of units to be served:

17. Industrial (describe

and no. of acres

21. Conservation District Use Permit (COUP)

Not Required (attach documentation from OCCL)

Site Photo

§ Required, COUP # date approved X Well is not in Conservation District

I have not checked with OCCL about whether or not a COUP is required. I understand that checking with the County prior to making this application will expedite my review. I further understand that issues raised b this a enc ma dela or result in denial of the rmit issuance, or revocation of the ermit after it is issued. 22. Special Management Area Permit (SMAP) o Required, SMA # date approved ___ .,..--

B Not Required (attach documentation from applicable County agency) I have not Checked with the county about whether or not an SMA is required. I understand that checking with the County prior to making this application will expedite my review. I

further understand that issues raised b this a en ma dela or result in denial of the ermit issuance, or revocation of the ermit after it is issued. 23. Historic Preservation Division (HPD) of the DLNR

8 I have consulted with the HPD regarding potential impacts of well construction activities on historic sites. I have attached applicable documentation from the HPD. I have not consulted with the HPD regarding potential impacts of well construction activities on historic sites. I understand that checking with the HPD prior to making this application will expedite my review. I further

understand that issues raised b this enc ma dela or result in denial of the rmit issuance, or revocation of the rmit after it is issued. Additionall the histo of ast land use is attached. Additional remarks, explanations, etc. (attach additional sheet if more space is needed)

C-S7/C-S7aJA License No.

Rodney K Diamond 3-6-08 Date

Print

HCR #3 Box 14073 Keaau HI 96749 Address

987-8100 966-4129 Phone Fax E-mail

Rodney K Diamond Print

HCR #3 Box 14073 Keaau HI 96749 Address

987-8100 966-4129 Phone Fax

C-S7/C-S7aJA License No. 3-6-08 Date

E-mail

WCPI App. Form 2/26/07

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

Hole Diameter: 8 inches.

Elevation at top of casing 111.4 ft., msl* Minimum of 2' Radius & 4" Thick Concrete Pad (to contain benchmark surveyed to nearest 0.01 ft.)

Ground Elevation: 110_ft, msl*

1/;;«:"\ Please refer to the lC------~---" " • 4, • . ' . ,'.

I Cement Grout: 84ft. I

I

HA WAIl WELL CONSTRUCTION AND PUMP INSTALLATION STANDARDS

. (min. 70% of distance from ground elevation to top of

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

water su rface or 500 ft., whichever is less.)

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

Grouting method: Total Length: 11 ° ft.

x Positive Annular space between Nominal Diameter: 4.5 in. Displacement hole and casing (1.5" for

Other positive displacement, 3" Wall Thickness: ___ -'S""4'->0'--____ ,in. for other methods):

Bottom Elevation: -0- ft., msl*

--1.L in.

I Open Casing: • Perforated D Screen

Total Depth Rock or Gravel Packing:

Total Length: __ --'1""0'--_____ ft.

~feet. ~ ft. Nominal Diameter: 4.5 in. Material: I x Crushed Basalt I

Wall Thickness: S40 in. I

D Rounded Gravel t Bottom Elevation: __ .:..-1""0'--____ ft., msl*

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

Estimated Water Level Elevation: Open Hole:

I _2 __ ft. msl* Length: NA ft.

I Diameter: _____________ in.

L ___ . ___ ~ ____ _

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

Bottom Elevation:

For non-salt water Basal Wells - bottom elevation of well should not be deeper than 1/4 of aquifer thickness or, Bottom Elevation of Well Limit = (Water Elevation - ) Example: Estimated + 2 ft. Water Level Elev. Bottom Elevation of Well Limit = (2 -) = -18.5 ft.

Solid Casing Material:

ft., msl*

Carbon Steel: compliant with (check one or more): D ANSIIAWWA C200 D API Spec. 5L D ASTM A53 D ASTM A 139 And compliant with (check one or more): D ASTM A242 (or A606) D Type E D Type S D Grade B D Other

Stainless Steel: (check one): D ASTM A409 (production wells) D ASTM A312 (monitor wells) ABS Plastic conforming to ASTM F480 and ASTM 01527: (check one) D Schedule 40 D Schedule 80 PVC Plastic conforming to ASTM F480 and (ASTM 01785 or ASTM 02241): (check one): • Schedule 40 D Schedule 80 D Schedule 120 Thermoset Plastic: (check one) D Filament Wound Resin Pipe conforming to ASTM 02996

D Centrifugally Cast Resin Pipe conforming to ASTM 02997

Open Casing Material:

D Reinforced Plastic Mortar Pressure Pipe conforming to ASTM 03517 D Glass Fiber Reinforced Resin Pressure Pipe conforming to AWWA C950 D PTFE Fluorocarbon Tubing conforming to ASTM 03296 D FEP Fluorocarbon Tubing conforming to ASTM 03296

Carbon Steel: compliant with (check one or more): D ANSIIAWWA C200 D API Spec. 5L D ASTM A53 D ASTM A 139 And compliant with (check one or more): D ASTM A242 (or A606) D Type E D Type S D Grade B D Other

Stainless Steel: (check one): D ASTM A409 (production wells) D ASTM A312 (monitor wells) ABS Plastic conforming to ASTM F480 and ASTM 01527: (check one) D Schedule 40 D Schedule 80 PVC Plastic conforming to ASTM F480 and (ASTM 01785 or ASTM 02241): (check one):. Schedule 40 D Schedule 80 D Schedule 120 Thermoset Plastic: (check one) D Filament Wound Resin Pipe conforming to ASTM 02996

D Centrifugally Cast Resin Pipe conforming to ASTM 02997 D Reinforced Plastic Mortar Pressure Pipe conforming to ASTM 03517 D Glass Fiber Reinforced Resin Pressure Pipe conforming to AWWA C950 D PTFE Fluorocarbon Tubing conforming to ASTM 0329 D FEP Fluorocarbon Tubing conforming to ASTM 03296

WCPI App. Form 10/05/04

DOCUMENT NO . .. QARTMENT OF LAND AND NATURAL RESO~

UAC OR AITACHED WORKSHEET DATE' March 10 2008 ,

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

S 08 326 C 1026 0752 (1 ) $25.00 HFS (Diamond Drilling)

" " " " " " (2) $25.00 Andree Lecocq

" " " " " " (3) $25.00 Douglas G. Stillwell

" " " " " " (4) $25.00 Stephen M. Osborne

" " " " " " (5) $25.00 HFS (Diamon Drilling)

" " " " " " (6)

(7)

(8)

(9)

(10)

TOTAL $ 125.00

REMARKS: LINE (1) Adasea Well LINE (2) Shalom Tzion Well LINE (3 StillWell LINE (4) Goodwill Well LINE (5) Mauumae LINE (6) LINE (7) LINE (8) LINE (9) LINE (10)

CQISSION ON WATER RESOURCE MANAGEMENQ ROUTE SLIP FOR PERMIT ISSUANCE 11/14/07

FROM: RYAN

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

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

ICE,C. ~IMATA,R.

KIMURA, J. ~~

DATE: 2127108

TO:

LEROUX, E. KUNIMURA, I.

--NAKAMA, L.\--'

~OHYE,M. \ 1" I SAKODA, E. ' )

8/' --SWANSON, S.

-- --UYENO, D. ----YODA, K. --

==YOSHINAGA, M. ==

SUSPENSE DATE:

Approval ~Signature 4::L,.lnformation

WELL NUMBER 3688-19 WELL NAME Homer's Adasea

application type BOTH 1 wCP COVER LETTER 2WCP 3 WELL CHECK PRINTOUT :iZ: 4 PIP COVER LETTER 5 PIP

COMMENTS: 6 SDWB 7 WWB 8 CWB 9 LD

10 HP 11 LUC 12 OCCL 13 SMA

NOTES: DRILLER TMK PUMP CAPACITY WELL OWNER LANDOWNER COMMENT DEADLINE

~ 'I<.

± not in conservation district not in conservation district not in sma

Fred Page o o o o

\ - <-;

PLEASE:


Take Action --Type Draft -2-Type Final s:z::..File

Xerox copies


Ref: 3688-19.wcp

Mr. Fred Page

o o





Dear Mr. Page:

Well Construction Pennit Homer's Adasea Well (Well No. 3688-19)



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


February 28, 2008

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

Special Conditions


Please refer to the Pennit 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/cwrm/forms.htm.

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

/

...

Mr. Page Page 2 February 28, 2008

o o

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,

r ~i~~Hi:al--Enclosures

c: Mark Heritage (with applicable comments - DOH SDWB, WWB, CWB) USGS Hawaii DWS

/

.,,-," o WELL CONSTRUCTION PERMI9

Homer's Adasea Well, Well No. 3688-19 Note: This permit shall be prominently displayed at the construction site until the work is completed


I.

2.

3.

4.

5.

6.

7.

8.

9.

10.

II.

12.

13.

14.

15.

