JF~ - higp.hawaii.edu · 0 Centrifugal 0 Rotary-Gear PROPOSED USE: 0 Install New Pump 0 Modify Pump...

State of Hawaii COMMISSION ON WATER RESOURCE MANAGEMENT Department of Land and Natural Resources R ., APPLICATION FOR PERMIT M Well Construction or £'( Pump Installation

Instructions: Please print in ink or type and send completed application with attachments to the CCVT1J,._..,..,, on Water Resource Management, P.O. Box 621, Honolulu, Hawaii Q6809. Application must be accompanied by 3 copies and a non-refundable filing fee of $25.00 payable to the Depl of land and Natural Resources. The Commission may not accept incomplete applications. For assistance, call the Regulation Branch at 587~ .•

1 {' ,1.1 i",'! \!ll fi:,.,

For further information and updates to this application form, visit http://www.state.hi.us/dlnr/cwrm. ltiJI'i•' ,', ,J• i ··~ fill' .• I\

. . . . rif.S·=JL., APPLICANT INFORMATION: (Fill out all three. if applicable, and place a check next to the pnmary conta

1. (a) ti WELL OWNER: .L.(Vf--:-"::'-'A'-'~-t·'-----<--'-'--=--__::::--'Mailing Address: ./-1 C. ~ Fax: [cJ=- '13.s"- .S~~cs E-mail: ________ _____,.__ 8"dt"

(b)~NDOWNER: ,/-.A.!Ji; 7/lC}t(rc .P. ~~;..:.&..-=.Z1a.....L~-f--Phone: 9iJ-il~-; Mailing Address: tJ 9 S "? Fax: ~~- £:3$ • Scg-:36

(c)!)( CONTRACTOR:TL> H. nE=I< \)e, \ \,.;_~ Mailing Address: _,__,0"--~"-=--"'<..J...-'-'--...!...L........,<-..J<-..:...l--"'-"'.........,.._-~.,_---------------Fax: 8?8 98J -8;2f;".S'"

WELL & PUMP INFORMATION: (Please fill in the diagram on the back of this fo --2. WELLLOCATION/NAME: }Cf?14AU.... PJS.-,R,c.l d~ U..N-14 Island: .#A w 14 J J'

3.

4.

5.

6.

7.

Address /S-/790 ,J)LIJA $-e-J fP, ~"'* !'A ~ t:lt.s.r l'••~ax Ma;J{ey: '3 ..... /-..SW'.S(. ... c;1 ' Attach the relevant portion of (a) a 7.5-Minute Series USGS topographic map (s e 1 :24,000), and (b) a property tax map, shOYiing well location

referenced to established property boundaries.

PROPOSED WORK: ll( Drill New Well 0 (Check all that apply) 0 Modify Existing Well 0

0 Abandon/Seal •

*Well No.:

CONSTRUCTION: 0 Dug 0 Bored

Is this well a part of a battery of we

PROPOSED PUMP INFORMATION:

Pump Type (Check one):

0 Deep WeD Turbine 0 Rotary

~Subme~le 0 0 Centrifugal 0 Rotary-Gear

PROPOSED USE:

0 Install New Pump

0 Modify Pump

0 Replace Pump

complete and submit well abandonment report upon completion of work.

Driven 5(1 Drilled 0 Radial

0 Yes ~o (Please de~be.) ~

~'/a ~ d 0(1 ~ gallons per minute

JF~ rl flaf' \ \/~ I'? ~ .Q{ E\kmc, rated horsepower: ___.._ ..... /...,:~..._.il_........_ __

(Check al that apply) 0 ) ~ ~~ustrial

,:El Domestic (individu te syst~ (;\~·of Dwelling Units:-------

+---+--t--~~-;-;-""~~o. of Acres:-----------0 Irrigation (crop) 0 ~ 0 Other(explain): ________ _

.:) S' 0 \) gallons per day

0 Military

{.a) PROPOSED AMOUNT OF WITH

(b) METHOD OF FLOW MEASURE 0 Weir 0 Orifice 0 Other(explain)

OTHER IMPORTANT INFORMATION·

8. PENDING ACTIONS: 0CDU 0 SMA OEIS OEA 0 NONE 0 Other (explain)

9. REMARKS, EXPLANATIONS:{--------------------------

more space IS n

I understand that approval of this a plication attaches the following standard condltlona: 1) the proposed work Ia to be completed within two (2) years~ the approval date; 2) the contract r shall submit to the Commission a well completion/abandonment report within 30 daya after. the completion date . the permitted work; 3) monthly 'fi er use data shall be submitted to the Commission; 4) such approval shall not constitute a determination of corr"latlv .. water rights and shaD not guarantee the pump capacity or future use up to the permitted pump capacity. ·

Well Owner ~~I< 111! 0. ,.<.-..a f Signature U .f) & Date ~ ..i<>tt>

Field Checked By -------

Date

. Landowner t:oit~M .ue: ;'(A JC y

• Contractot ~ Signature · 41.

Date ~0 Signature __________ _

Date ..1 o ~ .. ~ ...t. ~~o

Longitude------

Latitude --------

Aquifer System Name _______ _

State Well No.

WCPIFORM (3/1/00)

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Por. BLOCK "7"

s J•:;:~. s 152.....,.~, ••. 139

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KEAAU, PUNA, HAWAII Ld.

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Ct. App. 1053, Mop 58

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1-5-56

SUBJECT TO CHANGE

e 3RD DIV.

DIPARTMtNT Of 1'111 TAX COMMlSSIOND

TAXATION MAPS IUREAU STATE Of HAWAII

TAX MAP THIRD lONI SIC:. PUT

I I 5 156 CONTAINING PAilCIL$

SCAU1 I IN. 200 FT.

------,~ ..

U.S. DEPARTMENT OF THE INTERIOR U.S. GEOLOGICAL SURVEY . U.S. DEPARTMENT OF DEFENSE

·, NATIONAL IMAGERY AND MAPPING AGENCY

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l) _ r-n 1 F1 -TO __ ,,_·,~::._r·~1l~----~----------

''[[) i) q,bG DATE _________ TIME ___ _

WHILE YOU WERE OUT A-Jca

M----------------~--L---------------of._, _______ -:---------,---,---

CJZJ '/- Lf.!:YL)s, cc /luiCi-' Phone ________________________ __

TELEPHONED v" PLEASE CALL

CALLED TO SEE YOU WILL CALL AGAIN

WANTS TO SEE YOU UIIGENT

,.,__ ;d._l,4--f

f IIETUIINED YOUII CALL I I

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t':5-lq~ 7) ;d-- 1/f/<= rece, v~ N e.' 1 Message __________________________ _

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-State of Hawaii •• COMMISSION ON WATER RESOURCE MANAGEMENT Department of Land and Natural Resources

WELL COMPLETION REPORT - PART II Installation

Instructions: Please print in ink~r ~ !lind send oompjeted report (w)ttl attachmenf:s1 if applicable) to the Commission on Water Resource Manag-ement;P.0.' Bcoc6~1. Aonolulu; HSwaii-96809.· The Commission may not accept incomplete reports. This form shall be submitted within 60 days of the completion of work. For assistance, please consult the Hawaii Well Construction and Pump Installation Standards or call the Regulation Branch at 587-0225. For updates to this form or additional information, please visit our website at http://www.state.hi.us/dlnr/cwrm/

1. State Well No.: 3687-03 Well Name: Keeau-May Well

For Official Use Only:

/ t 1 MAY 3 P\2 : 0 3

~. > "1, I . -

Island: Hawaii

2. Address: 15-1790 Awa (3rd St.), Hawaiian Paradise Park Tax Map Key: 1-5-56: 99 ~ --~~------------------

3. Pumplns~llationCompan~ ~~~~~R~~~'~~~~D~R~'~'~'~'~~~~~~~~~~~~~~~~~~~~~~ 4. Date Pump Installed: /t!J-1 s-ot>

month/day/year

5. PERMANENT PUMP INFORMATION

Pump Type, Make, Serial No.: .?c.c.b. ~(.5 .tt=rJoQ IS~-~ 3 Rated Capacity: ~o gpm '

Motor Type, H.P., Voltage, rpm: rR,tu.j:.l..IIJ($- t% H p .j 3t>V 3 ~.So

Type of flow meter: _ _,Nr...:z....tE~e~Ti...!tA-="' ... e _______________ which measures in

6. Method of flow measurement:

Pi{ Flowmeter Manufacturer

0 Weir 0 Open Pipe 0 Orifice*

*attach schematic

~JJ-~11. Make Nr~Tec.~tE.

o Other*, explain below

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

8. Other remarks/comments:

Size cto ~~----

Pump Installation Contractor (print} ........ 6_.R.::..;IC_~-t-'-'-K;;........;.ft._tc.R....;....;;..N~IF-Jit......._ __ C-571C-57alA Lie. No. ~....;..t;...J ... ..s_~_7 ____ _

Signature Date ----~~~/J-'-+-0'....;;4....::1 ___ _

Permittee (print}

Signature

WCR2 Fonn 512100

I

0 9. AS-BUll T PUMP SECTION (Please attach as-built if different from diagrem provided below)

Bench mark elevation surveyed to nearest 0.01 ft. = SftJ, f 2 ft. mean sea level

elevation of top of chase tube ___ ft. mean sea level

Pump intake depth = ':1. ft. (referenced to bench mark}

Chase tube depth = ft. (referenced to bench mark}

if airline installed, bottom of airline elevation= ___ ft. mean sea level

0 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 Keeau-May Well (Well No. 3687-03) at 15-1790 Awa (3rd. St.), Hawaii, TMK 1-5-56: 99, subject to the Hawaii Well Construction & Pump Installation Standards (1/23/97) 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. The pump installation permit shall be for installation of a 20 gpm capacity, or less, pump in the well.

3. The permittee, well operator, and/or well owner shall provide and maintain an approved 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).

4. 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. This permit or the authorization to pump water from a well shall not constitute a determination of correlative water rights. The permittee, well operator, and/or well owner are notified and by this provision understands that the quantity of water taken from the well could be reduced by the Commission in the future. This permit is not a commitment that the pump capacity permitted here or even some lesser amount is guaranteed in the future.

5. The permittee, well operator, and/or well owner shall complete and submit as-built drawings and Part II - (Permanent) Pump Installation Report of the Well Completion Report (attached) to the Chairperson within sixty (60) days after completion of work.

6. 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.

7. The pump installation permit application is incorporated into this permit by reference and is subject to the Hawaii Well Construction & Pump Installation Standards (1/23/97). If the HWCPIS are not followed and as a consequence water is wasted or contaminated, a lien on the property may result.

8. The permit may be revoked if work is not started within six (6) months after the date of approval or if work is suspended or abandoned for six (6) months, unless otherwise specified. 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 good-faith performance. A request to extend the permit shall be submitted to the Chairperson no later than three (3) months prior to the date the permit expires. If the commencement date is not met, the Commission may revoke the permit after giving the permittee, well operator, and/or well owner notice of the proposed action and an opportunity to be heard.

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

10. 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.

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

Date of Approval: Expiration Date:

April 1 0, 2001 April 1 0, 2003

j, GILBERT . COLOMA-AGARAN, Chairp son Commission on Water Resource Management

I have read the conditions and terms of this permit and understand them. I accept and agree to meet these conditions as a prerequisite and underlying condition of my ability to proceed and understand that I shall not commence work until I and the pump installer have signed, dated, and returned the permit to the Commission. I also understand that non-compliance with any permit condition may be grounds for revocation and fines of up to $1000 per day starting from the permit date of approval.

Permittee's Signature:# 9 ~ Date:

Printed Name: ::ra -c.t41 ~ D, /Vt y Firm or Title: _C>:::....:t.V----=IJ~e....:a.....=-----------

Installer's Signature: C-57, C-57a, or A License#: -'4.59 2

Printed Name:

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

Attachments c: USGS

Department of Health/ Safe Drinking Water & Wastewater Branch Hawaii Department of Water Supply Turner Drilling

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l, · . APR-24-2001 04:20 PH T~ER DR! LLING & PUMP 530 257 6250 ,: ~

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'IURNER ~UNO a PUMP P.O. BOX 6941, HILO, HI 96nO

.... 982-12SS '' C&lifomia License ##522037 Nevada License ##41661 J!!lpii #2259?

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PAG&i:

DATE:

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.. ~:· FAX COVER SHEET

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NAdi./I TURNER TUftNER DRILLING A PUMP .

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wttLLOGS ... :

J • II (INCLUDING COVERSHEET)

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11. AI-8UILT wm.L .BBCTION ,.._IIIIH:h eHIIIIf tr _,.. _, ,.,_, l1fUIIkMI ,_,

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Bei\Ch merk

___ In_

Minimum of x Rldlul & •• Thick Concnt\e P.cl

_Ground E._..lon:$41' .. msl ... ,£ /flflf""

PluM r.wto ..

P. 02 F .....

~-_ft .• ~

Cement G~: &Z') ft. (min. 70% - -.....oe .... ground- elewlion to top of _..r...,.. Dr 500ft .. whirit1ewr ...... )

ttaWM !Dill CONSTRyg!IOJJ MID PWIP lf!ITAL.I.A]]Oft I[IAIIOARDI (SU~WYto.....e

0.01 ft.) :; .I! w

lu eneunt ltlat ya~~r •-built is In compl•• ..., applable staridardt ..

1 I ~------ Solid Culi!g: (~ 90% x [Ground Elev.-W.....- LIIWI Elw))

Annu .............. hall a CMiftt tmln-31~

:;:. ln.

Roc* ur Cbnl Peddng:

J l,.ength: '~ ft.

Nominal Dllmeter: i_f£ ln.

Wd Tllll:knlnl: ... /a:_ ln.

I!IOtiOm Elevetlon: I., mal

Op.n ca~ng: 121Pelfomt..s --=--::~~ft. Mlllltll: QICMMd-[J RcMnW OnM!I

l.englh:_~~..:;.ra.5;..._--:---~~ft. Nomintll Diameter: ___.J,I&.....,.,;.!...,. ______ In.

Wal Tblckneu: ~n.. ln. Wllilrl..evel EIIMilion:

• .12ft.mst* Bottom Elevation: ft., mal

loUd c; ?trw laWI!Ii

Open HoM:

~~--------------------k Di......-: ln.

8o8orlt Eleatlon: __ ~---- ft., m•l

CMiton ... oompiiMt wlh (dNiarcn OT mcn):Q14N$11AYMA C201J a API St*- 5l 0 ASTM A53 OASTM A138 And GOiftPiiMt wllh (rNdc on. or,....): 0 ASTM A2o42 0 Type E 0 T,.,e S 0 Qrade B 0 OIMr

bllftltU .... : (c:hedr one): OASTM MOl (procluc:tlon weAl) . OASTM·A312 (monilor_..) A8S ......._ oonbrnln8 to AS1ll F.eo Md ASTM 01527: (clledr one) o Schedu'- .a a Schedule ao PVC ,.._.conllormingtoASTM F48011nd (ASTND1785orASTM 02241): (check one): 0Bcheclule40 OSchedule 80 CSclledule 120

Thernl...a....alc: (c:llec* one) l;l Flllment WtMind Aelln ,.,_ oonformlnV to MTM 02986 0 Cenbtfug.a, c.t ~ Pipe confofming to ASTM 021U7

Qptn ....... ......

a Rainforted Plullc MorW Preuure Pipe confonlllng to ASTM 03517 OGIIM Fblr ~ ftesln P!ftt1.1111 Pipe c:onfarmlna to AWWA Ceo OPTFE fluGnx:IUbon T~ Cimforming to ASTM 032111 Q fEP FluurGCt~IOOft Tubltlg OOftlorming 10 ASTM 03296

~ ..._ ~ .... (m.c=rr one or1110f11J:OANSIIAWWA C200 U API Spec. 5l llASl"M 1'53 OMTM A1H

And OOinplllntwlltl (dMtclrOMorii'ICW): OASTMA242 Olype E IJType S CCI'IIdeB Oother 8 .. 1n._ _.: (c:INtdrane): aASTM AAOI (produdlon well5) OASTM A312 (monitor wels) A8S ..._... oonformlng 10 ASTM F.aG .net A8TM 01527: (c:ll8c* 0118) IJ Schedule o40 C Schedule 80

PVC ,.._ CIIDI'Iformlna to ASTM F480 llld (ASTM 01785 or ASTM 02241)! (cMd< one): USdledule 40 0 Sc:Mdule 80 a Sc:Mdule 120 ThermOMt ......-.:: (~one) a FIMienl Wound R_. Pipe amformlng to ASTN 02916

[J Centrlfug•llr Cut Rftln Pipe conforming to ASTM D21t7

IJI Reinforced PIIIIIUc Molblr PrMsure Pipe conforming to ASTM 00517 0 Glue Fiber~ "--n Prallllllt Pipe c:onJarminiJ Ia AWWA C950 0 PTFE f=luol.uc..mon lulling c:cmformlng to ASTM 03288 Q FEP Flucncwtlon T~ coftfvnning to ASTM 03298

•

APR-24-2001 04:21 PM T~ER DRILLING & PUMP 530 257 6250 :;

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I. AI-BUlL T PUMP SECTION .,.,.... • .., ...,,......, tam.......,.,_.,., II!Miw)

Benchnwk elhatlon .,rwyed. to ,IJipt 0.01 ft; = ~~ft. mean sea leV8I

elevation of top of chaR tube • r • - ft. mean sea tevel

....-....---. Pump intake depth • ft. (referanoad to bench

Chase tube depth = ft. +---t----1 (referenced to bench mark)

If aitllne Instilled, bottom or alr11ne alevatlon::: __ fl mean sea~

,. . '

MEMO and R~TE SLIP 0 04/20/01

1. Pump Tests Check( special condition of PIP? Yes/No J Glenn Bauer ~ (initial if yes) Yes No If no, describe~

Step-Drawdown Test:

followed WCPI Stds D analysis attached D proposed pump cap o.k. D

Aquifer Pump Test:

D D D

followed WCPI Stds D D T & S analysis attached D D

Well Interference: estimated Steady-State drawdown at 1-mile radius is---- ft.

analysis attached D D

Stream Surface Water Impacted: D D + If yes, identify most probable stream

2. Pump Installation Check Mitch Ohye ,Jb;...=;; (initial) · ~- 'i·O ,t?·t Yes No If no, describe deficiency

data complete followed WCPI Stds well database updated

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7 D D D

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a. charley/Lenoe ____ (initial) take action based on above analysis

4. Roy (initial) check

5. Susan Subia ____ (initial) finalize

6. Linnel (initial) signature

1. charley/Lenoreue

Sent By: Century 21 Homefiders of Hawaii; 9355830;

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APR-18-2001 04:08 PM ~NER DRILLING & PUMP .. ··-··---J .......... ,.,. ... ,.,., 53007 6250

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state of li•wall ,....__ ______ /

COIM8110N ON WATEA REIOUJilt!& MANAGeMENT De•rtnl•t _o, LaiNf and N•tur-~1 lt .. ourc• WELL COMPLETION REPORT • PART II

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8, PliRMANENT PUMP •NtoORMATION

PurnpTypt, MMe. s.i .. No.: $.,b. il.y.tR ~t$/50-/)3 ~CaDICity: 112. - gprn fMirtw-e. H.P., Voltage, rpm; .F.uw!li,~ I 1.Hf! ~41.2 V 3Y~Q ·-· Type err.., mew: __/ll.-A-i-, liJ.~ wttlcll rM8Gut'M In -· ~&!1. ....

