STATE OF HAWAII · Anahola, HI 96703 Dear Mr. Lluellen: c o STATE OF HAWAII DEPARTMENT OF LAND AND NATURAL RESOURCES COMMISSION ON WATER RESOURCE MANAGEMENT P.O. BOX 621 HONOLULU,

NEIL ABERCROMBIE GOVERNOR OF HAWAII

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

Dear Mr. Lluellen:

c o

STATE OF HAWAII DEPARTMENT OF LAND AND NATURAL RESOURCES

COMMISSION ON WATER RESOURCE MANAGEMENT P.O. BOX 621

HONOLULU, HAWAII 96809

June 13,2011

Withdrawal of Pump Installation Permit Application Gina Well (Well No. 1224-01)

WILLIAM J. AILA, JR CHAIRPERSON

WILLIAM D. BALFOUR, JR SUMNER ERDMAN

LORETTA J. FUDDY, A.C.S.w., M.P.H. NEAL S. FUJIWARA

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

WILLIAM M. TAM DEPUTY DIRECTOR

Thank: you for your email notice that the well owner has had a change of plans and will not be installing a pump in this well at this time. We are cancelling the application. You may reapply at any time without penalty or prejudice.

If you have any questions, please contact Charley Ice of our staff at (808) 587-0218, or toll free from Kauai at 274-3141, extension 70218.

CI:ss

c: Bill Mowry

Sincerely,

WILLIAMM. TAM Deputy Director

Well Background Check

Approved Well No. Well Name

1224-01

1222-13

1323-02

1120-58

Gina

Kingston

Rosenblum

Garcia

Applicant

Bill Mowry

David Kingston

Elliott Rosenblum

Mark & Sue Garcia

4/14/2005 1225-05 Kai Halalu 1 Miller Family Trust

10/17/2007 1122-02 Waiakalua-Hunt V. Stephen Hunt

1/29/2009 1122-03 Friedman Melinda Friedman

3/2/2009 0323-01 Wailua-Smith Gregory Kent Smith

3/5/2009 0919-12 Barnes James Barnes

3/5/2009 1222-08 Moorhead Aimee Moorhead

3/5/2009 1222-09 Kilden Terje Haakonsen

3/25/2009 1122-04 Betsy Sonja Geiger

4/8/2009 1221-12 Miranda Brandon Miranda

6/5/2009 1122-05 Kane David & Sandy Lear

10/30/2009 1120-53 Willy Wilfredo Estenzo

10/30/2009 1120-52 Tony Aldo Abondio Albertoni, Jr.

11/6/2009 1223-05 Northcutt Stephen Northcutt

11/20/2009 1120-54 Green Valley Green Valley Investments

11/29/2009 1224-04 Gerow David Gerow

4/9/2010 1222-10 Davies Philip Davies

5/25/2010 1222-11 Billy William Kreutzmann

717/2010 1120-55 High House Patricia Hanwright

8/20/2010 1120-56 Jack Jack Gardner

Wednesday, March 30, 2011

Well Construction Driller Pump Inst. Type Issued Signed WCR1 Accept

PUMP

C-29578 C-29578

C-29578 C-29578

C-29578 C-29578

C-24947 C-29578 BOTH 4/27/2005 5/112006 8/10/2006 12/19/2006

C-29578 C-29578 BOTH 213/2009 2/11/2009 3/16/2009 3/16/2009

C-29578 C-29578 BOTH 2/312009 2/11/2009 5/28/2009 7/13/2009

C-29578 PUMP

C-29578 C-29578 BOTH 3/612009 3/20/2009 5/28/2009 6/29/2009

C-29578 C-29578 BOTH 3/612009 3/19/2009 6/15/2009 8/812009

C-29578 C-29578 BOTH 3/5/2009 3/20/2009 7/14/2009 8/112009

C-29578 C-29578 BOTH 3/30/2009 5/22/2009 .' r ;;(

C-29578 C-29578 BOTH 4/16/2009

C-29578 C-29578 BOTH 6/17/2009 6/22/2009 10/2/2009 10/2/2009

C-29578 C-29578 BOTH 11113/2009 11/10/2010

Pump Installation Issued Signed WCR2 Accept

4/2712005 2/512009 2/18/2009 2/18/2009

2/312009 5/5/2009 6/15/2009 6/15/2009

2/312009 8/12/2009 8/16/2010 9/22/2010

3/512009 3/19/2009

3/612009 8/3/2009:'J i' ! - '.

3/6/2009 8/31/2009

3/612009 8/12/2009 8/16/2010 8/16/2010

3/30/2009 5/22/2009

4/16/2009

6/17/2009

11/13/2009

C-29578 C-29578 BOTH 11/13/2009 12/112009 1120/2010 2/16/2010 11/13/2009 212512010 3/18/2010 3/31/2010

C-29578 C-29578 BOTH 11/13/2009 11/10/2010 11/13/2009

C-29578 C-29578 BOTH 11/30/2009 11/30/2009

C-29578 C-29578 BOTH 11/29/2009 11/29/2009

C-29578 C-29578 BOTH 4/22/2010 412212010

C-29578 C-29578 BOTH 5/27/2010 5/27/2010

C-29578 C-29578 BOTH 7/12/2010 8/612010 9/20/2010 9/20/2010 7/12/2010

C-29578 C-29578 BOTH 9/312010 10115/2010 11/16/2010 9/312010

Pagelofl

. ' /i' ( _'j

./

o lIuelien [email protected]

06/06/2011 12:30 PM

o To [email protected]

cc

bcc

Subject Re: Gina (Mowry) Well (1224-01)

this point is moot as Mr. mowry ahs changed his plans and will not install pump ..... and concerning the "Jack" well: I seem to have misplaced report --- What is the estimated elevation of well head? thanks Shook

-----Original Message-----From: Charley.F.lce <[email protected]> To: lIuellen808 <[email protected]> Sent: Mon, Jun 6, 2011 11 :09 am Subject: Gina (Mowry) Well (1224-01)

Was Ms. Zapara going to transfer the well to Mowry?

Charley lee H "ydrol ogi sf

Ha'ofleii Water Comm ission 1151 P unchbo\f\A 227 Kalanim oku P .0.Box62-1, Honolulu 96809 (808) 587-0218

• Charley F IcelDLNRIStateHiUS

06/06/2011 11 :09 AM

To [email protected]

cc

bcc

Subject Gina (Mowry) Well (1224-01)

Was Ms_ Zapara going to transfer the well to Mowry?

Chari ey Icc H)'tIrologist

Ha'ofleii Water Comm ission 1151 P unchboVII 227 Kalanim oku P .0 .Box 621, Honolulu 96809 (808) 587-0218

o "Morikami. Lori Nil <Iori [email protected] ov>

05/03/2011 02:53 PM

To <[email protected]>

cc

bcc

Subject RE: Review for Comments

«452013001-GinaWeIl1224-01.pdf»

Hello Charley -

Hard copy being sent via Messenger.

Aloha,

Lori Morikami

DOH-Wastewater Branch, Oahu

From: Susan S Hoagbin/DLNR/StateHiUS@STATEHIUS@DOHMAIL On Behalf Of Susan S Hoagbin/DLNR/StateHiUS@DOHMAIL Sent: Thursday, April 21, 2011 9:03 AM To: CleanWaterBranch; Morikami, Lori N; Miyahira, Michael M; Palmer, Richard Cc: Charley F Ice Subject: Review for Comments

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

Itt] «File: 1224-01.PDF» 452013001·GinaWeIl1224·01.pdf

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STATE OF HAWAII DEPARTMENT OF lAND AND NATURAL RESOURCES

COMMISSION ON WATER RESOURCE MANAGEMENT P.O.BDX121

HOHOWLU. HAWAI _

April 21, 201]

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

Acting Chief, Chief, Safe Drinking Water Branch Alec Wong, Chief, Clean Water B

WLLIAM J. AlIA. JR -WLLIAM O. BALFOUR. JR. SUIoIIIER ERDMAN

LORmA J. FUDDY. A.C.S.W .• M.P.H. lEALa. FUJIWARA

DOMtIA FAY K.ICIYOSIIICI. P.e. LAWIENCIi H. MIIICE. M.D .• J.D.

WLLIAMM.TAM -...-

@ Dr. Keith Kawaoka, Office ofH aluation and Emergency Response

FROM: ~iIliam J. Aila, Jr., Chairperson Commission on Water Resource Manageme

SUBJECT: Pump Installation Permit Application Gina Well (Well No. 1224-01) TMK (4) 5-2-013:001

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

We would appreciate your comments on the captioned application for any conflicts or inconsistencies with the programs, plans, and objectives specific to your department rae- mooDd by retBpiDf this cover .. e .. o form by ManU, 2011. Ifwe do not receive comments or a requeStfor additiona review time by this date, we wr assume that you have no comments.

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

CI:ss Attachment(s)

RESPONSE: [ )

[ )

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legacy FIIe#: 3427 CAB

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Review Infonnation

Submit Date: 141512000

Reviewed: \412512000

plan Approved: 14125/2000

No Final ApprovalUr:

Inspectloft Date:

F"mal Approval:

Termination Date:

_""liM _'Filla W.MilP

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Added By: phsieh 2/26/2007 10:52 AM Last Modified:

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Dwelllrl""information

Lot Size (SCI ft.): 1 CPR Lot: [C] DwelDng Type: I !~I·

Existing IWS: [EJ • of Existing IWS: 1 other Wilstewater Bldos: [EJ Total Bedrooms: I More than 5 Bedroom

Designed Flow Rate (gpd): 11250 Building Type: I Raidential

LCC: [EJ Potable Well within 1,OOOft?: [C]

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Pro ect Information -------~-------------,

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Review Infonnatlon

submit Date: 111611998

Reviewed: 1215/1998 -""IIa Plan Approved: 1215/1998 es,. No Anal ApproVill Ltr: I -4"-inspection Date: 14125/2000 Final Approval: \5/412000 .11111. Termlnlltion Date: MilUliP

'~ayment Informatio!'!l

I Payment Type: 1r::N/:":"A:------Ii""il3II1 C~Number: ~Il ________________________ ~ Amount: \ ... 0----------,

CIIeck Dille: 111111899 Payor: Inla


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NER. ABERCROMBIE _ ... - WI.I.lAM J. AlIA JR. _. STATE OF HAWAII

DEPARTMENT OF lAND AND NATURAL RESOURCES COMMISSION ON WATER RESOURCE MANAGEMENT

P.O. lOX 4121 HONOLUlU. HAWAII II88DII

April 21, 201 I

WUIAM D. MLFOUR, JR. SUIiIIIER ERDMAN

LORETTA J. FUDOY. AC.B.W •• M.P.H. NEAL B. FUJIWARA

DONNA FAY Ie. IGYOSAKI. P.E. LAWRENCE H. MIlKE. M.D •• J.D.

WI.I.lAMM. TAM DlPurr_

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

Acting Chief. Chief, Safe Drinking Water Branch Alec Wong, Chief, Clean Water B

@ Dr. Keith Kawaoka, Office ofH aluation and Emergency Response

FROM: G,-William J. Aila, Jr., Chairperson Commission on Water Resource Managemen



We would appreciate your comments on the captioned application for any conflicts or inconsistencies with the programs, plans, and objectives specific to your department. PI,. respond by ret1lrniDf this eO¥J!r ;temo form by Man 23.2011. If we do not receive comments or a request for additiona review time y this date, we wi assume that you have no comments.

Please find the attached maps to locate the proposed well. If you have any questions about this permit application, request additional information, or request additional review time, please contact Charley Ice of the Commission statTat 587-02]8.

CI:ss Attachment(s)

RESPONSE: II

[ I

( I

II

II

( I II

Thia wen quliliu II a _ which will _ u a ...... orpotab" _10. p_lie -. system (cloflaed II HlY\nl 25 or men jIeOple.1eat 60 d8yI pot' y_ orhu J 5 or _ ...moe _Ii ..... ) and .1IIt .-i"" 0;.- cifHeahh approval JI!:!!!: 10 ilS _ II> """'ply witII Hawaii Admillillndlve RUI .. (HAR). Title II. Chopt .. 20. Rulea Relatina 10 Pat.a.Je Water $yllnls, §l1.2Q.29.

This _II cIoa lIOI ..... i17 ... s_ oavinla pablic _1)'_ (_I_than 25 ~ or ra ..... peoplo at .. 60 days JIll' y.- or 15 JmIice COIIIIICIi_) IIId if'the well __ ill unci (or driakin .. lhe private _.10011111 Ial ror bacieriolosical ond chenoical pms_ botcn illiria""a IIICh _ andlOllMllly m ... ilor the __ ~ity Illender Howe_. irfinunl planned _Iiom tllil lOIRe in_,o meet ,be puIJIill water ""em defiaiticm thea Dinoclor or Health approval II required IIEiII: 10 implementatio ...

Jfllle well illllld 10 supply IIotb potable ud DGft-pouble \IIIIIIOHI in a.""OI)'llIlll,'" _lhaIlolilllinate __ liGIII ond backflow COIIIICCIions by pb)'lieally ..,....in. potable ond ftOI>opoI"'le~ 1)'_ by .. air lIP or an lJIP'oved llackflow ~. and by clearly .. lias all no .... potable .pieou with __ nlli .... 10 prewnt ~ COftllllllPtioa or ROII-potable water. Backflow pmllntion daviQe slloald be lllUliaely inlpec:ted ond __

II cIocs nor appqr thIt litis well will be used ill' COIIlUmptiVC JIWPOIcsllld iI DOIlUbject ID SaI'c Driakin. Water Replatiolll.

For lhe applicanl's Inro.m.iaR.. _ orpossible __ c:oaIaIIIiaation [ ,Is II Is •• , 10CIIIed _ the JI'OPOIed well II" (inf_tiOll ahchedl

An NPOES pcmIil is required

0Ihcr ,.1.- DOH rulealrcplaticms, wormMiOII, or ___ na an attaohccI

III the _ thIt the locatioot o(Ihe well cIIan ... but is IliP within the pan:ellleac:ribecl on Ihi. applicatIOn, our clnlilioa ---. the _II II> 11111 be applicable. and we do not -" 10 revi_ the _ ~on

Phone: $fb ., ~zr is Date: 117, I J I

I • I

CWRM Application Source: Gina Well (State Well No. 1224-01)

Safe Drinking Water Branch Engineering Section

See attached private water wells information sheet.

Underground Injection Control (UIC)

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

The proposed well section details appear to be in error (bottom elevation) and should be corrected.

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

c

WARNING! As the owner of a privately-owned well, you should NOT assume that water from your well is safe for consumption. It is your responsibility to make sure that your well water is safe to drink. The only way to do this is to have your well regularly tested for bacteriological and chemical contaminants.

There are no regulations controlling water quality in private wells serving individual residences as there are for public water systems (public or privately owned utilities supplying water to 25 or more people or 15 service connections). In other words, there are no enforceable limits for contaminants and no requirements for regular testing. Private wells are often found in rural areas, where many activities such as onsite wastewater disposal can contaminate the ground water.

U.s. ENVIRONMENTAL PROTECTION AGENCY (EPA) RECOMMENDATIONS

The EPA recommends that private well owners test their well water each year for such contaminants as Total Coliform Bacteria, Nitrates, as well as any other contaminants that may be of concern in your area. More frequent testing may be appropriate if you suspect a problem. EPA also suggests that you consider testing for pesticides, organic chemicals, and heavy metals before using it for the first time. Please refer to the EPA website on Private Drinking Water Wells at http://www.epa.gov/safewater/privatewells/faq.html

OTHER CONTAMINANTS

Water testing can be very expensive. It is important that you spend time to identify what other potential contaminants may be of concern. Please refer to the EPA website on Private Drinking Water Wells at http://www.epa.gov/safewater/privatewells/whatyoucando.html for more helpful information. Be aware of what and how you use and dispose of household and garden chemicals. Also determine the location of nearby septic tanks or cesspools, and agricultural or industrial activities in the area. General information on known chemical contamination of ground water in Hawaii can also be found at the DOH website www.hawaii.gov/health/environmental/waterlsdwb/conmaps/pdf/conmaps05.pdf

LABORATORIES

Local commercial laboratories can be found in the yellow pages of the telephone book under "Laboratories, Analytical." Whenever possible, utilize a laboratory that is certified or approved for the speCific drinking water tests and carefully follow their instructions for collecting, storing, and transporting the samples. Just be sure to ask the lab to use EPA approved methods for drinking water analysis. A list of labs certified or approved by the Department of Health can be found at www.hawaiLgov/health/environmental/waterlsdwb/sdwb/pdf/Testing%20Labs.pdf.As lab certification status changes constantly, confirm their status when you contact the lab. Please note that the list is limited to currently regulated contaminants in public water systems.