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

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

The well construction pennit shall be for construction and testing of the well only. The pennittee shall coordinate with the ChaiIperson and conduct apumping test in accordance with the HWCPIS (the latest rump test worksheet can be obtained by contacting Conunission staff or at www.hawaii.gov/dlnr/cwrmlfonns.htm). The pennittee shal suomit to the ChaiIperson the test results as a basis for supporting an application to install a pennanent pump. No pennanent pump may be mstalled until a pump installation permit is approved and issued by the ChaiIperson. No withdrnwal of water shall be made for pUIpOses other than testing without a Certificate of Pump Installation Completion. The pennitted pump capacity described on the pump installation pennit may be reduced in the event that the pump test does not support the capacity.

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

The pennittee shall incoIporate 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 concentrntions of shells or charcoal are encountered during construction, the permittee shall stop work and inunediately contact the Department of Land and Naturnl Resources' State Historic Preservation DiVIsion. Work may recommence only after written concurrence by the State Histone Preservation Division.

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

The Well Completion Report Part I shall be submitted to the ChaiIperson within sixty (60) days after completion of work (please contact staff or visit www.hawaii.gov/dlnr/cwrmlforms.htmforcurrentfonn).

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

The well construction permit application and any related staff submittal approved by the Commission are incoIporated into this pennit by reference. This pennit 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 ChaiIperson prior to invoking the variance.

The work proposed in the well construction permit application shall be completed within two (2) ~ears from the date of permit approval, unless otherwise specified. The pennit may be extended by the ChaiIperson upon a showing of good cause and good-faith perfonnance. A request to extend the permit shall be submitted to the ChaiIperson 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 pennittee must apply for a well abandonment pennit in accordance with § 3-168-12( f) prior to any well sealing or plugging work.

The pennittee, its successors, and assigns shall indemnifY, defend, and hold the State of Hawaii hannless 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, contrnctors, and agents under this pennit or relating to or connected with the granting of this penni!.

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 pennit m accordance with Hawaii Administrative Rules §13-168-12(f).

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

~ Date of Approval: February 15, 2008 Expiration Date: February 15,2010

];/ LAU \v> Co


Driller's Signature:

Printed Name: Fred Page

C-57 License #: C-16653 Date:

Fred Page Drilling Finn or Title: International


Attachment

/

+


Ref: 3688-19.pip

Mr. Fred Page Fred Page Drilling International P.O. Box 1434 Pahoa, HI 96778

Dear Mr. Page:

o o




Pump Installation Permit Homer's Adasea Well <Well No. 3688-19)



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

KEN C. KAWAHARA, P.E. OEPUTY DIRECTOR

February 28,2008

Enclosed are two (2) originals of your approved Pump Installation Permit for the captioned well(s) that authorize permanent pump installation work for your well(s). 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.


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

Please sign both permit originals and return one for our files.

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

If you have any questions, please call 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.

S;;S~~L-fi~d~~~~ ~l~N

Enclosure c: Mark Heritage (with applicable comments - DOH SDWB, WWB, CWB)

USGS HawaiiDWS

- o PUMP INSTALLATION PERMI';:; Homer's Adasea Well, Well No. 3688-19

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 Homer's Adasea Well (Well No. 3688-19) at TMK 1-5-045: 029, Hawaii, subject to the Hawaii Well Construction & Pump Installation Standards (HWCPIS - February 2004) which include but are not limited to the following conditions:

\. 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 Certiticate 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 20 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.hawaii.gov/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:

February 15,2008 February 15, 2010

. flo! LA \" Co



Printed Name: Fred Page

C-57, C-57a, or A License #: C-16653 Date:

Fred Page Drilling Firm or Title: International


Attachments

LiM>.\U:-'f.u· {,r)'+.!<:"'-o~' l! "",,V \11

,.

February 22, ~008

o o

STATE OF HAWAII DEPARTMENT OF I.AND AND !'fATlJRAL RESOlJRCES

STATE HISTORIC I'RESERVi\rlON DIVISION 601 K.AMOKILA BOCilJ'\,,\RD, ROOM 555

KAJ>OIH 1l;\W,\H 96707

I\f"CK\\B!IA1<.A >IhU \'. ~ 'I

Ken C, Kawahara. P.E .. Deputy Director Commission on Water Resource Management SlaLe of I hmaii

LOG NO: 2008,t)463 DOC NO: 0802MD76 Archaeolog;

Department of Land and Natural Resources PO Box 62) HlillOlulu. 11awaii 96809

Dcar Me Kavvahara:

SlJRJECT: Chapter 6E-42 Histori~ Presen'ation Review-Request for comments on a Well ConstructionlPump Installation Permit Application, Homer's Adasea Wen (Well No. 3688-19); 10 square feet ora 1.8 acre parcel Por. Block "7" Keaau Ahupua' 8, Puna Districl, Island of Hawai' i TMK: (3) 1-5-045:029

I hank you for the opportunity to comment on the aforementioned project, \vhich we received on february L 2008~ we understand that you had requested a response by February 15,2008 and \ve appreciate )Ollr patience \\ ith the dday in our reply.

We determine that no historic properties will be affected by this undertaking becallsc~'7 . __ ', o Intensiyc cultivation has altered the land ~ Residential development/urbanization has altered the land l8J I)rcviotls grubbing/grading has altered the land o An accepted archaeological inventory sUfvey (A1S) found no historic properties o SlIP£) previously reviewed this pr~iect and mitigation has been completed o Other:

c::» CO

---,.-'"')~:::>

::::J

.J:..

::z::, C5

In the event that historic resources, induding human skeletal remains, lava tube!;. and..d;tva hlisters/bubhles are identified during the construction activities, all work needs to cease:tn 1Ile imm~ate vicinity of Ihe find. the find needs to be protected from additional disturbance, and the State Historic Preservation Division, Hawaii Island Section, needs to be contacted immediately at (808) 896-0514.

Please Lonlact Morgan Dads at (808) 896-0514 if }'Oll have <lny questions or concerns regarding lhis kttcr.

Aloha,

717 fit efrlL-Nancy Mcl\·1ahmJ, Acting Archaeology Branch Chief State Historic PreservatiQn Division

:::0 ;'1 (")

-n ./ ....

i-n CJ

TO:

fROM.

SUBJECT;

o o

lOU8 FEB - I

STATE OF HAWAII DEPARTMENT OF' LAND AND NATURAl RFSOURCES

COMMISSION ON WATER RESOURCE MANAGEMENT PO BOXf,21

HON(;lIJtU, HAWAII ,J(iI'J{j9

Jatmary ! 5, 2008

N;mcy McMahon, Acting Archculogy Branch Chief Historic Preservation

Ken C Kawahara, P.E., Deputy Direclor '11 Commission on Water Rcsoult;c Management

Well Construction/Pump Installation Permit Application lli!.tlicr's Adasea Well {Well No. ,1688-! 9} TMK 1-S-n4S;02~

D&JZ l;f[:)rl.t:,

FEB 2;- 2008

Transmitted for your review and l:omment is .1 copy orthc c:iptiol1t!d Well Coostfuctitm!Pwnp Installation pt\tmit applicfilion.

We would appreciate your comments on tllt! c<lpfinned application with regard to the programs, plans, and nlticclivcs specific 10 your division. PIt-alit' respond bv returning this cover memo form by February J5. 2008. If we dn not receive comments or a request fIx additional review time by this date. \\1,;' will aS$Umc you have 1)0 wmments.

Plca~e find the attached mnpsto 100'.flte the prollnscd welt If you have uny questions about this pcrmil apph.:ation or request addilional review time. P cllse contact Ryan lmata ofthl" Commis~iol1 staff at 5&7-025S, If yOU require additional information regardine: specific information that can be pr()vidt~d by Ihe applicant, pleas!.' contact the applicant directly at the cOI;tact information provided nn the applicalion f .. lrm,

RJ:ss Allachmenl(~)

RESPONSE:

l' ", 1\, C "1-

lhh j;; 111 j ,)lIhh., (,'ouRfy or statr) JlrojcN 1 I 11th ate project amI ( J will 1 I may Jisturb hlstoric "ite';,

t I

I J

('ontact P';I":-;nn'

.. 1

Phone:

c o ~~ __ .... ·--•• ~~1'::>"H~ ECEIVEO

LINDA LINGLE GOVERNOR OF HAWAII ·0 DIVISION LAURA H. THIELEN

CHAIRPERSON

15 A/(): 13




STATE Of: ~Kw~J :-! l: r{D_ (~ DEPARTMENT OF LAND Ajl.jH NAl'URM:R~W~~1C tS

COMMISSION ON WATER RESOUR~E.lMAN:i8EfflENT


TO:

FROM:

SUBJECT:

P.O. BOX 621 HONOLULU, HAWAII 96809

January 15, 2008

Morris Atta, Acting Administrator Land Division

Ken C. Kawahara, P.E., Deputy Director '11 Commission on Water Resource Management

Well Construction/Pump Installation Permit Application Homer's Adasea Well (Well No. 3688-19) TMK 1-5-045:029

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 February 15,2008. Ifwe do not receive comments or a request for additional review time by this date, we will assume you have no comments.