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~FbMnllllr MtlnuMurttr ~.c. Make /lk.plu t!.e Size /J.D --···· OW* o Open Pipe D Orifice• Ll OCher*, e~llllt1 below

-..u.n SCI*ri•ac 1. Fill in 1he ....Utl.-.ctton an "'• ottler •Ide of thl' ahoet.

I. 0\her ,.,.,.,camme"ta:

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APR-18-2001 04:09 PM ~NER DRILLING & PUMP P. 03

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•· n.. p;up I - IIMI nat ~ .._. .-.rw or r~ ~qp~1 u.~~ fit .... r "' the -. !net~~ My IIUrfKa •• or IAII: .. hWindWn ,..,ltlnhftllo 'TNI...,m\ar Ill .WfirlrtDD Ill DUI"I1D .... tam I ...... IIIII mn!llllfe n ............... d . • ,,..,_ """ rtahll. Till ~.Will ...-, lndlar Will -.r 1111 ndllled tnd ~ tnll ,...... __ .._.. lhlt 1M ~fl-....,. _,. Ill _. ..:Ill • l'84luoed ~ lhl Co~Mt~N~tn 1ft tht ....._ 'thl& ,.,...at ,. nat • CIIMIIIII!Ntft• tt.t ._......-r jMI_mMictiiiiWar .w.n ..,. ~a~• nount II~ In 1M future.

s. 1t1e .,., • n Will ......,, aNUor •" ...- ...., aamp~tM • ..,.. M-IMII .. ,..,.. ..a l"•rt " • (f'll~no ....,.,., WI II lh'i ....... OI .. W..Cofnplllllan,_...(IA ohudlto!M~ .. ,wllttnlll!ly(ID)ct.p...,~of...tc.

I. Thl ... lll ... , wfl aperMir, Mlilet ... OMW IMII almfl'~ .... nU 11ppiCIIIM ... ..,., aid~. 11\f ~ mey .. ONIUftdlll for ...-allol'l Clf ., .. ,.,.,...

t. ,.... ,.....,. 11 'Ilion pMIIIl ...-aon • lfMIOI'DOrllt:KI inkllhlf DfiY'Iil ~,.,...,... llld II au• ta 11111 ~~ w.1 c:......, a Pu:JIIIII-1 lin 8tlndlnll (112M1), lftMI HWCPII ... nOI aaw.d nl • 1 ~--_.r .. ...ted or cortiMIInltla, a IM ......... ..,..._. .... ..

a. T'-..,.,. IMr ........ 1r ..-,.nat...,_ wftnln 1111 ($) rnontna .,.. .. dtdl ciiii'III1MI or I-'C • ......,_. 01......._. · llar•(t)---.. .._._...., p • at: n.. "rtc prapoHO Ill N _,. kiiiP PeAl pennJt IIPIIII-.IIon thitl be a;plalud 1liliin ._ 111 ,._ ............. ,_ ,_.. ~. "":.nn otww1na ...OIIIIL n. ,.,.,.!'lillY ba lllllend..S IJY N 0111111111..., upnn • ......... ., ... ---.I .......... ...,,_,.__ A,.., ... lit 8IIIMIII 1111 _...... .tte11 t. 1111llmitaMI tD lie eM!,.,... no r.a.r 11w1 .._ tl),.,... .- tD ~»ate fit ,...-nit..,_, H a.~ diM Ia nat n.t, ._~may 6'8VDII• an• ,.,......,..,... • Plfl"l-, - ..,._., .ndfor w.ll owner noti~:e of lie PI'ODGIId Mllor'lllld.., Clpllllf\,!"1\r lot. "-d.

t. lfiMwalla,...•w\ntiMI•""*'-~_,.INI. lf._woelllaflllllle.,...~--..Jhe...,., ...... ..:t~ • ...-.et~ _____ _, ... - .............. ,.,..In ICCOI'di!Wiewlth f1~111-1a(f) JIIPiar .,..., ........ "' .......... ...., 40. ,... .............. .... .......... thelll,.,."~· a.t.Rd, Mel .......... sJ W....ll .... ..,.. ... ,.._. wtd ..... lll'f ... .

• ....., ....... - ........... ~ ...... ..,..,...'""""· ... dMII ........ Old or ... , ...... am:.nkln fiP .. ilflllllalnt, ..... ,.. • ......., .. ..., ••. cann.-..lbld ....,. .. ...., .... permltll'JitWIInQ 10 or oanl-"d • 1M arM'IiiG ~ lltlt ....._ .. --~-----··c.,~B~n.

,...,_, AINII1D,JG01 GL~W.ABMAN,ct.i ~ntlan OM: Aprii10.10DS Commiii•W, on W ... RHI:Iurm ~

Permlltl"l Sign•ture: ,.I.E!!~:Ir.fr.

PmtedN.,.;

lnektlle,..8igrWutw: .4~:a. ....... 6......~~4!'A~- I C-fJ? •• orA LIC$1··•: a:b:f! 2 bale: 1_-J"')~(JI_ Prlntect PMme: .......L....._.~...~~~.-....... .a.c.4..._.~!11-..- Fitn'l ~;~r Tit!.; ~ d.«"c::H. ~~ fsL.•"t?

UBGa o,..aMM car r-..v a• Drtflt*lt W8iel' • w • .-. •• Brllf!Cto ...,...,...........,w ... a..-v T""""Orlltn,

.APR-'18-200 1 04: 10 PM QNER DRILLING & PUMP 53c0.>7 6250 P. 04 • •· r l ·•· · 1· ' 1 ~: · ,. •• • 11 •• &J ,.. · 14,,1::11111114~ts~u ;," ..... \f!\, ...... !1!. .::., ....... i"'i"P"''' .................. :oauoeua•• ••u i~nt ay: century 11 Ho••fide~• of Hewt~i; aassaao:

- ..... .e.llll~-~~.= __ : ........... _. ______________ . ------ .. -·---·· Apl"-11·01 10:13; Pill 5/t1 ·

1. A~UILT PUMP 8ECTIDN (PIM• ••Qtl .....,. r 41M1rwnt 11U1n ~ JJifJ'IIfltd blfmrJ

?

elewatlon of &gp of chaaa tube - ... J __ ft. rMM sea level

----·~-...,...------~----.

tT 11r1ne .,_.led, ballllm of llirline •kwetlon • ____ ft. Jrl•n lelllevttl

In •ooordllnce wttn cepanment 'd ~nd and Netur1t Reaourcea, Commialon on Wlblr ~RBDume M.rl~g .... nrs Adminielr'all'ftl AWN, BeGtiOn 18-tll, entitled 'Water U••· Welle, and etr'o.m Oiwtraion Workt". thle document ponnb ttl8 pump in ... IM far ~Y-Mtly W.U (Well No. B887'-QB) .t 15-1'780 Awe (3rd. &t.), HilMI, TMI< 1•0.t58: 98, subject to lfle Hawaii w.a .. Canltn.tolon & Pump IMtiHatlon St8ndarde (1123187) wnlch lndude but are not llmlto<l to tl'le following conditione:

1. Tn. Qha.,_on to the Comm!.-lon an wa• Reeauroe Manqtmtnt (Comm-.ian), P.O. lox 821. ~ulu, Hl88809, slwll bit naiiiMI. In wriiJnt, at leal 1111110 tri) _.. DefOre any wartc GOYeftiCI by ttlla pMnlt ~ .nd ntf 1hell be 111vweC1 to lneotet kl...-...n ~In ....... "" Wll't !11 ;,-19·10, 111WIIII AdmlnlllrariYt Rules.

a, Thw pump 1n...aan l!elftlll ftlal lla far inatdiiiiOn Gf • 10 gpm c:~~padly, or lhs, pump in the well. ' '

3. The .-nnm.. ,.,.,. ettMIOr, 1nc110r WI owntr lh•CI provld• II'ICI rn.lnaln 11n ~pnw.ci. m.w or ather IIPPI'ODfli• mHn:s for rntnunnu and ,.,art~na ~ Md Mllr tev.tt. and *PIJI'OPri•l6 ~ 011 ,.,_,. for rMMtlf'lriQ chlortda lind *"P•••~. Ttt.. d8la •MD be rne.lo!Nd ,........, 11m1 IWJIOI'IId to the Commi .. IOn on a IIIDhiiiiY IMIIIa, on I'Orml proVIded by lhe ~ (lttad'led). .

"· The priiiPCiftd .,.. •t.el nat lldwr'llly 1ffeat exMitlng or r~,~ture 1eg111 u•• ar WIICir rn the tru, lncl~lng any eurflce water or ntuathft tntnlm now ltenOitU. Thtl permit ar lht 1\111o11z.dorl to DUtl'\0 W118r trom 1 Wllllhallnot oonstilJI.e 1 def.efmlllltiOn ci CIOI'I'II.tiw ..,..., l'fOhtl, Thll pttmtlt~A, .a _. .. .,., 11ndlor wtll owner .,.. nocm.d ~ by this provision ~ that the q~ flf •• lltlca" ~ N Mill aauld be ,..,oed by th• CornmiQion '" the futunt. Thl& pMM!t 1e not a comtn~t~Mnt lhllt the Pll'"l' aapac~~y ~G Plwe or tMin .cm"~l 1a11r amount ta gu.,.,IMd In !he future.

5. T'- ltWm1ittiH, w.l ...-11110r. and/or w.ll owrwr atlall GGI'Ilpld •n~ ~R •·bUilt drhll~• 11nd !'"art II • (Pa11'1'1411n•nt) ~ump cn.-IOn ReiJQit of lie Wei Coftlplttlon ReDo1 (alllohed) to the ~eif'P41r.on within allll.y Cln) deye lifter aornplelloft of work.

8. The pennlf.all, well aper'ICDr, ll\dll!er .well OWMr lln .. l cornply wlttl Ill lppllc.bll lllwtl, IUIII, ancf erdlnlrteH, a"'f not\-eCI'npiiiiNle IYI8Y bl OMUnde for re~~eCeliOtt of lhill permiL

1. n.. pump ,_...aon permit ~tton II IMOrPO~tlld intQ lhlt Ptrmil bJ roflfeiiGI lnd It 1\lbjtot to lhll Htwlll Wtl Coniii'Uellon I Pump fl'lllllllllon &tilnMrde (11ZH7), If tl'll HWCPI8 are 1"01 ftMiawed MCI • 1 cxmHquenoa watar ia wn.tlld or contlmtnated, 1 lien 0" tM .,...rty May ,..ult.

a. The penn11 mtr ~ ,..w~e.s If WIHk 11 not ltartect Within IIIX (OJ mon"• afl•r 11e diet Of IPP'0\'11 or If wort~ 111 suspended or aa.ncton.d for lilt (I) ment1t, 11n1111 CIIWWIM ~- Tht wt~ P"'PCIHG tn the P""P lnMiblon permtt tppllcatlan thiN bo cx~mptotcd within '- (I) ~ flom lhe ell .. flf.,.,.,... IP~. unleH othiiWIH 11\*ilied. Thl PIJ"''It rnty be extended by N Cl'lllfJHtniOn upon 8 llllMIIIO till IICIM -.. Md CIOGd-tdh PB""""II'WII. A ,.quat ID ltldllnd tho t~el'ft'llt aMIII ba aubmitted to the Chalr~tSorl no later lhlln t... (S) monhl pt1Gr tD the date thf ptm~lt apn.. If thll ~t d1ta Ia not m11, lh1 Commtallon may revoke the """".,llfviniN ptfm!WM, Will aperator, lndlor Mil awr~er notice of lie propotiCf aotlon 1111d •n oppartunlty lo bl h•atd.

Iii. If 1M -Ill• not to M UMd It mliiM bB pmpeltf o.ppec:l, If 1\8 Will II to tie lbel'ldoned then the pennltiMI, -11 operator, and/or well OWMt MWt IPPIY for 1 W.U lblfld011ment pemtlt In ICCOfdlnae with f13-1H-12(f) prior to lln\'weii8MII~ ar pllJW!nV work.

iO.

11.

Date or APProval: ~xplratlon Dttl:

ADrtl 1 O, 1001 April 1 0, 1003

OIL ERT . COLOMA-AGARAN. Chslr son Commia11on on Wttlr Re10urce Management

I hllv• ~ h ......._ and ....._ flf thftl parmh •nd uriMr•.,... tt.n. I .-pi .net ·~ to mM U.M wndlt!GN a a ................. UIICIINIWIIII eendllleft af "'Y lbllltf to ,..,... aNI IIMtnlalld tMI I aMII not •ornmet~ett work unlf IIIIMithe pum' .._...._ ._,. . ....,.._ -... anal t1llumM 111e jillettl\11 to 1M Commhlelon. 1 alto lolllftfWtand u.t non-compliance with •ny pMnit candlhn mar..,~ • ...,.,......,. anG llnll of"' to tiDOO per dQ alllrtlna trom the pennll date of IPProval.

Permittee'• S"'nature: ....4~:S:::~i:!fr.._J~- --~'----

Printed N..-n•:

lnetaller'e 8ignaturw; T, C-571, or A. Llcen•• #; a..2s't 7 - bate: 1.:i..2:..0L Printed N.mc: Fit'l'fl or Title; :=rz, d.l!dU, ~,·kf,·"j

,.,.... '""' '"'* ., .. «.,. '""'"' twrvm ..,. • 1M GllllflltrHII. 1nd 1'111111 1M ttlfttr tDr raur tfNIIOIW.

UBGS D"*"*" Of l'tlriiiV e ... Dl11'1idf10 Wlll•t & W•.t-.- Dranc:h HaWIII DlllllftiMftl of w .. au.-v Tumtrgrilling

530 257 6250 "P r- Hf o 1 U : 1 2 j

State of H•wall COMMISIION ON WATER REIOUJIIe& MANAGEMENT O..-rtmont of Land and Natural JtaaourcH 11 ., .~ v

WELL COMPLETION REPORT. PART U .; lltn i 3 llllltanatlon

p. 02 Flage 4/11

P12 : Q 3

1. State w.t1 No.: 817..03 WeiiN.me: Keeau..U....,lW.al - I:Jiand~ HIW!!I_ ·-1a.11'-' Awl [J"'ILI. Hawaiian P•r•dlae "•rk 2. ACICf,...: Tax Map Key: 1·5-H~ It

3. Pump tnat.tll•tlon Company: JlJ&N e I --nAIL(ll/---· -----.. - -----· 4. Oat• Pump ln•tarled: w!8c -~.s--a:> ·--,.y,,.... -6. PERMANENT PUMP INFORMATION

Pump Typ11 Malee, ~al No.: £~h· hd)IS .,.~too-f)~ Rated Capacity: . _ II;L,.,_ gpm

MotDr Type, H.P., Voltage, l'fkTl: FA uta.~ l 1J&I:lf. :J. ~l2 ~- 3 {!!5'0 --· Type of flow m.,.; ~IJ.i:u.m~ whicfl measures In ~em. -" -

G. Method of ftaw measuremeftt:

~Flowmeter ManufaCturer .3..ttm'-- Make /}), 6Jlu.IJ!..e.._ Size f.UJ_ • OWAir o Open Pipe o Orifice" I:J Othar*, explain below

"attach sch.maac 1. Fill in tne 1&-built HCtton on the othar side of thil shoet.

8. Other ...rnt~rkelcommonta:

- - - .. --......... - ---

__ .. ......._.,._ ---· -- ... . . ... . '~.:...-... ' .. - .. ~ .. .. . . - -· -- --·--n• ••'' ... ...

---- -- •-w·-~-------·-

.. --- -· -- ___ ... - - .. - ·----··· -

·.

Pu~-~= lvM>elt C-87/C-57atA Lie. No._US'P2 -·

Date tj-17 - 61 S1gn1tUI'tt _ ·~ __..