RESULTS

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

• STATE OfI""".WAIi

.-'". ,.:or Official Use Only:

DEPARTMENTt)F LAND AND NATURAL RESOURCES ~ COMMISSION ON WAlER RESOURCE MAHAGEIIENl ,

APPLICATION FOR A WELL CONSTRUCTION I i

PUMP INSTALLATION PERMIT 2011 MAR 21

instructions: Please print in ink or type and send completed application with aIbIc:hmenls to the Commission on PH 12: 48

Water Resource Management, P.O. Box 621, Honolulu, Hawaii 96809. Appficatlon must be accompanied by 10 copies and a non-refundable filing fee of $26.00 payable to the Dept. of Land and Natural Resources. The Commission may not accept Incomplete applications. For assistance, catl the Regulation Branch at 687..0226. For further information and updates to this application form, viSIt httpJIwww.hawaii.govldtnrlc:wrm.

WELL LOCATION INFORMATION 1. STATE WELL NO. (W already 88Oigned) 12. WELL NAME : IdLAND 14. ThlK ~..- ·L· {'5 of

l '1..1-'-1- Ol '" I;';~ '~{k(A- i -.;;;;e sac plat --pw;r The following musI be attached beIDre this application Is accepted as complete:

• Portion of 7.S-Minute Series USGS topographic map (scale 1:24.(00) with _location labeled and include the name of the quad map • Proper1y tax map. showing well location reI~ to establlehad properly boundaries • Photograph of the proposed _" Bite • A sdHtmalic diagram showing the wall site. acceos road and proposed wall infrastructure .For dug wells atteell a ~ plan with cross section -. e_ and nnish_

5. WELL_ DPERA~'S N~r;:,:;ANY DILL- OW

I: Well Operator's Contac:t ~t!C@, lOP; - /0;: .::..

6. LANDO~Ex.M~PANY 1 Landowne(s Contact

Well Opsrai/ Mailing, i"'~ 72af . bet 1\0\'1. I )<:IIAru. ~ ;). ftf9t Landowner'. MaDing Address

'fA ~atoih7)e I W:" Oparato(s Fax I; Well OpsralDr'@-m&U ~sPhona I Landowner's Fax I Landowne(s E-mail J:.llAe~&m .' yAJia,c'

PROPOSED WELL CONSTRUCTION PROPOSED PUMP INSTALLATION 7.~ ~~l'ype 10. Proposed Work 11. Proposed Pump Capac:ity, 13. Method 01 flow measurement '. Construct New Well o Orlfted $Inslalt New Pump gpm (gallons ~ minute) J2f Flowmeter

o Modify Existing WeH o Dug o Replace Pump o Other (explain) o Abandon/Seal WeH o Shaft

12. Proposed Amount of WlthdlllWal, o Tunnel gpd (gallons per day)

9. Is this welt part of a battery of wells? 0 Yes ld"No .d}ooo 14. Proposed Surveyor name and license number (a surveyor is required for aR Wen ConstrucIion Pennits and may be required for some Pump Installation Permits)

P€..FPJ2-PROPOSED USE

o 15. Municipal (water systems seNlng greater than 25 Individuals or 15 service connections)

lJ:I--'16. Domestic Number 01 units to be SeNed: I

o 17. Industrial (desaibe)

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

o 19. Military (describe)

o 20. Other (desaibe)

OTHER LEGAL REQUIREMENTS If required, items 21. and 22. must be obtained before the Commission can leaal/y issue a permit: 21. C .......... atIon DIIIrk:t Uae PermIt (CDUPI 22. SpeclalIIanagement ANa Permit (SIIAPI o Well is in Conservation District o Required. SMA# date approved ___

o Required. COUP # date approved ___ o Not Required (ottaell documentation from applicable County -"cv) o Not Required (attach oowmentation from OCCL) o I have not checl<ed with the county about wheth ... or not an SMA Permll is required. o I have not checked with OCCL about whether '" not a COUP is required.

o Well Is not in Conservation Olslricl

,at have not checked if well is in or out of Conservation District.

23. _ Hlatorlc _on OI_on (SHPD) of the Department of lAnd and Natural Resources o I have consulted with the SHPO reganllng potential Impacts of _ construction activities on historic sites. I have attached applicable documentation from the HPD,

0-' I have not consulted with the SHPO ragalding potential impacts of _I construction activities on historic sites.

24. C ......... :ws o An Environmental Assessment was completed. and

o An Environmental Impact Statement was required and has been accepted (attach latter of acceptance). Publication dale in The Environmental NotIce:

0 A Finding of No SIgn_t Impact has been detennined (attach letter). Publication date in The Environmental NoIios: This project proposes: o Use of state or county lands. or use of state or county funds o A __ treatment 111ft

o Use within a sIaIe oonsarvation district o Waste-to-energy facility o Usa within a shoreline satb8ck ares o LamB o Usa within a national or Haws. registered historic site o 0iI1lIfinary o Use within the Waikiki Spacial District o Power_rating facility

o The cons1ruclion. expansion or modification of helicopter facility M NoneoftheaboYa11 items

25. Water Use Permit No. (if applicable):

Additional remarks, explanations. etc. (attach additional sheet if more space Is needed)

NOTE: Signing below indicates that the signatories unci_land and _ that the lnIormatlon provided is accurale and true to the best of their knowtedge. Further, the signatories und_tand that upon perm" approval: 1) the proposed work Is to be completed within two (2) yea'" of the approval date; 2) the contractor shan submit to the CommISsIon a well completion/abandonment report within 10 days after the completion date of the permitted work; 3) In the ewnt thai the application Is not completed correctfy, any permit may be suspended unt~ the item is brought In to compfiance, and any work done white the permit is In suspension may result in fines 01 up to 55ODQlday.

26, :-VEll ~RlllER (Must be;1ed out warnon is for WaH Construction) 27. PUMP I~S~ER ~ be filled r w application is for Pump tnstalalK>n)

M:m j)"ii!J(Q wkJ ~'S 7B tAu.i,' ~ tt-4~ c!.--7-fsZ6 licensee business name C license No. ucense: t1:: name 11£ C-571CS7aJA license No.

f\('... --- t~Jh,vj"-s..", ;;-"'-:/1 Signature Print Date

SiiI;d),.B U ;;t/~ Ii Date '" L/3 If-J It . t?f-~~ Address Address

IkJB (£] rt/ b~ .- tLudP;vf)~k;, / Phone Fax E-maM Phone Fax E-mail

WCPI AppItca\Ion Form 0613112010

~

\ \: Bernard P. Carvalho, Jr. o o Michael A. Dahilig

Director of Planning Mayor

GaryK.Heu Managing Director

Dee M. Crowell Deputy Director of Planning

April 26, 2011

PLANNING DEPARTMENT County of Kaua'i, State of Hawai'i

4444 Rice Street, Suite A-473, LIhu'e, Hawai'i 96766 TEL (808) 241-4050 FAX (808) 241-6699

~ ------~-~F:-

William 1. Aila, Jr. Chairperson State Department of Land and Natural Resources Commission on Water Resource Management P. O. Box 621 Honolulu, HI 96809

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Subject: Gina Well (Well No. 1224-,01 TMK (4) 4-9-011 :012

In response to the request for a letter requesting a determination that the proposed Gina well for the above referenced tax map key is located outside of the Special Management Area, please allow this letter to serve as the Planning Department's response.

Should there be any questions regarding the above, please contact Coastal Zone Management planner Lisa Ellen Smith at 808-241-4499.

Michael A. Dahilig Planning Director

An Equal Opportunity Employer

· J


Mr. Ian Costa, Director Planning Department County of Kauai 4444 Rice Street, Ste. A473 Lihue, Hawaii 96766

Dear Mr. Costa:

o




April 21, 2011

WILLIAM J. AILA, JR. CHAIRPERSON

WILLIAM D. BALFOUR, JR. SUMNER ERDMAN

LOREnA J. FUDDY, AC.S.w., M.PH NEAL S. FUJIWARA

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


o,u~nY OF K,6.UAI

11 PPR 25 P 2 :48

Special Management Area Use Permit Requirements for Pump Installation Permit Application

Gina Well (Well No. 1224-01)


We would appreciate your comments on the captioned application with regard to the SMA permitting requirements specific to your division. Please respond by returning this cover memo form by May 23, 2011. Ifwe do not receive comments or a request for additional review time by this date, we will assume you have no comments.

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

Sincerely,

CI:ss

RESPONSE:

[ 1

[ 1

[ 1

[ 1

Signed:

This well project [ 1 requires Wdoes not require a SMA. and [ 1 is [ 1 is not currently ~~.

:E c:,

If a SMA is required it [ 1 has [ 1 has not been a~oved"" .' ; .' I '

\D

Other relevant ruleslregulations, information, or recommendations are attached. -0 ::x

No objections

Other comments:

Phone: --------

Date: ----------

N .. ~~~~~ fY1fT1 :;1:::;0 ~">~1

• o o

NEIL ABERCROMBIE OOVERJrilOR OF HAWAII

WUIAM J. AILA, JR. CIWII"""'"




April 21, 2011

WIlLIAM D. BAlFOUR. JR. SUMNER ERDMAN

LORETTA J. FUDOY, AC.S.W., M.P.H. NEAL S. FUJIWARA

DONNA FAY K K1YOSAKI. P.e. LAWRENCE H. MilKE. M.D., J.D.

WlLLIAMM. TAM DEPUTV DIReCTOR

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

Acting Chief, Chief, Safe Drinking Water Branch Alec Wong, Chief, Clean Water B Dr. Keith Kawaoka, Office ofHa aluation and Emergency Response

FROM: f2....william J. AHa, Jr., Chairperson \~ Commission on Water Resource Management

SUBJECT: Pump Installation Pennit Application Gina Well (Well No. 1224-01) TMK (4) 5-2-013:001

Transmitted for your review and comment is a copy of the captioned Pump Installation pennit 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 retumin~ this cover memo form by May 23, 2011. Ifwe do not receive comments or a request for additiona review time by this date, we will assume that you have no comments.

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

CI:ss Attachment( s)

RESPONSE:

II

[ I

[ I

[ I

[ J

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This well qualifies as a source which will serve as a source of potable water 10 a public water system (defined as serving 2S or more people at least 60 days per year or has I S or more service connections) and must receive Director of Health approvall!!i!!! to its use to comply with Hawaii Administrative Rules (HAR), Title II. Chapter 20, Rules Relating to Polable Water Systems, §11-20-29.

This well does not qualify as a source serving a public water system (serves less than 25 people or more people at least 60 days per year or 15 service coMections) and if the well water is used for drinking, the private owner should test for bacteriological and chemical presence before initiating such use and routinely monilor the water quality thereafter. However. if future planned use from this source increases to meet the public water 'system definition then Direc10r of Health approval is required I!!i!!! to implementation.

If the well is used to supply both potable and non-potable purposes in a single system. the user shall eliminate cross-connecrions and backflow :;;;: , ,. ,\ connections by physically separating potable and non-potable systems by an air gap or an approved bacIdIow preventer. and by clearly Iaheling all no_ potable spigots with warning signs to prevent inadvertent consumption of non-potable water. Backflow prevention devices should be routinely inspec'ftll' ,- , and tested. :::J:

l::bo It does not appear that this well will be used for consumptive purposes and is nol subject to Safe Drinking Water Regulations. -<

For the applicant. information, a soun:e of possible wastewater contamination* II is Dot located near the proposed well site (infonnation altac~ An NPDES pennit is required. .:0 ;;; :.

One-Stop database screecatnfOj; ' •. '. ,.' Other relevant DOH rules/regulations. information. or recommendations are attached

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

)<[' No comments/objections \0 ~:::: ;;:0

Contact Person: Lori Vettet, Eng·1 on K~uai 241-3~23 Signed:---=~~_'.L-·~----=:..-=-«'--=--_-,-·--=tJ71---"--,,,t)-,-~-,-,,-,--,-t1_ ~~~~-:-'8--4~-?t)--{ /

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First Name: ~IM=IC=HA=E=L================~ last Name: ~IZA=PA=RA=========~

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Street Address: I~==============; street Address 2:

suite/ Aptit:

City:

state:

Zip Code:


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Added By: phsieh 2/26/2007 10:52 AM last ModiFied:

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Dwellin Information

Lot Size (sq ft.): I CPR Lot: [EJ Dwelling Type: I Existing IWS: [EJ it of Existing IWS: I Other Wastewater Bldgs: [EJ Total Bedrooms: 15 Bedroom

Designed Flow Rate (gpd): 11250 Building Type: I Residential

lCC: [EJ Potable Well within 1,0000?: [EJ

Save

\

o

o

o o NEIL ABERCROMBIE

GOVERNOR OF HAWAII WILLIAM J. AILA, JR.

CHAIRPERSON

TO:

FROM:


COMMISSION ON WATER RESOURCE MANAGEMENT po. BOX 621


April 21, 2011

Russell Tsuji, Administrator ~ Land Division

William M. Tam, Deputy Director W . Commission on Water Resource Management


LORETTA J. FUDDY, AC.SW., M.P.H. NEAL S. FUJIWARA

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

WILLIAM M. TAM OEPUTY DIRECTOR


,.....,)

( r. .." 53 (--

Transmitted for your review and comment is a copy of the captioned Pump I~~taH~iion ~it ?::0 application. '.: :-5 .. ::: ~'r;

,~

, , 1''0 :'~ _,_ We would appreciate your comments on the captioned application with regarq:t<?the programs, ',~ ~

plans, and objectives specific to your division. Please res ODd b retDrniD this co\t .1; memo- orm b =;:';::; May 23, 2011. Ifwe do not receive comments or a request for additional review tin1¢by{bis d e, we .~'.2 a will assume you have no comments. .~ C'! ~"t, <;> ~.~

1"':1 .... V> C>

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

CI:ss Attachment(s)

RESPONSE:

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

[ ]

[ ]

[ ]

tiol

division. ::::: ;I>

A water lease/permit is not required of this applicant. -0 ::;:':)

N ..... A water lease/permit has been obtained by the applicant through lease no. >2:~ ---------.,,--~_=o .. -::

Other relevant Land Division rules/regulations, information, or recommendations are attached. " :::;:,.., :z ">. __ '0

N.. ~:,;C:;: No objections

Other comments:

:~ .. :::~ fli tTl

-..I 4::;0

Original source of private title is Land Commission Awa~d No. 8559-B:39 issued between 1845 and 1855.

Contact Person: _--,-,Gt<.d::lL.Lr~y---,-Ma..u:.ur-,t...Jiun-,--_________ _ Phone: 587-0/121

• Signed:_..,tLAry'---"---_-+-_~ _____ "'--_____ _ Date: Apr; 1 2 5 , 2011

Charley-

o "Nikaido, Jennifer" <jennifer [email protected] .gov>

04/27/2011 01 :36 PM

Please see attached.

Aloha, Jennifer

Jennifer Nikaido Safe Drinking Water Branch Department of Health, State of Hawaii 919 Ala Moana Blvd., Room 308 Honolulu, Hawaii 96814 Phone I (808) 586-4262 Fax I (808) 586-4351 [email protected]

~ 1224·01.pdf

o To <charley.f.ice@hawaiLgov>

cc

bcc

Subject DOH/SDWB Comments: Gina Well 1224-01


Mr. Michael Lluellen Kauai Water Well P.O. Box431 Anahola, HI 96703

Dear Mr. Lluellen:

o o




April 21, 2011

Pump Installation Permit Application for Well No. 1224-01

WILLIAM J. AILA, JR CHAIRPERSON

WILLIAM D. BALFOUR, JR SUMNER ERDMAN

LORETTA J. FUDDY, A.C.SW., M.P.H. NEAL S. FUJIWARA

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


1224-01.pipa

On April 11, 2011, the Commission received your completed Pump Installation permit application and filing fee for the Gina Well (Well No. 1224-01). Your application will be processed within ninety (90) days from this date.

The attached table describes the process, responsible parties, and deadline requirements for drilling or modifying a well and installing, modifying, or replacing a pump.

By this acceptance letter, we are also notifying the well operator/landowner that no water may be pumped other than for testing until a certificate of pump installation completion letter is issued to the well operator and landowner.

The permitted pump capacity described on the pump installation permit may be reduced if the pump test does not support the capacity. No certificate of pump installation will be issued until the Commission determines that the pump capacity will not have adverse effects on the aquifer, other nearby wells, or streams. Thus, you may need to remove the pump and install a smaller pump if the Commission decides a smaller pump is required to protect water resources before you can withdraw water for purposes other than testing.

If you have any questions about your permit application, please contact Charley Ice of the Commission staff at 587-0218 or toll-free at 274-3141 (Kauai), extension 70218.

CI:ss Attachment

c: Bill Mowry

Sincerely,

WILLIAMM. TAM Deputy Director

c o NEIL ABERCROMBIE

GOVERNOR OF HAWAII WILLIAM J. AILA. JR.