. -::'~ c:::J! Please find the attached maps to locate the proposed well. If you have any que{stions abo~is

permit application, request additional information, or request additional review time, please conta4rRyan Imata of the Commission staff at 587-0255. fT1 ::w en

RI:ss

Pl ~)

Attachment( s) ):0

~~~~~~--------------------------------------------------------------~----~rn RESPONSE:

[ ] A water lease/penn it is required of this applicant and an application for such will be ;et'}fi(!sted by~ division.

rxK 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.

o

[ ]

[xk No objections

Other comments: OriginaiL source offprivate title was issued prior to statehood.

Contact Person: ___ -"'G""a=.r.J...y_Ma"-"='r"=--"'-t1""'· n"-'---_---::-_____ _

Signed:~~~---=---F-_~_---=--_-____ _

Phone: _5....,8"-<7_--"'-04=2 .... 1"--_

FEB 1 3 2008 Date: --------

.,... JAH-3f'l-200e, 17: 23 From: DOW SAFE "~TER BRAHH 8085854351 To:P"""'" 587 0219 P.l·'3

~ 'I

UND" LINGLE ¢t!.\"t;RHOIII 0$ MAW'" I

TO:

FROM:

~ r. RfCflV£D s~lr.; DRlNICING WATER BRANCH

, ,. ! ,: 2003 LA"I'I.o. fl. THll:lEN

1CM11'l~50t4

MEREDIT"~. CHING JAMES A. FRA;:IJ;R I£A~ S FUJIW.o.I\A

STATE OF HAWAII OlOPA,RTLllON10F LAND AND NATURAL RESOURCES

COMMISSION ON WATER ~I;SOURCE MANAGEMENT "0 eoXG21

>iONOLULU. HAWAII S66~

January 15,2008

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

l\IJarshalt LOin, Acting ,Wastewater Branch ~tuart Yamada, Safe Drinking Water Branch

Alec Wong, Clean Water Branch

Laura H. Thielen, Chairperson 11 Commission on Water Resource Mana~ement

CMIVOME L FUI(INO. M 0 DONNA FAY K. KIYOSAKI. p.e

lAWRENCE H MilKE. M.D. J.O

I<fN C KAWAHARA. P E OE.JlIfTVI'It:EeiOfl:

In General: 1t '7~ 'b~.- t.:j-

Q = looo1ro use = dOIM~ti(..., I Ur\;1

location ;;; H PPJ ~.v (above)(~UIC line grd. e1ev. = It.v' well dia. ;:;::: C, I' well depth I ~Dr

SUBJECT: Well Construction/Pump Installation Permit Application Hgmer's Adasea Well (Well No. 368lH9) (J?) t- 9-~; vt

fred PNl,t.. D,.;II;"F-j :r:t(rQ he.

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 captione.d application for any conflicts or inconsistencies with the programs, plans, and o~iectives specific to your department. Please respond by returning this cover memo form by February 15 ... 2008. Ifwe do not receive comments or a request for additional review time by this dale, we will assume that you have no comments.

Please find the attached maps to locate the proposed well. If you have any questions about thjs permit application, request additional informatjol1~ OJ' request additional review time, please contact Ryan Imata ofthe Commission staff at 587·0255.

RI:ss Attachment(s)

RESPONSE: II

[ J

II [ J

[ 1

Il

J J

[ J

T~;,; well q"al.~"" 8' • 50 .... " w~iel1 Will '"'''''' as •• o"r •• ofpo\able w~lcr 10. publ;.; water SY8l •• H (dclillCd 3$ onvinS 2,.". ,,,.,... P"'JP1e 8'1e"".t hi) d8}S per year or hru 15 or more selVlce cOllne~liOl1~) snd IIIbf<t t~C~I'" [),rtaor ofHcalIb apf)I'(lv.a1 J!!!!! ttl its tlSO til <a!\lply with HilN.;i Adminl5tntive lI.ule> {HARi, nile II, C""ptcr10, Rule. ReI ... ,,!!.o P" •• blo W.tor System,. §11-20-29

Thi$. well d~~ not qvalify IS a source servillgll public wal~r sy"em (l"t,,,,.1.65 th9" 2S p~(If)lo: or otto..., po"l"lo aI.l ... st 60 <bY" per year or 1 S ser.lcQ connootiOl1i) and if the well W8I£T is u~d for drmltiflg. Ihe private ~wncr should I<SI fo' ~L1~f1Qlogic;,1 ~ dll:,"~ Ilre:;eJJ\ie before initllmny such use III1d rOl1ulldy Ml,)ttil()l' the ~ICt Q\~IiIY thereafter. However. ift"lllle pi.a1U1ed U$e frOm ~lJ" sou""o ""',.".._ t<l meel the public w.m .yolem dIl:tlnit;()n Ib;n Di~t\ll' of Hc;.'~h QpJlTO\'ll1 is r;quircd m:W: 10 Ilnp\Clnctll.lliOIL

IftJIof well i$ used 10 S"l1piy both pilt.bl. 0"" HO,,-pol~bk PU'l"'''''' .n • "n\;I~ sy't~m, the u.~r .hoItl "'iminal" <r088-c:onneclions and booo::know .ommtiOlli by physically ~cparatinll potable and t1Qtl1)(llable 5nt.m5 by;J]t elr ~ap 0< In 9J)proved b.2clcOow preveam. aad by clcnrly IabcliD8 all nOIlpotable &Jli~()\8 with _hill!! $i~ tl) prev.nt in"dvorjont co~5tll"p\"'n of rion-p<liuble ",attl. Back/low prt>(nliOH dt~i,c. mould be l'DIItllM:ly irl$pcttod Mod ' •• I.d.

for tne Ippho:anl'~ Inf\)rIl13.iOIl. a s(\u~4 ufpo"ibl; wastewalcrcontamlllation i 1'$ I J ;$ .o.lol;.9\~d neIK tbe propoged well site (iafonnllion 3I'I~hccl)

I\n "PDES pcrt1l~ is required

ot~er n;~v~1I1 DOH rIIJes're~ul.ti""$. illfonllalloo. or re~omlDend.aliom JUT; ll!laeh!4

In II.., ~'o;f1I11"'t Ih~ 1o-;alion of lite well 'hall~ bill ifi ~Iill withilllhe p~fC~1 de!wib.d <)TI 1\, •• apphcation, our diviSion coUldet$ the (Olllmmtsto still be ~pphCllbk.:md we do 1101 need 10 review lhe lIew IQt~t;on

N~ Cnlnlneal~(lh~llml

Contact Person: M('~fq",( 44'C'F'~

Signed: ~ .. ~ Phonc; ----------------

Date: 1-]0 0<;; cJlf1. .7 ( .

JAt-l-30-2008 05: 37PM FAX: 8085864351 ID:DLNR CWRM PAGE: 001 R=94%

JAN-30-2008 17:23 From:DOWSAFE I.IClTER BRANH 8085864351 To:8"'Q 587 0219

CWRM A:e:e1ica. tion Source: Bomer's Adasea Well (Well No. 3688-19)

Safe Drinking Water Branch Engineering Section

See attached private water wells information sheet.

Underground Injection Control (UIe)

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

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

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

cw~~ Well Application Standard Comments (SDWB) Verso 611/07

JRN-30-2008 05:37PM FRX:8085864351 ID:DLNR CWRM PRGE: 002 R =94:~

.JAN-J,2j-2008 17:23 From:DOWSAF~ "TER BRANH 8085854351 To:F ~ 587 0219 P.Y3 .' .. . . '>

WARNING! As the owner of a privately-owned well, you should NOT assume that water

from your well is safe for consumption. It is your responsibility to make sure that your well water is safe to drink. The only way to do this is to have your well regularly tested for bacteriological and chemical contaminants.

There are no regulations controlling water quality in private wells serving individual residences as there are for public water systems (public or privately owned utilities supplying water to 25 or m re people or15 service connEf'ctjons). In other words, there are no enforceable limits for co t~minants a.nd\ro requirements for regular testing. Private wells are often found in rural = ;~: ~e~~,:~ .~ivi;i" ~T · ~~'i~ W.S\e7t~~'.Po~ \ncon~in~te~ groun:

NVIRONIiIENTAL R TECTION GEN(;;Y EP/A .. ECOMMENOA S ii' I '. " ,I :'", :, "

T e EPA recommend t at priv te well oVvner$-/test t~eit· well wate~ each year for slJch co taminants as Total.Ctliform a teria, Nitrates, as Well,aS.anY,other contaminants.that may be of concern in your area, More frequent testing may be appropriate if you suspect a problem. EPA also suggests that you consider testing for pesticides, organic chemicals, and heavy metals before using it for the first time. Please refer to the EPA website on Private Drinking Water Wells at http://WWN.epa.gov/safewater/privatewells/fag.html

OTHER SO~TAMINA~TS " "I... :':;\ \. :'! . , ,I , "

Water testing can be v..e~ expen¢ive .. Iti~im.portant ~h:atow spend time to ide~tify whiiU other potential ~~tarrJn~nts~,m~y b~ qf conCE,lm. PleflS" refer th~!EFA web~ite on lPrivate DrinKing Water We~s flt tt :1/. ~~a. 'ov/saf~waterl I'iv tewell IWh oucan~O:'h, I' i

for more h~IP~~ l~formatiofIJ./ ~ aw~e of.whatjan1d how ou ~se:'and"diSJ?cse q, household and garden che'11IQaI~. Also ~e~rr'nine t~e Ipcatlon-of reanby,sePt~ t~.nks or,ea,~SP90IS, and agricultural Qr in~ustrial a~iviiies in the area:' Genf!ralinfoTmatiofl on known ch~rriical contaminatiohof ground water in Hawaif'cari'als'ij'6e fouiia at theDOtfwebsite" www.hawaii.gQv/health/environmental/waterlsdwb/conmaps/pdfIconmaps05.pdf

LABORATORIES