P•nnltllt (print)

~ ~- ''" 14 'I I

Signature GP ~ Date I 2 '*' p til. 1 l:• .JdQC .. --ZJ-.·

WCIU ~om. Hl!)t)

~PR-18-2001 04:10 PM TURNER DRILLING & PUMP •. r • , ., 1 ~~ II' . tl• • • 11 •• A &I ,.. · · 1: ': ••. .'/~ ........... ~x.::. .............. """'d "

i'~·~ray':""c"~nt'u~y"ii""Ho~·~f.:i.dti"B .of Hewa11; Q3558BO i

p. 04

t. AI-lUlL T PUMP IECTION (PI•ue •"-M ....01111( fl dlfrfnnr ttom d/agrrJ!fl proYicttcl below}

Benchmwk elevatiOn 1urveyed to nl"'•rat·0.01 ft. =

.$f, 1 "7 ft. mnn sea level

·"'

elevation of top of ch:u:a tube ·---]· __ ft. m•an aea lev ..

Pvmp Intake depth = ft. (referenced to bench

Chace~ tub@ depth • ft. (refa~Wnced to b.noh mark)

If alrtlne inatalled, bOttom of air1ine elevation •

--ft. meen sea level

BENJAMIN J. CAYETANO GOVERNOR OF HAWAII

Mr. Jackie May HCR 2 Box 9570 Keeau, HI 96749

Dear Mr. May:

0 Q

STATE OF HAWAII DEPARTMENT OF LAND AND NATURAL RESOURCES

COMMISSION ON WATER RESOURCE MANAGEMENT P.O.BOX621

HONOLULU, HAWAII 96809

April 12, 2001

Pump Installation Permit Keeau-May Well (Well No. 3687-03)

GILBERTS. COLOMA-AGARAN CHAIRPERSON

BRUCE S. ANDERSON ROBERT G. GIRALD BRIAN C. NISHIDA DAVID A. NOBRIGA

HERBERT M. RICHARDS, JR.

LINNEL T. NISHIOKA DEPUTY DIRECTOR

3687-03.pip

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:

Sceclal 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. Please be aware that your proposed driller has unfinished business with the Water Commission, and It may have to be resolved before we can accept his signature on a permit, and no work shall commence unless a copy of the permit has been fully signed by both permittee and driller.

3. The current erroneous elevation benchmark etched on the concrete pad shall be removed.

The permittee, well operator, and/or well owner are responsible for all conditions of the permit Be advised that you may be subject to fines of up to $1000 per day for any violations of your permit conditions starting from the permit approval date.

Please sign and have the contractor sign both permit originals and return one for our files. A copy of your water use report form is enclosed for your use.

Except for the monthly water use report form, please provide copies of all the information in this packet to your pump installation contractor.

Finally, this letter is notice that we have accepted your Well Completion Report- Part I as complete.

If you have any questions, please call Ryan lmata 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.

Enclosure c. Turner Drilling

! ' :eJ u /'}--Aloha, ;y----Rt

~ERT s. CoLoMA-AGA Chairperson

I

O PUMP INSTALLATION PERMIT Keeau-May Well, Well No. 3687-0~

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 Keeau-May Well (Well No. 3687-03) at 15-1790 Awa (3rd. St.), Hawaii, TMK 1-5-56: 99, subject to the Hawaii Well Construction & Pump Installation Standards (1/23/97) 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. The pump installation permit shall be for installation of a 20 gpm capacity, or less, pump in the well.

3. The permittee, well operator, and/or well owner shall provide and maintain an approved 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).

4. 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. This permit or the authorization to pump water from a well shall not constitute a determination of correlative water rights. The permittee, well operator, and/or well owner are notified and by this provision understands that the quantity of water taken from the well could be reduced by the Commission in the future. This permit is not a commitment that the pump capacity permitted here or even some lesser amount is guaranteed in the future.

5. The permittee, well operator, and/or well owner shall complete and submit as-built drawings and Part II - (Permanent) Pump Installation Report of the Well Completion Report (attached) to the Chairperson within sixty (60) days after completion of work.

6. 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.

7. The pump installation permit application is incorporated into this permit by reference and is subject to the Hawaii Well Construction & Pump Installation Standards (1/23197). If the HWCPIS are not followed and as a consequence water is wasted or contaminated, a lien on the property may result.

8. The permit may be revoked if work is not started within six (6) months after the date of approval or if work is suspended or abandoned for six (6) months, unless otherwise specified. The work prop<>sed 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 good-faith performance. A request to extend the permit shall be submitted to the Chairperson no later than three (3) months prior to the date the permit expires. If the commencement date is not met, the Commission may revoke the permit after giving the permittee, well operator, and/or well owner notice of the proposed action and an opportunity to be heard.

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

10. 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.

11. Special conditions in the attached cover transmittal letter are incorporated herein by reference. ' / .11

_.JJ. Date of Approval: Expiration Date:

April 1 0, 2001 April 1 0, 2003 Commission on Water Resource Management

I have read the conditions and terms of this permit and understand them. I accept and agree to meet these conditions as a prerequisite and underlying condition of my ability to proceed and understand that I shall not commence work until I and the pump installer have signed, dated, and returned the permit to the Commission. I also understand that non-compliance with any permit condition may be grounds for revocation and fines of up to $1000 per day starting from the permit date of approval.

Permittee's Signature: Date: ____ _

Printed Name: Firm or Title:-----------------

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

Printed Name: Firm or Title:----------------

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

Attachments c: USGS

Department of Health/ Safe Drinking Water & Wastewater Branch Hawaii Department of Water Supply Turner Drilling

/

' I )

c COMMISSION ON WATER RESOURCE MANAGEMENT

FROM:...:...R.:...;.Y.:...;.A;;_:N _____ _ DATE: lf(ID/ 0 ( SUSPENSE DATE:

BAUER, G.

CHING, F. FUJII, N.

1 HARDY, R.

HIGA,D.

HIRANO, E.

ICE, C.

5 IMATA, R. -. --JINNAI, R.

KUNIMURA, 1.--

WELL NUMBER '3 (;tp? _ o"3>

0 WELL CONSTRUCTION

3 4

2

LUM,A. 3 NAKAMA,L. 3

NAKANO, D. 4 NISHIOKA, L. OHYE M ~ _A_ !,c_. ' ' . ,,~'-..) """ -

SAKODA,E.

SUBIA,S. ~ SWANSON, S. ____!..L UYENO, D. YODA, K.

WELL NAME

Approval

Signature

Information

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

3 PUMP TEST 4 DOH COMMENTS

5 LAND DIV. COMMENTS

6 WCRFORM

~ PUMP INSTALLATION

TO BE SENT TO APPLICANT

FOR OFFICE USE ONLY

ATTACHMENTS FOR PUMP INSTALLATION PERMIT:

1 COVER LETTER

2 PERMIT (2x) .3.-DGH COMMii!N'tS

4-L.AN.D DIV COMMii!NT$

5 WCR FORM <?t 6 WURFORM -...l


se..V\t .J/ ~;-t-

PLEASE·

See Me 1 Review & Comment

--Take Action

Type Draft

2 Type Final

5 File

Xerox copies

FOR OFFICE USE ONLy L I '~ -f..' ~)

,FEB-09-2001 04:25PM T~NER DRILLING & PUMP 530 2517 6250 P. 01 / c1· ----~ ----7-T-..,.

.Mr • .KOy HWY

1URNER DRILLINO cl PUMP I-

P.O. BOX 6941, HILO~ HI 96720 982.&255

HA WAll LICENSE #22597

Commission on Wat.er Resource M~~~U~gement P.O.Box621 Honolulu. m 96809

Deer Mr. JUrdy: 3l..'Ol- o:,

After consulting with my hus~ he informal me that I have bi:m stating the wrong hole diameter in wells for Jack May, Ardith Harms and Edna Christensen. The correct hole diameter is 12". 'Ibis is due to the fact that he WJed a larger size hit than I WIIS aware of.

I am 50I'IY for any inconvenicn£e this may have caused you. If you have any questions or need fiuther infmmadoo, please call me at 982-8255.

- Sincerely,

TURNER DRILLING A PUMP

~· -z;:::_____. Naomi Turner

NT:lab

1. State W.U No.: 3117-13 Well N.mt; .Kt!!u-May Wwll ,

P. 02 PIQI 4/11

a. Ada.-: 1..,710 Aw. p,. .. J. H.., .. LIR P•radl•e ...... Tax Mllp Key: .... 1_-5-11---::..;=:_11 ____ ----.--3. Pump Jn.tal-.tlon ~: JY8,N ~e,l :DJI.l.L!J "ff

~-~-·~- ··--··---~-~ ... on Pump tnet~rll!d: ~-~ ...

S. PERMANENT PUMP INFOR.U.TION

Pump T~,., MMI, Strit11 NQ,; S,.,. Jl.y~ ~~ IOo--;}~ R*ed CapaCity:

MGiatType. H.P., Voltage, rpm; ~~ /1.Ht!, ~~4V" 3¥'6~~ TVPI rllftaw mew; ~~iu.lllc. WhiGh measuruln _ .~&.'-Jie""-~m-.... ____ _ ..

G. M.thad ol taw rneasun~~Mnt: OI)F~ Manufldurer SAme. Make .IO,.p&ae Size ----'();c:..ID'i£-. ___ _

D WIJJI 0 o.,.n Pipe 0 Om100• 0 OU'Iqr·. lxfJI•in bei01N

7. Ffll ift b ~ ..attDn an th• ether •Ide of thts •hoot.

I. Other rtmBrlcelcorMHinlll=

........... -.-......~---...-...---------~-~-....__-

.-------· ------~------- --~· ---·-·----~~~-~~-~·,·~~---------=~t

--- .. • =--· ~--=--===9'_,..,.. -·--- ·-· ·-

tr/tr aBed

'APR-18-200 1 04:09 PH QNER DRILLING & PUMP 530 07 6250 t· ,_:, ·.~ ,..I•· ••••····· -··-··· , -. . - . P. 03

ant ··ay; ·a:ii:t~·r;··i;-·H;;~11d"~~"i .. ot"H;;;;iii""osii5aao·i····--- ............. _ ... :ij;~·~·1·a-~a·1 ... 1o·i·;-o·;--·······--·· Page 2

PUMP INIT ALLATION PERMIT K .. au-Mu Wtll. WeU ~.IP!.oJ

In •~ will g••runllf1l ·vt LM1d lllll'd N•IU,... FteiOUrcaa, COmmiMIDn Oft w- .._.... •-nenr5 ~ ......._ ..._, 11-t•, ......., 'Will• Utt, w••· M1CI tttMnJ PMtrU;Jn WOf'Q", 11111 duG11111eN penna Ow pump h 1

7

71ft.., "'IMY- w .. (Well NO. 8187-08)-' 1,_1110 ,_ f.lnl- 8t.), HnMII, TMIC 1~: .•• .-n.to lie HIMIIIIW411_CIIMbDian • .......,lnUaldO" ....... ,. (112Mt1) wttldl .,..bUt .. noE llrnii!Kt "fit fallcMtla COIIdllone:

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Tt-..,....,... tM CeiMHIIIII'III't Wttlr ,.._,rat Ma,...,.,. (ComilMicln). P.O. IGK 82,, ~ Hl81801, .... bit ~ ........ 1M lilell- ft)- ..... anr .....-~ by lila PM~~~~••··~ ........ ..._.., " ....... tD lniDtCI 1111 r *"...._"'...,,, ... _..!,:t-1ee-1o, H~We~IAdmlniiPMftuiM. l1.- ....... ,_..lllu:it.-rmttWIIMI fllr iiiiiiUdan fl• IV gpn -~.or ..... pump In thiMII,

The .....,.._, _. ........,, ·~ ..a tMMr tl!llll ,.owr. •"CI m1tnt.ln • IIPfiiWMCI Mellr ur .,_, iiiPPI_., ,....... fat .,........,..........,......_.. ... ....,._..end ap~·--~~~~---.-..- ............ "'-....... a. .......... ........,.- ..,ot'IMJ 1o tile co~ can • ...-w ...... on I'CiriM pnMGad,. • o.,.,...., (M*IItld). . .

TM 111• ..... UM .._ nat ....... , ...._ lllllllnCJ or ruture 1eg111 u- r11 we•r 1r1 111 ..., lncii,IG!f'l ltly ~ •• or •' lilllltl...._, ftiiW ..,.,., 'ftlll ptrmllar .... eu~ IIIIHJ""' •• tam 1 Will ablllrd GOnlliUit 1 ~~~ ot ••t~~~~Jt Wlllr fill*, Tlw ,...,_ _ _. .,......, lndlar wtlt owner .,.. ......, _, br 11:11 ~ ...we.•• '* ... ....._ ,..., ..................... ....,.. "" thl Calhl'niNion "' .......... ,. ,..,...... .. nat. OCIIINftiiLMM .... -..,........,. JNI'' .... ,. .. er-. ..... - lltlount Ia giJIIIIIfltMd 1ft I'IC fubnt. 1'111 .......... Will .......... ancuar 'Mil vwn.r ...... -JIIIId _,.. Mimi Mo!Mit 1bwl~ .nul l"•rt II ~ ~nO I"Wftp '"' r a ,._.... • .,.w..~ ......._CW.alwdl :ou-~w1111n lillY (In) days ...,..__fllwtrk. 'TIMI...,-miiiMi, ..W apii'Mir, .,., .-GMW ...., mn~y .,.. .. aU appJIC81111 lnlc, rultl. entS Cll'dii'IN:M, .,.. Mft..CIIIIIIIIII'IMifttl/ ba Of'CII,NiDI; ... ,.,_.1101'1 "" ltlt. p.rmll.

,. ,.... h••••n,.,... .............. •li'I8CifPOftit:KI iolll thlt 11'19111lii IIJ ,.,.. .... ..,_.Ia "'' Hlwll Wtl eon.u.an·a PYrll; 1: r' R '111 1 .. ....,. (111H7), If 1'1• HWOPtB .,. not ftlllDWI!d .... • 1 CICII'IIIquena» ll'llltllr is ...._ or COIIIM!Inatld, 1 u ... .......... ..,.111":.,....... . Tltl ~ I'Mf ... ..w~• I _.Ia net-- -.tW11 lillf 18) rn.nN llftlr N __ ...._. 0t IWIIiltl • ._.,..or---. fot• Ct)--. ...._. ..,, .. *F 'lsd. Tht WWI\ llftKioeel In.,.....,. lrilllliiiOnDWTNt .,._an lhlltal 1Dl$ ... J wll1fn .... -- fl!oin ............ ..,...a, IIL'ItaP ~ ........ "",.....I'IUIV be--- tw 118 Cft .. r~mt gpM • ......... .... ..... .... .... .... ............ A ....... to ...... N ............ INI SUiulftiiBd b the ettlll....,_.. "a lal.r ll.n ..... ca• rMftiiW ,,. 1:1.,. dlitl 1t1t ,...,... ...... :f a.~ .._ Ia nal i!Wl, M t:G!MIIIIIIan lillY IIMIIIa 1he ,...... .......... ,........., WIIIGIMirag, IM\Cflor'WIII Dllll'let' notiatai'N DIUIIGIIdiiJIIon n ar1 ~lty~ ba~.

lf .................. lli'MIMINI~-M. lfNWIIIIIII!IM .. ,. .......................... , ......... ...,.. .... .....,,...._, fDraw.ll ....... ._.. """"''" acc:onlzna.wln f13-1..,1acft ..,._. ~_......., .. ,....... .... . ..,......, ..... • •••• =e. eM...,_.,..., 1~ • ......_,, w hahll• ... ol ~ ... wall hrrml.- hrrt • ..-. ....... LillY !Gia, ...,, ~ ........ - ... ~ ..,..., ~ lnM'ro 91" .. ., an11:11"' .,.,,~- Di' Gm ... Gf.,. .,....n1, ....... ........ .... _.. ............. NI ..... Ie undlr 1111 r-mft«nilltlnQ ID or DOn,..., •nn N ...... t11 Lilt• plll'fiiL __ ,. ... ____ ... ,~~a--

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Dltoof~l: ~xpinaMonDIIII:

Altr1t 1D.ICK11 AfN'fl10, JOlla

ln.telleN 8plu:-..

Ptlnted r-.t.Me:

UIIG5

. .4,!i~~~L-..,~"4~i!1CP-T, C-57a. 01' A L..._,RII. c94.ff "J - llBtfl: .t-J] ~()I

.......L.~!Uit_.... _ __.. ...... ..,..~......_- fitm or Titl•; ~ N!Qt. -::Dac l,I.•'J"-7--~~~

Dlll*"oiLIIM or,_... 8aMI2~aw.. & w--... ...... er.-.d\ H:illll D•••lill'li atWIWI\IMI TUMerl:llillifle

APR--18-200 1 04: 1 C PM 0NER DR ILL! NG & PUMP ~ •· r ,. ~ ... : .• t.~!.I.LJII.II.II.fJ .......... ·, ____ P.f. .. nn-..... k ... .

i;~'t""iy': century 11 HOIIeUdt,.& .o' ~ll'lla11; ;a!!iSUO i

530~7 6250 P. 04 ~ • ..,...._X,~.mm .......... : .......................................... . Apl"-1&·01 10:1a; Pat• &/11

r-;;vatl-on_ot_•_ot_ch_•_-_tu_b_•_--:--·J L= ft. 11\tM ._ kwef

Chell•• tUbe dtlplh• ft. ,,...nc.d to~ nwlc)

-i-, .utn;-;w.lled, ballam ar arll'lC IIMYiltlan .. __ ft. rfl..., .....