CHAIRPERSoN



HONOLULU. HAWAII 96809

April 21, 2011


LORETTA J. FUDDY. AC.SW. MPH NEAL S. FUJIWARA

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


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

Acting Chief, Chief, Safe Drinking Water Branch Alec Wong, Chief, Clean Water Bra Dr. Keith Kawaoka, Office ofHaz (I aluation and Emergency Response

FROM: CL-william J. Aila, Jr., Chairperson ~ \:" Commission on Water Resource Management



We would appreciate your comments on the captioned application for any conflicts or inconsistencies with the programs, plans, and objectives specific to your department. Please respond by returning this cover memo form by May 23, 2011. If we do not receive comments or a request for additional review time by this da,te, we will assume that you have no comments.


CI:ss Attachment( s)

RESPONSE: [ I

[ I

[ I

[ I

[ I

[ I

[ I

[ I

[ I

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

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

If tbe well is used to supply both potable and non·potable purposes in a single system, the user sball eliminate cross·connections and backflow connections by physically separating potable and non·potable systems by an air gap or an approved backflow preventer, and by clearly labeling all non· potable spigots with 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 [ Jis [J is not located near the proposed well site (information attached).

An NPDES permit is required.

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

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

No comments/objections

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


TO:

FROM:

SUBJECT:

o




April 21, 2011

Russell Tsuji, Administrator ~' Land Division .

William M. Tam, Deputy Director ~ . Commission on Water Resource Management

Pump Installation Permit Application Gina Well (Well No. 1224-01) TMK (4) 5-2-013:001



LORETTA J. FUDDY, AC.S.W, M.P.H. NEAL S. FUJIWARA

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

WILLIAM M. TAM OEPUTY DIRECTOR


We would appreciate your comments on the captioned application with regard to the programs, plans, and objectives specific to your division. Please respond by returning this cover memo form by May 23, 2011. If we do not receive comments or a request for additional review time by this date, we will assume you have no comments.


CI:ss Attachment(s)

RESPONSE:

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

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

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

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

[ ] No objections

[ ] Other comments:

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

Signed: __________________ _ Date: --------


TO:

FROM:

SUBJECT:

c o




April 21, 2011

Dr. Puaalaokalani Aiu, Administrator ~ Historic Preservation

William M. Tam, Deputy Director U/t Commission on Water Resource Management

Pump Installation Permit Application Gina Well (Well No. 1224-01) TMK: (4) 5-2-013:001



LORETTA J. FUDDY, AC.S.W, M.P.H. NEAL S. FUJIWARA

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



We would appreciate your comments on the captioned application with regard to the programs, plans, and objectives specific to your division. Please respond by returning this cover memo form by May 23, 2011. If we do not receive comments or a request for additional review time by this date, we will assume you have no comments.

Please find the attached maps to locate the proposed welL If you have any questions about this permit application or request additional review time, please contact Charley Ice of the Commission staff at 587-0218. If you require additional information regarding specific information that can be provided by the applicant, please contact the applicant directly at the contact information provided on the application form.

CI:ss Attachment(s)

RESPONSE:

[ ] This is a [ ] public (county or state) project [ ] private project and [ ] will [ ] may disturb historic sites.

[ ] We concur that the work described under this permit will not disturb historic sites.

[ ] We do not concur that the work described under this permit will not disturb historic sites. We require the following for our concurrence:

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

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


Mr. Ian Costa, Director Planning Department County of Kauai 4444 Rice Street, Ste. A473 Lihue, Hawaii 96766

Dear Mr. Costa:

o


COMMISSION ON WATER RESOURCE MANAGEMENT po. BOX 621


April 21, 2011

Special Management Area Use Permit Requirements for Pump Installation Permit Application

Gina Well (Well No. 1224-01)



LORETTA J. FUDDY, AC.SW., M.P.H. NEAL S. FUJIWARA

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



We would appreciate your comments on the captioned application with regard to the SMA permitting requirements specific to your division. Please respond by returning this cover memo form by May 23, 2011. Ifwe do not receive comments or a request for additional review time by this date, we will assume you have no comments.


Sincerely,

w~~ (). WILLIAM J. AILA, JR. r Chairperson

Cl:ss

RESPONSE:

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

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

[ ] No objections

[ ] Other comments:

Contact Person: ___________________ _ Phone: --------Signed: ____________________ _ Date: _______ _

,\.

FROM: CHARLEY

i~ 0 C~ISSION ON WATER RESOURCE MANAGEMENT

ROUTE SLIP FOR NEW APPLICATIONS

DATE: 30-Mar-11 SUSPENSE DATE:

PLEASE:

6-Apr-11

KUNIMURA,I. See Me FUJII, N. -3-TAM,W.

Approval -3-Signature

Information -1-Review & Comment

Take Action -1-HARDY, R.

~ 2 HOAGBIN,S_ -4- ICE,C.

IMATA, R.

WELL NUMBER 1224-01

o WELL CONSTRUCTION

NAKAMA, L. UYENO, D. YODA, K. YOSHINAGA, M.-

WELL NAME Gina

~ PUMP INSTALLATION

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

Xerox copies

WUP Number na

DWUPA o WUP Transfer

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

2 PERMIT PROCESS TABLE

3 CWRMMAPS

4 APPL. FORM (11 COPIES)

5 USGS MAPS (11 COPIES)

6 TAX MAPS (11 COPIES)

7 PARCEL OWNER VERIF.

8 CONTRACTOR VERIF.

'\ 9 ALL INFO FILLED IN

~ " 10 BACKGROUND CHECK

11 $25 FEE DEPOSIT SLIP

12 DHP/CDUP/SMA pre-screen

13 EA 343 5(a) triggers?

FOLDER:

making 1-mile radius and penciling in on hanging maps

MLS PRINTOUT DCCA LICENSE SCREEN PRINTOUT

(SMA map printout http://gis.hicentral.com/website/parcelzoning/viewer.htm.,or INGRID'S SMA/CD MAP) (LUC map printout http://luc.state.hi.us/luc_maps.htm., or INGRID'S SMA/CD MAP)

NO YES - trigger identified is: (if triggered, exemption analysis memo must be attached before accepting)

o o

MADE NEW FILE FOLDER, ATTACHED FILE FOLDER ALREADY MADE, IN FILE CABINET

INCOMPLETE ACTION DATES:

DATE ACTION

, I .. /

• ,' <

: ." /~ J

L

.-STATE OF HAWA For Official!l;Jseqhlyr: DEPARTMENT OF LAND AND NATURAL RESOURCES Cof';". 't-~:fr,pnER COMMISSION ON WATER RESOURCE MANAGEMENT ; ,[ ~3 ~~: U . ' ~;':,~NT

o APPLICATION FOR A WELL CONSTRUCTION I

2011 APR II PUMP INSTALLATION PERMIT PM ,: 46

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

WELL LOCATION INFORMATION 1. STATE WELL NO. (if already assigned) \2. WEI.L N}~ME 3. ISLAND 14. TMK - of 1'2.2~- 0\ /(Or<;.A-" ...:S ---.L-/3 ~ I ;v~'+ ---zone sec pial parcel

The following must be attached before this application is accepted as complete: • Portion of 7.S-Minute Series USGS topographic map (scale 1 :24,000) with well location labeled and include the name of the quad map • Property tax map, showing well location referenced to established property boundaries • Photograph of the proposed well site • A schematic diagram showing the well site, access road and proposed well infrastructure • For dug wells attach a grading planwilh cross section profiles showing existing and finish grades

5. WELL OPERATOR'S NAMElCOiANY

13 f L \..., {t1 OW \i'J. 1 Well Operator's Contact 6.LANDO~~~~PANY I Landowner's Contact

Well ope~a4~q. idres}::u AV ~ 72aP 1<, L.-~ ~ ~ftl!:lt Landowner's Mailing Address

Well Operator's Phone I Well operat:'s Fax I Well Operator's E-mail Landowner's Phone I Landowner's Fax I Landowner's E-mail

PROPOSED WELL CONSTRUCTION PROPOSED PUMP INSTALLATION 7. Proposed Work 8. Construction Type 10. Proposed Work 11. Proposed Pump Capacity, 13. Method of flow measurement

o Construct New Well o Drilled ZlnstaJl New Pump gpm (gaIlOn;vo minute) ,l2(" Flowmeter o Modify Existing Well o Dug o Replace Pump o Other (explain) o Abandon/Seal Well o Shaft

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

9. Is this well part of a battery of wells? 0 Yes ld'No ;;000 14. Proposed Surveyor name and license number (a surveyor is required for all Well Construction Permits and may be required for some Pump Installation Permits)

PI£FfZR-PROPOSED USE

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

.J¥16. Domestic Number of units to be served: L , o 17. Industrial (describe)

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

o 19. Military (describe)

o 20. Other (describe)

OTHER LEGAL REQUIREMENTS If required, items 21. and 22. must be obtained before the Commission can legally issue a permit: 21. Conservation District Use Permit (CDUP) 22. Special Management Area Permit (SMAP) o Well is in Conservation District o Required, SMA # date approved

o Required, COUP # date approved o Not Required (attach documentation from applicable County agency) o Not Required (aUach documentation from OCCL) o I have not checked with the county about whether or not an SMA Permit is required. o I have not checked with OCCL about whether or not a COUP is required.

o Well is not in Conservation District

,,0'. have not checked if well is in or out of Conservation District.

23. State Historic PreservatIon Division (SHPD) of the Department of Land and Natural Resources 0 I have consulted with the SHPD regarding potential impacts of well construction activities on historic sites. I have attached applicable documentation from the HPD.

~'I have not consulted with the SHPD regarding potential impacts of well construction activities on historic sites.

24. Chapter 343 o An Environmental Assessment was completed, and

0 An Environmental Impact Statement was required and has been accepted (attach letter of acceptance). Publication date in The Environmental Notice:

0 A Finding of No Significant Impact has been determined (aUach letter). Publication date in The Environmental Notice: This project proposes:

o A wastewater treatment unit o Usa of state or county lands, or use of state or county funds o Use within a state conservation district o Waste-to-energy facility 0 Use within a shoreline setback area o Landfill 0 Use within a national or Hawaii registered historic site o Oil refinery 0 Use within the Waikiki Special District 0 Power-generating facility 0 The construction, expansion or modification of helicopter facility o None of the above 11 items


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

NOTE: Signing below indicates that the signatories understand and swear that the information provided is accurate and true to the best of their knowledge. Further, the signatories understand that upon permit approval: 1) the proposed work is to be completed within two (2) years of the approval date; 2) the contractor shall submit to the Commission a well completion/abandonment report within 60 days after the completion date of the permitted work; 3) in the event that the application is not completed correctly, any permit may be suspended until the item is brought in to compliance, and any work done while the permit is in suspension may result in fines of up to $5000/day.

26. WELL DRILLER (Must be filled Ollt if aPi'cation is for Well Construction) 27',PUMP I~ST~LLER (Must be fillezt if application is for P~mp Installation)

i/" . /3 /, / . ., l/">/ ...., ..., f-1'-1CAi-tf (/V'''/ u'""{.~ )l../' .-'7 -,..-. G ? 7 ;:, /1'"5 lAuvt-t ft)/-H'7r!2 tt4 ~ C!.--.2-f S-76

Licensee business name C-57 License No. L~~essname !fl.' C-57/C-57a/A License No.

i ~It!.d f.uf'e:/ j~ ~ -/.tp'-: /1 Signature Print Date

Si9;;Jj '- (S Print {;{ Date

L/3/ kJt,i,bil/(' 9(;~~ Address Address

l! &.013 (c£7 T.Lbs·

....-tlV4f1Rwf)49@kJ, (

Phone Fax E-mail Phone Fax E-mail

PROPOSED WELL SECTION (Please attach schematic if different from diagram provided be/ow)

Hole Diameter: /1 in.

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

r;~' ~;:j r Ground Elevation: ft., msl* ,',". ":-0. ',<II. oq'

'7_' .~ o' .: ":: ...

'//mo' ///l'A"

'0 " .... Please refer to the . .. .4 •• . ' , " .

Cement Grout: ft. ,', ,'. HAWAII WELL CONSTRUCTION AND

(min. 70% of distance from :. ~. :·1-' .. :.~ 0': PUMP INSTALLATION STANDARDS

ground elevation to top of ! .... .:-: ;. .:,,' to ensure that your as-built is in compliance with water surface or 500 ft., .;.,:.

~ :~:. .... applicable standards. whichever is less,) ":"/:: 'p ,-..... • •• ~: '0 ....

,'. , '.

Annular space between hole :. ~ :.!'o Solid Casing: (~ 90% x (Ground Elev.-Water Level Elev» Grouting method: .,0.: 0.:

and casing (1.5" for positive ~"'.

ppositive .:-: ;. .: rl

Total Length: ft. displacement, 3" for other ';.:' :::: ~ b displacement methods): .. ,":

Nominal Diameter: in . . .. .p .,

.'~'.'. ..... .. o Other V .6 ••

in. ;.:.:" ;.', ;6 Wall Thickness: in. - :. ~. :.!'. ~:.: .A. ':. Bottom Elevation: ft., msl*

Rock or Gravel Packing: - t-

Tt;;;(;h ft. I""'---< I I

Open Casing: o Perforated o Screen ft. Material:

~ o Crushed Basalt Total Length: ft.

8 o Rounded Gravel V Nominal Diameter: in. '<:J is; Wall Thickness: in.

Estimated Water Level Bottom Elevation: ft., msl* 'I I_-Ele:vation: note: Neither bentonite nor mud should be used in -~ (-

ft. msl* saturated zone·during drilling

Open Hole:

Length: ft.

Diameter: in.

- Bottom Elevation: ft., msl*

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

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

Bottom Elevation of Well Limit = (Water Elevation _ 41 x WelgLe:;1 Eleyation )

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

Material: mpliant with (check one or more): D ANSIIAWWA C200 0 API Spec. 5L 0 ASTM A53 0 ASTM A139

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

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

ABS Plastic conforming to ASTM F480 and ASTM 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 onn) o Filament Wound Resin Pipe conforming to ASTM D2996

o Centrifugally Cast Resin Pipe conforming to ASTM D2997

o Reinforced Plastic Mortar Pressure Pipe conforming to ASTM D3517

o Glass Fiber Reinforced Resin Pressure Pipe conforming to AWWA C950

o PTFE Fluorocarbon Tubing conforming to ASTM D3296

o FEP Fluorocarbon Tubing conforming to ASTM D3296

MateriJ!:. o API Spec. 5L 0 ASTM A53 0 ASTM A 139

o Type E 0 Type S 0 Grade B 0 Other


ABS Plastic conforming to ASTM F480 and 9\STM D1527: (check one) 0 Schedule 40 0 Schedule 80

PVC Plastic conforming to ASTM F480 and (ASTM D1785 or ASTM D2241): (check one): 0 Schedule40 0 Schedule 80 0 Schedule 120

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

o Centrifugally Cast Resin Pipe conforming to ASTM D2997

o Reinforced Plastic Mortar Pressure Pipe conforming to ASTM 03517



o FEP Fluorocarbon Tubing conforming to ASTM D3296

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c State of Har ,., lii ( COMMISSION ON WATER RESOURCE MANAGEMENT Department of Land and Natural Resources

WELL COMPLETION REPORT - PART I Well Construction

For Oftieial Use Ooly:

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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 C I APR 16 p 2: 3 2 not accept incomplete r.ports. This form shall be submitted withm 60 days of the completion of work. For a88istance. please consult the Hawaii Well Construction and Pump IMtaUation Standards or caD the Regulation Branch at 687..0225. For updates to this form or additional information, please visit our website at http://www.state.hi.usldlnrlcwrml Gr=.;" >" . - '! I!; ,\"T~

\L-. ...... l~· •• '".'·· _.1 '_."

1. State Well No.: 1224-01 Well Name: _G~ln=a,--_________ Island: Kauai

2. Address: 4591 Kuawa Rd. Tax Map Key: 5-2-13:01

3. Drilling Company: OAsis t0At~ S'1*"1 -'1\6 ~~...;...:------4. If drilled, type of Rig: If{ Rotary 0 PercussIOn

5. Date Well Construction (drilled,cased.grouted) completed: 1- 6- Q \ Attach Driller's Log (7126199 DL Form) monIhfdaylyear

In addition to the drlller's/og, If a geologic log was prepared, please submit w1th this fonn.

6. Initial water-level encountered Sf:,' ft. below ground Date and time of measurement 1 'l..-fS- ()O monthlday/ye8r time

,,~ 0 Yes Attach Step-Drawdown Test form (12117197 SDP7D Fonn) 7. Step-Drawdown Test completed?