Local comf:rerciallabo/alOfjes can ~e,found in the yellow patJes lof he telephone book under "Laborat?~i~s,~f.~alytieal!.i~ '(Vhenever/possible, utilize a.l~bo atoty hat is certifi~d or approved for the speCIfIC '~n~Klng Wa,ter t~sts aliid .. carefully follow: their Ins ruc~io s for collecting, storing, and transporting ,he sanipl~S. \JU,st be sjure to ask the ~ab.to use EPA ppr~v~d-rrreth~s for drinking water analysi$. \A list pf labs (:er1lfi~d or;ap,proved ~y tjle De art nt of Heal.~~ can be found at www.hawaii. )h ' , e' I a s b dwb 'df es in °Q2DLa s. 'Of, As lab certification sU1tu'c~angesool1StantIY, qonfirm their,status he y u I?ontaot th~ ISP, Please note that the lisl i~ l\inited tocutrently regultUed contaminan in p blic,water systefns.

'. . .; \,' ~

RESULTS

Once the lab provides you with the test results, you will be in a better position to determine if your well water is safe to drink or what contaminant you need to treat for. Generally, you should compare the results with Federal (1NWW.€08.gov!safewater/mcl.html) and State (www,hawaii.gov/health/environmental/waterlsdwb/sdwbfpdf/State%20MCL.pdf) drinking water standards. Where your test results are greater tharl the State or Federal maximum contaminant levels, your well water should be considered as unsafe for consumption,

JAH-30-2008 05:37PM FAX: 8085864351 ID:DLHR CWRM PAGE:003 R=94%

o OM? JAN 1 7 ';I~:~



TO:

FROM:




January 15, 2008

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

vMarshall Lum, Acting Wastewater Branch Stuart Yamada, Safe Drinking Water Branch Alec Wong, Clean Water Branch

Laura H. Thielen, Chairperson 1 Commission on Water Resource Management




SUBJECT: Well ConstructionlPump Installation Permit Application Homer's Adasea Well (Well No. 3688-19)

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 conflicJs or ~ inconsistencies with the programs, plans, and objectives specific to your department.1>rease res ond b returning this cover memo form by February 15,2008. Ifwe do not receive comments or a uest 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 abOlfflhis permit application, request additional information, or request additional review time, please,conta~yan Imata of the Commission staff at 587-0255. :::

RI:ss Attachment(s) \ ..... ,

RESPONSE:

[ I

[ I

[ I

[ I

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This well qualifies as a source which will serve as a source of potable water to a public water system (defined as 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, §I 1-20-29.

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

If the well is used to supply both potable and non-potable purposes in a single system, the user shall eliminate cross-connections and backflow connections by physically separating potable and non-potable systems by an air gap or an approved backflow preventer, and by clearly labeling all nonpotable spigots with warning sigus 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,Xs II is not located near the proposed well site (information attached).

An NPDES permit is required. J~ " _

Other relevant DOH rules/regulations, information, or recommendations are attached. CQ.. & b PCXJL pr UJ I J.e/' In the event that the location of the well changes but is still within the parcel described on this application, our division considers the comments to still be applicable, and we do not need to review the new location. .

)( No comments/objections

Contact Perso?: UeYtj tJ~ o@a WOo Qa3.{)401 0(- IB-wOE>

Phone:

Signed~ ~ <.9n oahu Date:

TMK (3) 1-5-045: 029

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I Pennit 11), 25'S9I IWS Type: [~~!~Q~I.Ne.. A_igned To: I ( .. ~;;~~:;. _______ ... ___ S_ta_tu_~:_=c~~~~~~~ .. ,,:="_'~ .... =-~j _ Oes_c_~_~:~ r_W_B __________ --.d -lfuie(t Information 1-· ..... - .. ·----.. -----.... ------.. --·- I Review Infurmation}---·------

Engineer:

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!ZiP Code:

1315045029

P",yment lyp .. : V

the<:k Data,

I¥'RBdiN' last Modif1ed: 2/26/200710:55 AM

Submit O",ta, \1115/1999

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Inspection O",te:

Check Number: ~l ========~ P"'yor:

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Jan-22-2008 12:04pm

Fax to: Company:

Fax No.:

From-DEPT OF HEAQNVIRCtit.ENTAL LtlGMT 8085864352 o T-466 P. 001/018 F-190

Mr. Ryan Imata

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

Date: January 22, 2008 Com mission On Water Resource Managen'lent Department of Land and Natural Resources 587-0219

Fax from: Joanna L. Seto

Total Pages, inc!. cover: 18

Subject: Well ConstrudionfPump Installation Permit Applicatioo(s) Well No(s). 5058-05; 6734-03; 3957-01; 3687-56; 3586-27; 3688-19; 5949-02;

3787-10j 3487-04; 3586-28; 5611-01; 3688-20; 5653-01; 3383-01; 3687-57; 3687-58; 3688-20

The Department of Health, Clean Water Branch (eWB) h~s the following comments:

t. 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~ Title 11 ~ Chapter 55, Appendix I, effective October 22,2007. Treated process wastewater effluent covered by this general permit includes well drilling slurries, lubricating fluids wastewater, and well purge wastewater. This general pennit does not cover well pump testing. The applicable Notice of Intent (NO I) Fomls and filing fee shall be submined at least thirty (30) calendar days before the start of discharge to the:

Departmem of Heal1h Clean Water Branch 919 Ala Moana Boulevard, Room 301 Honolulu, Hawaii 96814-4920

The CWBuNOI Fonns are available online at httj>://www.hawaii.govlhealrhlenvironmental/water/cleanwater/tbrms/genl-index.html. Inquiries may be directed to the eWE at (808) 586·4309 or by fax (808) S86-43~2.

2. For Well Pump Testing

The discharger shall take all measures necessary to prevent the discharge of pollutants from entering State waters. Such measures shall include, if necessary, containment of initial discharge until the discharge is essentially free of pollutants. If the discharge is entering a stream or river bed, best management practices shall be implemented to prevent the discharge from disturbing the clarity of the receiving water. Jftbe discharge is entering a storm drain, the discharger must obtain written pennission from the owner of the storm drain prior to discharge. Furthermore, best management practices shall be implemented to prevent the discharge from collecting sedilllents and other pollutants prior to entering the storm drain.

JAt-.1-22-2008 11:49AM FAX: 8085864352 ID:DLNP CWPM PAGE: 001 R=96\

Jall~22~2008 12:06pm From~DEPT OF HE~' -" ENVI RONUENTAL UNGMT 8085864352 T~466 P.007/018 F-190

LAUAA H. THIELeN (~i'1E~80h

MERIODITH J. CHING r'" .J.+ JAMES A. FRAZIER 0 \J ~ NEAL S. FUJiWARA

CHIYOME L FuKINO. M D OCINNAFAY K KIY05.~KI, P.t:. /1, IJ.II'IRI'NCE I"l. MIII<"-, M,O .. J,P, V

STATE OF HAWAII KENC. KAWAHARA, p.!!.

TO:

FROM:

OEPARTMENT OF LAND AND NATURAl. RESOURCES COMMISSION ON WATER RESOURCE MANAGEMENT

PO BOX6ll HONOLuLU. HAWAII 98809

January 15,2008

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

Marshall Lum, Acting Wastewater Branch S,tuart Yamada, Safe Drinking Water Branch ~Iec Wong, Clean Water Branch


DfIitUT,"~CTO~

l. : .. ,

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SUBJECT: Well ConstructionlPump Installation Pennit Application C"l Homer's Adasea Well (Well No. 3688-19)

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

Please find the anached 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.

Rl:ss Anachment(s)

RESPONSE: r J

1 I

[ J

r J

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[ J

1.( r 1

This well qllalitic6D~D &OIITQC whi"h will ~ervc a~ u !o~rct ofpombl~ wOll:rro 0 pLlbli, Wal.:r ~~,;(cm (defined a. 5ClVin~ 2501' lIIilie pooJlI~ al lea!160 d.l):i!i pcf)'C8T or has )5 or mor~ servi~ connecti-lns) ad mus' T(,CCl'VC Dircctof afHcalth *pplc ... al p .. i ... to;l;i, uSB to comply wlilt, ,,*,wAii Adm;nlillllTiltivC" 1\"1i!$ (HARJ, Tille II, Olllpler 20, Rules Rdaling ICI POlable Wate,' SYSlems, *'l-20-29.