BENJAMIN J. CAYETANO 00VERN0R OF HAWAII


Dear Mr. May:

0 0




FEB 6 2001

Well Completion Report for Well No. 3687-03

TIMOTHY E. JOHNS Ct-WRPERSON

BRUCE S. ANDERSON ROBERT G. GIRALD BRIAN C. NISHIDA

DAVID A. NOBRIGA HERBERT M. RICHARDS, JR.

LINNEL T. NISHIOKA OEPUTY DIRECTOR

3687 -03.ackb

We have received your elevation updates to Well Completion Report Part I for the Keeau Well (Well No. 3687 -03). However, upon further review, we found an additional matter that must be addressed before we accept your report as complete as follows:

1. There appears to be a discrepancy between your reported grouted annulus of 3" and the calculated annulus of only 1.5" difference between your hole diameter of 9" and your casing diameter of 6". The minimum requirement is a 3" annulus, in accordance with the Hawaii Well Construction Standards Section 2.6d. Therefore, the calculat~d difference of 1 .. 5" is either in error or does not meet the minimum standard for an annulus width. You need to explain this discrepancy or how you will correct this insufficient annulus width as it was also highlighted as a special condition of your permit.

Please respond to the above item(s) within sixty (60) days of this letter's date. Failure to do so may result in fines of up to $1000 per day.

If you have any questions, please contact Ryan lmata 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).

RH:ky

Sincerely,

LINNEL T. NISHIOKA Deputy Director

I

Search Results Q

Page 1 of

Copyright 1/31/2001 by Hawaii Information Service

• PUBLIC RECORD DATA Taxkey Subdiv/Condo-Apt TnrProperty Address Owner/Lessee Beds Baths Land area Living area 3-1-5-56-99 Hawaiian Paradise Park F 15-1790 3RD AVE MAY,JACKIE D /ETAL 3 2+2/2 1.00 ac 2844

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

http://webresearch.hawaiiinformation.com/REsearch/Asp/Functions/Property/Searc . 1/31/2001

0 "o COMMISSION ON WATER RESOURCE MANAGEMENT (10/99)

FROM: _ __.L ....... IN=N..,.E .. L..__ ____ DATE: __ NO_V_2_9_2_uoo ____ SUSPENSE DATE. _______ _

_BAUER, G. _CHING, F. _ DANBARA, S. --7FUJII, N.

"}-~HARDY, R. _HIGA,D. _HIRANO, E. _ICE, C. --LlQIMATA, R. _JINNAI, R. _ KUNIMURA, I.

_LUM,A. _NAKAMA, L. _NAKANO, D. __i__ NISHIOKA, L.

l _0_ OHYE, M. _SAKODA,E. _._SUBIA, S. _SWANSON, S. _UYENO, D. ~ YODA,K.

_Approval 4-- Signature

_ Information

/'"">-I • 1 1 i i '~-. ''•·' '

PLEASE:

See Me Review & Comment Take Action

___1_ Type Draft ----2.. Type Final _fL. File _Xerox_ copies



Dear Mr. May:

0 0


COMMISSION ON WATER RESOURCE MANAGEMENT P.O. BOX621


NOV -6 2000


TIMOTHY E. JOHNS CHA.IRPERSON




3687 -03.ack

We have received your Well Completion Report Part II for the Keeau Well (Well No. 3687-03). However, matters which must be addressed before we accept your report as complete are as follows:

1. The appears to be a discrepancy between the ground elevation provided on the as-built section and the survey document provided by the surveyor. Please note comments on attached copy of your as-built, make the proper corrections, and resubmit the as-built to us.


If you have any questions, please contact Ryan lmata of the Commission staff at 587-0255 or toll-free at 97 4-4000 (Hawaii), 27 4-3141 (Kauai), 984-2400 (Maui), or 1-800-468-4644 (Lanai & Molokai).

Rl:ky

Sincerely,

·~ LIN EL T. NISHIOKA Deputy Director

'- •_.J" ~

_. - ---r r· .. -- .. ~--' ~-~~., .-"--""

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<:.- J __ ,. _.::,.. C::! ....:;. ..... rv (.0

:J:2 -(..t.)

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·•

State of H0aii ····o For Official Use Only{ -.

COMMISSION ON WATER RESOURCE MANAGEMEN'J; Department of Land and Natural Resources ~ 't:'-::: ':!' i ·:.·: .

. ...... :..·-, WELL COMPLETION REPORT - PARTI

· ~ Well Construction , . 'M' N V 2 g A II : 3 2 lnstructl~ns: .Please print in ink or type· and. serid completed report (with attachments, if applicable)Jo.~~ .. _ Commission on Wate.r Resow-~ Manag~f11ent, P.O. BOx 621, Honolulu, Hawaii 96809: The Commissior\'rriay · · ·' ( not accept incorilplete reports.-- This fOf!Jl shSII be submitted within 60 days of the completion of_ work .. For . . . . _. ~ t '-"'' .•

assistance, please consult the Hawai_i Well.t?onstructio~ and -~ump l_nstallati?n Standards ~r ~II trye ~eg~lat&~Mf lSSlO}l ON'WAH~G_ -t,. ••• t .;.;r~ : Branch at 587-0225. For updates to th1sforrn .. or add1t1onal 1nforrnat1on, please VISit .our webslt&,Ea'O' RCE ~AilNAGPlE'H"''·''··"''~-··•' http://www:state:hi.us/dlnr/cwnnl #·,. ·: •. --~ -~ .:_ • • __ • , • • ., • h '- 1 1

' • -• 1 ,--·<F '"7. ~~w ·r: t:' t.,,

-· • • - • i• . - - ';1

¥""" ,., ................ 'l>

1.' State Weii.N.i:J.: 3687-03 Well Name: ....!.!K:::e:::ea~u~·.!.W!.:e::l:.:l·__c~------- Island: _H~aw=a·~·; __ _

2. Address: '15-1790.Awa.(3rd St:);Hawaiian Paradise Park Tax Map Key: ~1-:,-5:::·5~6::,:_,.,9::::9_/ _____ _

3.

4.

5.

6.

7.

8.

•',,

Step-Drawdown Test completed?".. · • •• .<•

Constani Rate Aquifer Test completed? ..

Parameters prior to pump test:

JiLNo ).1' No

0 Yes

0 Ye_s

Attach Step-Dra'-:-'down Test ~orm <.!2117197 SDPTD Form)

Attach Constant Rate A~uifer Test form (12/17/9,7 CRPTD Form)

9. Water-level: S b . • ·ft. above msl Date and time of measurement:

10. Chloride: Jso ppm Date and time of sampling:

11. Temperature: zo " ~oF Date and time of measureme'nt:

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

13. Attach plot plan and syrveyor's stamped elevation report. , .. .. '

14. If a pump is not planrie'ci'to be instal!ed, please describe (below in the re·marks section) how well is secured tci ' .. prevent unauthorizedaccess:Jexample: Jockable co.ver, threaded coupling; etc.) . . . '

15. Remarks: f/ ~ - ·o'; · " ... .• , ' ' : ' ..

C-57 Lie. No.__,()"'-. ,:::d.'-"59~:...,....<:/~~----'

Signature # ••• -

' . -Surveyor (print) Nr'e.l;. . c h rl~f~,...,.5 e.,_,

pl~as~ attach stampe~~ . J /) 1 . 1 . ·.

S1gnature ~ ~

U~,L.S. Lie. No .• _._tf.L.'...:0---=.:7_7_·.--'-----··' . '

-- -·------..:.I'S ____ l_ __ ,_c _.?~...._:'a_:.

-.. --,

Permittee (print) • 'I

Signature S-3>o Fau

- --~---·

' J ,, ' i

·I

•,

'. '. . ' -13 .. AS-BUIL T WEOECTION

. ' (Please attach as-built if different rronQra:m pro~id_ed ~:tow)

0 · in. .·1--

Bench mark elevation:

M!~im,ym of 2' Radi~.:~s·~,4" Thick Con~ete Pad

Ground Elevation:~~f.t_ft., msl

Total Depth

20 ft.

.·

Cement (min. 70% of di;;!;~0io~ ground elevation to water surface or whichever iS less.)

Annular space between hole and casing (min.3"):

Rock or Gravel Packing:

·,.M:-a.,-te'"'n,..at,..: - ft:

0 Crushed ·BaSalt 0 Rounded Gravel

Water.Level Elevation:

st. ~- msl•

... *ins! = mean sea -level

Solid Casing Material:

. ·'

Pte3se:refer ·tO·the HAWAII WELL CONSTRUCTION AND PUMP INSTALLATION STANDARDS to ensure that your as-built is in compliance

with applicable stan~ards.

Solid"C3sl6g: (~ 90%-X (Ground Elev.-Water Level Elev))

Length: ·· ' $ ft.

Nominal, Diameter: __ _:_..:__.:__~=.,....,..,.._in.

Wall Thickness: -;-------"':../c, . ..cS'.>...:S':..__ in.

Bottom Elevation:_;--'---.,---- ft., msl

Open Cas'ing: 0 Screen

Length: ________ :-_,_:;;_ __ ft.

Nominai_ .. BjameteF.·-------"=---'"·

Wall Thickness: if? 'ji" in.

BOttom Elevation: · ft., msl

'· t- ..

Open Hole:

Length: ___ !.JII:.,!:B:Z,.------~ft .. Diameter: --,,.,---'---------,-in.

Bottom Elevation::c· ________ :._ ft .. _msl

I' .. ,,_:_.,•~t. )!t (": •.:• ·' ( ·'' ...

Carbon Steel: compliant with (chock ono or moro):O ANSI/AWWA C200 0 API Spec. 5L 0 ASTM A53 J!\ASTM ,A,139 ... , And compliant with (chock ono or mora):. · 0 ASTMA242 · . OType E OType S ')!;Grades· · · 0 Other · · ' '.

Stainless Steel: (check ono): 0 1\STM A409 (production wells)· OASTM A312~(monitor Wells) · 1

ASS Plastic conforming to ASTM F480 and ASTM 01527: (check one) D Schedule 40 0 Schedule 60

.PVC Plastic conforming't? ASTM F460 and (ASTM. 01785 or ASTM 02241 ): ·(check one): 0 Schedule 40 0 Schedule 80 0 Schedule 120 Thermoset Plastic: (check one)

Open casing 'M.aterial: •

0 Filament Wound Resin. Pipe conforming to ASTM 02996

0 Centrifugally Cast Resin Pipe conforming to ASTM 02997_

0 Reinforced Plastic Morta"r Pressure Pipe conforming to ASTM 03517

0 Glass Fiber Reinforced Resin Pressure Pipe conforming to A'V'rNt/A C950

_ 0 PTFE.Fluorocarbon.Tubing·conforming·to·-ASTM 03296 ·· --.-

. 0 FEP Fluorocarbon Tubing conforming to ASTM 03296

Carb_on Steel: compliant With (check one ormomlJ;1ANSI/AWWA C200 OAPI-Spec. 5L 0 ASTM A53 · ·o ASTM A139

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

Stainless Steel: (check one): 0 ASTM A409 (production wells) 0 ASTM A312, (~onitor')Vells) ASS Pl_astlc conforming to ASTM F480 and ASTM 01527: (Check orio)· 0 Schedule 40 0 Schedule 80 PVC Plastic conforming to ASTM F48.0.~nd (ASJM 01785 or ASTM 02241): (check one): 0 Schedule 40

·. 0 Schedule 80 0 Schedule 120 Thennoset.Piastlc: (check'one) .... ;:0 Filament Wound Resin Pipe conforming to ASTiv1 02996 ! -- · --~ ·---~·-=' -·: ,_.::.:. '-· :..:.....:: "·U·ce~irifuQauy Cast Resin PiPe -;~n-i~~in9 t~ ASTM 02997

' .. - .

0 Reinforced Plastic Mortar Pressure Pipe conforming to_A.STM 03517

0 Glass Fiber Reinforced Resin Pressure Pipe conforming to A'V'rNt/A C950

Q PTFE Fluorocarbon Tubin9 co~orllJJng to ~sTM:i:l3.296 · ;. .: ·. · · !_-·-, \. 0 FEP Fluorocarbon Tubing conforming to ~STM-03~96~ ' • ·- • .... •• -.It ' • ,, ••• .._

--

State of Ha&ii 0 COMMISSION ON WATER RESOURCE MANAGEMENi Department of Land and Natural Resources

WELL COMPLETION REPORT- PART I


Rr-f""!"n?~-,-, ..__. • , , • j I ··-' .

Well Construction nc 401/ 29 All : 3 2 Instructions: Please print in ink or type and send completed report (with attachments, if applicable)Jojhe ._ Commission on Water Reso1,1rce Management, P.O. Box 621, Honolulu, Hawaii 96809. The Commissiort'iriay · · not accept incomplete reports. This form shall be submitted within 60 days of the completion of work. For-.r. 1 ,

assistance, please consult the Hawaii Well Construction and Pump Installation Standards or call the RegulatioJ.A· ~! S ~it'; 1 ,,! \! \.! .. ' ~. r: \

Branch at 587.0225. For updates to this form or additional information, please visit our website cR [ :: http://www;state.hi.us/dlnr/cwrm/

1. State Well No.: 3687-03 Well Name: _:..:K:.=e;::ea:::u=-·-=-W:.:e::.:.l=-1 -------- Island: Hawaii

2. Address: 15-1790 Awa (3rd sq, Hawaiian Paradise Park Tax Map Key: 1-5-56: 99

3. Drilling Company: ~!liVed. f)Ri(.C d.JJ 1- Pu,YLp 4. If drilled, type of Rig: M Rotary 0 Percussion

5. Date Well Construction (drilled,cased,grouted) completed: /c 'IS. ~o Attach Driller's Log (7/26199 DL Form) ". mon day/year

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

',,-:.

6. Initial water-level encountered Sb ft. below ground Date and time ofmeasurement: 1~5~<~ I PM. month/day/year time

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

8. Constant Rate Aquifer Test completed? )zf No 0 Yes Attach Constant Rate Aquifer Test form (12117197 CRPTD Form)


9. Water-level: 6-b ft. above msl Date and time of measurement: . 1 0. Chloride: ----~4~ .. ~~5~·~·~~----ppm Date and time of sampling:

11. Temperature: ___ _._2-"""L?-'-.-- OF Date and time of measurement:


13. Attach plot plan and syrveyor's stamped elevation report. •·

14. If a pump is not plann'ed to be insti=~lled, please describe (below in the remarks section) how well is secured to prevent unauthorized access {~xample: lockable cover, threaded coupling, etc.)

15. Remarks: ,11 ~ ~--~----------------------------------------------------------------------

Licensed Driller

Signature

Surveyor (print) NJ'e../> c h ri ;$.I e.n.5 ~ p/~ase attach stam~ /) 1 1

Signature ~

Permittee (print)

Signature

C-57 Lie. No. (} :J59?

.Date IS 6Ct oo .·.

L.P.L.S. Lie. No. __ t(t..-0_7_? ______ _

Date Oc.), I 5") Z OD o >

Date ;;;:---'-s __ o_!._-_1 __ d_6_o_o __ ..

WCR1 Form 512100

13. AS-BUlL T WOECTION (Please attach as-built if different r4gram provided below)

Elevation at top of casing ~.o~ ft., msl* (to nearest 0.01 ft.)

Hole Diameter:_ 9' __ .in.

Minimum of 2' Radius & 4" Thick Concrete Pad

Ground Elevation:~~!.r.t_ft., msl

G.$,c-;-,.,.... .Jl.r $ r .... p,..,ulu•• o~

Total Depth

20 ft.

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


t3 in.


•

~.,.--,-,-- ft. Material: 0 Crushed Basalt 0 Rounded Gravel

Water Level Elevation:

st. ft. msl*

"

*msl = mean sea ·level

Please refer to the HAWAII WELL CONSTRUCTION AND PUMP INSTALLATION STANDARDS to ensure that your as-built is in compliance

with applicable standards.

,__--1 Solid Casing: (:2: 90% x (Ground Elev.-Water Level Elev))

Length: ' $ ft. Nominal Diameter: ______ __o::....__.,...-_in.

·/·od Wall Thickness: • _ ~ D in.

Bottom Elevation: _________ ft., msl

Open Casing: Perforated OScreen

Length:------------'--'---- ft. Nominai'Diameter-r· ______ ...::z;:;;;L_ __ in.

Wall Thickness: iS ??' in.

Bottom Elevation: ft., msl

Open Hole: -, •

.AI~ .. Length: --~...::..........::...~z,..---------ft. Diameter: _____________ in.