8. Constant Rate Aquifer Test completed?

Parameters prior to pump test ~ lit' No 0 Yes Attach Constant Rate Aquifer Test tonn (12117197 CRPTD Fotm)

9. Water-level: _~jB!ifi!i!5'l_~~~ ___ ft. above Il,1sl Date and time of measurement ...........

/-22.-01 ~rtime

10. Chloride: 35 ppm Date and time of sampling: 1-2.~-o(

=t"l0 OF 11. Temperature: ____ -t.-+-l(b.~_-_ Date and time of measurement

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

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

14. If a pump is not planned to be installed, please describe (below in the remarks sectiOn) how well is secured to prevent unauthorized access (example:)ockable cover, threaded coupling, rtc.) ,

15. Remarks: ~ \er..) \$.. S &..:? \ \-Ar-:-f W-t' ,\\ $.f ~\

Licensed Driller (pri

Signature

G-57 Lie. No. 4=-- '4 5 '] Date ':1-6- 0 I

Surveyor (print) _S.,.c.;C.=..;:L~ __ -+ ...... --=-_ ........ oo...,;;;:~_ L.P.L.S. Lie. No. ________ _ pleue attach stamped report

Signature Date __________ _

Pennittee (print)

3ignature Date ________ _ . ,

WCR1 Fonn 5I2lOO

/

LINDA LINGLE _cw_

Ms. Gina Zapara Rule21C P.O. Box 720 Kilauea, ill 96754

Dear Ms. Zapara:

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STATE OF HAWAII DEPARTMENT OF LAND AND NATURAl RESOURCES

COMMISSION ON WATER RESOURCE MANAGEMENT . P.o. BOX 621

HONOlUlU, KAWAU 96809

July.!,2oo8

lAURA H. THIELEN -MEREDITH J. CHING JAMES A. FRAZIER NEAl.. S. FUJIWARA

CHIYOME L FUKJNO, M.D. DONNA FAY K. K1Y0SAKI, P.E. LAWRENCE H. "IKE, M.D., J.D.

teeN C. KAWAHARA, P.E. DlPVTYhICTOIO

1224-0I.ccwc

Certificate of Well Construction Completion for Well No. 1224·01 (TMK (4) 5-2.013:001)

The Commission on Water Resource Management (Commission) is pleased to inform you that the Well Construction work permitted for the Gina Well (Well No. 1224-01) is complete and acceptable. We welcome you as a new member of the community of well owners and ground water users in Hawaii.

Please be aware that the Commission's permitting process addresses both well construction and pump installation. The Commission received Well Completion Report Part I for the well on April 16, 2001, and accepted the report on May 3, 200 1. We understand that a pump was never installed. Water from this well may not be used without completing the pump installation permit process. Use of water from this well (for purposes other than testing) without a certificate of pump installation completion is a violation of the State Water Code and is subject to fines of up to $5,000 per day.

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

1. Before this well can be pumped on a regular basis. a certificate of pump installation completion must be obtained,

2. If the well is no~ in use it must be properly capped.

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

4. If the well is to be used, the landowner shall cause the well operator to install and maintain a meter or other appropriate means for measuring and reporting the amount of water withdrawn from the well and water levels. These data shall be measured monthly and reported to the Commission on an annual basis on forms provided by the Chairperson (Annual Ground Water Use Report. attached),

I

o o 13. AS-BUILT WELL SECTION (Please atlach as-buRt /I dllf8t&nt from diagram provided below)

Elevation at top of casing ~ ft., msl" -L.-+_in.

Minimum of'Z Radius & 4" Thick Concrete Pad

Ground Elevation: '3 \ ~ ft., msI (to nearest 0.01 ft.)

Benchmark elevation:

mal" (SUntey to nearest 0.01 ft.)

Total Depth

If'B ft.

Cement (min. 70% of ground elevation to top of water surface or 500 ft., whi!:hever Is less.) ".

Annular Spae8 batwean hol8 and casing {min.3j:

$'n . ~ .. -...

Rock or Gravel Packing:

- ft. Matertal: e Crushed Basalt e Rounded Gravel

*msl = me~'sea level

Please refer to the HAWAII WELL CQNSTRUCDQN AND PUMP INSTALlATION STANDARDS to ensure that your as-bUiIt is in compRance

with applicable standards.

....c.:~ ('-tiiod Bev __ ~ E:))

Nominal Diameter:' '.' • in.

WaD Thickness: ?C \.\ 0 in. Bottom Elevation: 4.d3 -' ft., mal

Open Casing: 9 Screen

length: 40 ft.

Nominal Diameter: 6 in.

Wall Thickness: ~ l{Q In.

Bottom Elevation: q4'3 ft., mal

Open Hole: length: ___________ ft.

Diameter: _______ ~-'-__ in.

Bottom Elevation: ft., msl

Solid Casing Material: .... carbon 8tHl: compliant with (check one or I7l0l8):8 ANSUAW'NA C200 8 API Spec. 5L e ASTM A53 e ASTM A139

And complant with (check one or mot8): e ASTM A242 e Type E e Type S e Grade Be Other Slalnl ... Steel: (check one): 9 ~ A409 (production wells) I) ASTM A312 (monitor wells)

ASS PlastIC conforming to ASTM F480 and ASTM 01527: (Check one) 9 Schedule 40 / 9 Schedule 80

PVC Plastic conforming to ASTM F480 and (ASTM 01785 or ASTM 02241): (check one): ., Schedule 40 9 Schedu~ ~ 9 ;Schedule 120

Thermoset Plastic:: (check one) e Filament Wound Reain Pipe conforming ID ASTM D2996 9 Centrifugally Cast Resin Pipe conforming to ASTM 02997

Qpen calnR MaterIal:

e Reinforced Plaetlc Mortar PresaUI1I P,1pe conforming to ASTM 03517

e Glas Fiber Reinforced Resin PressUI8 Pipe conforming to AVNJA C950 9 PTFE Fluorocarbon Tubing conforming to ASTM D3296 8 FEP Fluorocarbon Tubing conforming to ASTM D3296

Carbon atHl: compliant with (c;heck one or trl'IJ9)~1! ~UAW'NA C200 e API Spec. 5L e ASTM A53 e ASTM A 139 And compliant with (chedc one or 1tioAf,: & ASTM A242 0 Type E 0 Type S 0 Grade B J 0 Other

Stalnl ... StItI: (chtck OM): e ASTM A409 (pIOduction wells) 0~12 (monitor wells) ASS Plastic: conforming to ASTM F480 and ASTM 01527: (check one) 0 Schedule 40 0 Schedule 80

PVC Plutic conforming to ASTM F480 and (ASTM D1785 or ASTM 02241): (chfK;Ic one): Schedule 40 0 Schedule 80 0 Schedule 120 TherrnoMt PIa8tIc: (chedc one) 0 Filament Wound Resin PIpe conforming to ASTM 02998

o Centrifugally cast ~ Pipe c:onfonnfng to AStM 02997 o Rek,lfon::ed Pladc Mortar PAIssure PIpe conforming to ASTM 03517 o Glass FIber ReInforced Resin Pnmu .. PIpe COIIforI'rmg to AWWA C950 o PTFE Fluorocarbon Tubing COrIformIng to ASTM 03296 o FEP Fluorocarbon Tubing conforming to ASTM 03296

(.

o

WELL NUMBER: 1224-01

DRILLER'S LOG (7126199 DL Fonn)

Depths (fl) Rock Description, Water Level,etc. Dates

~ to ~ ~~u;lf\ -~ .... CC2 C \'1 \a..- \4,-00

dJ:L",.£3. f>\\>L.f,fAe-IICk H"..[ ,I

B2to.B& !>naklti\ G(''''i~ck \ \

~ tol:iB (j)\ve. ~QC k ~ )",,-\'3

~to~~tc)\S6\. b(~ &ck _l_~_

J.a tol53 BrGW~ C! \~ _\_' _

~to.2l3 ~\~L ~ek l~ _\_' _ 1/ \ \

~to~?b trou.7~ Q.eOf- C'+( __ ~to~ f("d~ ~\J<rkk \).-J\j

'30B to 331 ~)V~ C¥.ock lkr&. \ I ~to'~ f(~ch)JJ1 ~cK ,\

t \

26.Sto 3 7b_e.=-.1-\4.:.... .... -t-r ___ ~_ , \ '"3 Itlo~ £>\vf. ~c\-( ~ l.JLJ5 tct>rob,<b!. \Lock 1,'5 _ to ________ _

_ to __________ _

_ to ________ _

_ 10 __________ _

Remarks:

o

Depths (ft.) Rock Oesaiption, Water Leve~ etc. Dates

_to ________ _

_to ___________ _

_10 ___________ _

_to ___________ _

_to ___________ _

_to ________ _

_to ________ _

_to ________ _

_to ________ _

_to ________ _

_to ___________ _

_to __________ ----'_

_to ________ _

_to ________ _

_ to ___________ _

_to ________ _

_to ___________ _

_to ________ _

".......

c:omrrr ~ UDAl' PLADIBG DBP.d1'la:atT

C') ZOllIBG PDHIT Al'PLlCATIOil () USB PllHIT.APPLlCATIOR ( ) PRO.JBCT DBVBLOPKD'r un PaJlIT APPLICATIOR ( ) VAIT4 11CB PDltIT APPLlCATIOlI ' ( ), sncIAi. .... rr APP.LlCA'lIOil ( ) SHA PDIIIT APPLlCATIOII

~Icun-+~ ______________ ~ __________ _

..,_ aG. (work) , (h~) L ------------- -------~--

PlaDlliDS Depart1leac Vee OIl 7

ZoraiD& Pend.t 110. " ~1.

Uae Perait Wo. Variance Perait'--I10~.----~-------Special Perait 110. SIIA Pend.t 110. .-------Zoa1D8 Pendt C;::l .. ~.:-,-------Date !tecei".. By Date Appro.ed By-" ,-~~.: --Plaua By Perait l'e.'::e-'$~---':Da""t:-e--:----

Exiatins Land

Tax Map Key Lot NO • ..,;··' __ Lot Size __________ Zoning ______ Use

4PPLICANT IS: (check one) " ,

A. B. C.

Owner of Property _'_' (Holc:iE!r> of at least 75%.0£ the equitable and legal title.) Lessee of Property __ *Number'of Years Leased Frccto Authorized Agent ," Attach Letter of Authoriiation. ---""'"- -----

lIOT!: *Le8see must have an unexpired and recorded leelse of five, (5). years or more from "'~.~./\~!"; •• l-~~*c~;t~:"'ChirrteiW'~) 1iI~tit!fig!! below 'if lea8~' is leas than

five(S) yearsiremaining and/or unrecorded.

DBSCRIPTIOH OF PIlOPOS£» USE, IHPI.OVBMElIT. ALTDATIOH, ABD/OR. COBST1lUCTIOB: (specify exact u.e. number of units, etc.) ____ ~ __ ----------____ --~--------------~~~------~~----

~ I. ,

JOt. VAIUIICB OR USE PllHITS OIlLY'

Conditions justifying Variance or Use Permit application: ~.quired) j,. -'" ;, iT It i~ i 'lj.( !, ',. "

(use additional sheets as

e owner an or saut or1ze representac • prior to coaaencing .erection,construc'tion, installation or place.ent of ,the foundations and/or footings of the improveDients allowed hereunder, and after c01llpu'ance with the foregOing condition. notify the Plannin& Department no later thanS work ina day. to c01lllJlenceme~t of such work, in· order. that the Planning DepartMnt miaht tn. et ande.reif the a ' l1cableand im oiled aetbacks and ache,r zonin re uire ... nta •

• construction, work, Ule,,,()r activity approve in t is permit lb. .u ject to lnapection by the P1annblS Inspector Or authorized' per.onnel of thePl-anning Department. County of Kauai. The appUcant 11 advised that inspection will occur prior to or during construction and u •• to a.certain compliance with the provi.ion. of Ordinance No. 164, as aMnded, (Coaprehen.lve Zoning Ordinance, County of Kauai. and/or o.ther laws which are enforced by the Plannins Department.

Sipature OWner/Applicant

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,.,....., t-\ D~RTMENT OF LAND AND NATURAL RESOU~S

DOCUMENT NO.: UAC OR ATTACHED WORKSHEET DATE: April 11 ,2011

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

S 11 326 C 1026 0752 (1 ) $25.00 Kauai Water Well

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

TOTAL $ 25.00

REMARKS: LINE (1) Gina Well LINE (2)

,~ ~/ 1/ LINE (3 I

LINE (4) LINE (5) LINE (6) LINE (7) LINE (8) LINE (9) LINE (10)

c lIuellen [email protected]

03/31/2011 05:57 PM

To Charley. F [email protected]

cc

bcc

Subject Re: Gina Well (1224-01)

Okay, I misunderstood I thought there was no complete review so I only sent one copy, do you need twelve and 25 $ of course?

-----Original Message-----From: Charley.F.lce <[email protected]> To: IIuellen808 <[email protected]> Sent: Thu, Mar 31,2011 4:11 pm Subject: Gina Well (1224-01)

(We sent a certificate of construction completion in July 2008) The PIPA also requires a review and a filing fee. We have not received the fee nor the circulation copies. Ready to go, otherwise.

STATE OF HAW'-DEPARTMENT OF ~ AND NATURAL RESOURCES • COMMISSION ON WATER RESOURCE MANAGEMENT APPLICATION FOR A WELL CONSTRUCTION I PUMP INSTALLATION PERMIT

For Official Use Only:

R CCi~~':;:~; .~ Ct~i\C

OJ!, ~'T-C'f)

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

2011 MAR 21 PH 12: 48

WELL LOCATION INFORMATION 1. STATE WELL NO. (if already assigned) 12. WELL N~ME

,22,-/ - D\ '" I ;V~'+ 14. TMK -_..5_--.L- /3

sec plat

The following must be attached before this application is accepted as complete: • Portion of 7.S-Minute Series USGS topographic map (scale 1 :24,000) with well location labeled and include the name of the quad map • Property tax map, showing well location referenced to established property boundaries • Photograph of the proposed well site • A schematic diagram showing the well site, access road and proposed well infrastructure • For dug wells, attach a grading plan with cross section profiles Showing existing and finish grades

5. WELL OPERA!9-R'S NAME/COM/ANY I Well Operator's Contact 6. LANDO~E~S ~A~':'9PMPANY OILL.,\jJ 'O(.(.)R>'1 15~g;>1B3il,;-/C,);"~' , )V1I'V,£'-

1 Landowner's Contact

Well operat,~s Mailing.Afre~/ '7""/ f, 1/ ;/_ landowner's Mailing Address

. "1S-q { (:-u ~ \\- 1<-.0{ r---I t.-Iru ~ /;-t f/;f!:1/ ~' Operator's Phone I W~II Operator's ~ax I Well Operator's ~-m~\" Landowner's Phone I landowner's Fax

MB)Jp C(J.oB I~Ae?~rQY#H',"'~ I Landowner's E-mail

PROPOSED WELL CONSTRUCTION PROPOSED PUMP INSTALLATION

0/ parcel

7. 'Proposed WorK 8,: ConStJUctian type 10. Proposed Work 11. Proposed Pump Capacity, '/0 Construct New Well .' 0 Drilled' ..Jit(lnstali New Pump gpm (gallons ~ominute)

13. Method offtow measurement J2f'" Flowmeter

o Modify Existing Well 0 Dug 0 Replace Pump ~L o Abandon/Seal Well 0 Shaft

o Tunnel

9. Is this well part of a battery of wells? 0 Yes ld"'No

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

/fOoo 14. Proposed Surveyor name and license number (a surveyor is required for all Well Construction Permits and may be --_ .. ,

P-l£F~ PROPOSED USE

o 15. Municipal (water systems serving greater than 25 Individuals or 15 service connections) Nole: -fl:!6. Domestic Number of units to be served: I o 17. Industrial (describe)

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

o Other (explain)

o 19. Military (describe) Ii ( 020. Other (describe) l il1~ ~ ()'"L OTHER LEGAL REQUIREMENTS If required, items 21. and 22. must be obtained before the C ~ (j , 21, Conservation DIstrict Use Permit (COUP) 22. Special Management j J: I\...() o Well is in Conservation District 0 Required, SMA # __ tLi-n ~

o Required, COUP # date approved 0 Not Required (attach do o Not Required (attach documentation from OCCL) o I have not checked with OCCL about whether or not a COUP is required. 0 I have not checked with

o Well is not in Conservation District

l"eI have not checked if well is in or out of Conservation District.

23. State Historic Preservation Division (SHPD) of the Department of Land and Natural Resources

3b-, I r,

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

Vi have nol consulted with the SHPD regarding potential impacts of well construction activities on historic sites.