Thi.s .. "II ~~ 1001 q.,;llif~ _. a .... ...-te $o!t_j"l! a I'''''l'~ w.'or Sy.,om (,,,rv •• I ... lli;,o 2S p.opl •• w m" ... ".:opl .. ill lca,;l 60 diy' pcr y.:ST or J 5 service QQlIlIeQIiDns) and ifllJ., "",II W~!er il n:i~d ror dTmkinl!.lh~ priv~l~ owner ~h!oI,ld le~! forbaol<:rl,~o~ieal md ch.:mical Pft::!rllCe before inilialin& sueh "~ -"" (OI.ltindr moniror rhe WBICI' qualiry Ih~r~afla-. HOlVtver, if fUlure plall""d lise trom [his ~,,'CC iOCfCliSCS ro one<ll rhe p'lhl~ wale!, $y"em dc:finili(ln dlOJl DireClor of Healrll approval is requil'Cd .1l!i!!!: 10 implcmelllS1ioll.

Iflhe well isl15Cd TO i\lppl) I10lh potable and non-porablc purp06tS III a sillJlle syslem, the user sball t1iminazc crosHQnOOClioflS and 1t.1Ck1l ... ", cooneCJiQns by ph)sically scpararing porabk a,ld noo"jlQt8b1c sYSlcms by a" ai,' gap ot 1111 ipllt.)....,g bae\:t1""" p(eYORlet, and by ~Iea.-Iy I.bclinU .,11 nonpotat>l~ ~il!nc;\ wil" W:U'r.iIIS ~iglls 10 pre-em illaC)v~rl~nl C()!)~Ulllpll\'n of nOll' POI able w.11~r. I~;,.;kfl(lw prev.:nrioo dcvic0:6 should be Joulindy inspecled and lCUed.

II dcQs n()I ilpp'.-II(;11lhii. w~1l will Ill! 11$"41 f.)r ~c)11~lImpliv~ P\l'll\"'~. ~ml i. nol '''~Je~IIQ S;II" DTinkins War.:r RClIuhll:ion&.

for the ilppliellll1'~ inf()rIr.aliOlI, a \oIlI\fC.: ofl'<.l>~ibl<: w~~I~w;\l.:r WlI\;lmin;I\lon Iii. II ~ nol k~;II..u TICilr Ihe propo~ w.:ll S\~ (intolmSlion 8118Chcd).

1\11 NPDES pennir i& rcquireil.

0100 roie-ilnl DOH t'lle>ll'G~Lllali ... M, illf"rm~lil)n, (I( ''8I;I)"""e,,~I~lion~ ,or.: ;\1I~cl""d,

In The Blhllllll .. 1 I]le 11)C~liO'1 of,J(I!I w~\1 ch:all!;es bi,l,. slill wil"i~ Ih"IW,~1 ~>cribe", ill' fhi' 41~>Ii~li"", QIIT 4i>·j..aon von»idcf$ Ilw .X)mmenl5 10 litill be ;lllPh~bI~, iIIl<l "" do nO! I~ 1<> re""'" Ih. Il1"O \<:I<;'llino,

[ I No wmmcnl:;/objc;Jtio1\;>

Contact Person: _--,"dr>'-=-"'~.ac....::l<-=-=:.....L",--. -=~....::..!.. _____ _ Phone: ~(r411o":>

Date: t· tz,., oe,

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Signed:-....,r~~~d4-?to~~----D2/r/&2.

JRH-22-2008 11:52RM FRX:8085864352 ID:DLHR CWRM PRGE:007 R=96%

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

Well Number 3688-19 Well Name Homer's Adasea Ground Elevation 120 Cement Grout 115 Grouting Method I positive displacement Hole Diameter 12 Total Depth 130 Depth to Water 110 calculated head 10 Public Water Supply Well? no Solid Casing Material Ipvc plastic plastic Solid Casing Specification Schedule 40 Solid Casing Length 120 Solid Casing Diameter 6 Solid Casing Wall Thickness 0.25 Open Casing Length 10

Results

Well Depth Theoretical Thickness of Aquifer 410 1/4 Aquifer Thickness 102.5

~'1!JfJprfjl'QtWeJbbe/f)wSea' Level' '."" .. :., .. ",::." . ,,', ,.,>,'"", i\":':;P::: ' .. ;', ",.; ,,,,. " -10 okaY"I"" ....... Section 2.2

Well Casing Minimum Wall Thickness

Material pvc plastic Minimum Thickness per standards no requirement

:' .:::WiJlI'Thir;/fnes/$Provided , " , , ,,' ':i'>"",,,,;:.' , , 0.25 to'" ~rft .. 1I"\.. Section 2A(b) Minimum Length of Solid Casing v

90% of ground to top of aquifer 99 ,I:) tllffffith;r)f~:(JTio':da$lhtJ·:ProWded .. ' ';iTI'1;~'; I:) ok"y:,:,··: . r';,l"~!1.}~;I",, .. ,"",I,:;::, j,;:,;,t2!

" Section 2.4{c) ,

lCfii.ItQl ,. : Ii, ,';;,~, .',;' '.::i\'''',(;:···.·. ,." !",;~; SQ6j!;fi:lle~O' ';' ';\,""':·,;;':';i~;:: l~i~QnJpli8J1~e",·,.' .". ' Section 2~4(d) ':'(faf:p'(canJy:~;che~for2()t)r'llllJlt)'; ";i :'::'::"";';!"'~t· """"'1 "",,,,,.,,";'.;'!.:::)':,;' ,",;,,:;: 01<., '" ?~, " ' Section 2.4(d) Annular Space

Depth of Grouting Calculated Depth of Grouting 77

Deptlto7. Grouting provided 115 okay Section2.6(c) Minimum Annular Space required 1.5 Thick11es$'Of"'ArulularSpacfL; ,i/ " "" ,," .. ' ,; ;,' , . ,,:,: ;" ';";';"" 3 okay Section 2.6(d)

r-:. Q COMM.ON ON WATER RESOURCE MANAGEMENT

ROUTE SLIP FOR NEW APPLICATIONS

FROM: RYAN DATE: 27-Aug-07 SUSPENSE DATE: ----------------

CHING, F. -::I"NAKAMA, L. FUJII, N. NAKANO, D. GOODING, K. OHYE, M.

1 Approval -1-Signature -3-lnformation

-1-HARDY, R. ~ --SAKODA, E. --HIGA, D. --SWANSON, S.

2 HOAGBIN, S. .' == UYENO, D. ICE, C. YODA, K.

-4-IMATA, R. -- --YOSHINAGA, M.--KUNIMURA, 1.- --

WELL NUMBER "'S&6e- I~

D WELL CONSTRUCTION

WELL NAME Homer's Adasea

D PUMP INSTALLATION

ATTACHMENTS FOR APPLICATION PROCESSING - Both applicant & staff generated 1 TRANS. LEITER ~ 2 PERMIT PROCESS TABLE t/

3 CWRMMAP ~ 4 APPL. FORM (11 COPIES)

5 USGS MAPS (11 COPIES) ----1L... 6 TAX MAPS (11 COPIES) ~ 7 PARCEL OWNER VERIF. --vr MLS PRINTOUT 8 CONTRACTOR VERIF. t;;:- DCCA LICENSE SCREEN PRINTOUT 9 ALL INFO FILLED IN ----v-

3-Sep-07

PLEASE:


Take Action Type Draft acknow letter

-2-Type Final, label file folder, update People.db -4-File

Xerox copies

10 BACKGROUND CHECK ---::;- \ '

11 $25 FEE DEPOSIT SLIP ~ Yw-t l ~ C/O ~~ IIf"\ <; ~ 12 DHP/CDUP/SMAp .. ·.cr •• n ---:;- (SMA map printout http://gis.hicentral.com/website/parcelzoning/viewer.htm.,or INGRID'S SMA/CD MAP)

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

FOLDER: MADE NEW FILE FOLDER, ATTACHED

D FILE FOLDER ALREADY MADE, IN FILE CABINET

INCOMPLETE ACTION DATES:

DATE ACTION


Mr. Fred Page

o Q




January 15, 2008


Dear Mr. Page:


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




3688-19.ack.doc

Well Construction/Pump Installation Permit Application for Well No. 3688-19

We acknowledge receipt, on December 20,2007, of your completed Well ConstructionlPump Installation permit application and filing fee for the Homer's Adasea Well (Well No. 3688-19). 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.

RI:ss Attachment

c: Mark Heritage

Sincerely,

W.fTf7 1't

KEN C. KAWAHARA, P.E. Deputy Director

/

o o LINDA LINGLE LAURA H. THIELEN

GOVERNOR OF HAWAII CHAIRPERSON

TO:

FROM:




January 15, 2008

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

Marshall Lum, Acting Wastewater Branch Stuart Yamada, Safe Drinking Water Branch Alec Wong, Clean Water Branch




KEN C. KAWAHARA, P.E. OEPUTY DIRECTOR

SUBJECT: Well Construction/Pump Installation Permit Application Homer's Adasea Well (Well No. 3688-19)


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 February 15,2008. 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 staff at 587-0255.

RI:ss Attachment(s)

RESPONSE:

[ I

[ I

[ I

[ I

[ I

[ I

[ 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 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.

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

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

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

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

An NPDES permit is required.

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

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

No comments/objections

Contact Person: Phone: --------------------------------------------Signed: ________________ __ Date:


TO:

FROM:

SUBJECT:

o o


COMMISSION ON WATER RESOURCE MANAGEMENT P.o. BOX 621


January 15, 2008

Morris Atta, Acting Administrator Land Division

Ken C. Kawahara, P.E., Deputy Director '11 Commission on Water Resource Management

Well Construction/Pump Installation Permit Application Homer's Adasea Well (Well No. 3688-19) TMK 1-5-045 :029






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 February 15,2008. lfwe 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. ]fyou 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.

Rl:ss Attachment( s)

RESPONSE:

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

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

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