Solid Casing Material: Carbon Steel: compliant with (check one or more):O ANSI/AWWA C200 0 API Spec. 5L 0 ASTM A53 J\ASTM A 139

And compliant with (check one or more): 0 ASTM A242 0 Type E 0 TypeS ]'(.Grade B 0 Other

Stainless Steel: (check one): OASTM A409 (production wells) OASTM A312 (monitor wells) ABS Plastic conforming to ASTM F480 and ASTM D1527: (check one) 0 Schedule 40 0 Schedule 80

PVC Plastic conforming to ASTM F480 and (ASTM 01785 or ASTM D2241): (check one): 0 Schedule 40 0 Schedule 80 0 Schedule 120 Thermoset Plastic: (check one)

Open Casing Material: ~

0 Filament Wound Resin. Pipe conforming to ASTM D2996

0 Centrifugally Cast Resin Pipe conforming to ASTM D2997

0 Reinforced Plastic Mortar Pressure Pipe conforming to ASTM 03517

0 Glass Fiber Reinforced Resin Pressure Pipe conforming to AWWA C950 0 PTFE Fluorocarbon Tubing-conforming to ASTM D3296

0 FEP Fluorocarbon Tubing conforming to ASTM D3296

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

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

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

ABS Plastic conforming to ASTM F480 and ASTM D1527: (check one) 0 Schedule 40 0 Schedule 80

PVC Plastic conforming to ASTM F48~l.;:md (ASTM D1785 or ASTM 02241 ): (check one): 0 Schedule 40 0 Schedule 80 0 Schedule 120 Thermoset Plastic: (check'one)

•

--0 Filament Wound Resin Pipe conforming to ASTM 02996

0 Centrifugally Cast Resin Pipe conforming to ASTM 02997


0 Glass Fiber Reinforced Resin Pressure Pipe conf?rming to ft:WWA C950 0 PTFE Fluorocarbon Tubin~ conforming to ASTM 03.296

0 FEP Fluorocarbon Tubing conforming to ASTM-03~96 . . ••

State of HaCtii 0 For Official Use Only:

COMMISSION ON WATER RESOURCE MANAGEMENf Department of Land and Natural Resources

WELL COMPLETION REPORT- PART I _____ __::.W:.::e:.:.:.II..::C:.:;:;O.:.:.:ns::,:t;.:rU:.::::C.::.;tio:::..:n.:.,__ _____________ ~n n mv 29 All : 3 l Instructions: Please print in ink or type and send completed report (with attachments, if applicable )_to _the .. Commission on Water Resource Management, P.O. Box 621, Honolulu, Hawaii 96809. The Commissiorti'riay · · not accept incomplete reports. This form shall be submitted within 60 days of the completion of work. For.,,assistance, please consult the Hawaii Well Construction and Pump Installation Standards or call the RegulationC C Branch at 587-0225. For updates to this form or additional information, please visit our website ~ES ~~ http://www:stale.hi.us/dlnr/cwrm/

1. State Well No.: 3687-03 Well Name: _.:...:K:.=:e..:::.ea=u=-·...:.W:..:e:.:l=-1 _______ _ Island:

2. Address: 15-1790 Awa (3rd sq, Hawaiian Paradise Park Tax Map Key: 1-5-56: 99

Drilling Company: '7UtttVed. -i)RiU.t IVJ ..... Pu,np If drilled, type of Rig: ~ Rotary 0 Percussion

Hawaii

3.

4.

5. Date Well Construction (drilled,cased,grouted) completed: /!i:~o Attach Driller's Log (7126199 DL Form) . '•. men day/year

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

',,·;

·._ ....

Initial water-level encountered .... :5'6 ft. below ground Date and time of-measurement lo/!.$'~(1 I !?M monthfday/year time

6.

7.

8.

Step-Drawdown Test completed?

Constant Rate Aquifer Test completed?


):(No DYes

)n'No DYes

Attach Step-Drawdown Test form (12117197 SDPTD Form)

Attach Constant Rate Aquifer Test form (12117197 CRPTD Form)

9. Water-level: S b ft. above msl Date and time of measurement: '

10. Chloride: ----~4~-~~s~·~o~ ____ ppm Date and time of sampling:

11. Temperature: ?0 Date and time of measurement:


13. Attach plot plan and syrveyor's stamped elevation report . ..

14. If a pump is not plann'ed to be installed, please describe (below in the remarks section) how well is secured to prevent unauthorized access f:xample: lockable cover, threaded coupling, etc.)

15. Remarks: /) J1. ~--~--------------------------------------------------------------

Licensed Driller C-57 Lie. No. (} :J59 /

Signature .Date IS OCt 00

Surveyor (print) Nie..l > c h ,..,· ~-! e 1-1.5 ~ L.P.L.S. Lie. No. __ tf.__o_7 __ 7 ______ _ pl~ase attach stamp~ /)

1 1

Signature ~ ~ Date Oc. J, I 5'1 Z OD o •

Permittee (print)

Signature Date ::---'-s __ o __ t._-_1 __ d __ <=>_6_o __ .. WCR1 Form 512/00

13. AS-BUILT w.osECTION (Please attach as-built if different f.gram provided below)

Elevation at top of casing ~.o~ ft., msl* (to nearest 0.01 ft.)

9_.in. Minimum of 2' Radius & 4" Thick Concrete Pad

8.$1C"r'l-... $ r ,J,

f'~AdU'« Oit

)

Total Depth

20 ft.

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


t3 in.


•

-:-:--.,.--:-:-- ft. Material: 0 Crushed Basalt 0 Rounded Gravel


..5 (, ft. msl*

•

*msl = mean sea level

% jjJ

Ground Elevation:~'-·aft., msl



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

Length: ' S ft.

Nominal Diameter: --------'=--~-in.

Wall Thickness: "/ g'~ in.


Open Casing: Perforated 0 Screen

Length: -----------'--'. ___ ft. Nominai'Diameter~· ______ _::r;:;;.z_ __ in.

Wall Thickness: I g ?{ in.


Open Hole: ,, ,

Length: ----..-:,1(1:.-. "-'BE,-_______ ft . Diameter: _____________ in.

Bottom Elevation: · ft., msl

Solid Casing Material: Carbon Steel: compliant with (check one or more):O ANSI/AWWA C200 0 API Spec. 5L 0 ASTM A53 )\ASTM A 139

And compliant with (check one or more): 0 ASTM A242 0 Type E 0 TypeS XGrade B 0 Other Stainless Steel: (check one): OASTM A409 (production wells) OASTM A312 (monitor wells)


PVC Plastic conforming to ASTM F480 and (ASTM D1785 or ASTM D2241): (check one): 0 Schedule 40 0 Schedule 80 0 Schedule 120 Thermoset Plastic: (check one)

Open Casing Material: ~

0 Filament Wound Resin. Pipe conforming to ASTM D2996


0 Reinforced Plastic Mortar Pressure Pipe conforming to ASTM D3517

0 Glass Fiber Reinforced Resin Pressure Pipe conforming to AWWA C950

0 PTFE Fluorocarbon Tubing conforming to ASTM D3296

0 FEP Fluorocarbon Tubing conforming to ASTM 03296

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


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


PVC Plastic conforming to ASTM F48P.~nd (ASJM 01785 or ASTM 02241): (check one): 0 Schedule 40 0 Schedule 80 0 Schedule 120 Thermoset Plastic: (check one)

•

--0 Filament Wound Resin Pipe conforming to ASTM 02996



0 Glass Fiber Reinforced Resin Pressure Pipe conf?rming to ft:WWA C950 0 PTFE Fluorocarbon Tubing conforming to ASTM 03,296

0 FEP Fluorocarbon Tubing. conforming to ASJM.03296 Jt .. ~ ••

State of Ha&ii 0 COMMISSION ON WATER RESOURCE MANAGEMEN'f Department of Land and Natural Resources

WELL COMPL,.ETION REPORT -PART I


Well Construction D n r·': / 29 A) I . 3 I Instructions: Please print in ink or type and send completed report {with attachments, if applicable)_to_tRe ~- 1

Commission on Water Resource Management, P.O. Box 621, Honolulu, Hawaii 96809. The Commission'iTiay · · not accept incomplete reports. This form shall be submitted within 60 days of the completion of work. For assistance, please consult the Hawaii Well Construction and Pump Installation Standards or call the Regula~ · \;_~·::·:''• i'\ \~J -~. T f.~ I~ Branch at 587-0225. For updates to this form or additional information, please visit our webs it~- ;~t I CJ r' . ' ' c t:-1 ~: il .. http://www:state.hi.us/dlnr/cwrm/ '' ·· · '

1. State Well No.: 3687-03 Well Name: Keeau Well Island: ~~~~~-------------------

Hawaii

2. Address: 15-1790 Awa (3rd St), Hawaiian Paradise Park Tax Map Key: 1-5-56: 99

3. DrillingCompany: =--&tt!Ued f)Ri((.tiVJ r P()/Ylp 4. If drilled, type of Rig: ~Rotary 0 Percussion

5. Date Well Construction (drilled,cased,grouted) completed: /~o -'' _ mon day/year

In addition to the dri/ler's log, if a geologic log was prepared, please.submit with this form.

Attach Driller's Log (7/26/99 DL Form)

· ......

:.· .. '•

6. Initial water-level encountered 56 ft. below ground Date and time of measurement: l~s~<~ I !?M.. month/day/year time

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

8. Constant Rate Aquifer Test completed? )6 No 0 Yes Attach Constant Rate Aquifer Test form (12117197 CRPTD Form)


9. Water-level: S b ft. above msl Date and time of measurement:

1 0. Chloride: Date and time of sampling:

11. Temperature: Date and time of measurement:


13. Attach plot plan and swveyor's stamped elevation report. "

14. If a pump is not planned to be install.ed, please describe (below in the remarks section) how well is secured to prevent unauthorized access f:xample: lockable cover, threaded coupling, etc.)

15. Remarks: P IJ. ~--~--------------------------------------------------------------

Licensed Driller C-57 Lie. No. () c959 ?

Signature .Date IS oc£ oo

Surveyor (print) N,·e.t > c h ri ~- f e t/1.$ ~ L.P.L.S. Lie. No. __ 9~...--o_7_7 _____ _ p/~ase attach stam~ /)

1 1

Signature ~ ~ Date Oc. -/, I 5"1 Z OD o >

Permittee (print)

Signature Date ::---'-s ___ o __ !. __ 1 ___ d __ <=>_o_c.> __ _ ..

WCR1 Form 512/00

13. AS-BUlL T wesECTION (Please attach as-built if different rrOgrom provided below)

Elevation at top of casing JJ• 0~ ft., msl* (to nearest 0.01 ft.) Minimum of 2' Radius & 4" Thick Concrete Pad

Ground Elevation:~~~f:t.ft., msl

. fl.SIC"'ii.U. .Jt;;;.'·'J'r ·,.~.. P.-cAc!u•• Oft

Total Depth

20 ft.

Cement Grout: 50 ft. (min. 70% of distance from ground elevation to top of water surface or 500 ft., whichever is less.)


t3 in.


•

~:--:--:-- ft. Material: 0 Crushed Basalt 0 Rounded Gravel


..5 t;_ ft. msl*

•




<11----l Solid Casing:(~ 90% x (Ground Elev.-Water Level Elev))

Length: ' S ft.

Nominal Diameter: --------"=----:---in. , / oc/ Wall Thickness: • _ Q. D in.


Open Casing: 0 Screen

Length: -----------'---..l.--_ft. Nominal :Diameter-:" in.

-------~~----Wall Thickness: / S ?{ in.

Bottom Elevation: ______________ ft., msl

Open Hole: \ ,,

Length: __ _,....:/V"-R:...£,--------ft . Diameter: _______________________ in.

Bottom Elevation:_·-------------- ft., msl

Solid Casing Material: Carbon Steel: compliant with (check one or more):O ANSIIAWWA C200 0 API Spec. 5L 0 ASTM A53 ~STM A 139

And compliant with (check one or more): 0 ASTM A242 0 Type E 0 TypeS ,XGrade B 0 Other Stainless Steel: (check one): ClASTM A409 (prodUction wells) ClASTM A312 (monitor wells)

ABS Plastic conforming to ASTM F480 and ASTM D1527: (check one) 0 Schedule 40 0 Schedule 80 PVC Plastic conforming to ASTM F480 and (ASTM D1785 or ASTM D2241): (check one): 0 Schedule 40 0 Schedule 80 0 Schedule 120

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



0 Glass Fiber Reinforced Resin Pressure Pipe conforming to AWWA C950 0 PTFEFiuorocarbon Tubing conforming to ASTM D3296

. 0 FEP Fluorocarbon Tubing conforming to ASTM D3296

Open Casing Material: .. Carbon Steel: compliant with (check orie or more~ ANSIIAWWA C200 0 API Spec. 5L 0 ASTM A53. 0 ASTM A 139



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

PVC Plastic conforming to ASTM F48.0 ~nd (ASJM 01785 or ASTM 02241): (check one): 0 Schedule 40 0 Schedule 80 0 Schedule 120

Thermoset Plastic: (check one)

•

... a Filament Wound Resin Pipe conforming to ASTM 02996



0 Glass Fiber Reinforced Resin Pressure Pipe conforming to AWWA C950 0 PTFE Fluorocarbon Tubinj;l conforming to ASTM 03.296 '

0 FEP Fluorocarbon Tubing conforming to ASTM-03296 Jt ··• ,,



Dear Mr. May:

0 0




NOV -6 2000


TIMOTHY E. JOHNS CtWRPERSON


HERBERT M. RICHARDS, JR


3687 -03.ack

We have received your Well Completion Report Part II for the Keeau Well (Well No. 3687-03). However, matters which must be addressed before we accept your report as complete are as follows:

1. The appears to be a discrepancy between the ground elevation provided on the as-built section and the survey document provided by the surveyor. Please note comments on attached copy of your as-built, make the proper corrections, and resubmit the as-built to us.


If you have any questions, please contact Ryan lmata 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).

Rl:ky

Sincerely,

,~e_J.~ -~~~JEL T. NISHIOKA

Deputy Director

/

MEMO and RSl.JTE SLIP 0

I WCR 1 Check for Well No. 3687-03 (survey to regulation memo)

1. Pump Tests Check Glenn Bauer ____ (initial} Yes No

Step-Drawdown Test:

followed WCPI Stds 0 0 analysis attached 0 0 proposed pump cap o.k. 0 0

Aquifer Pump Test:

followed WCPI Stds 0 0 T & S analysis attached 0 0

Well Interference: estimated Steady-State drawdown at 1-mile radius is ____ ft.

analysis attached 0 0

If no. describe deficiency

Stream Surface Water Impacted: 0 0 + If yes, identify most probable stream

2. Construction Check Mitch Ohye k;J (initial} Yes No If no. describe deficiency

10/24/00

data complete 0 £ St-:t:::: k>- ~ I (..;'( ~u.·1 I 0 _)

followed WCPI Stds 0 )On/ well database updated 0 .~

3. Charley/Lena~ ~ial) take action based on above analysis 4. Roy± (i.·nitial) check _____ l

.. / (i ~ ~ 4--S"; ~v,l+ (t-p~ lJ, 5. Susan Sub . 1··t ':~.-" (initial) finalize ~~S ~~ L~ ~ 1~ )

6. Linnel · ~ (i~tial) signature

7. Charley/Leno~ile

. . ....,; ""

• • State of Haw.,.ii For Official Use Only:

COMMISSION ON WATER RESOURCE MANAGEMENT Department of Land and Natural Resources

WELL COMPLETION REPORT- PART I --------------~VV~e~I~I~C~o~n~s~t~ru~c~t~io~"~----------------------------------~~ Instructions: Please print in ink or type and send completed report (with attachments, if applicable) to the -Commission on Water Resource Management, P.O. Box 621, Honolulu, Hawaii 96809. The Commission may not accept incomplete reports. This form shall be submitted within 60 days of the completion of work. For assistance, please consult the Hawaii Well Construction and Pump Installation Standards or call the Regulation•- ,, ; • · Branch at 587·0225. For updates to this form or additional information, please visit our website ~t;_-; ___ , http://w\Nw.state.hi.us/dlnr/cwrm/ i4

·, t~: ... - _.;. '--

\8

1. State Well No.: 3687-03 Well Name: Keeau VVell ~~==~~-------------------

Island: ~H=aw=a::::li __ _

2. Address: 15-1790 Awa (3rd St.), Hawaiian Paradise Park Tax Map Key: _1-=-·..::.5-=-5..::.6-=--: 9=-:9=-------

3. Drilling Company:

4. If drilled, type of Rig:

5. Date Well Construction (drilled,cased,grouted) completed: Atti!.ch Driller's Log (7126/99 DL Form) ., mon a ar

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

6. Initial water-level encountered '-56 ft. below groun Date and time of measurement: l~s~ I PM month/day/year time

7. Step-Drawdown Test completed? )iNo D Ye~- Attach Step-Drawdown Test form (12117197 SDPTD Form)

8. Constant Rate Aquifer Test completed? )1 No D Yes ·,~ch Constant Rate Aqu:fer,Test orm (12117197 CRPTD Form)

Parameters prior to pump test: ~ ' . 9. Water-level: S ~ ft. abdW\e ms Date and time of measureme /t3 IS .2~•o

/ 10. Chloride: _J S .<!) ppm -. ._, Date and time of sampling:

~- I 11. Temperature: ?~ or Date and time olmeasurem

12. Fill in the as-built section on ~er side of thlssheet ;·

13. Attach plot plan and syrveyor's si~mped elevation report. 'I

14. If a pump is not planned to be instaljap, please d.escribe (below in the remarks section) how well is secured to prevent unauthorized access (exampl~ockable-cover, threaded coupling, etc.)

'-...._.../ 15. Remarks: -LI'_:_:__:~:__ _____________________________ _

C-57 Lie. No. a cJ59?

Date IS ocr oo

L.P. L.S. Lie. No. __ 9t_;;;_o_7.:__/ _____ _

Date Oc. -/, /~1 Zooo

Permittee (print)

SignaturE Date __ ,_s __ o_t._-;-__ d_6_6_0 __

WCR1 Form 512100

13. AS-BUll T we SECTION \1:::'-'-' \-\ l (o,..l A o>.o4~ (,~ • ~ /-

Elevation at top of casiril _2.~ ft., msl*

(Please aNa~h as-built .it different tro-agram provided below)

r\ / ~J\<1>--t 1':;. ,l"'t..t Ov ooa~ ~\01_~ r Hole Drameter: f t~i m. { 0 ,,_, -..· t <:::;; .-

-.. ~ .. ~

(to nearest 0.01 ft.) \-.____../ • Mm1mum of 2' Radius & 4"z;I7i ncrete Pad . , , !?e ~ I,. S4- ~"'·"' \

r Ground Elevation: ft., msl S\-lO..I. U:J

Total Depth

}0 ft.

i

I I I• I

I I

Cement Grout: ..._70 ft. (min. 70% of distance from ground elevation to top of water surface or 500 ft., whichever is less.)


s3 in.