24, Chapter 343 o An Environmental Assessment was completed, and

o An Environmental Impact Statement was required and has been accepted (attach letter of acceptance). Publication date in The Environmental Notice: ___ _

o A Finding of No Significant Impact has been determined (attach letter). Publication date in The Environmental Notice: ___ _ This project proposes: o Use of state or county lands, or use of state or county funds o Use within a state conservation district o Use within a shoreline setback area o Use within a national or Hawaii registered historic site o Use within the Waikiki Special District o The construction, expansion or modification of helicopter facility


o A wastewater treatment unit o Waste-t<Hlnergy facility o Landfill o Oil refinery o Power-generating facility ~ None of the above 11 items

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

NOTE: Signing below indicates that the signatOries understand and swear that the information provided is accurate and true to the best of their knowledge. Further, the signatories understand that upon permit approval: 1) the proposed work is to be completed within two (2) years of the approval date; 2) the contractor shall submit to the Commission a well completion/abandonment report within 60 days after the completion date of the permitted work; 3) in the event that the application is not completed correctly, any permit may be suspended until the item is brought in to compliance, and any work done while the permit is in suspension may result in fines of up to $5000/day.

Signature Print Date

27. PUMP I~ST ~LLER (Must be fill7 if application is for Pump Installation)

J:Au1{' IIJIWt!2 ~ ~ C!--7-9 S-78 liCe .... ~ n.me iii C-57~7.'A U,en .. No.

'f\f\ U .. i:;MJjVlelj~ ~-f-/I

Si9;d)~~ L/3/ ;C:,Io~d 9t:~;;

26. WELL DRILLER (Must be filled out if apppcation is for Well Construction)

i/" . /1 /A. /.'1 J" / I /" ...., ..... . (Aft..-..., <:.- >:. l;:: .£.- 7 ::> / K

Licensee business name C-57 License No.

Address

Phone Fax E-mail

WCPI Application Form 08/3112010

...<'"

uJ~~~ 'I!0 '3 Pr"---K- .

(a~WJ ~r~r Please attach schematic if different from diag

Hole Diameter: in.

Elevation at top of casing __ ft., msl*l_ r c,- Minimum of 2' Radius & 4" Thick Concrete Pad (to contain benchma . )I surveyed to nearest 0.01 ft.)

i.1 .":4. ~ ~ ~.': r Ground Elevation: ft., msl* • :<11

~1111<'\ ..... . .. 17~\ ~ ".0." '.~: " Please refer to the · ..

Cement Grout: ft. ~'.: ~-: BAWAll WELL CONSTRUcnON AND

(min. 70% of distance from :. f- ::"::. ground elevation to top of

~.:.: !-.': PUMP INSTALLATION STANDARDS :-: ;. .:1Jl' to ensure that your as-built is in compliance with water surface or 500 ft., ~:!: ~:1:: whichever is less.) 0,,4; applicable standards. ..... . .... ',',- ..

- · .. :.4°, • i.'.: .'.

Grouting method: Annular space between hole :. ~ :. ~.

Solid Casing: (~ 90% x (Ground Elev.-Water Level Elev» 'A.',: ~~.~ and casing (1.5" for positive o Positive .:-: ;.

Total Length: ft. displacement, 3" for other fA ~::: displacement methods): :.6:

Nominal Diameter: in . .•.. .... . ... o Other V .4 •• • A ••

i.'':" ;.',:6. Wall Thickness: in. in. - :. ~. :. ~. ~:.: 4. -:. Bottom Elevation: ft" msl*

-' f-

I :: ;.

Rock or Gravel Packing: ~ Total Depth ft. fl

Open Casing: o Perforated o Screen ---,

~ ft. Material:

o Crushed Basalt ~ Total Length: ft.

o Rounded Gravel ;; / Nominal ~iameter: in. ,.,.

Wall Thickness: in. -,. ~) ~ Estimated Water Level ;J, Bottom Elevation: ft., msl* ~ Elevation: ~ -l,--- ~---' note: Neither bentonite nor mud should be used in -

ft. msl* saturated zone during drilling

Open Hole:

Length: ft.

~iameter: in.

- Bottom Elevation: ft., msl*

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

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

Bottom Elevation of Well Limit = (Water Elevation _ 41 x Water ~ E!eyatjop )

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

Material: mpliant with (check one or more): 0 ANSI/AWWA C200 0 API Spec. SL o ASTM A53 0 ASTM A 139

compliant with (check one or more): 0 A~TU A",A , o Type S 0 Grade B

ASTM A312 (monitor wells)

o 0 Schedule 80

o Other

Stainless Steel: (check one): 0 , ABS Plastic conforming to ASTM F480 and ASTM 01

PVC Plastic conforming to ASTM F480 and (ASTM 0 o Schedule 40 0 Schedule 80 0 Schedule 120

Thennoset Plastic: (check one)

Material:

o Filament 1/\

o Centrifugal

o Reinforced

o Glass Fibel

o PTFEFluor

12996

02997

I to ASTM 03517

ning to AWWA C9S0

296

o FEP FluorOl __ ._ .. ,"UII'\:I COnforming to ASTM 03296

pliant with (check one or more): 0 ANSI/AWWA C200 0 API Spec. SL 0 ASTM A53 0 ASTM A139

'-~lU.IiIamlpliant with (check one or more): 0 ASTM A242 (or A606) 0 Type E 0 Type S 0 Grade B 0 Other


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

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

Thennoset Plastic: (check one) 0 Filament Wound Resin Pipe conforming to ASTM 02996

o Centrifugally Cast Resin Pipe conforming to ASTM 02997


o Glass Fiber Reinforced Resin Pressure Pipe conforming to AWWA C9S0

o PTFE Fluorocarbon Tubing conforming to ASTM 03296

o FEP Fluorocarbon Tubing conforming to ASTM 03296

rk

WCPI Application Form 08131/2010

",..... 0 '-' "-

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1 .'- . :~<: ~ . @f .. t i h " ~Wt}t~fF~ ~ lii ,.~. 0

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o State of Har 'lii COMMISSION ON WATER RESOURCE MANAGEMENT Department of Land and Natural Resources



/

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. Hawail96809. The Commission may D 1 APi: 16 p 2: 3 2 not accept incomplete reports. This form shan be submitted within 60 days of the completion of work. For assistance, please consult the HawaH wen Construction and Pump InstaDation Standards or caD the Regulation Branch at 587-0225. For updates to this form or additional information, please visit our website at http://www.state.hi.usldlnrfcwrml:!:. ,',' ' " I,:' ""c::

.. ,~ ... '.~

1. State Well No.: 1224-01 Wall NarTla: -=G::.;in=a=--__________ Island: Kauai

2. Address: 4591 Kuawa Rt!. ... Tax Map Key: --=:.5--=2~-1:.::3~:O;;..:1~ _____ _

3. Drilling Company: VA SiS t.=? M:~ S'f*'"" \I\Cr 4. If drilled. type of Rig: tf{ Rotary 0 PercussIon

5. Date Well Construction (drilled,cased.grouted) completed: 1- 2)- 0 \ Attach Driller's Log (712&f99 DL Form) monlhldaytyear

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

6. Initial water-Jevel encountered Sb I ft. below ground Date and time otmeasurement 1 'l--rS-OD

7. Step-Drawdown Test completed?

8. Constant Rate Aquifer Test completed?

mon1h/daylyeaT time

m' ~o 0 Yes Attach Step-Drawdown Test form {12117197 SDPTD Fonn}

rifNo 0 Yes AttlH:h constant Rate Aquifer Test tonn (12117197 CRPTD Fotm)

Parameters prior to pump test "- -J.-' 9. Water-level: _Jw!iit;=5.. -~~~i--- ft. above I"Dsl Date and time of measurement

............. 1--2 2.-0/

mon1h/dayiyear time

10. Chloride: 35 ppm

:::or"\ 0 11. Temperature: ____ -L-4-""~u-_-- OF

Date and time of sampling:

Date and time of measurement

j-ZZ--o( monthlday/)'ear lime t - "Z.:Z .. ,.... CO' ,

month/daylyear time

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


14. If a pump is not planned to be installed, please describe (below in the remarks section) how well is secured to prevent unauthorized access (example:)ockable cover, threaded coupling. ,etc.) ;

15. Remarks: ~\er\)" S&t=?' ~ v..x A\, S-f~

Licensed Driller (pri C-57 Lie. No. 'd=... \ 4 51 Signature Date J..!- 6- 0 ,

Surveyor (print) _S~.=::e:.:;";:::~=----l~;...l...I~:"""";:;;;;,.,..x.~=.:lL,;.,_ loP.L.S. We. No. _________ _ plesse attach stamped report

Signature Date ________________________ __

Permittee (print)

6ignature • t

Date ________ _ :~ ; ,

WCR1 Fotm 5/2/00

j

o o 13. AS~BUILT WELL SECTION (Please attach as-built If different from disgram provided below)

Elevation at top of casing ~ fl, msl" Hole Diameter: ,'-\ in.

Minimum of 2' Radius & 4" Thick Concrete Pad

Groond Elevation: '3 \ '"\ ft., msl

(to nearest 0.01 ft.)

Bench mark elevation:

Total Depth

tt'f?J ft.

Cement Grout =.:::;.J,+-.'~ (min. 70% of dlstctnce ground elevation to top of water surface or 500 ft., whichever is less.) ,

Annular spaee batwean hole and casing (min.3''): .

~In:.


- ft. Material: 9 Crushed Basalt 9 Rounded Gravel

*msl = mean 'sea level

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

with applicable standartls.

~--l Solid Casing: (~90% x (Ground Elev.-Water level Elev»

Length: if~. ft.

Nominal Dlameter:·_..r;~~·I.-..-=·--:-_____ In.

Wall Thickness: :;;c...~ '-\ 0 in.

Bottom Elevation:_4.~Q~·..::S=-____ ft., mal

Open Casing: 9 Sereen

Length: 4=Q ft.

Nominal Diameter: ~G~-~----- in.

Wall Thickness: ~ 4.0 In.

Bottom EI~vatlon:_~_~~::;.. ____ ft., msl

Open Hole: length: ___________ ft.

Olameter: ______________ in.

Bottom Elevation: ft., msl

Solid Casing Material: carbon Steel: compliant with (check one or more):9 ANSIIAWWA C200 a API Spec. 5L e ASTM A53 e ASTM A 139

And compliant with (check one or more): e ASTM A242 e Type E 9 Type S e Grade Be Other Stainless Steel: (check one): (I AS~ A409 (production wefls) a ASTM A312 (monitor wells)

ABS PlastIC conforming to ASTM F480 and ASTM 01527: (CheCk one) e Schedule 40 / 9 Schedule 80

PVC Plastic conforming to ASTM F480 and (ASTM 01785 or ~ 02241): (check one): ,",Schedule 40 9 Scheduf'18Q. Q .schedule 120

Thennoset Plastic: (check one) e Filament Wound Resin Pipe conforming to ASTM 02996

e CentrifugaUy Cast Resin Pipe conforming to ASTM 02997

Open Casing Material:

9 Reinforced Plastic Mortar Pressure Pipe conforming to ASTM 03517

a Glass Fiber Reinforced Resin Pressure Pipe conforming to AWWA e950 e PTFE Fluorocarbon Tubing conforming to ASTM 03296

B FEP FluorotarbOn Tubing conforming to ASTM 03296

Carbon Steel: compliant with (chen:lcOIlfl ormore}:O ANSIIAWWA C200 eAPI spec. 5L a ASTM A53 e ASTM A139

And compliant with (check one or mote); e ASTM A242 0 Type E 0 Type S 0 Grade B 0 Other

Stainless Steel: (check one): 0 ASTM MOO (production wells) 0 AtS12 (monitor wens) ASS Plastic conforming to ASTM F480 and ASTM 01527: (check one) 0 Schedule 40 0 Schedule 80

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

ThelTT103et Plastic: (check one) 0 Filament Wooncl Resin Pipe conforming to ASTM 02996

o Centrifugally cast Resin Pipe conforming to ASTM 02997


o Gla~s Fiber Reinforced Resin Pressure Pipe conforming to AWWA C950




DRILLER'S LOG (7/26/99 DL Form)

Depths (ft) Rock Description. Water Level,etc. Dates

~ to 2..Q (O~'"' -r;;...~tL c \'1 $).;' ~-oo '"' ~to..83. f>\\Je..6rA~ock ~'---_

B.2..to~ \?t~Ke .... Gr~f~k. \ \

KtoBB §)\ve '¥,oc. k \t~ $,-\'3

~ to.l§.L <i>tU\sC .... (Q(~1 ~ -~-~-

121-10 1.S3 £tOUJ ~ e ~.,...., _\_' _

~to~ ~\~e. ~ck l~ _\_' _ 1/ \ \

2.13 to ??b ~t\)uJ r.J Qed£.. C. \+f ~G to 309 f(1tC+~ ~ug. ~ \).-llj

'30Bto~ ~)ye. ~ock 1hoc& _l_'_ ~IO'3fJ3 6~ch)/Jl ~cK

.... , 1\

2..6.S to '$7 O----=:C-...L\4-.:... ..... +f ______ _ 1\

'3 /~o~ £>\ve. ~cK ~ 445 f(~r<bL ~ck 10/"15 __ 10 __________ _

___ 10 ____________________ _

___ 10 __________ _

__ 10 ____________ _

Remarks:

o

Depths (fl) Rock Description. Water Level. etc. Dates

__ to ________ _

__to ________ _

__ to __________ _

__ to ___ - ________ _

__ to ___________ _

__to __________ _

__to __________ _

__ to __________ _

__ 10 __________ _

__10 ________ _

__ 10 __________ _

__to ________ _

__ 10 __________ _

__ to ________ _

__ to ________ _

__to __________ _

__ to __________ _

__10 __________ _

", \\\

\\\ :.' ,~\ .... , .'

" .I ,'I j' 'L. ~ VI.;' \, \ .r 'l \~\ ~.\

\ ,

\ \ \ , \1 I I

U1T13+1O (.:.t.'-

ir ,: :.

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Z· .... '\ :: . ~)?

'.' CI{'l~'s~V W.

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...

';.tIJ)O' , :. '/ ~~ " .

V~ LOT le-6-1I; \_i I . "-',,::::' ~ ""' .... 1:S.zn J.w:rfH~ '. J

",.\\ ( .::::.. ~ 1v'1IG.~!06 lou.. . :L: .----.. ~ .... ,(''''-... ... _ !~_. . . , .••. ~;.r~~. ')

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Lor 1').,....

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~...,,""" ,,' . ........ _'1111. //J"-:!!':'."HI-'_ /' / :':;:"~_H too _'-'-/ ..-

~,,,,.,,,,,,,, ./ ./ -.

\ ~"'I ~ - / ~ \Oi\ • . ___ rrt::.;: /' '

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, '~~ .• -.-.... _ 'r'"J" /' • . - , 1'(' (--r·r ( ...... """ .... ,I

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~101{ -- JIQ'l'-JI::lO' .~:,,, ~_-: .. ':;';-,f~ :;. . ~C& '" ,,,..,t1J ~", .. ~ """

»0- t ~~. _:,., 'OJ ...r::;:::<' ...... , ,

4- ~!;;;::- '" ~ .~!~'" ~ , .... ~~:..;! .\

tor t.l

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t"l 11,,1\ • I L.OT \5-13-11 .{ 1<1~AUt:A Pl.-ANi AriON SUeDIYI510N

~ AT KI~A, HALaUo, KAlJAI. HAMAl! ItJO 0 W XXI 4tXl ~---- : .