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

[ ] No objections

[ ] Other comments:

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

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


TO:

FROM:

SUBJECT:

o o




January 15, 2008

Nancy McMahon, Acting Archeology Branch Chief Historic Preservation

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

Well Construction/Pump Installation Pennit Application Homer's Adasea Well (Well No. 3688-19) TMK 1-5-045 :029





Transmitted for your review and comment is a copy of the captioned Well ConstructionlPump Installation penn it 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 February 15,2008. 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 penn it application or request additional review time, please contact Ryan Imata of the Commission staff at 587-0255. If you require additional infonnation regarding specific infonnation that can be provided by the applicant, please contact the applicant directly at the contact infonnation provided on the application fonn.

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:

ContactPerson: __________________________________ _ Phone: ____________ _

Signed: ____________________________________ __ Date: --------

Professional and Vocational rgnsing (PVL) - powered by eHawaii.g<Q Page 1 of 1

GENERAL LICENSEE

LIC ID: CT-16653 Active/Inactive: ACTIVE

NAME: FRED PAGE DRILLING INTERNATIONAL INC

TRADE NAME:

STATUS: CURRENT, VALID & IN GOOD STANDING

ENTITY: CORPORATION BUSINESS CODE:

ORIG L1C DATE: 04/25/1991 EXPIRE DATE: 09/30/2008

CLASS PREFIX: C SPECIAL PRIVILEGE:

RESTRICTION: EDUCATION CODE:

BUSINESS AD DR: 15-3105 HALELO PL PAHOA HI 96778

MAILING ADDR: POBOX 1434 PAHOA HI 96778

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

587-3295.

License information on this site reflects information in the Professional and Vocational Licensing Division as of January 11, 2008; howevE applications and forms are subject to standard processing time, and the information here does not reflect pending changes which are being reviewe The site is updated daily, Monday through Friday, except holidays. , The State of Hawaii makes no guarantees as to the accuracy of the .information accessed, the timeliness of the delivery of transactions, delivery the correct party, preservation of the privacy and security of users and makes no warranties, including warranty of merchantability and fitness for particular purpose. User is advised that if the information obtained herein is to be reasonably relied upon, user should confirm the accuracy of suo information with the provider thereof.

http://pvl.ehawaii.gov/pvlsearch/app?_a=d&_f=n&lictp=CT&licno=16653&off=&nm=FR...111112008

Search Results o Q Page 1 of 1

Copyright ©1/11/2008 by Hawaii Information Service

Assessed Values reflect tax year 2007.

Search criteria: TMK Taxkey 3-1-5-45-29

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

re3-1-5-45-29 Hawaiian F 15- HERITAGE, 0 0 1.88 ac o 6/4/2003 DEED $31,500 Paradise Park 1398 MARK L/ETAL

11TH AVE

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.com/REsearchIHIS/Searchisearch_PUB.asp?NOCACHE...111112008

Well Background Check

Approved Well No. Well Name Applicant

3587-14 Audrey Kenneth Pantalion

5005-06 Makea Robert Ferazzi

1/5/1993 3587-03 Hawaiian Park-Ol Mark G. Olmstead

7/28/1993 5307-03 Wailea-Mccully James William McCully

8/5/1993 4905-02 Lutkenhouse Dan J. Lutkenhouse Revoka

12/18/1996 3489-01 Rozett

A.8/2002

~1/2002 3586-03 Shea

1229-03 H Brothers

Rozett's Nursery

Rick Shea

Ellis Hester

Well Construction Driller Pump Inst. Type Issued Signed WCR1 Accept

C-16653 C-16653

C-16653 C-16653

C-16653 C-16653

C-16653 C-16543

C-16653 C-16653

C-16653 C-16653

C-16653

C-16653

C-16653

C-16543

BOTH

BOTH

BOTH 1/5/1993

BOTH 7/28/1993

WELL 8/5/1993

1/29/1996

217/1994

6/29/1993

BOTH 12120/1996 11/30/1998 2110/2000 5/26/2000

BOTH 7/512002 8/27/2002 1/29/2003 1/1212004

BOTH 8/28/2002 216/2003 6114/2004 10/18/2005

11/18/2002 3787-04 Gudrun Gudrun Maurins Family Trust C-16653 C-16653 BOTH 11/27/2002 2125/2003 7/26/2004

6/19/2003 3686-02 Greenlaw

11/6/2003 2979-11 Moana 1

11/14/2003 3687-07 Noni Kai

2/27/2004 3687-09 Hale 0 Kai

Daniel Greenlaw

Moana Technologies LLC

Patrick Fix

Bennet Taylor Jr.

7/2/2004 3687-12 That's a deep su Tom and Cindy King

8/13/2004 3505-02 Puna Certified Nu Puna Certified Nursery, Inc.

8/27/2004

1/312005

n3/2005

'-"3/2005

3687-15 Greenlaw 2

4707-01 JJCO

3586-05 Mika 1

3802-07 Laka

Daniel Greenlaw

JJCO Properties

Noi Phanucharas

Ruben Xiu

8/8/2005 3688-09 Maka Puna Luaw David E. Young

8/8/2005 7549-04 Uluwehi 1 Thomas Baldwin

8/8/2005 3586-08 Waipuilani Noel & Stephanie Morin

8/8/2005 3081-03 Szom Jas Alohilani Nursery

8/8/2005 3688-13 Little Dog William L. Ray

1211/2005 3687-17 Greenlaw 3 Daniel Greenlaw

12/3/2005 3087-01 Moxley Jan Moxley

4/13/2006 3687-32 Terry D Elisebeth Haspe

Monday, August 27, 2007

C-16653 C-16653 BOTH 71212003 7121/2003 1211212003

C-16653 WELL 111212004 9123/2005

C-16653 C-16653 BOTH 11/17/2003 1215/2003 7/26/2004

C-16653 C-16653 BOTH 3/312004 41712004 8/3/2004

C-16653 C-16653 BOTH 7/19/2004 8/18/2005 11/23/2005

C-16653 C-16653 BOTH 812412004 8/30/2004 8/29/2005

C-16653 BOTH 9/23/2004 101212004 8129/2005

C-16653 BOTH 1/612005 1/24/2005 11/28/2005

C-16653 BOTH 116/2005 1131/2005 1112312005

C-16653 BOTH 11612005 4/15/2005 81812006

C-16653 C-16653 BOTH 8124/2005

C-16653 C-16653 BOTH

C-16653 C-16653 BOTH 8/24/2005 8/30/2005

C-16653 C-16653 BOTH 8124/2005

C-16653 C-16653 BOTH 8/2412005 11/1812005

C-16653 C-16653 BOTH 121212005 121312005 711712006

C-16653 C-16653 BOTH 211412006 51812006 211412007

C-16653 C-16653 BOTH 4/1812006 412212006 21112007

Pump Installation Issued Signed WCR2 Accept

1/511993

217/1994

6/29/1993

6/26/2000 6/28/2000 2110/2000 5/26/2000

1/14/2004 211012004 211212004 4121/2004

11/4/2005 11/17/2005

10/24/2006

10/24/2006

10/24/2006

10/24/2006

10/24/2006

311312006

10/24/2006

10/24/2006

10/24/2006

812412005

8/24/2005

8/24/2005

8/24/2005

121212005

2114/2006 5/8/2006

4/18/2006 21112007

Page 1 of2

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

4/13/2006 7348-02 Opononi Springs Jason Coombs C-16653 C-16653 BOTH 4/26/2006 4/26/2006

4/13/2006 2485-04 Larisa Yuriy Skripchenko C-16653 C-16653 BOTH 4/18/2006 4/18/2006

4/13/2006 3687-28 Irina Yuriy Skripchenko C-16653 C-16653 BOTH 4/18/2006 4/18/2006

4/13/2006 3687-30 Golden Spur Stewart 0 Tuttle C-16653 C-16653 BOTH 4/18/2006 4/18/2006

4/13/2006 3687-29 Stewie Stewart 0 Tuttle C-16653 C-16653 BOTH 4/18/2006 4/18/2006

8/10/2006 3687-36 Iraida David Jwanisik C-16653 C-16653 BOTH 8/11/2006 10/18/2006 1212012006 8/11/2006 10/18/2006 12120/2006

8/10/2006 3486-03 Woody James & Mari-Ann Family Tru C-16653 C-16653 BOTH 8/11/2006 1/11/2007 3/27/2007 8/11/2006 1/11/2007 3/27/2007

8/10/2006 3687-35 Bessie Ronald L. Robertson C-16653 C-16653 BOTH 8/11/2006 212012007 8/11/2006 212012007

0>/2006 2981-01 Ayen Kenneth S. Kamei C-16653 C-16653 BOTH 8/11/2006 8/11/2006

1/512007 3185-03 Rainbow Serpent Fred Page Drilling Int'l C-16653 C-16653 BOTH 1/30/2007 1/30/2007

4/612007 4305-01 Kilauea 1 194 Kilauea, LLC. C-16653 C-16653 BOTH 4/1212007 4/13/2007 4/1212007 4/13/2007

4/612007 3587-11 Wallace One Lesley & Lisa Wallace C-16653 C-16653 BOTH 4/1212007 4/13/2007 7/10/2007 4/1212007 4/13/2007 7/10/2007

6/612007 4001-01 Kipimawa KL WH Shipmand, LTD. C-16653 C-16653 BOTH 6/6/2007 6/6/2007 6/6/2007 6/6/2007

6/6/2007 3585-06 Puna Tiki Craig Beasley C-16653 C-16653 BOTH 7/6/2007 8/3/2007 7/6/2007 8/3/2007

6/6/2007 3687-49 Everftow Kurt Backus C-16653 C-16653 BOTH 7/3/2007 7/6/2007 7/3/2007 7/6/2007

6/6/2007 3688-17 Flo Laura & Aki Lintunen C-16653 C-16653 BOTH 7/3/2007 7/3/2007