:-:-----:--:-- ft. Material: 0 Crushed Basalt 0 Rounded Gravel


..3( ft. msl*

•

J_ _________________ ----


' ///»"

-

;jffi"'\



Solid Casing: (~ 90% x (Ground Elev.-Water Level Elev)}

Length: fD( ~/it.

Nominal Diameter: £, in.

Wall Thickness: ,t.?S<ff in.

Bottom Elevation: ft., msl ,

Open Casing: Perforated 0 Screen

Length: -c;- ft.

Nominal Diameter: .I; in.

Wall Thickness: , i g ';?' in.


Open Hole:

Length: __ ____!fti:.....:....!:.:.JBL... _______ ft.

Diameter: _____________ in.


Solid Casing Material: Carbon Steel: compliant with (check one or more):OANSI/AWWA C200 OAPI Spec. 5L OASTM A53 J!\ASTM A139

And compliant with (check one or more): 0 ASTM A242 0 Type E 0 1 ype S XGrade B 0 Other



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


Open Casing Material: "

0 Filament Wound Resin Pipe conforming to ASTM D2996



0 Glass Fiber Reinforced Resin Pressure Pipe conforming to AWWA C950

0 PTFE Fluorocarbon Tubing conforming to ASTM D3296


Carbon Steel: compliant with (check one or morelJ< ANSI/AWWA C200 0 API Spec. 5L OASTM A53. OASTMA139

And compliant with (check one or more): 0 ASTM A242 0 Type E 0 1 ype S 0 Grade B 0 Other

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


PVC Plastic conforming to ASTM F480 and (ASTM 01785 or ASTM D2241): (check one): 0 Schedule 40 0 Schedule 80 0 Schedule 120


•

0 Filament Wound Resin Pipe conforming to ASTM D299E



0 Glass Fiber Reinforced Resin Pressure Prpe conforming to AWWA C950

0 PTFE Fluorocarbon Tubing conforming to ASTM 0329E

0 FEP Fluorocarbon Tubing conformrng to ASTM-D329E •• #>

.,

K

/7 CJC.~ eo

R Y141-4.... I MA 1!4

0

f2 Y p. T-Al fLE~.St: (IJ.f:.Les•d.

fA.P,/{ t:;t>.N.fl•t:"l~H {<~flo~, .. PA~t l 11 .... .!. $«-f<-11, 1 --"'-"v iiJ. .-;;,... t< E' e .. R ...-;.

flt!>f'£ 'J"Jkr t> At~ y .. ~ Mr~rd--.-Jr Jk' b fJ( ... ~~GG C:: ~~/ M#' ' / lh S S fl<> ,._t., d- f'11·11 s N -r II,£. ~ .. of..,_... ,

{J/;4:t.lll- yoU/ :J7,4 t;£<.te p, A~ y H t::t2- .i ~l< c;s 7o

/GEA.II.l..t... II J 7'-'" ( f;J~ 7~.J-7~3 {H)

73s .. 7Jl? CL.V/

• nn C,.....,.. 18 "'"' vi p 1 1 3 I ,,

r· .......... ~·

l: -·

... '·'

\.

r---------1 / For Official Use Only:

~s fH 0.. Q tate o awan ...

COMMISSION ON WATER RESOURCE MANAGEMENT n"""-.-..a.-- -- .. tnd and Natural Resources . r~,~l\'' ... f'i

I '

:TION REPORT- PART I

lnstru~tl~n /\ .fi 1 ( 1 r~ fA: G CommiSSIOI (:;,.-,.,IG "-0 \.

----------------------~~ ~118 P\ · I completed report (with attachments, if applicable) to ttW \oi v •

not accept - ~ assistance, .---- <::::::----Branch at

'. Box 621, Honolulu, Hawaii 96809. The Commission. may submitted within 60 days of the completion of work. For :tion and Pump Installation Standards or call the RegulatiOil[""''i .. ''lt"1' '·' \ \',' \ . or additional information, please visit our website a.~:~·,: , _;: .

http://www.s I\ c .. : .: . \ .... ·

1. State Well No.: 3687-03 Well Name: Keeau Well ~~~~~------------------

Island: Hawaii

2. Address: 15-1790 Awa (3rd St.), Hawaiian Paradise Park Tax Map Key: 1-5-56: 99

3. Drilling Company: 7vn1Uetl f2RilCd)j J- Pu/YI.p 4. If drilled, type of Rig: ~ Rotary D Percussion

i I l

5. Date Well Construction (drilled,cased,grouted) completed: /rf:/6o Attach Driller's Log (7126199 DL Form) . '-_ mont day/year

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

6. Initial water.:level encountered 56 ft. below ground Date and time of measurement: I'Y's/~o If>~ monthfdaityear time

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

8. Constant Rate Aquifer Test completed? jf No D Yes Attach Constant Rate Aquifer Test form (12117197 CRPTD Form)


9. Water-level: S b ft. above msl Date and time of measurement:

10. Chloride: --~J,._·.:~s::.._· ·o=---- ppm Date and time of sampling:

11. Temperature: ____ _,_Z.Jol2"""---- oF Date and time of measurement:


13. Attach plot plan and Sl:Jrveyor's stamped elevation report.

14. If a pump is not planried to be instF~Iled, please describe (below in the remarks section) how well is secured to prevent unauthorized access (example: lockable cover, threaded coupling, etc.)

15. Remarks: I' 14 ~--~-------------------------------------------------------------------

LicensOd Driller (pri~/(aJetf! S1gnature ·· ~

/ Surveyor (print) Nie/5. c h n' ~ le ~.s-~

C-57 Lie. No. :;I cJS9?

.Date IS ocr oo

L.P.L.S. Lie. No. _ _.tf~....-0_7_7 _____ _ pl~ase attach stam~ /) 1 __j_

Signature ~ Date Oc -/, I S'1 Zoao ;

Permittee (print)

Signature Date __ t _s __ a_f.._-_\ __ d_6_e>_o __

WCR1 Form 512100

13. AS-BUll T ..J:i.L SECTION (Please atta~h as-built .if different g diagram provided below) ,-'

Elevation at top of casing~ ft., msl* (to nearest 0.01 ft.)

Bench mark elevation:

5h • S' ft., msl* (Survey to nearest 0.01 ft.)

Cement Grout: 50 ft. (min. 70% of distance from ground elevation to top of water surface or 500 ft., whichever is less.)


,'3 in.

6 in.

Minimum of 2' Radius & 4" Thick Concrete Pad

20 ft., msl \ (:,.. .. -:=""~\ 1> .'



.,__-l Solid Casing: (~ 90% x (Ground Elev.-Water Level Elev))

Length: /0 ft.

Nominal Diameter: in.

Wall Thickness: , [.f{?l in.


Total Depth

20 ft.


,...,.....,,........,....,....--ft. Material: 0 Crushed Basalt 0 Rounded Gravel

><

Open Casing:

Length:

Nominal Diameter:

Wall Thickness:

OScreen

ft.

.b in. , jg_)( in.


st:. ft. msl* Bottom Elevation: ft., msl

• • Open Hole:

• Length: __ __....:IV~:.JBE,-.. _______ ft . Diameter: _____________ in.



Solid Casing Material: Carbon Steel: compliant with (check one or more):O ANSI/AWWA C200 0 API Spec. 5L 0 ASTM A53 )\ASTM A 139

And compliant with (check one or more): 0 ASTM A242 0 Type E 0 Type S )I;,Grade B 0 Other Stainless Steel: (check one): 0 ASTM A409 (production wells) 0 ASTM A312 (monitor wells) ABS Plastic conforming to ASTM F480 and ASTM D1527: (check one) 0 Schedule 40 0 Schedule 80 PVC Plastic conforming to ASTM F480 and (ASTM D1785 or ASTM D2241): (check one): 0 Schedule 40 0 Schedule 80 0 Schedule 120 Thermoset Plastic: (check one)

Open Casing Material: "


0 Centrifugally Cast Resin Pipe conforming to ASTM D2997 0 Reinforced Plastic Mortar Pressure Pipe conforming to ASTM D3517

0 Glass Fiber Reinforced Resin Pressure Pipe conforming to AWWA C950 0 PTFE Fluorocarbon Tubing conforming to ASTM D3296


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

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



PVC Plastic conforming to ASTM F480 and (ASTM D1785 or ASTM D2241 ): (check one): 0 Schedule 40 0 Schedule 80 0 Schedule 120 Thermoset Plastic: (check one)

•




0 Glass Fiber Reinforced Resin Pressure Pipe conforming to AWWA C950 0 PTFE Fluorocarbon Tubing conforming to ASTM 03,296 •

0 FEP Fluorocarbon Tubing conforming to A~M 03?96 . . " ·. ...

.r

- t' • .... Q . ' The Independent H ·~s awa11 urveyors

1044 Oli Oli Way, Hilo, Hawaii 96720 Phone/FAX 808 959-0360 Email [email protected]

Niels Christensen, Surveyor -REPORT-

To: State of Hawaii Commission of Water Resource Management Department of Land and Natural Resources P.O. Box 621 Honolulu, Hawaii 96809

TMK: (3) 1-5-56: 99 /

Description of Services: Determine Elevation at Well Site.

Findings of survey:

October 17, 2000 Job No. 2099

Elevations were run from a temporary bench mark at the comer of Paradise Blvd. and 21st Street in Hawaiian Paradise Park in Puna on the island of Hawaii to the well site. The elevation of the ground at the well site was found to be 56.54 feet above mean sea level.

/JU,~ Niels Christensen, L.P.L.S. 9077

rf

~21. Homefinders of Hawaii 586 Kanoelehua Avenue Hilo, Hawaii 96720 Business (808) 935-7119 Fax (808) 935-5830 E-Mail cent21 @turquoise.net

f<YJJ11, Pl.t:A.s-6 r'{J.~ IH-~L&s'lc:l -/, wfll t:.::>usi"'ee.c..c:~•o*' p,9.H-,'r.tD 3~'/"J·t:>'J

-2. PL" T PLAN ... Lt:JC#4 i7o"',s o;; C Essf'~oL J. W' II .

/".,A/A" I( Y~ G4.,..

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Each Office Is Independently Owned And Operated

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0 D SEP 13 P 2 : 0 2

cc l 11~;:~:';' . ;ij \V.';ji~~ Rt:2

QwELL CONSTRUCTION PERMI"TQ Keeau Well, Well No. 3687-03

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 Keeau Well (Well No. 3687-03) at 15-1790 Awa (3rd) St., Hawaii, TMK 1-5-56: 99, subject to the Hawaii Well Construction & Pump Installation Standards (1/23/97) which include but are not limited to the following conditions:

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

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

The well construction permit shall be for construction and testing of the well only. A minimum 1114-inch diameter monitor tube shall be permanently installed1 in a manner acceptable to the Chairperson, to accurately record water levels. The permittee, well operator, and/or well owner shall coordinate with the Chairperson and conduct a pumping test in accordance with the Standards (a pump testing worksheet is attached). The permittee, well operator, and/or well owner shall submit to the Chairperson the test results as a basis for supporting an application to install a permanent pump and withdraw water for use. No permanent pump may be installed until a pump installation permit is approved and issued by the Chairperson.

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

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

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

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

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

The permi~ee, weiJ operator, and/or well owner shall comply with all applicable laws, rules, and ordinances; non-compliance may be grounds for revocation of th1s permit.

The well construction ~rmit application is incorporated into this permit by reference and is subject to the Hawaii Well Construction & Pump Installation Standards (January 23, 1997; HWCPIS). If the HWCPlS are not followed and as a consequence water is wasted or contaminated, a lien on the property may result.

The permit may be revoked by the Commission if work is not started within six (6) months after the date of approval or if work is suspended or abandoned for six (6) months, unless otherwise specified. The work proposed in the well construction perm1t application shall be completed within two (2) years from the date of permit approval, unless otherwise specified. The permit may be extended by the Chairperson upon a showing of good cause and good-faith performance. A request to extend the permit shall be submitted to the Chairperson no later than three (3) months prior to the date the permit expires. If the commencement date is not met, the Commission may revoke the permit after giving the permittee, well operator, and/or well owner notice of the proposed action and an opportunity to be heard.

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

The permittee, its successors, and assigns shall indemnify, defend, and hold the State of Hawaii harmless from and against any loss, liability, claim, or demand for property damage, personal Injury, or death arising out of any act or omission of the applicant, assigns, officers, employees, contractors, and agents under this perm1t or relating to or connected Wllh the granting of this permit.

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

Date of Approval: August 4, 2000 August4,2002

TIMOTHY E. JOHNS, Chairperson Commission on Water Resource Man Expiration Date:

1 have read the conditions and terms of this permit and understand them. I accept and agree to meet these conditions as a prerequisite and underlying condition of my ability to proceed and understand that I shall not commence work until I and the driller have signed, dated, and returned the permit to the Commission. I also understand that non-compliance with any permit condition may be grounds for revocation and fines of up to $1000 per day sta~ from 'the permit date of approval.

Permittee's Signature: ~j • e ~ Date: ~ <:1

PrintedName: ~KII~ P._~ FirmorTitle: ~RoPIR';-ty::c~6f\ _./)' v . . CIJ ''J

Driller'sSignature: ~~ .~~~ ...- C-57License#:)/2592 ~t?:9-~:1 Printed Name: v//7:;.11tPI( AtV~E'I( Firm orTitle:c::lru~tC G f N~/t~tt.(,tJ' Please sign both copies of this pennit, return one to the Chairperson, and retain the other for your records. _ _· ~ ;

Attachment c: USGS

Department of Health/ Safe Drinking Water, Wastewater, and Clean Water Branches Hawaii Department of Water Supply

-, :~: ~ - -·

"

.i· :

Show• Location cf' all building:~, ut1'll.ty lines extornal ~o the bu!ldln9s, property lines, and other leg~l boundaries, individual Wl\St.cwotcr system/systems, s~:rfacc Wlltcrs, and ;roadways.

OW!lBI\ 1 S CEilTIFI C'-'l'I.ON S'l'J\'l'&J:U;;t·J·:

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cover ~pee lflic~~l.ons

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!'Jan hole: /6..~o~ 16 1' Rcbars:

s i :a __ # ... L,...,_,. __ j sr.>acLn'il~--

l certify that l am the owner, duly authcri~cd aGent ot the ~ndl.vidu~l waete,.ator system dcscr:ibcd on the at::c.chod plot plan and <lrawing(s) tmc l:hat s's.id incHvicl.ual Wl.stc~latcr ~ystc:n as lns~c;llcd cornpl!.cs With 'l'l.tlc 11, Ch11ptor Gl,llawal.l • · ;!lcitain.istrative Rules, which I have road and. und.c.SJ)pH!~ ,/ I .

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...... -.. -1-lotaJ:y Public si~;~na::urc :::equired. .i.f _,.····~~ ,., . ••• : ·· .. potsotls other than owner si9ns •• •' ·· · ~---: · :: "Owner's Cctt.ification St01.tcmcmt" ,.:; •• -·· ····.:·;:. ,., .. .,,,.,, ••• ,j~~~-~£· ~::~--: -ni- ---.. ~~ ~~~~~f . • . . . -~~ \ . '~-~-~.: ··:.· ~·~ . ~) No tory Puul ic, Ju, r:l!ll ~ ··· ••• •• • .·-Circuit·, !;t:~to o 1!.1\~all. ':"-:;. ::'..::-._ •. -··:.· , _ .. ,.~ ... --;.- .-. ·::--- ;: .. : ,. :.·-1·1)' Connissic.n Expires: Jtt-1.0 ,.q) ·--.... :: .. _ ... :: ... ···

-; ·-

~MISSION ON WATER RESOURCE MANAGEME~ FROM:..:..R.:...:Y..:...;A::..:N~-----

BAUER, G. CHING, F. FUJII, N.

-1-HARDY, R. .&__ HIGA,D. ~ HIRANO, E. ICE, C.

-5-IMATA, R. JINNAI, R. KUNIMURA, 1.-

S /II' /Hi DATE:._~fB..:....._/_'-\.!......!./_{l_O ___ SUSPENSE DATE:

M,A. AKAMA, L. AKANO,D. --

SHIOKA,L.-HYE,M. <

--SAKODA, E. -2-SUBIA, S. --SWANSON, S.

UYENO, D. YODA, K.

3 Approval -3-Signature -4-lnformation

PLEASE:

See Me -1-Review & Comment

Take Action Type Draft

-2-Type Final -5-File

Xerox copies

WELL NUMBER "3> (p 01 -0 ~ WELL NAME I~ W.eA I --~----~~--------------

~ WELL CONSTRUCTION

ATTACHMENTS FOR WELL CONSTRUCTION PERMIT: 1 COVER LETTER 2 PERMIT (2x) 3 PUMP TEST 4 DOH COMMENTS 5 LAND DIV. COMMENTS

0 PUMP INSTALLATION


FOR OFFICE USE ONLY

ATTACHMENTS FOR PUMP INSTALLATION PERMIT: 1 COVER LETTER 2 PERMIT (2x) 3 DOH COMMENTS TO BE SENT TO APPLICANT 4 LAND DIV. COMMENTS 5 WCRFORM 6 WURFORM

} FOR OFFICE USE ONLY


0 0 TIMOTHY E. JOHNS

CHAIRPERSON



LINNEL T. NISHIOKA




AUG 1 4 2000

DEPUTY DIRECTOR

3687-03.wcp


Dear Mr. May:

Well Construction Permit Keeau Well (Well No. 3687 -03)

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

Special Conditions

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

2. The water level in your area appears to be much less than what was stated on the application. Please confirm this amount and ensure that your well is constructed in accordance with the Hawaii Well Construction and Pump Installation Standards (HWCPIS).