~iIt 'lGAI..t " FfEf 1,l'csota.n:) ..... ""'.."..,,.. .... '1 'fi""".l ~

.!doI"') .... "-1'" ,. 'ft"""" "-_ "J,J'\.._~ r.\...-fht1 ... '11r1 ~~~~~

~~~,lttc" .......... " _ .... IIU <-J_nu

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I.ftiB2 "~It: FD. -1'lCUO eM- eurHA!: ~-1P-IIl'1L11'Y~ ~~

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P:

~ ___ """'M 1H:etHr'~

=~I.<n:I~ ----.11.0.""''' """'''.''': .:s.I

:

\ I I

\ I

LINDA LINGLE GOVERNOR OF HAWM

Ms. Gina Zapara Rule 2IC P.O. Box 720 ~ue~fU 96754

Dear Ms. Zapara:

o o

STATE OF HAWAII DEPAR7MENT OF LAND AND NATURAl RESOURCES

COMMISSION ON WATER RESOURCE MANAGEMENT P.o. BOXS21

HONOLULU. HAW AU !l68OS

July.!,2008

MEREDlTH J. CHING JAMES A FRA2JER NEAl S. FUJIWARA

CHIYOME L FUKlNO. M.D. DONNA FAY K KlVOSAKl. P.E. LAWRENCE It MIlKE. M.D .• J.D.

KEN C. KAWAHARA, P.E. DbVn'bltecTOfl

1224-0J.ccwc

Certificate of Well Construction Completion for Well No. 1224-01 (TMK (4) 5-2-013:001)

The Commission on Water Resource Management (Commission) is pleased to inform you that the Well Construction work pennitted for the Gina Well (Well No. 1224-01) is complete and acceptable. We welcome you as a new member of the community of well owners and ground water users in Hawaii.

Please be aware that the Commission's permitting process addresses both well construction and pump installation. The Commission received Well Completion Report Part I for the well on Apri116, 2001, and accepted the repon on May 3,2001. We understand that a pump was never installed. Water from this well may not be used without completing the pump installation permit process. Use of water from this well (for purposes other than testing) without a certificate of pump installation completion.is a violation of the State Water Code and is subject to fines of up to $5,000 per day. "

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

1. Before this well can be pwnped on a regular basis. a certificate of pUmp installation completion must be obtained.

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

3. If the well is to be abandoned then the landowner must cause a licensed contractor to apply for a well abandonment pennit in accordance with §13-168-l2(f) prior to any well sealing or plugging work.

4. If the well is to be used, the landowner shall cause the well operator to install and maintain a meter or other appropriate means for measuring and reporting the amount of water withdrawn from the well and water levels. These data shall be measured monthly and reported to the Commission on an annual basis on forms provided by the Chairperson (Annual Ground Water Use Report. attached).

I

o Charley F To [email protected]

• Ice/DLNRIStateHiUS cc

03/04/2011 03:11 PM bcc

Subject Bill Mowry

We see that the parcel owner is now Mowry Trust. If there's any way, we'd like to have Gina Zapara of Aloha Associates or "Rule 21 COl transfer ownership. A simple letter like the one she sent last time is fine.

Search Results

o Page 1 of 1

Search criteria: TMK Taxkey 4-5-2-13-1

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

re4-5-2-13-1 Kilauea F 4591 MOWRY, 4 4 13.23 ac 6,306 12/28/2004 QD $10,OO( Plantation Subd KUAWA WILLIAM F LIV 1/2

RD TR/ETAL

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

Copyright ©6/6/2011 by Hawaii Information Service

http://web08.hawaiiinfonnation.com/REsearch/HIS/Search/search ]UB.asp?NOCACHE= 1307417314718 6/6/2011

• c

Char1ey F Ice/DLNRIStateHiUS

03/04/2011 02:47 PM

To [email protected]

cc Roy Hardy/DLNRIStateHiUS@StateHiUS

bcc

Subject Fischer, Gina Wells

We received two pieces of paper, a signed WCP for 1326-04 (Fischer), which we think means you're taking over for Valley Well Drilling; and one page of a PIP application for the 1224-01 (Gina), which had been approved, but expired and cancelled back in 2003.

1) 1326-04 Kalihiwai-Fischer: the way to assume responsibility for this work is to have the well owner send us a notice that they have selected a new contractor (you), and for you to sign the original application (not permit), to indicate you know what specs were approved. If they cannot find a copy of the original application, we can provide it.

2) 1224-01 Gina Well: this was completed by Steve Goldberg back in 2001, but no pump was ever installed, and no pump tests conducted. Pump installation will require a full application and review. A new PIP would normally carry the special condition that you conduct the required pump tests, but in this case, at 44 gpm, no pump tests would be required.

We have transferred the well ownership to Gina Zapara. Where does Bill Mowry fit in?

o

~~ STATE OF HAW~ 1.. ~ ~ DEPARTMENT OF !WD AND NATURAL RESOURCES 0

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


Instructions: Please print in ink or type and send completed application with attachments to the Commission on 2811 MAR -4 AM 9: 54 Water Resource Management, P.O. Box 621, Honolulu, Hawaii 96809. Application must be accompanied by 10 copies and a non-refundable filing fee of $25.00 payable to the Dept of Land and Natural Resources. The Commission may not accept incomplete applications. For assistance, call the Regulation Branch at 587-0225. For further information and updates to this application form, visit http:/twww.hawaii.gov/dlnr/cwrm.

WELL LOCATION INFORMATION

~- Z- --L3: zone sec plat

1. STATE WELL NO. (if already assigned) 12. WELL NAME

J 2.2-t-/ -0 J G.,/~4 3.ISLAND ,

KIkl£4( 14.™K 0)

parcel

The following must be attached before this application is accepted as complete: • Portion of 7.S-Minute Series USGS topographic map (scale 1 :24,000) with well location labeled and include the name of the quad map • Property tax map, showing well location referenced to established property boundaries • Photograph of the proposed well site • A schematic diagram showing the well site, access road and proposed well infrastructure • For dUD wells, attach a gradina plan with cross section profiles showing existing and finish grades

5. WE~PERATO~ NAME/~PA'Y I Well Operator's Contact 6~DOWNER~NAMElC~~ANY I ~~er's Contact

~lLi..,( '/Ou..JICV '7~808-1f6..:JtJ2.g HLL pla.AJ~y 1~&B-~~-7t>28

Well Operator's Phone I Well Operator's Fax I~~I~ ~~tor's E-mail Landowner's Phone I Landowner's Fax I Landowfier's E-mail

$D~-4lk ... q1-og --.- !Sf/1Ii?28@y~.esxIJ ~-IJ2.k-9u)Co - ~fYl¥J;fIId:>.~ PROPOSED WELL CONSTRUCTION PROPOSED PUMP INSTALLATION 7. Proposed Work I 8. ~ .,

D Construct New Well ~ ~llIIed D Mod~' Existing WelD Dug D Abandon/Se ell D Shaft

D Tunnel

~s well part of a battery of wells? DYes D N~

10. Proposed Work IZ Install New Pump D Replace Pump

11. Proposed Pump Capacity, gpm (gallons per minute)

~.~ 12. Proposed Amount of Withdrawal,

gpd (gallons per day)

3.000

13. Method of flow measurement )!f Flowmeter D Other (explain)

14. Proposed Surveyor name and license number (a surveyor is reqUi~ for all Well Construction Pennits and may be required for some Pump Installation Pennits)

AJ.14 , PROPOSED USE

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

0' 16. Domestic Number of units to be served: I

D 17. Industrial (describe)

D 18. Irrigation (describe aop and no. of acres)

D 19. Military (describe)

D 20. Other (describe)

OTHER LEGAL REQUIREMENTS If required, items 21. and 22. must be obtained before the Commission can legally issue a permit: 21. Conservation District Use Permit (COUP) 22_ Special Management Area Permit (SMAP) D Well is in Conservation District D Required, SMA # date approved

D Required, CDUP # date approved D Not Required (attach documentation from applicable Coun-ty-ag-e-n-cy-"")

D Not Required (attach documentation from OCCL) D I have not checked with OCCL about whether or not a CDUP is required. 9-' have not checked with the county about whether or not an SMA Pennit is required.

D Well is not in Conservation District

.LJ1"have not checked if well is in or out of Conservation District.

23. State Historic Preservation Division (SHPD) of the Department of Land and Natural Resources D I have consulted with the SHPD regarding potential impacts of well construction activities on historic sites. I have attached applicable documentation from the HPD.

Q'- I have not consulted with the SHPD regarding potential impacts of well construction activities on historic sites.

24. Chapter 343 D An Environmental Assessment was completed, and

D An Environmental Impact Statement was required and has been accepted (attach letter of acceptance). Publication date in The Environmental Notice: ___ _

D A Finding of No Significant Impact has been determined (attach letter). Publication date in The Environmental Notice: ___ _

This project proposes: D Use of state or county lands, or use of state or county funds D Use within a state conservation district D Use within a shoreline setback area D Use within a national or Hawaii registered historic site o Use within the Waikiki Special District 1;:;1 The construction, expansion or modification of helicopter facility


D A wastewater treatment unit D Waste-to-energy facility D Landfill D Oil refinery o Power -generating facility D None of the above 11 items

Additional remarks, explanations, etc. ~h additional sheet if more space is needed)

-J~,",p ji.t~~~ -fbrtf// -1~r IJ-:1 33t,' NOTE: Signing below indicates that the signaJbries understand and swear that the information provided is accurate and true to the best of their knowledge. Further, the signatories understand that upon permit approval: 1) the proposed work is to be completed within two (2) years of the approval date; 2) the contractor shall submit to the Commission a well completion/abandonment report within 60 days after the completion date of the permitted work; 3) in the event that the application is not completed correcUy, any permit may be suspended until the item is brought in to compliance, and any work done while the permit is in suspension may result in fines of up to $5000/day.

2~. ~ELL DRILL.,R (Must be filled,yu' if a~plication is for Well Construction)

K,(\fAII~:r ~t.( DIU L 27. PUMP INSTALLER (Must be lied out if application is for Pump Installation)

fA{)/{ ~ W/nPi W tJ - 9 S-C-57 License No. licensee business name

I = 7t~( ,:to .t.B1 ~~ ;m4I-Vfo( -- /Lua/uJa:a()/ic( ~ ~

Print Date Signature

Address

Phone Fax E-mail Phone Fax E-mail WCPI Application Form 0813112010

LINDA LINGLE GOVERNOR OF HAWAII

Ms. Gina Zapara

o




July 1,2008

Aloha Associates 2000, LLC P.O. Box 720 Kilauea, Hawaii 96754

Dear Ms. Zapara:

Transfer of Well Ownership for Gina Well (Well No. 1224-01)

LAURA H. THIELEN CHAIRPERSON

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

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

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

KEN C. KAWAHARA, P.E. DEPUTY DIRECTOR

We acknowledge receipt of your letter dated June 6, 2008', informing the Commission on Water Resource Management of the transfer of the Gina Well (Well No. 1224-01), located within Tax Map Key 5-2-13:01. We understand the transfer is from Aloha Associates 2000, LLC to Rule 21C. We will keep your letter and a copy of this letter in our files for future reference. We are also sending a certificate of well construction completion to the new owner, Rule 21e.

Thank you for providing the information. If you have any questions, please call Denise Mills at (808) 587-0251 or toll-free at 274-3141 (Kauai), extension 70251.

DN:ss

c: Rule 21C Kauai Department of Water Oasis Water Systems, Inc.

Sincerely,

~~w HARA,P.E. Deputy Directo

/


Ms. Gina Zapara Rule 21C P.O. Box 720 Kilauea, HI 96754

Dear Ms. Zapara:




July!, 2008

LAURA H. THIELEN CHAIRPERSON

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

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

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

KEN C. KAWAHARA, PE. OEPUTY DIRECTOR

1224-01.ccwc

Certificate of Well Construction Completion for Well No. 1224-01 (TMK (4) 5-2-013:001)

The Commission on Water Resource Management (Commission) is pleased to inform you that the Well Construction work permitted for the Gina Well (Well No. 1224-01) is complete and acceptable. We welcome you as a new member of the community of well owners and ground water users in Hawaii.

Please be aware that the Commission's permitting process addresses both well construction and pump installation. The Commission received Well Completion Report Part I for the well on April 16, 2001, and accepted the report on May 3, 2001. We understand that a pump was never installed. Water from this well may not be used without completing the pump installation permit process. Use of water from this well (for purposes other than testing) without a certificate of pump installation completion is a violation of the State Water Code and is subject to fines of up to $5,000 per day.

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

1. Before this well can be pumped on a regular basis, a certificate of pump installation completion must be obtained.

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

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

4. If the well is to be used, the landowner shall cause the well operator to install and maintain a meter or other appropriate means for measuring and reporting the amount of water withdrawn from the well and water levels. These data shall be measured monthly and reported to the Commission on an annual basis on forms provided by the Chairperson (Annual Ground Water Use Report, attached).

· Ms. Gina Zapara Page 2 July 1,2008

o

5. In the event the landowner and/or the well operator changes, the Commission shall be notified of the change prior to the change and all forms shall be transferred to the new owner or operator.

6. In the event the benchmark in the concrete base of the well is altered in any way, an updated elevation survey (page 5 of the Well Completion Report Part I) shall be submitted to the Commission.

The Application for Pump Installation form, Well Completion Report Part I and Part II, and the Annual Ground Water Use Report form can be obtained by contacting the Commission's staff or on the Internet by going to www.hawaii.gov/dlnr/cwrmlforms.htm.

Because groundwater in Hawaii is a public trust, and adverse effects at one well may affect other water resources, any violation of the above conditions or any other provision of the Water Code and Hawaii Administrative Rules, may be subject to fines of up to $5,000/day. The Commission needs your help and asks that you to do your part in using this shared resource. We prefer to work with you in meeting the goal of protecting our ground water resources together.

If you have any questions, please contact Denise Mills of the Commission staff at 587-0251 or toll-free at 274-3141 (Kauai), extension 70251.

DN:ss End: Water Use Report Forms

c: Aloha Associates 2000, LLC Kauai Department of Water Oasis Water Systems, Inc.

' ..

~ l '. t "' f ~~ COM .... SSION ON WATER RESOURCE MANAG'_J,ENT (06/08)

FROM: ROY DATE: JUN 1 7 2008 SUSPENSE DATE: --------- ------- -----------TO:

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

~ HARDY,R. ~ HOAGBIN, S.

ICE,C. IMATA, R

A KAWAHARA, K. KIMURA, J.

L M~U." I U>.~

INIT. TO:

KUNIMURA L LEROUX, E. MILLS, D. OHYE, L. OHYE, M.

__ OSHIRO, K.

•

SAKODA,E. , '," == SWANSON, S. _' __ TORRES, R

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

INIT: FOR:

-z.. Approval 4' Signature

Information

PLEASE:

See Me Review & Comment

--.L Take Action ..... c..J..t '1 Type Draft C-vJA