6/12/2007 5731-08 Maui Fresh Fish Melvin Mendes C-16653 C-16653 BOTH 6/26/2007

6/25/2007 3687-46 WaiOla Shawn Icari C-16653 C-16653 BOTH 7/3/2007 7/6/2007 7/3/2007 7/6/2007

7/30/2007 3588-04 Molly-Anne Tate D. Robinson C-16653 C-16653 BOTH

0

Monday, August 27, 2007 Page 2 of2

QRTMENT OF LAND AND NATURAL RESOGS DOCUMENT NO .. UAC OR ATTACHED WORKSHEET DATE A ugust 20 2007 ,

SRCI COST F YR APP D OBJ CTR PROJECT PH ACT AMOUNT NAME/DESCRIPTION(\NANG INPUT)

S 08 326 C 1026 0752 (1 ) $25.00 Wailani Drilling Inc. . (2)

(3)

(4)

(5)

(6)

(7)

(8)

(9) i

(10)

TOTAL $ 25.00

REMARKS: LINE (1) Homer's ada sea well LINE (2) LINE (3 LINE (4) LINE (5) LINE (6) LINE (7) LINE (8) LINE (9) LINE (10)

STATE OF HAWAII DEPARTMENT OF LrJ> AND NATURAL RESOURCES. 0 COMMISSION ON M TER RESOURCE MANAGI::MENT APPLICATION FOR A WELL CONSTRUCTION I PUMP INSTALLATION PERMIT


/

FtECEIVEO

Instructions: Please print in ink or type and send completed application with attachments to the Commission on Water Resource Management, P.O. Box 621, Honolulu, Hawaii 96809. Application must be accompanied by 10 copies al1Jl a non-refundable filing fee of $25.00 payable to the Dept. of land and Natural Resources. The Commission may not accept incomplete applications. For assistance, call the Regulation Branch at 587-0225. For further information and updates to this application form, visit http:/twww.hawaiLgov/dlnr/cwrm.

07 AUG 20 A 9: 3 5

WELL LOCATION INFORMATION -, The following must attached before this application is accepted as complete: .

-Portion of7.5-Minute Series USGS topographic map (scale 1:24,000) with well location labeled and include the name of the quad map • Property tax map, showing well location referenced to established property boundaries • Photograph of the proposed well site -A schematic .

IX Construct New Well o Modify Existing Well o Abandon/Seal Well

~ Drilled DOug o Shaft

XJ Install New Pump o Replace Pump

(gallons per minute) 0 Flowmeter

20 8 Open Pipe 1-------------"'" 0 Weir

o Tunnel 12. Proposed Amount of 0 Orifice Withdrawal, gpd (gallons per day) 0 Other (explain)

Iopa Maunakea 2-7546

PROPOSED USE

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

o 17. Industrial (describe)

" 0 18. Irrigation (describe crop and no. of acres)

,~D~1~9~.M~i~lit=a~~~(~de=s=c~rib=e~) _________________________________________________________________________ ~

o 20. Other (describe)

OTHER LEGAL REQUIREMENTS If required, items 21. and 22. must be obtained before the Commission can legally issue a permit:

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

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

22. Special Manageme Area Permit o Required, SMA # date approved ___ _ o Not Required (attach documentation from applicable County agency) ~ I have not checked with the county about whether or not an SMA Penn It is required. I understand that checking with the County prior to making this

application will expedite review. I further understand that issues raised by this agency may delay or result in denial of the pennit Issuance, or the is issued.

Natu rces o I have consulted with the HPD regarding potential impacts of well construction activities on historic sites. I have attached applicable documentation

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

prior to making this application will expedite my review. I further understand that issues raised by this ",gel"'=y msy delay or result i,l denial of the of the after it is issued. Add land use is attached.

remarks, explanations, etc. (attach additional sheet

Signing below indicates understand and swear provided is accurate and true to ir knowledge. Further, the Signatories understand that upon permit approval: 1) the proposed work is to be completed within two (2) years of the approval date; 2) the contractor shall submit to the Commission a well completion/abandonment report within 60 days after the completion date of the permitted work; 3) in the event that the application is not completed correctly, any permit may be suspended until the item is brought in to compliance, and any work done while the

result in fines of

C-16653 C-57 License No.

8/16/07 Date Print Date

HI 96778 Pahoa HI 96778

Same Same Fax E-mail Fax E-mail

e ..

,

•

,

) •

o o

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

Hole Diameter: 1 2 in.

Elevation at top of casing ..J.2L ft., msl* l~ r Minimum of 2' Radius & 4" Thick Concrete Pad (to contain benchma surveyed to nearest 0.01 ft.)

r7~ ~R r Ground Elevation: 120 ft., msl* • ,<0 •• ~.

"''''':4. • •• ,6 ••

Y/,>O<\\ 'Do., .~ " /T~\ -= ',0' .... ..•. • ,4., Please refer to the

Cement Grout: 115 ft. . '. ,' . RA WAIl WELL ~ONSTRUCTION AND (min. 70% of distance from :.f'. :: ::

ground elevation to top of .~. ':. 4, ," PYMP INSTALLATION STANDARDS .::;. ::' ;.

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

whichever is less.) ': .4: applicable standards. ,,:,, ."',. " " :',4:.: • ,6 • . ' . .' .

Grouting method: Annular space between hole :.f' :.f'. Solid Casing: (~ 90% x (Ground Elev.-Water Level Elev»

and caSing (1.5" for positive .~.:.: ~~"~.

CXPositive ·.:t·· Total Length: 120 displacement, 3" for other it

;.:. ft. displacement methods): : ,"

:. :;:. Nominal Diameter: 6 'Do ., in. . . ' .....

o Other / .6 •• :.A" • . ' .

Wall Thickness: °250 3 in. ",',.4 ",',4 in. :.f- . ::~'. . . ' .. ' Bottom Elevation: ]2Q ft., msl* ~'.< ~' .. :

Rock or Gravel Packing: -i- ~ I~ Total Depth JQ ft. --.., I , Open Casing: IX Perforated o Screen

130 ft. Material:

IX Crushed Basalt ~~ ~ Total Length: ]0 ft.

~~! / Nominal Diameter: 6 in. o Rounded Gravel II ' //

" v/ Wall Thickness: °250 JI;J8 in.

Estimated Water Level Bottom Elevation: DO ft., msl* - TP. i Elevation: I

-- ~ -- note: Neither bentonite nor mud should be used in 10 ft. mslo saturated zone during drilling

Open Hole:

Length: nLa ft.

Diameter: in. - --- ~---~---- ---- L_ ----''- Bottom Elevation: ft., msl*

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

For non-salt water \3asal Wells - bottom elevation of well should not be deeper than 114 of aquifer thickness or, Bottom Elevation of Well Limit = (water Elevation _ 41 x Water Le71 Elevation )

Example: Estimated + 2 ft Water Level Elev. -+ Bottom Elevation of Well Limit = (2 _ 41 ~ (2) = -18.5 ft

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

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


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

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

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

o Centrifugally Cast Resin Pipe conforming to ASTM 02997


o Glass Fiber Reinforced Resin Pressure Pipe conforming to AWWA C950 o PTFE Fluorocarbon Tubing conforming to ASTM 03296 o FEP Fluorocarbon Tubing conforming to ASTM 03296

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




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







rk

WCPI App. Form 05/1"~

~he Ind$p~ndent o

Hawai~ Surveyors 10440/1 Oh Way, HUo, Hawaii 96720

Phone/FAX 808 959-0360 Email niels@oloho,net

-coale~~f>e~~dfciy~r scherra1ic

To: Title Guaranty Eacrbw ServiQes TMK: 1-5-045-029 450 Kilauea Aven~ Mark Heritage

April 23. 1999 Job No. 1176

Hilo, Hawaii 96720 , ,

Eacrow Acct . ., 99.~.044S d,-"'*'

1'MK: (3) 1-5-41: » ~ Description oj Services:

I!, ! 'r' \ I

oaOA C-41 Stakinl of Hawaiian Paradise Park, Lots 1411 &. 1412. Block 7

Boundary comers are VERIFIJ¥> AS CORRECf and have an avcra,e error of 0,43 feet which is within acceptable toJcrance forpropenx- of [his rype and in tlus subdivision.

! The followin. Ibtcli lives the dimensions fOWld by this field survey (F) as compared to the record dimel1lions CR) of tbis property. and the type of pins found (FND.) and set at the comers. Improvements were ~ot located ~n this stakina.