3. The annular space shall be in compliance with section 2.6d of the HWCPIS.

This permit does not authorize work for your permanent pump installation. Approval and issuance of your pump installation permit is contingent upon completed application and information provided to and accepted by Commission staff as required in the Well Construction & Pump Installation Standards (1/23/97) and any special conditions performed under this permit. However, a permanent pump may be installed prior to the permanent pump installation permit issuance in accordance with the Commission's April 15, 1998 Declaratory Ruling No. DEC-ADM98-G5, which states that:

"Permanenrpumplnstallatioifforcapacltiesoetween -a-70-gpfiHJrid wllere th£fpr6p6seaTise1s for private individual needs in non-ground-water management areas may be allowed prior to the final pump installation permit issuance. When required as a condition of the well construction permit, subsequent pumping tests shall validate the acceptability of the permanent pump. The permanent pump installed prior to final pump installation permit issuance is subject to removal if the testing shows that a smaller pump is required to reduce the potential of affecting neighboring wells and localized upconing at the applicant's well. "

Mr. Jackie May Page2

AUG 14 2000

0 0

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

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

IMPORTANT- Drilling work shall not commence until a fully signed permit is returned to the Commission. Please provide all the information in this packet to your well drilling contractor. The permittee, well operator, and/or well owner are responsible for all conditions of the permit. This includes ensuring that the well construction contractor, or other party who constructs the well(s), submits a completed Part I of the Well Completion Report form (enclosed) within sixty (60) days after the well construction work is completed. Be advised that you may be subject to fines of up to $1000 per day for any violations of your permit conditions starting from the permit approval date.

If you have any questions, please call Ryan lmata of the Commission staff at 587-0255 or toll-free at 974-4000, extension 70255.

Aloha,

~~ TIMOTHY E: JOHNS t Chairperson '

Enclosures

~ELL CONSTRUCTION PERMITO

Keeau Well, Well No. 3687-03

In accordance with Department of Land and Natural Resources, Commission on Water Resource Managemenfs Administrative Rules, Section 13-168, entitled ''Water Use, Wells, and Stream Diversion Works", this document permits the construction and testing of Keeau Well (Well No. 3687-03) at 15-1790 Awa (3rd) St., Hawaii, TMK 1-5-56: 99, subject to the Hawaii Well Construction & Pump Installation Standards (1/23/97) which include but are not limited to the following conditions:

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

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

The well construction permit shall be for construction and testing of the well only. A minimum 1114-inch diameter monitor tube shall be permanentlr installed, in a manner acceptable to the Chairperson, to accurately record water levels. The permittee, well operator, and/or well owner shal coordinate with the Chairperson and conduct a pumping test in accordance with the Standards (a pump testing worksheet is attached). The permittee, well operator, and/or well owner shall submit to the Chairperson the test results as a basis for supporting an application to install a permanent pump and withdraw water for use. No permanent pump may be installed until a pump installation permit is approved and issued by the Chairperson.

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

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

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

The proposed well construction shall not adversely affect existing or future legal uses of water in the area, induding 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 following shall be submitted to the Chairperson within sixty (60) days after completion of work: a. Well completion report, (attached -Part I, Well Construction Report). b. Elevation (referenced to mean sea level, msl) survey by a Hawaii-ficensed surveyor. c. As-built sectional drawin~ of the well.

Jte· Plot plan and map shoWing the exact location of the well. ~ Complete pumping test records, induding time, pumping rate, drawdown, chloride content, and other data.

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

The well construction ~rmit application is incorporated into this permit by reference and is subject to the Hawaii Well Construction & Pump Installation Standards (January 23, 1997; HWCPIS). If the HWCPlS are not followed and as a consequence water is wasted or contaminated, a lien on the property may result.

The permit may be revoked by the Commission if work is not started within six (6) months after the date of approval or if work is suspended or abandoned for six (6) months, unless otherwise specified. The work proposed in the well construction perm1t application shall be completed within two (2) years from the date of permit approval, unless otherwise specified. The permit may be extended by the Chairperson upon a showing of gOOd cause and good-faith performance. A request to extend the permit shall be submitted to the Chairperson no later than three (3) months prior to the date the permit expires. If the commencement date is not met, the Commission may revoke the permit after giving the permittee, well operator, and/or well owner notice of the proposed action and an opportunity to be heard.

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

The permittee, its successors, and assigns shall indemnify, defend, and hold the State of Hawaii harmless from and against any loss, liability, daim, or demand for property damage, personal injury, or aeath arising out of any act or omission of the applicant, assigns, officers, employees, contractors, and agents under this perm1t or relating to or connected Wllh the granting of this permit.

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

Date of Approval: August4,2000 August 4, 2002

TIMOTHY E. JOHNS, Chairperson Commission on Water Resource Man Expiration Date:

1 have read the conditions and terms of this permit and understand them. I accept and agree to meet these conditions as a prerequisite and underlying condition of my ability to proceed and understand that I shall not commence work until I and the driller have signed, dated, and returned the permit to the Commission. I also understand that non-<:ompliance with any permit condition may be grounds for revocation and fines of up to $1000 per day starting from the permit date of approval.

Permittee's Signature: _____________ _ Date: ______ _

Printed Name: Firm or Title: _______________ _

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

Printed Name: -------------- Firm or Title:----------------

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

Attachment c: USGS

Department of Health/ Safe Drinking Water, Wastewater, and Clean Water Branches Hawaii Department of Water Supply

+ 0 0 AlL· v :

'.{ ~ JUN 14 2000 \

BENJAMIN J. CAYETANO TIMOTHY E JOHNS t-v..._ CHAIRPERSON 4 -GOVERNOR OF HAWAII



STATE OF HAWAII LINNEL T. NISHIOKA

DEPUTY DIRECTOR

DEPARTMENT OF LAND AND NATURAL RESOURCES COMMISSION ON WATER. RESOURCE MANAGEMENT

P.O. BOX621 HONOLULU, HAWAII 96809

JUN -8 2000 ~I .----~~

c:) ~ C:) .'·-· ..

~ ?J TO: Honorable Bruce S. Anderson, Director Department of Health ... ,;)

C~~ C) ,fl

Attention: Dennis Tulang, Wastewater Branch William Wong, Safe Drinking Water Branch

;•';! •'") ~· .. -, N ., -· - l

' -l

,.. _;_,., :J:o - 1 -FROM: fn Timothy E. Johns, Chairperson .-g

Commission on Water ResourcJ fvlanagement ~~ ;_·:; ::ll" -y

r·71 4

SUBJECT: Well Construction Permit Application Keeau Well (Well No. 3687-03)

·--·--·-i '.' c:::t

-.1

Transmitted for your review and comment is a copy of the captioned well application.

We would appreciate your comments on the captioned application for any conflicts or inconsistencies with the programs, plans, and objectives specific to your department. Please respond by returning this cover memo form by June 23. 2000.

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 lmata of the Commission staff at 587-0255.

Rl:ss Attachment(s)

RESPONSE:

I I

I I

I I

I I

)(

X I I

This well qualifies as a source which will serve as a source of potable water to a public water system (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 1ts use to comply with Hawaii Administrative Rules (HAR), Title 11, Chapter 20, Rules Relating to Potable Water Systems, §11-20-29.

This well does not qualify as a· source serving a public water system (serves less than 25 people or more people at least 60 days rr year or 15 service connections) and if the well water is used for drinking, the private owner should test for bacteriological and chem1ca presence before initiating such use and routinely monitor the water guahtv thereafter. However, if future planned use from this source 1ncreases to meet the public water system definition then Director of Health approval is required m:!2!: 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 11ap or an approved backflow preventer, and by clearly labeling all non-potable spigots with warning signs to prevent inadvertent consumption of non-potable water. Backflow prevention devices should be routinely inspected and tested.

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 []Is [] Is not located near the proposed well site (information attached). [/ J ma. bG-Other relevant DOH rulesl;egulations, information, or recommendations are attached. (!l~S fXXJI.- {2.l. UJ vz;{ ~ . No comments/objections

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Showt Location of all buildings, ut.l.ll.ty lines external to the 'buildinqs, property li.nes, ana other legc.l boundaries, individual wa.stcwatt:r system/systems, s~:rfacc 'Jatcrs, and roadways.

OWNER'S CE:IlTIFIC).'rl.ON S'rl\'l'EI..'U'i!:l.:;.:

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I certify that l am the owner, dul~ authoriaed aGent ot the :ndlvidu~l wastew ... tor sys:t:em described on the at~ached plot plan antl clrawing(s) anc that s'e.io . individual wastewater systc:r. !\s instcllcd compLies wi tl1 'l'itla ll, ch~tptor G2,llnwa11 ' Jldnlini.strative Rules, which I have t:oad and.und~o~ -~~~!~ / . l I ~,__L !J-4-~f"-l . . DBPAR'l'MEN'r OF HE~LTH S :Il.Oll s qna turo da ~a

llC'f,l\ll.Y PUDtolC

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'i/ -.-~IJ; 'II- / lL1D

0 0 BENJAMIN J. CAYETANO

GOVERNOR OF HAWAII TIMOTHY E. JOHNS

CHAIRPERSON


COMMISSION ON WATER. RESOURCE MANAGEMENT

BRUCE S. ANDERSON .. --~- -- R(fBEFfTG.GTRALD --- -- ..

BRIAN C. NISHIDA DAVID A. NOBRIGA


LINNEL T. NISHIOKA DEPUTY OtRECTOR

RECEIVED P.O. BOX621 HONOLULU, HAWAII 96809

JUN -8 2000 SAFE DRINKING WATER BRANCH

JUN I t 2.000 TO: Honorable Bruce S. Anderson, Director

Department of Health Attention: Dennis Tulang, Wastewater Branch

William Wong, Safe Drinking Water Branch

FROM: fn Timothy E. Johns, Chairperson~ Commission on Water Resourcd Management



We would appreciate your comments on the captioned application for any conflicts or inconsistencies with the programs, plans, and objectives specific to your department. Please respond by returning this cover memo form by June 23, 2000.


Rl:ss Attachment( s)

RESPONSE: [ 1 This well qualifies as a source which will serve as a source of potable water to a public water system (serving 25 or more people at least 60

ays per year or has 15 or more service connections) and must receive Director of Health approval ~rlor to 1ts use to comply with Hawaii Administrative Rules (HAR), Title 11, Chapter 20, Rules Relating to Potable Water Systems, §11-20- 9.

[I

[I

[I

[I

[I

This well does not qualify as a source serving a public water system (serves less than 25 people or more people at least 60 days per year or 15 service connections) and if the well water Is used for drinking, the private owner should test for bacteriological and chem1cal presence before initiating such use and routinely monitor the water quality thereafter. However, if future planned use from this source 1ncreases 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 syslems by an air 11ap or an approved backflow preventer, and by clearly labeling all non-potable spigots with warning signs to prevent inadvertent consumption of non-potable water. Backflow prevention devices should be routinely inspected and tested.


For the applicant's information, a source of possible wastewater contamination []Is [] Is not located near the proposed well site (inf0m1at10n attached). c::fJ

Other relevant DOH rules/regulations, infom1ation, or recommendations are attached.

No comments/objections

:::0~ d rn C'5 ~ :~'~ ~ -:» -- . --:.>'! ',.·rr. ... 0t;.~ ~ (') C/'Y - C)

Phone: __ 51_1

....;.,~;:._~4:~_¢___,n ___ ~_-""""'J:--. Date: ___ 6~*~·;«:~,~~;-.L.Jt--=t?'t!f':.....-:,"0.--' _-~,'e~.J-

~~-~ .. a

ContactPerson: 1"11~~4/o Signed: 7iZ \)

/ :.:;:~, rn ,.,-· ~-:·;:a -1

-

BENJAMIN J. CAYETANO GOVERNOR Of HAWAII

TO:

0 0




JUN -8 2000

Dean Y. Uchida, Administrator Land Division

FROM: /n Linnel T. Nishioka, Deputy Director1 Commission on Water Resource Management

SUBJECT: Well Construction/Pump Installation Permit Application Keeau Well (Well No. 3687-03)

TIMOTHY E. JOHNS CHAIRPERSON


DAVID A NOBRIGA HERBERT M. RICHARDS, JR.


-.. c

Transmitted for your review and comment is a copy of the captioned well application which includes a request for a pump installation permit.

We would appreciate your comments on the captioned with regard to the programs, plans, and objectives specific to your division. Specifically, Item 9 on the application has been added per your request concerning water lease/permits administered by your division. Please respond by returning this cover memo form by June 23, 2000.



RESPONSE:

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

&d: 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

ki Other comments: Tis property wa13 registered with the Land court of ·the Territory of Hawaii as Land Court Application No. 1053 in April, 1959.

Contact Person: Gary Martin Phone: 587-0421 ---~~-----------------

Signed: __ ___,,,c.~~---:rl--~__:__..=:::~_.,-==-.---------'Date: _...J6:;>.,/~9'-!-/~0LUO-------

Search Results 0 0 Page 1 of 1

Copyright 8/4/2000 by Hawaii Information Service

Assessed Values reflect the year 2000 .

• • PUBLIC RECORD DATA

TMK # 3-1-5-56-99 --- 15-1790 3RD AVE Owner: MA Y,JACKIE D lET AL

Tax Payer: MA Y,JACKIE D/LORRAINE Tax Bill: HCR 9570 , KEAAU, HI 96749 USA

Assessed Value Land: $12,000

Total Building: $235,200

Exemption $0

$80,000

10/2711989 DEED

Size 1.00 ac

2844 sq ft

SALES

MAY JACKIE D/LORRAINE 5/24/1991 TRANSD

MAY JACKIE DILORRAINE

Tenure: Fee Simple Semi-Annual Tax: $372.02

Buildings: 1 Dwellings: 1 PITT Code: 900 Zoning: A-lA Land Use: 0 Nbhood Code: 1557

$17,000 LCD 1678720

$0 LCD 1822543

http://webresearch.hawaiiinformation.com/REsearch/Asp/Functions/Property/SearchTMK.asp?A 8/4/00

Well No.

Well Name Applicant

0

0 0 0

SECTION 1: WELL LOCATION INFORMATION

data

Date of Review

Reviewer 8/4/00 RRI

Island #N/A Proposed Use #VALUE! ##### 0 Aquifer System

Aquifer Sector ##### Proposed Withdrawal

System Sustainable Yield #VALUE!

SECTION 2: WELL SECTION DATA (enter data in grey cells only)

Elevation at top of casing ft., m.s.l. Solid Casing Ground Elevation ft., m.s.l. Material Cement Grout ft. Designation Rock Packing ft. Length Hole Diameter in. Diameter

Total Depth ft. Wall Thickness Casing

Estimated Head -ft.,m.s.l. Material Calculated Aquifer Thickness 2665 ft. Designation

Length

County Water Supply (Y/N ?) - Diameter

Wall Thickness

Openings Open Hole

Length ft. Diameter in.

SECTION 3: CHECKLIST (values to check are shaded)

Well Depth

Theoretical Thickness of Aquifer

1/4 Aquifer Thickness

Depth of Well below Sea Level Well Casing

Minimum Wall Thickness

Material County or Non-County

Minimum Thickness per standards Wall Thickness Provided

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

Length of solid casing Provided Casing Material

Annular Space Depth of Grouting

Calculated Depth of Grouting

Depth of Grouting prov[fJed Thickness of Annular Space

Steel

2665 ft.

666.3 ft.

·15ft.

non-county #N/A in. 0.250 in.

9ft.

okay (refer to HWCP/S Section 2.2)

#NJA (refer to HWCPIS Section 2.4 c)

-----,..,-70 ft. okay (refer to HWCPIS Section 2.4 d)

----.:-:="::" ASTMA139 okay (refer to HWCPIS Section 2.4 e) -----

7ft. ------..5-1 ft.

0 in. -----

"the cell above reads #N/A, reference HWCPIS)

.okay too small:

Page 1

(refer to HWCPIS Section 2. 6 c)

(refer to HWCPIS Section 2. 6 d)

E 7/8/00 OOC\.f'IENT N:>. ~C OR ATTACt£0 \t.ORKSt£ET OAT . . . SRC/ COST

F YR N>P D OBJ CTR PRruECl PH ACT ~ NAME/DESCRIPTION. (W~ INPUT)

G 00 000. G. ~ P-"z5.2 (1) 25.00 __ 2acki~~~---------------- -- ---(2)' - -- --- - ---- ---- ----- -- --- --------------------

- -- --- - --- ---- ----- -- --- (3) --------------------- -- --- - ---- ------ -- --- (If) ---- --------------------

TOTAL 25.00

REJ-4ARKS: LINE (1) Well No. 3687-03 (WCPA/PIPA)

LINE (2) LINE (3)

LINE (4)


Mr. Jackie D. May HCR 2 Box 9570 Keaau, HI 96749

Dear Mr. May:

0 Q




JUN -8 2000

TIMOTHY E. JOHNS CIWRPERSON



LINNEL T. NISHIOKA DePUTY DIRECTOR

.Well Construction I Pump Installation Permit Application for Well No. 3687-03

We acknowledge receipt, on June 6, 2000, of your completed well construction I pump installation permit application for the Keeau Well (Well No. 3687-03). You can expect your application to be processed within ninety (90) days from this date.

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

If you have any questions about your permit application, please contact Ryan lmata of the Commission staff at 587-0255 or toll-free at 974-4000, extension 70255.