-- '\ ~ Type Final ~-<..

File ~. __ Xerox _ copies

\.. c Aloha Associates

POBox 720 Kilauea, HI 96754 OB JUN 17 A 9: 4 4

Tel 808-828-0944 Fax 808-828-0923

June 6, 2008

State of Hawaii Department of Land & Natural Resources Commission on Water Resource Management PO Box 621 Honolulu, HI 96809 808-587-0218

Re: Gina Well (Well No. 1224-01)

I request the transfer of Gina Well (Well No. 1224-01) to:

Rule 21C PO Box 720 Kilauea, HI 96754

Attention: Gina

Ifpossible make the transfer effective 1/1/2007.

Should you have any questions please call 828-0944

/



COMMISSION ON WATER RESOURCE MANAGEMENT

CERTIFIED MAIL

P.O. BOX 621 HONOLULU, HAWAII 96809

July 2,2003

RETURN RECEIPT REQUESTED

TO: Aloha Associates P.O. Box 720 Kilauea, HI 96754 Attn: Gina

I REVOCATION OF WELL CONSTRUCTION PERMIT Previously issued on May 14,2001, for

Gina Well (Well No. 1224-01) Kuawa Road. Kauai. Hawaii

PETER T. YOUNG CHAIRPERSON

MEREDITH J. CHING CLAYTON W. DELA CRUZ CHIYOME L. FUKINO, M.D.

BRIAN C. NISHIDA HERBERT M. RICHARDS, JR.

ERNEST Y.w. LAU DEPUTY DIRECTOR

Ref: 1224-0 1 cancel.let

On May 14, 2001, the Commission on Water Resource Management issued you a permit to construct and test Gina Well (Well No. 1224-01) within Tax Map Key 5-2-13:01 for domestic use. The permit was valid for two years from the May 3, 2001 approval date and required that a well completion report be submitted within 60 days after completion of the well.

We understand, from a May 21,2003 telephone conversation with Gina, that the subject well was never constructed. Accordingly, because the well was not constructed within the allowable period, which has now expired, the permit should be revoked.

You are hereby notified in accordance with Administrative Rule 13-168-12(k) that the permit to construct the above-mentioned well shall be revoked within 60 days of the date of this letter unless you can show good cause that it should not be revoked. In the meantime, your well should be properly capped so that pollutants cannot enter your well.

If you have any questions, please contact Lenore Nakama at 587-0218 or toll-free at 274-3141, extension 70218.

Sincerely,

~k~

LN:ss

c: Steve Goldberg, Oasis Water Systems

ERNEST Y.W. LAU Deputy Director

,


CERTIFIED MAIL

..... :




August 14, 2003

RETURN RECEIPT REQUESTED

Aloha Associates P.O. Box 720 Kilauea, HI 96754

Attn: Gina

REVOCATION OF PUMP INST ALLA TION PERMIT Previously issued on May 14, 2001, for

Gina Well (Well No. 1224-01) Kuawa Road, Kauai, Hawaii

PETER T. YOUNG CHAIRPERSON

MEREDITH J. CHING CLAYTON W DELA CRUZ . CHIYOME L. FUKINO. M.D.

BRIAN C. NISHIDA HERBERT M. RICHARDS, JR

ERNEST YW LAU DEPUTY DIRECTOR

Ref:1224-01 revoke pip

This follows our July 2,2003 letter in which we erroneously notified you of the expiration of the well construction permit, rather than the pump installation permit, for Well No. 1224-01. We apologize for any confusion that this may have caused.

On May 14,2001, the Commission on Water Resource Management issued you a permit to install a 30 gpm capacity, or less, pump in the Gina Well (Well No. 1224-01) within Tax Map Key 5-2-13:01 for domestic use. The permit was valid for two years from the May 3, 2001 approval date and required that a well completion report (Part II) be submitted within 60 days after installation of the pump.

We understand, from a May 21, 2003 telephone conversation with Gina, that the pump was never installed in the well. Accordingly, because the pump was not installed within the allowable period, which has now expired, the permit should be revoked.

You are hereby notified in accordance with Administrative Rule 13-168-12(k) that the permit to install a permanent pump shall be revoked within 60 days of the date of this letter unless you can show good cause that it should not be revoked.

If you have any questions, please contact Lenore Nakama at 587-0218 or toll-free at 274-3141, extension 70218.

LN:ss

Sincerely,

~/w~ - -ERNEStV.W. LAU

Deputy Director

c: Steve Goldberg, Oasis Water Systems

BENJAMIN J. CAYETANO GOVERNOR OF HAWAII

Mr. Steve Goldberg Oasis Water Systems P.O. Box 535 Kilauea, HI 96754

Dear Mr. Goldberg:

-GILBERT S. COLOMA-AGARAN




May 14, 2001

Pump Installation Permit Gina Well (Well No. 1224-01)

~ ~ ~ "',.t.~J .Ill( -( "\

C ..... IRPERSON

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

HERBERT M. RICHARDS. JR.

L1NNEL T. NISHIOKA DEPUTY DIRECTOR

1224-01.pip

::Y'~~ .'j.~\' Enclosed are two (2) originals of your approved Pump Installation Permit fc 3

permanent pump installation work for your well(s). As part of the Chairperson's approval, the following special conornons were added and are part of your permit under Permit Condition 11:

Special Conditions

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

The permittee, well operator, and/or well owner are responsible for all conditions of the permit. This includes ensuring that the pwmp installation contractor submits a completed Part II of the Well Completion Report form (enclosed) within sixty (60) days after the pump installation 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.

Please sign and have the landowner sign both permit originals and return one for our files. A copy of the Well Completion Report (Part II) and a copy of your water use report form are enclosed for your use.

IMPORTANT - Pump installation shall not commence until a fully signed permit is returned to the Commission. 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 as of May 3, 2001.

If you have any questions, please call Lenore Nakama of the Commission staff at 587-0218 or toll-free at 274-3141, extension 70218.

Enclosure c. Aloha Associates 2000 LLC

Aloha,

0V8J.OXdY/ U ~~ERT S. COLOMA-AGARAN Chairperson

- PUMP INSTALLATION PERMlk ..., Gina Well. Well No. 1224-01 'WII

I • 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 Gina Well (Well No. 1224-01) at 4591 Kuawa Road, Kauai, TMK 5-2-13:01, 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 30 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 an annual 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. n,

Date of Approval: Expiration Date:

May 3, 2001 May 3, 2003

'\ i "

(j GILBERT S. COLOMA-AGARAN, Chai erson 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 permit, return one to the Chairperson, and retain the other for your records.

Attachments c: USGS

Department of Health! Safe Drinking Water & Wastewater Branch Kauai Department of Water Supply Aloha Associates 2000 LLC

/

05/03/2001 12:46 8088280778 ~. - ~---... ------... PAGE 01

IFAX TO:

Phone Fax Phone

Icc;

Lenore Nakama

808-587-0219

LPate 513101

LNumber of pages including cover sheet

FROM:

Phone Fax Phone

SteVe Goldberg Oasis Water Systems Inc. P.O.Box535 Kila.uoa Hi 96754

808-828-6876 808--82lJ..0778

3

I REMARKS: o Urgent ~ For your review 0 Reply ASAP o Plesse Comment

Hi Lenore:

Please am mend well # 1224-01 pump capacity to read 30gpm. Enolosed are the signed Well Construction Permit for 1324-02 & The As-built drawing of pump section for 0622~03

Thanks

Steve


To: Steve Goldberg

o o




FACSIMILE TRANSMITTAL

From: Lenore Nakama

Company: Oasis Water Systems Date: April 23, 2001

Fax Number: 828-0778 Pages Including Header: 1

Phone Number: 828-6876 Subject: Outstanding Items

Notes/Comments:

Steve, as discussed by telephone last week, the following items need to be submitted:

1324-02 - Signed Well Construction Permit

GILBERT S. COLOMA-AGARAN CHAJRPERSO,,","-,


HERBERT M. RICHARDS, JR.

LlNNEL T. NISHIOKA DEPUTY DIRECTOR

1224-01 -If pump capacity> 50 gpm, step-drawdown test. If pump capacity >= 70 gpm, step drawdown & longterm tests,

0622-03 - As-built drawing of pump section,

P.O. BOX 621, HONOLULU, HAWAII 96809 PHONE: (808) 587-0218 FAX: (808) 587-0219 EMAIL: [email protected],hLus

MEMO and R9uTE SLIP o I WCR 1 ChecJ("'f(jrWel'I!:No.>1224-01 (survey to ~g:tila~prfrnemo)

1. Pump Tests Check Glenn Bauer d (initial) I Yes No If no, describe deficiency

Step-Drawdown Test:

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

Aquifer Pump Test:

o o o

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

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

analysis attached o o

Stream Surface Water Impacted: o o .- If yes, identify most probable stream

2. Construction Check Mitch Ohye l~ (initial)

data complete followed WCPI Stds well database updated

Yes No

o o o

If no, describe deficiency

04/17/01

3. Charley/Lenore/Ryan (initial) take action based on above analysis and double check with well check program again

4. Roy (initial) check

5. Susan Subia (initial) finalize

6. Linnel (initial) signature

7. Charley/Lenore/Ryan File

o

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

• State of Hawaii '.r ~ tI .. oal)':

, CO ... SION ON WATER RESOURCE MANACEMIINT o.,.,.."ent of latMIand ... tu .... Ra_ouroee

WELL COMPLE11ON REPORT ... PART' • Wd~ ........ ...: ........... Ift "* II ..................... IIIIHIA , .......... If...-) to tl'le

c- _In M w.wtlMOlftl-......... P.o ... 111. tiOIItIIIIIlI ....... 01 IMIIGI. 11Ie"::-:= ~ ~ inCOI'IIIIMt ...... ' 1Ha tofM ...... lit .,.,.,- willi'" to •• .... 00fI'f ... 1.-. ~ __ IM ........ w... c..lllllitft"'" "II1I'I1 II\IIIIIIIIIII" _MI." Of ca111N .... 10" ..... ,,: ., .... ,., ......... falW1 or .oIllOlMlJ \~IlIOft, ...... Vllit wr ....... _~nwww . ...,..N""'r,","

1. a._WeUNO,: '1224·01 Well MaIM: GIna ,,\and: .lMi

2. Add ..... ; .1!Y ..... ltd. r • ..,te.y. !.2·13:0'

3. erllint COMl'IIftl': -4. 11 drilled, ~ Of Rig: o Rotary O~

S. 0 •• WIU ~truotion (dII)ed,cHld,groutad)~· • MKII DriWaI.ol11A1M1 DC. 1Iatm) -l1IIIItI/IIe/WINr

................ ..".,..,. " ...... ,." ... ~,,,,......,...,, MIt tbIJ JliDI'II'I.

e. lnih! wttIIr..Iavel encounwed It beea. Ground Cite Irld ~ of MeeeuremeM~ _.,;;I, \WIlt

7. ~p.~ Teet complelBd? ONG 0"'. .... ~MI!'I reettoftft ,fm1lt' 1CP1'D"""

e. eonlttl1t R_ AqIolI1W T •• t ClMI,*,,", 1:1 "10 OV .. AtIIIotI ce .... IIIISII ........ TtIM""" (,,",m CItMD,..".

P.,.m .... prior'" !,U",P tnt:

9. w .. 4eveI: ft, ...... mII 0.. W time of mHlUNmenl: .-- -10. ~Iorlde: Date end .me of IImpllng:

"*~ IftIIe

wn ~""

-11. TempetllUrt:

., Date ana tine of m .. .uternem:

I -~-12. AI Ie the ....... eeetlOft on the ottwf ... of .ie ......

13. ~ ~ pfIfIlf'ld N'WIfOf" ItIImped MIYdM ~

~. It. pumo II net _ned to be Installed. pleau dMcriH (DetOW In the remark, Mellon) IlCIWwell iaI MCurtd to ~ uMUlNrbd acoIII (_"..; Ioc:~ CXMW. th,...,. coupInt, etc)

15 "enwtca~

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SUN., ("In1) ",.......,. ....-;;;;oa LP.I..S. uc.. No.

SlOnalure - - 0IIe

.......... (fWIt) ~:ona Assoic~tcs 2000 LLC

SteIn ..... ~""Jo,.- March 20, 2001 .~ "- Dar. -

"""" ... 1IK1JI',..,., nucJ

JAN-le-01 09:07 AM PETER TAYLOR INC 808 245 8928

- 0 I 0

,----_ ...........•... _ .. _- .. --- ..• -.-----.~------------------.

CJ .... i'li 1111 ... ·'."-- SLBV -321.7 : Ii II ii' , I i II II I

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.. I I I Ii . I - . I _.. ... I II. __ , . .---1 I - ... ,.,...l. ~""~.j __ .LJ

WELL ELEV A TION WELL 1# 1124-01 ("GINA")

OWNER:ALOHA ASSOCIATES (

T .M.K.( 4 )5-2-13:01

LlCBNSBD PROFBSSIONAL LAND SURVEYOR No.9149

, I )BENCH MA1\K \)SE.D: ;. ON CONe STEPS OF G.T.B.HA WAIIAN 1BLEPHONES' J IKILAUBA BLDG, HAVINO AN ELEVATION OF 319.87' INfORMATION PROVJDBD BY THE COUNTY OF KAUAI s"rR.VEY OFPICE. ~-... . _ .... __ .... _.. .-..... . __ ....... --- '--- ... _._ ....... _--_. ---_. ,,-

State of Hat-Jlii 0 COMMISSION ~ WATER RESOURCE MANAGEMENT Department of Land and Natural Resources



/

Instructions: Please print in ink or type and send completed report (with attachments, if applicable) to the r I .~ ''':'r'"1 16 P 2 3 2 Commission on Water Resource Management, P.O. Box 621, Honolulu, Hawaii 96809. The Commission may l.i l hi j \ :

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/ '! I,: ' ~;--:

1. State Well No.: 1224-01 Well Name: Gina Island: ~~~----------------------

Kauai

2. Address: 4591 Kuawa Rd. Tax Map Key: 5-2-13:01

3. Drilling Company: VA gjs LV A1=~ S'fs-kIlo\S .,1\(, ~=---=-:;;..:...::..:..------4. If drilled, type of Rig: ¥Rotary 0 Percussion

5. Date Well Construction (drilled,cased,grouted) completed: 1- 8- 0 \ Attach Driller's Log (7/26/99 DL Form) month/day/year

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

B~I 6. Initial water-level encountered --"'_:30~'---_ ft. below ground Date and time of measurement: \ '2--1$- ()O

7. Step-Drawdown Test completed? ri'~o 0 Yes

Ilt'No 0 Yes 8. Constant Rate Aquifer Test completed?

Parameters prior to pump test: ~ 9. Water-level: _Jjf!ii·€iM~;_~~~~ ___ ft. above msl

10. Chloride: 35 ppm

"7/\0 11. Temperature: --------I-.-#---{,~<..!...----

month/day/year time . Attach Step-Drawdown Test form (12117/97 SDPTD Form)

Attach Constant Rate Aquifer Test form (12117/97 CRPTD Form)

Date and time of measurement: {-22--0/ month/day/year time

Date and time of sampling: } -2. 2..-01 month/day/year time

Date and time of measurement: 1- ,-~C11 month/day/year time

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


14. If a pump is not planned to be installed, please describe (below in the remarks section) how well is secured to prevent unauthorized access (example)ockable cover, threaded coupling, ftc.) . ._-

15. Remarks: ~ \€) (\) ~ S &'t-? \ \-~ W:!.\\ S1 ~\

Licensed Driller (prin <'A'~~...:::;;....;;.....a;~-=f'~~=--=~'---t----

Signature

C-57 Lie. No. :h \ Y 51 Date y- 6-0 ,

Surveyor (print) _S_~e:..=,,;C-:::::::::_-K.-+....t....L----':'----I~-=~_ L.P.L.S. Lie. No. ___________ _ please attach stamped report

Signature Date __________ _

Permittee (print) j ,~'

Signature ~" . f

Date ______________ _

WCR1 Form 5/2/00

/

13. AS-BUlL T WELL SECTION (Please attach as-built if different from diagram provided below)

Elevation at top of casing '3;)..\ ft., msl* (to nearest 0.01 ft.)

n;"IT".to:u·. \ '-\ in.

Minimum of 2' Radius & 4" Thick Concrete Pad

Ground Elevation: -;" " ft., msl Bench mark elevation:

, msl* (Survey to nearest 0.01 ft.)

Total Depth

LfLf?J ft.

Cement Grout: ~-=-~_' (min. 70% of distil"ce from ground elevation to top of water surface or 500 ft., whichever is less.)

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

:3 in.


- ft. Material: e Crushed Basalt e Rounded Gravel

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


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

Length: lf~. . ft.

Nominal Diameter: ~ in.

Wall Thickness: '5L.~ L\ 0 in.

Bottom Elevation: 40'3> ft., msl

Open Casing: e Screen

Length: lJ.Q ft.

Nominal Diameter: G in.

Wall Thickness: ~ 4:.0 in.

Bottom Elevation: 4q3 ft., msl

Open Hole:

Length: _____________ ft.

Diameter: __________ --- in.

Bottom Elevation: ________ _ ft., msl

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

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

Stainless Steel: (check one): a AST~ A409 (production wells) a ASTM A312 (monitor wells)

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

PVC Plastic conforming to ASTM F480 and (ASTM 01785 or ASTM 02241): (check one): {SChedule 40 e Schedule, 80 Q.Schedule 120

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

a Centrifugally Cast Resin Pipe conforming to ASTM 02997

Open Casing Material:

a Reinforced Plastic Mortar Pressure Pipe conforming to ASTM 03517

a Glass Fiber Reinforced Resin Pressure Pipe conforming to AWWA C950

a PTFE Fluorocarbon Tubing conforming to ASTM 03296