I -..,

I i ! .r/)/Ji i j,lCl(;7 ,. I i

Niels Ouistensen, L.P.L.S. 9077

For services reJldered .. , .... , .. $5S0.00 L ___ ______ --~ tax .. , . . . . . " 22.92 AMOUNT DUE ... , ...... $512.92

cc: Buil Takeda, RSM, 345 K.ekuanaoa St., Hilo, HI 96720

laVOK1el lie _ ad peyabJe wttbia 30 days of bilUng date hereon a.nl.i due whe~r an e,cruw is cla.ed or .:an.celed. A 8erVice duqe of $10.00 will be lCClC.e. fot fucarc •• ements and our policy i6 to clwJe a •• moruhly lire clw~ (1IIlDUl pen:e-ae aft of 12.) on all pelt - ~.

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trt :::0 -o :::0

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Por. BLOCK "7" KEAAU, PUNA, HAWAII Ld. CI. App. 1053, Mop 58

e. S

• !II '="l:...r. ~ ::.3 j." .............. ,...

II ;=:.~··s o.;'J!"~ S !II iI I MfM N ~~e,," !!:J GW;:~i.r;;:: I- ~

12 §

372

1-5-45 3RO OIV.

... .. ... II.

SUBJECT TO CHANGE

TYPICAL Lor .$.:./ •. /.;.,. ~ 2tlof'l.

....... MINT Of till f ... caJiiiiiiIONlR TAXATION MAPS aUlllAu

STA.TE at MAWAU

TAX MAP

45 ..am.

DEPARTMENT OF AND NATURAL RESOURCES 0 STATE OF HAW~ Fer Official Use Only:

COMMISSION ON TER RESOURCE MANAGEMENT APPLICATION FOR A WELL CONSTRUCTION I PUMP INSTALLATION PERMIT

Instructions: Please print in ink or type and send completed application with attachments to the Commission on Water Resource Management, P.O. Box 621, Honolulu, Hawaii 96809. Application must be accompanied by 10 copies and a non-refundable filing fee of $25.00 payable to the Dept. of Land and Natural Resources. The Commission may not accept incomplete applications. For assistance, call the Regulation Branch at 587-0225. For further information and updates to this application form, visit http://www.hawaii.gov/dlnr/cwrm.

WELL LOCATION INFORMATION

8. tX Construct New Well KI Drilled o Modify Existing Well o Dug o Abandon/Seal Well o Shaft

o Tunnel

9. Is this well of a battery of wells? 0 Yes

XJ Install New Pump o Replace Pump

(gallons per minute)

20 12. Proposed Amount of Withdrawal, gpd (gallons per day)

A,ECEtVED

Am 20 A 9: 3&

Landowner's E-mail

13. measurement o Flowmeter 80pen Pipe o Weir o Orifice o Other (explain)

14. Proposed Surveyor name and license nlJ,mnAr (a surveyor Installation Penn its)

Pennits and may.be required for some Pump

Iopa Maunakea 2-7546

PROPOSED USE

o 15. Municipal than 25 individuals or 15 service corln~,ctiQ,n~\

EX 16. Domestic 1

o 17. Industrial (describe)

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

o 19. Military (describe)

o 20. Other (describe)

OTHER LEGAL REQUIREMENTS If required, items 21. and 22. must be obtained before the Commission can legally issue a permit:

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

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

22. agement o Required, SMA # . date approved .,..-__ -:-o Not Required (attach documentation from applicable County agency) ~ I have not checked with the county about whether or not an SMA Permit is required. I understand that checking with the County prior to making this

application will expedite my review. I further understand that issues raised by this agency may delay or result in denial of the permit Issuance, or

Preservation o I have consulted with the HPD regarding potential impacts of well construction activities on historic sites. I have attached applicable documentation

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

prior to making this application will expedite my review. 'further understand that issues rl'lised by tbis 3aen,=y may delay or result ;,-; denial of the or revocation of the after it is land use is attached.

(808)965-5339 Phone

Same Fax

C-16653 C-57 License No.

8/16/07 Date

HI 96778

E-mail

INSTALLER (Must be filled out if application is for Pump Installation)

Fred Page Drilling Int'l Inc. C-16653 Li C-571C-57a/A License No.

Fred Page 8/16/07 Print Date

Pahoa HI 96778 Address

(808)965-5339 Same Phone -=F=-a-x------- E-mail

I o

, o o PROPOSED WELL SECTION (Please attach schematic if different from diagram provided below)

Hole Diameter: 1 2 in.

Elevation at top of casing -12L ft., msl· ~\. .. _f _____________ Minimum of 2' Radius & 4" Thick Concrete Pad (to contain benchmark

----L surveyed to nearest 0.01 ft.)

,----- ------- ------------r,:;:fI 'YN r Ground Elevation: 120 ft., msl·

/~\ '. " ... •• '1.1:« .. :\ ~ r------------, ..... . .. . ..... . .... . Please refer to the Cement Grout: 115ft. (min. 70% of distance from ground elevation to top of water surface or 500 ft., whichever is less.)

. '. . '. HAWAII WELL CONSTRUCTION AND PUMP INSTALLATION STANDARDS to ensure that your as-built is in compliance with

applicable standards.

Grouting method: Annular space between hole and casing (1.5" for positive displacement, 3" for other methods):

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

CcPositive displacement

Total Length: 1 20 ft.

Nominal Diameter: 6 in. o Other

3 in. Wall Thickness: ·250 in.

Bottom Elevation: 120 ft., msl·

Total Depth

130 ft.

/ /

" /'

Open Casing: Ql Perforated o Screen

Total Length: ]0 ft.

Nominal ~iameter: 6 in.

Wall Thickness: ·25Q in.

Bottom Elevation: J30 ft., msl·

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

Open Hole:

Length: ____ .:..:n:L,l.=a'--______ ft.

, . ~iameter: _____________ in. _____ ~L_ Bottom Elevation: _________ ft., msl·

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

For non-salt water t3asal Wells - bottom elevation of well should not be deeper than 1/4 of aquifer thickness or,

Bottom Elevation of Well Limit = (Water Elevation _ 41 x Water Let Elevation )

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

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




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




o Glass Fiber Reinforced Resin Pressure Pipe conforming to AWWA C950 o PTFE Fluorocarbon Tubing conforming to ASTM 03296


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




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







WCPI App. Form 05/12105

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Ind$p5hd~nt Hawal~ Surveyors I .. 1044 OIl Oli Way, Hi/o, Hawaii 96720

Phone/FAX 808 959-0360 Email nielsOoloho,ne,

Niels C..bdnenSi.tl, S.I.ILv..Iyor - CORRECT~D INVOICE.

Schematic

To: Title Oumnty F&.zt,.". Services 450 Kilauea Aven~

TMK: 1-5-045-029 Mark Heritage

April 23. 1999 Job No. 1176

Hilo, Hawaii 96720

Sacrow Acct. II 99·~-044S d-v-k

TMK: (3) 1·5-4!: B ~ Description oj Services:

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DROA C-41 Staking of Hawaiian Paradise Park, Lots 1411 &t 1412. Block 7

Boundary comers are VERIPIJ¥> AS CORRECT and have an avera,e error of 0,43 feet which is within acceptable tolerance forpropert)' of rhis rype and in tluI subdivision.

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'[be foilowiD, lketch lives the dimensions found by ttus field survey (F) as compare<l to the record dimeDJions (R) of tIJis property. and the type of pins found (FND.) and set It the comers. Improvements were not located on this stakin,. . --,

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,?L£~ Niels Oui.stensen, L.P.L.S. 9077

L ________ ' -_._-____ ~ For services rendered .... , ..... $550.00

tax .. , . . . . . ., 22.92 AMOUNT DUE .......... 5572.92

cc: Buil Takeda, RSM. 34S Kekuanaoa St., RHo, HI 96720

iJavOH:elIn deB Iftd payable witbia 30 daya of billing date hereon ilZIloi d~ whe~t atI e.av .. ill dOlled or .:aru:eled. A service clIarJe of SI0.00 will be ICce.e4 for future s*e:menlS and out policy i.J to clwJe a •• moruhJy life clwae CtQA\&I.l pen:esaae '* olI2.) on aU ".. dat 1(;ICCbrta.

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