LN:ss

Sincerely,

W.Af-7 } LINNEL T. NISHIOKA

Deputy Director

0 0 BENJAMIN J. CAYETANO

GOVERNOR OF HAWAII TIMOTHY E. JOHNS

CHAIRPERSON


COMMISSION ON WATER. RESOURCE MANAGEMENT P.O. BOX621


JUN -8 2000




TO: Honorable Bruce S. Anderson, Director Department of Health Attention: Dennis Tulang, Wastewater Branch

William Wong, Safe Drinking Water Branch

FROM: --j-n Timothy E. Johns, Chairperson rg Commission on Water Resourcd Management



We would appreciate your comments on the captioned application for any conflicts or inconsistencies with the programs, plans, and objectives specific to your department. Please respond by returning this cover memo form by June 23. 2000.



RESPONSE:

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I I

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 (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 orlor to its use to comply with Hawaii Administrative Rules (HAR), Title 11, Chapter 20, Rules Relating to Potable Water Systems, §11-20-29.

This well does not qualify as a source serving a public water system (serves less than 25 people or more people at least 60 days rr year or 15 service connections) and if the well water is used for drinking, the private owner should test for bacteriological and chemiC& presence before initiating such use and routinely monitor the water qualitY thereafter. However, if future planned use from this source 1ncreases to meet the public water system defimtion then Director of Health approval is required m:12r 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 11ap or an approved backflow preventer, and by clearly labeling all non-potable spigots with warning signs to prevent inadvertent consumption of non-potable water. Backflow prevention devices should be routinely inspected and tested.


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

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

No comments/objections

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

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

BENJAMIN J. CAYETANO GOVERNOR Of HAWAII

0 0




JUN -8 2000

TO: Dean Y. Uchida, Administrator Land Division

FROM: jn Linnel T. Nishioka, Deputy Director~ Commission on Water Resource Management

SUBJECT: Well Construction/Pump Installation Permit Application Keeau Well (Well No. 3687-03)

TIMOTHY E. JOHNS CHAIRPERSON




Transmitted for your review and comment is a copy of the captioned well application which includes a request for a pump installation permit.

We would appreciate your comments on the captioned with regard to the programs, plans, and objectives specific to your division. Specifically, Item 9 on the application has been added per your request concerning water lease/permits administered by your division. Please respond by returning this cover memo form by June 23. 2000.



RESPONSE:

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

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

[ ) A water lease/permit has been obtained by the applicant through lease no. ----------

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

[ ) No objections

[ ) Other comments:

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

Signed: Date: --------------------~ -------------

00 MAY 2~ All : I 7

w;le-w I j"'VlAfLilcl.._F<Re>ii/Yw;IS jr'IWH<:;I RESC: JC[ ~ , , , '.{i-'IEil f

fpc;.e C?F fJfP}_t'ctJ.71<3·,._c -cJ.C/!J?c(c

[c(!)P'I c F !1-ffLtcv£11;,~ tuc.Lobscl)

Cf~~s li()'Ns ~ ·p;_ tf H~c el4ll1

I'L1 e Jii c J~ ~~ V~ ~ 14 '

7 3 7- u~ 7 5 c E t

9 .3~- 7117 ~F~

7/1 A-ate:.;?

4 Cc;P;;e ~r- ;3J4r:lc fDR _ Ll ~r,

;-rafe T)l,~ 1 ~ eo~~~a:t.e ~

State of £aii 0 For Official Use Only:

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

Qr.:"f''<'\,lr;:"f) '\ '-.. I "

M Well Construction or ~ Pump Installation

lnstrucUons: Please print in ink or type and send completed application with attachments to the Convnission on Water Resource Management, P.O. Box 621, Honolulu, Hawaii Q6809. Application must be accompanied by 3 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.

08MAY 24 A\\. 18

r further infonnation and updates to this application fonn, visit http://www.state.hi.us/dlnr/cwrm.

8'dt" Phone: 9 R.:» - i I~~

...x.;:::,_:,o"c-.,.-.L.-=-=---""'--"-'1<..:~--- E-mail: -------::----.,..----

-.~-.c..ar.=.c.___u.LD,.Ll~-- Phone: 98:J 8d,5:,~~~

2. WELL LOCATION/NAM

Address /.S -/ 7 7o

... Island: OIAwAI /

f•-.~ax Map Key: '3 .... /-..S-5(- .. c;1 " Attach the relevant portion of (a) a Minute Series USGS topographic map (scale 1 :24,000), and (b) a property tax map, showing well location

referenced to established property bo ndaries.

3. PROPOSEDWORK: n(D Neww~~--(Check all that apply) 0 Mod Exi ing Well 0 edri

0 Aban n/Seal

Install New Pump

0 Modify Pump

0 Replace Pump

-+----- Be sure to comple and submit well abandonment report upon completion of wor1<.

4. CONSTRUCTION: 0 Dug Bored

5. PROPOSED PUMP INFORMATION:

Pump Type (Chock one):

0 Deep WeD Turbine

:m._ Subme!Wie

0 Centrifugal

0

0 Rotary

0 Roiary-Displacement

0 Rotary-Gear

6. PROPOSED USE: (Check al that apply)

;gl._ Domestic (individual, noncommer

0 Driven ~ Drilled 0 Radial

0 Yes MNo {Please de$Ctibe.)

I '/a ~ dOG ym gallons per minute

PoWered by:

Propeller

Reciprocating

Impulse

0 Diesel

0 Gas

\ \/-: If") a Electric, rated horsepower. .....1.-.:...1.:.:!:!'--1!:1:.~--

0 Industrial

0 Irrigation (crop)------'*------

No. of Dwelling Units:-------

No. of Acres:-----------

0 Other (explain):---------0 Military

7. {.a) PROPOSED AMOUNT OF WITHDRAWAL:-~~~~- gallons per day

(b) METHOD OF FLOW MEASUREMENT: 0 Orifice 0 Other(explaln)

OTHER IMPORTANT INFORMATION:

8. PENDING ACTIONS: 0CDUA 0 SMA OEIS OEA 0NONE 0 Other (explain)

9. REMARKS, EXPLANATIONS:

I understand that approval of this application attaches the following standard conditions: 1) the proposed wo to be completed within two (2) yeara of the approval date; 2) the contractor shall submit to the Commission a well completion/abandonment report In 30 days after. the completion date of the pennitted work; 3) monthlv ).Yater use data shall be submitted to the Commission; 4) such approval shall not nstltute a determination of corr~tlatlve ... water rights and shaD not guarantee the pump capacity or future use up ·,o the pennltted pump capacity.

Well Owner "'J1l C' I< 111! 0 · J...a. Q 'I Signature n 'z) & Date

0 ..2 ~ ~ .:t .:>4>

Field Ch8CXed By--------Date ___________ _

Landowner t:o~q.~tt.ue: ~ !C y •

Signature _________ _

Date ..1 o ~ .. '( ..1 d~O

Longitude------

Latitude --------

Aquifer System Name _______ _

State Well No.

WCPIFORM (3/1/00)

Received: 5/23/00 12:08; 530 257 6250 -> Century 21 Home~iders o~ Hawaii; Page 2

MAY-23-2000 02:46 PM 0NER DRILLING & PUMP _53Q57 6250 p' 02

11. PROPOSED WELL SECTION

r-

Total Depth

----It

......... - .. -·- ...

Cement Grout [ 7 1\.---..,J, (m!n. 70% of distance from i ground elevation to top or ,. water aurface or 500 ft .• whichever Is less.) I

Minimum annular space between hole 1nd casing 0!: 3• -

-Rock or·Gravel Padting: 0 ft.---~

Malerlal: 0 Crushed Basalt ![ Rounded Gravel

Hole Diameter: " ·:· ln.

MJ"Imum of 2' Rldlus & 4" Thidt Concrete Pld

- ~~' . ... . .. _. £- Ground Elewtlon: --J.JJ.... ft., msr

~ • ii:i

I ...:J ... .s ~

1 UJ -o <:: :5 e g )(

~ !II

rr. ;\. ),.P~V.·

.. 10

Please refer to the HAW AD WELL CONSTRUCTION AND.: P\JMP INSTAl..LATJQN STANQARDS to assure that your eonstruction plans are in ·

compliance with all existing regulations .

- Solid Casing: (~ 90% W(Grou~~tev-~~! Level Elev)) Maleritll; f_if " ;tt ~~~-· ~:~1 Stand-\"b .. ~ rL ::U!§ ft.

Diameter. t ~ ' ' ln. Wan Thidtness: I q ; · Bottom Elevation; 0 ft.. n:;.

.. l· / "'=~' ~"""!?'"¢ rrr:r-6-s l ,/ Material Standard~ ~:?r' ~'}J

Waler Level Elevation:~-~-'-- ll msr _,.: -:F::~oll-.....-'1~11--:- {' · Length: Q ft.

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. ! ~~~~neu·=~·~ : • --=:: ~- l Ope11ings: 0 ~ :,:·: . .::.J ... ';, • • .• ~· ln.IL.F. ,i....-t- Bottom Elevation: 73: ft .• rntl• .· I

-·-· OpenHole: ·~ length: ---~-=--.-...----- ft. Diameter. in. BoUom Elevation: ft., m&r

j _______ ........ . For non-sail water Baaal Weill ·bottom elevation of wen should not be deeper than 114 of aquifer thidmess or,

Bottom EJev.tion of Weft Limil = (Willer EleVIIIion. 4 ' 11 WIW LM1 E!tllfUOn ) . .. Eample: Eiidlmd!d +2ft. water level EleY. -.BCIIIom EJeolauon OIWII Lmll = ( 2- tl.{C2.l) = -18.5 It

• The approximate elltvatknl muat be lwferenced to mean sea level (tnsl) at the time t1 application filing. Final elevations of well components ahaD be aubmitled In the Well CompletlofbWel Abandonment report& and ~fereneed to a btnchmartl which has been established by a sul'leyor licensed by the State.

Solid C1slng Material:

Stee~ compltanl with (check ()t)t or ti'IOtt):

And eompllent wiU\ (ch«:k one or men):

If AHSJJAWWA C200 D ASTM A242 D Type E

0ASTMA312

0 API Spec. 5L ~ ASN A53 0 ASN A139

0 Type S 0 Grade B 0 Other ----------------Stalnleea Steel: (check one): 0 ASTM M09

ABS Pla•tlc confonning to ASTM F480 and ASTM 01527: (dJDck ono) 0 Sehedule 40 0 SChedule 80

PVC Plastic confOnnlnglo ASTM F480 and (ASTM 01785 Of AS"TM 02241); (ciHiclc Omt); 0 Schedule 40 0 SCI'ieduiO 80

Thermoset Plastic: (clledc OM) 0 Filament Wound Resin Pipe conforming to ASTM 02996

Qpen r.~•l!1!l MatArfal:

0 Centrifugally Cast Ftaaln Pip. i:hnfonning to AS'T'M 02997

0 Reinforced Plastic Mottar Pressure Pipe conforming to ASTM 03517

0 Glass Fiber Reinforced Resin Prasure Pipe conforming to AWNA C950

0 PTFE Fluoi'OCIIrbon Tubing conforming to ASTM 03296

CJ FEP FluoroCarbon Tubing conforming to ASTM 03296

Steel: compliant with (check one or more): 'Df ANSIIAWNA C2o0 0 API Spec. 5L f/f ASTM A53

And compliant with (ch«Jt OM or mtn): D ASTU A242 D Type E 0 Type S D GI'Pde B

Stalnl .. a Steel: (check ont): 0 ASTM M09 0 ASTMA312

ABB Plaetlc conforminG to ASTM F-480 and ASN 01527: (check OM) · 0 Sehe~ule 40 0 SQhedule 80

IJ ASTMA139

0 other ----------------

PVC Plastic confonnlng to ASlM ~480 and (ASTM 01785 or ASTM 02~41): (cheCk one~ 0 Schedule 40 0 Schedule 80

Thennout Plastic: (CIIedt one) D Filament wound Resin Pipe· eo~forming to ASTM 02996


0 Reinforced Plestie Mortar Preaeute Pipe eonforming to ASTU 0351 7

0 Glass Fiber Reinforced Resin Pre&&ure Pipe conforming to AVM/A C950

0 PTFE FluotoearbOn Tublno·eonrormlng toASTM 03296

State ofHc8aii . .( 0 COMMISSION ON WATER RESOURCE MANAGEMENT Department of Land and Natural Resources APPLICATION FOR PERMIT ~Well Construction or ~ Pump Installation

Instructions: Please print in ink or type and send completed application with attachments to the Corrvnission on Water Resource Management, P.O. Box 621, Honolulu, Hawaii~. AQQ!ication must be accompanied by 3 copies and a non-refundable filing fee of $25.00 payable to the Dept of Land and Natural Resources. The Commission may not acoept incomplete applications. For assistance, can the Regulation Branch at 587..()225.


n l"l t~A· " , .1 u J 1'1 j '- '1 AIO : • 7

; For further infonnation and updates to this application form, visit http://www.state.hi.usldlnr/cwrm. r·r'"' 'I" r··: ~" r'·l '" ·' '' -, l • ·: .4._ '· ~ . '' ' ,t' '. ' ·.,

APPLICANT INFORMATION: (Fill out all three, if applicable, and place a check next to the primary contact)

1. (a)~ WELL OWNER: MA ~ ~IU;l( I~ D, Contact Person: ':;t).cf<IE J), ~,.y' MailingAddress: He~ ,;) hX 7S"Jt$ l<lfi4J'CJ,, 1t1 '' "> 4'7r Fax: S't'f- ?3-"' .. ..S 8'2cs E-mail: ----------

(b)~DOWNER: J1A.Pft -:Yif~l<r,; .P. ContactPerson: 7P.CI'Ir D. M11'( MailingAddress: #t:R ..1 J3e)l, 95'76 /C~.p,-u,., h'l ''''~' Fax: ~i:- '3 S • SCj"36 E-mail: -------::-------

(c) l)l. CONTRACTOR:TL>H.nt=\1 '\)Q,\ \,;,SO Contact Person: .§::RQn\Z:r;.29Q&R

MailingAddress: Po Y>ox ?,9'-1/ H,\o \-.\, 9f>),J,O

test" Phone: 9 i~ - i I CS ~

Phone: 98~ Sri.~'~

Fax: a,g 9eJ -~&',5'" E-mail:----------- Lie#: ~\n~ ""'~-~ (CfrcleinejJt ~57 a, or A)

WELL & PUMP INFORMATION: (Please fill in the diagram on the back ofthis form.) ...

2. WELL LOCATION/NAME: K li'"14AU..t 1)Js l'llu:.l d,:: pu,~14 Island: #Awi41/

Address /S-/'7'7'0 ALvP. {.:~) fF. ~~ I'A9.t~. t:ltsp f•s~xMa;.{ey: '3.,../-.S-.S,.c;"t Attach the relevant portion o~.5-Minute Series USGS topographic map (scale 1 :24,000), an< 5 •perty tax map, showing well location referenced to established property boundaries.

3. PROPOSED WORK: }J( Drill New Well - 0 Deepen 0 Install New Pump

( Checl< aD that apply) 0 Modify Existing Well 0 RedriU 0 Modify Pump

0 Abandon/Seal * 0 Replace Pump

*Well No.: _____ Be sure to complete and submit well abandonment report upon completion of work.

4. CONSTRUCTION: 0 Dug 0 Bored 0 Driven lei Drilled 0 Radial

Is this well a part of a battery of wells? · 0 Yes .kNo (Please describe.) !'

5. PROPOSED PUMP INFORMATION: Rated Pump Capacity: I'/a €2 dOGvm gallons per minute

PoWered by: Pump Type (Check one):

0 Deep Wei Turbine

~ Subrnersi>le

0 Centrifugal

6. PROPOSED USE: (Check al that apply) .

0 Rotary

0 Rotary-Displacement

0 Rotary-Gear

0 Propeller

0 Reciprocating

0 Impulse

0 Municipal (indudlng hotels, stores, etc.)

)S:l Domestic (individual, noncommercial water system)

0 Irrigation (crop)-----------

0 Military

0 Diesel

0 Gas

\ \/2.. "? a Electric, rated horsepower: --L-L.:/:_!:L.L.L __

0 Industrial

No. of Dwelling Units:-------

No. of Acres:----------

0 Other (explain):---------

7. (il) PROPOSED AMOUNT OF WITHDRAWAL: ---'~liC..l=S~Oo£.._ __ gallons per day

(b) METHOD OF FLOW MEASUREMENT: flq Flowmeter 0 Open-pipe 0 Weir Oorifice 0 Other(explaln)

OTHER IMPORTANT INFORMATION: / feJ. :} ..... ""-~'/ '!,/!Jl/110 $£. ¢ENDINGACTIONS: 0CDUA OsMA OEIS OEA li'NoNE 0 Other (explain)

9. REMARKS, EXPLANATIONS: ---------------------------

(if more space IS needed, p&ease attaCh addibonal sheet)

1 understand that approval of this application attaches the following standard conditions: 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 wen completion/abandonment report within 30 days after. the completion date of the permitted work; 3) month~ ~ater use data shall be submitted. to the Convnission; 4) such approval shall not constitute a determination.ofcomtJatJve;,, water rights and shaD not guarantee the pump capacity or future use up to the permitted pump capacity. · : '·

Field Checked By------Date

Landowner t:"'"'"'""; J"JJJ< i Contracto~ Signatur~~,e IIA~-.- ~Signature ·

Date ..2 CJ M"'i J. ~~o Date 'lo M-./ ~~oe .

Longitude------

Latitude

Aquifer System Name--------

State Well No. 31..~1-0?>

WCPIFORM (311/00)

)•

135 r:~

-..

JF~ - higp.hawaii.edu · 0 Centrifugal 0 Rotary-Gear PROPOSED USE: 0 Install New Pump 0 Modify Pump...

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