a FEP Fluorocarbon Tubing conforming to ASTM 03296

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

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

Stainless Steel: (check one): 0 ASTM A409 (production wells) 0 AZSM 12 (monitor wells)

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

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

Thermoset Plastic: (check one) 0 Filament Wound Resin Pipe conforming to ASTM 02996

o Centrifugally Cast Resin Pipe conforming to ASTM 02997



o PTFE Fluorocarbon Tubing conforming to ASTM 03296


o


DRILLER'S LOG (7126/99 DL Form)

Depths (ft.) Rock Description, Water Level,etc. Dates

~ to 2.Q 6('C)lDf) -R~Q C \ A1 \d< \:1. -00

'd:-LLtoB3 f,lv ... 6r"t!¥,ock ~ II

f12to1l& f,,,K'~ Gr~;tck II

~to~ ~\\)e \¥,U( l" tt-d \,,,-\3

~ to '61 ~~\S~ brei &xK _~_~_

~to123 BrowI'. ~\~ _\_\ _

123.to~ ~\0~ ~Qck l~ _\_'_ (J \ \

:ll3.to~¢.b tfO~t0 QeOL c'+t ~to3Q6 H~+.)~Q ~\o~kk \)..-~y

'305 to 331 ?l)ve- ~ock tb-& l' ~to'~ h~c.~u/~ ~cK '1\

\ , 368 to '3 7 b --=e....1-\4-,--'-+-( ___ __

\ , ?> Iqo~ ~\\)e.. ~ck'

~ LJi.fS tClTVtu/<c9- ~ck t¢- '5

__ to ____________ _

__ to ____________ _

__ to ____________ _

__ to ____________ _

Remarks:

Depths (ft.) Rock Description, Water Level, etc. Dates

__ to __________ _

__ to __________ _

__ to __________ _

__ to ____________ _

__to ____________ _

__to ____________ _

__to ____________ _

__ to ____________ _

__ to ____________ _

__ to ________ _

__ to __________ _

__to __________ _

__ to __________ _

__ to ____________ _

__ to __________ _

__to __________ _

__to ________ _

__to ________ _

11/12/2000 20:54 8088280778 ---- -'----" >-_ .. _--

Nov 13, 2000

State Of Hawaii Water Commission ArT: Lenore Nakama

Dear Sir,

Oasis Water Systems, Inc. P.O BOX 535

KILAUEA, HI 96754 Phone: 808-828-6876

Fax # B08-587 -0219

Please be advised that Oasis Water, Inc. License No. C-214S7 will begin work on the Gina Well # 1224-01 in the next few weeks ~ /

Sincerely,

Steve Goldberg Oasis Water inc. C-21457

PAGE 01 /

11/12/2000 20:54 8088280778 PAGE 02 ~,/ -.-:!. -_ .. __ .. ". ~

01/00/00 12:f P.009 ~

-t

"-., "w

WELL CONSTRUCTION PERMIT Gin, Vbll. Well No. 1224-01

In 301.l0rdance with o-tmlf1t of Land end NlI1ural R.SOU~'. Commission on Wiler ftesourte Men'gofJ.1lnfa ACSminiltrative ~ ~ction '~.168, .rtltled 'Water u'e, Wf/II, and Stream D1~l1Ilon WorkS", Ihia dOC\,lment~: the cotl5U'Uc1Ion and tet5ti1,of Gina Well ffail No. 1~4~) 814111 Ku.M ~d~l KaU.iJ~1< i.2.13:~1\ slJtljeCl II;) the .t!awan I cn,truction II rymp 'nstafta n b~

3cl!?) ~cl' include !JUI are ~ IIrnllOQ 10 the lCJIlowlno CQnditlonl.; llIiIynalr1!"- ~f "" C.mlJlillllon an Wllat ~.ouroe MIIVICI"""" (ColYlflll,,19n), P.O. 80K LU1, ~U ,..~, ..... IMt noIIfIao. III wri~ng, III .. U _ (2]'" De"', ~ wo:1I tu'I'IOIi~.cI by tll' ~~ QjlIN'II",,,,,,' M1I1 ,1,1t .".11., •• uowed b InspeC\ IlIstlllllion K'.ivttieS in ,;carhrd VfIII1 Sl~'IIa.'6, ,.

:I.

3.

~.

~.

•• 7.

6

11.

11).

11.

~M MJnIlt~M RUIN. tlIII wd COPllllUc:oGft . .,."" •• na. 0. for conttI\.IIIIItn ,00 ~f II'ot WltM ONy. A mInlmUl1l11t<H1C1\ dllmPll' ft1MitOr Wbe,.... be """.tl*1Il~ iI1Stalilld. In • "'..,.... .~ .. 1& '" Chal/1lCnon, III lICQ,Irll'W wa\lr Iawll. ihl Ptfll1i11l1e. well "" .. ,.W, .M/or WIlli O¥oftI!t .h.1l oaordlna" wI\tIlrIe C/'IDltpInon .,.., O\I~ I IlUIDlIll'\lI"flIn .ciOff1!lnClt vIIIh \.InCl.tOs (lp\lfllP ! .. lIno ~ Ie I~' Th, IMIffllIlloe. WIll oper.lllr. afldldt ,..L CMMr ,he11lutlmit., tile ChIII~'" , .. , """Its A' Is for IIUP))OIMQ In .~tlOl't ID l",bIII • ~ln'nI pump aM ~11IW .... tor ~ 1'10 ~n.oI pump m.nolle .... Ided .nlI , pllmp 'Mwb •• Ol'l ,IInI" II approv.d I ncr IIUfO II), It. Ch;rllJlOfJOn. In llasal ~ ....... CIalItl ,,' IN ..... mty i'lQ\ IlI\o'IIIId on!J.fQ\,IPlII (ltc) or the Ih.orellcal t"'~ ( .. , ~ma l/IiCllllllacl) (If the ""lllIfOn w.t.r ",,,'~s CI'lIen.'lill ,1M Dillies b~ 1M cn.irpll1l0n. Thor ~1Tfl1'1IO.1N11 or.-etor, ""'or WIlli ~.r an_UlnQQrpqllle milia ill"" m.nu .... Ig PIlIV"" tCll'SIrJ!:l1OI'I ~ .... *II1II en...w.a IIIIlqutllle erwi,or;mtnt. Iv tdlo'4ule wOtt to ,\/IIW .,./lliIs&! "10" rN!fell, _10 ,.~. ,,.., ~ ,rw. ".QIlfl at~, In 1M CI~_~II ,~CI CUItIIIaI r.".!~. ,1ld1 II Ir1I\IfD. but1ll. or (;4r\QeJ1\r.llons of .Mb or ;/lIlClOaI ;fro II\CIO;Iftle. C!Ul1ng consl"'dion, Ihf: ..mII\111of. _t aplrllOI', aMlO" \MIll ~ sn.u .. wMt InC! COPII,c\ the OIIPIIUMnt'1 -'ollG ~;luon Im~. The P[~1''' ,.;t CICI!ItIn.Ictton -"In I\/:It ""ve ... I~ ''''1:1 e.~"~ or Tutu,. l,.gll u", or WIUJr Yill'» ... " Indloldlnll an~ ILIUOII ""lIIIr or "'lllllI''''O __ lrO.m ftow ....... 111 •• 1lIIS 111"'1" OI'lIIt .\IIhgrjpdon III ccnstrve'l .. win ~.u rtDI conall\Ule I .. tInMlIlIOn Of Cl)n'-- ...... JitfItI, ,."., ~ a"" be tu\IIIIIIIIId 10 "" QWrperwrfwllhln _tidy IDO) IS.,., .lIer cornpimlCl" III WOIk:

e. Willi aarfItIIelion report, ,llUcMcI- •• nl. Will C:o",truotl\)11 ... ~Jt). b. EllWrUon (rt.~ III mean ........ , ml~ surwl DV" Hawa»·11;IIIUd wvoyor, c. MoIIUIIIldIO/lll *'WInD of tilt WIll, •. Plot." and ft1ICIlIhoWI"lJ Ihl ol\lGllu(;l.o~ of 1",....,1. e. CCImPI'- PII",Qing I.t rtllQ!'dl. InGlull~O lime, p\lfl1pirg ,alll. Ilrawdown, dIlol'IcIe C«lIenl .• 1Id 611'N1t d_:a.

:: =r:"' we" ..,alcf. ~r _n -.r sh.H oomgly toiIh .1 'l)pl:cab:a 111'4. nJte •• end mllP",aea: lWI.-npli8nQf ml, bo ~ fl'f HI\IOc:I~on of

lWnd~~:~~~._;;r1 l'lflr1t~1)I0ril!adsl"'.!.lPInlal ~L'I ~l!l) r~f,r~rtCG ."cI ... IS &UIiII"'111l .1111 Hewell Well eonilrvclliln & f'u"" In,I.II,do" .. "~_. t.' 111 . . 'ow HWCPI"I '. u fo '...-" .nO IS a COIIIeq noe wa .r II WI,IDlIa, """"'lfIIled. ' .

"ll1eE may bo _hid by ... CoITlmlsSlon If WQIt .. h9I 1I.lIlet ""'th~ ,be tal 1'lI0I'I11' after lie ... oflPJIID"-or ,,~ Is _"~ ." IJIJ"OIlO<! fer IhI C IftMIM, U"'"' '1111~ IpcICII\eCI. 'Th, ~ IIrOOOMCl fl 1M ~I oon.~ioo IHImIIl ~ ~f ~ ~ *'*' !wv.OO",'''' flCI'/IIhe Chll. 0( , "*-~ ,~. 1l1. I rrilC"ey III .*"" .. , by 1hI OIIlllM/'ICn I.lIlO!' • ~ of a~ e.WI~~I. PII1G"I\lNICe. A ~tque.,~ .. .. ~ IUbrrltltd 10 l: 'It rpo!'1on no lal.r tnll'l til,... ~ordM prIOr to It-. ,ta ~ """~ " If .... ClOIJIfII"'~ CI.le II not MIll the Com~DI' mlY ~e the PDlmTt .1: QIVItIG Ina pormlMo, well DptMOr, 1:1dIor wet own« tIOtlOi Of pro~ adlcln " all oppol1\1nitw 1D bo ""111.

If tIw _1111 nal "'III uM4111 mUll be P.I"~tI) c:alllll't. If the weIll. 10 tI. ;II)~ndGMl1ll1en the perml1lN. "....11 QjjlII".-or • ."",or •• own.r mlKluppl)' fOr I well IlbandannumC pemdlln ~.~ with !l1S:1.12l') ""Of to ''11 MIl seaUng or pl\lggl~ wcttt.

I~. 11llt~. Itt I~ .'III .... IO!\&MtII~.Kv. "'"d. II'Id 1'I~1! ,'" S~1P. 01 Hawaii hllml'lla .",... M:laaalnst any IOU. !i,bility. cleim. at dlrna1d for ~ 1/'1IlIIge. peIICIrII! ,,*,1')', or ~ IrI1II.111 out" of In) .qt Qt \lm."I.", af lilt! ap"II~, Issigns,~. tilI~. cantraClln, and iI~1 unciill'

. till. petN 01 ~ '" \If",........, _u. Cllntq oflhll pennlt.

" ' .... -." ... --.. '~ .. --'-....,-,o"'ro .. ·-~(:JA--1.~",.. D.te Of A~!)r'Oval. July 13, 2000 TI~ .. E. JOHNS, Chairperson ~ Exptrflti(Jf1 Oate: July 13, 2002 Commission on Wawr Retourt:8 Management

I t.v. fwd a. GOI'IdI1lOt'f ..,d tenn_ of tt> .. ~ _/lei IIfKIIntta"d....... I na.pl ancf AGree 10 ~ "- cond"'ont M • p~,..qul.ltII ~ unWl)'IIt. Gefldltlon of "'Y_ tblllly • preeatICf aftd .~na th.t I ahall 11\1\ ~OlY1m'~ WOftI until 11m' ttl. drllr.r Mitt 1t'lIntcl. da!M. MCI ... turrWd the permit 10 tile ~Oft. 1.110 u ....... no ... non<ampllllnCI wlU'I IIfY permit c;OfIdlUon may be 1I'8U". 1'Ot rwOClitlO"

P.rmit.e·.Sig .... ature: ::5: ~~ ~ O~: 20 July 2DOO

Printed Nam,.'''---M"'' ~a i Firm or TiI~: l~ol!gr ii91!i ~i~!!1 t25 00 l.LC

Dr;"'.S~n_; ~~:. ~1UC8nse#: 2-IY5! Dolo: JI.b., acx:o Printed Namu: w. Go Firm or Title; CJtJst{ ~_ ,., ..... bOCh COpIu IIf WI penn~ ,.tlHft (1M to tit. C",*"110n. Ina ,.r,'n me oth.r for yOur monts.

lll\lclllmenr ¥ USQlI

~ ... ...,., ~ 0tInIdIqJ "".er. \W-..er . ."., Citan Wat.1 Bl1IndJe,

==\&o~~

/


REF:CWRM-SS


Dear Mr. Goldberg:

o




JUL 1 8 2000

Well Construction Permit Gina Well (Well No. 1224-01)

TIMOTHY E. JOHNS CHAiRPERSON




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 wall thickness of well casing shall be selected in accordance with good design practices applied with due consideration to conditions at the site of the well and shall be sufficient to withstand anticipated formation and hydrostatic pressures imposed on the casing during its installation, grouting, well development, and use.

3. All wells (excepting salt-water wells, artesian wells, and temporary monitor wells designed for immediate or short-term monitoring purposes and subsequent abandonment/sealing) shall be constructed with a casing string having a minimum length of solid casing equal to 90 percent of the depth measured from the ground surface to the top of the selected aquifer.

4. To prevent surface contamination, the annular space of all cased non-artesian wells (except monitor wells designed for immediate and short-term monitoring purposes and subsequent abandonment) must be sealed with grout from the ground surface to a minimum depth of 500 feet or 70% of the vertical distance between the ground surface and the top of the aquifer selected for exploration, long-term monitoring, or development, whichever depth is less.

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:

Mr. Steve Goldberg Page 2 J'" ., '" '1000 Vi.... i v (..

o o

"Permanent pump installation for capacities between 0-70 gpm and where the proposed use is for private individual needs in non-ground-water management areas may be allowed prior to the final pump installation permit issuance. When required as a condition of the 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. H

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 landowner 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 the Commission staff at 587-0218 or toll-free at 274-3141, extension 70218.

Aloha,

~j. 6~ ___ ,?V TIMOTHY E. JOHNS I) Chairperson"

Enclosures

o WELL CONSTRUCTION PERMIT

Gina Well, Well No. 1224-01

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 Gina Well

ell No. 1224-011 at 4591 Kuawa Rd., Kauai,TMK 5-2-13:01, subject to the Hawaii Well Construction & Pump Installation Standards 1/23/97 which inc ude 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 11/4-inch diameter monitor tube shall be permanently installed, 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 approveCI and issued by the Chairperson.

In basal ground water, the depth ofthe well may not exceed one-fourth (1/4) ofthe 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 (referenced to mean sea level, msl) survey by a Hawaii-licensed surveyor. c. As-built sectional drawing of the well. d. Plot plan and map showing the exact location of the well. e. Complete pumping test records, including time, pumping rate, drawdown, chloride content, and other data.

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

The well construction permit 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 HWCPIS are not followed and as a consequence water is wasted or contaminated, a lien on the property may result.

The permit may be revoked by the Commission if work is not started within six (6) months after the date of approval or if work is suspended or abandoned for six (6) months, unless othelWlse specified. The work proposed in the well construction permit application shall be completed within two (2) years from the date of permit approval, unless otherwise specified. The permit may be extended by the Chai!person 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 tfle permit e1Q)ires. 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 § 1 ~ 16s:.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 ouf of any act or omission of the applicant, assigns, officers, employees, contractors, and agents under this permit or relating to or connected with the granting of this permit.

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

Date of Approval: July 13, 2000 July 13, 2002 Expiration Date:

I have read the conditions and terms of this permit and understand them, I accept and agree to meet these conditions as a prerequisite and underlying condition of my ability to proceed and understand that I shall not commence work until I and the driller have signed, dated, and returned the P.8rmit 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: _______________ _

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

Printed Name: Firm or Title: ______________ _

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 Kaual Department of Water Supply Aloha Associates 2000 LLC

Well No.

Well Name

Applicant

o 1224-01

Gina

Aloha Associates

SECTION 1: WELL LOCATION INFORMATION

Island

Aquifer System

Aquifer Sector

KAUAI

HANALEI

KALlHIWAI

data

Date of Review

Reviewer

Proposed Use

o

Proposed Withdrawal

System Sustainable Yield

7/13/00

RRI

#VALUEI

25000

16

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

Elevation at top of casing Solid Casing

Ground Elevation

Cement Grout

Rock Packing

Hole Diameter

Total Depth

Estimated Head

Calculated Aquifer Thickness

County Water Supply (yIN ?)

m.s.l.

, m.s.!.

o ft.

Material

Designation

Length

Diameter

Wall Thickness

Casing

Material

Designation

Length

Diameter

Wall Thickness

Openings

Open Hole

Length

Diameter

ft. in.

in.

ft. in.

in.

sq.in./I.f.

ft. 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 provided

Thickness of Annular Space

PVC

o ft. o ft.

-300 ft.

non-county

0.280 in.

0.000 in.

270 ft. Oft.

---S""'c""""h-4"'""0

210 ft. Oft.

----~ 3.75 in.

okay (refer to HWCPIS Section 2.2)

too small (refer to HWCPIS Section 2.4 c)

too shallow (refer to HWCPIS Section 2.4 d)

okay (refer to HWCPIS Section 2.4 e)

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

not enough (refer to HWCPIS Section 2.6 c)

okay (refer to HWCPIS Section 2.6 d)

Page 1

Ii'()

•

32

,.-,_._---

5.

o

/ .'!'

120

1~'d'IMIDI<:uaeae \

37

-....


TIMOTHY E. JOHNS CHAIRPERSON



LlNNEL T. NISHIOKA

TO:

FROM:

SUBJECT:




Dean Y. Uchida, Administrator Land Division .. r) . 'I '

Linnel T. Nishioka, Deputy DirectoOW'\::.> j. Commission on Water Resource Manag~ment Well Construction/Pump Installation Permit Application Gina Well (Well No. 1224-01)

DEPUTY DIRECTOR

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. Please respond by returning this cover memo form by July 14. 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 Lenore Nakama of the Commission staff at 587-0218.

LN:ss Attachment(s)

RESPONSE:

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

bel 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

~t Other comments: Original source of title is Royal Grant 2896 issued in 1851. :-.::-~ ~~ C'J

" , : CJ

L Contact Person: Gary Martin Phone: 587-0421

Signed: A?-'---~---4.-:-' -.,..-/-------nate: 7/7/00

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BENJAMIN J. CAYETANO GOVERNOR OF HAWAII l..~ TIMOTHY E. JOHNS

CHAIRPERSON



TO:

FROM:




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

William Wong, sa;~~~~~~) ~at~~ .Brf9ch . .

Timothy E. Johns, Chairperson ( 1ft"e;J. 0 >~. fy Commission on Water Resource ¥aha~ment C'


SUBJECT: Well Construction Permit Application Gina Well (Well No. 1224-01)

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 July 14. 2000.


LN:ss Attachment( s)

RESPONSE:

[ 1

[ 1

[ 1

[ 1

)(

This well qualifies as a source which will serve as a source of potable water to a public water system (servinQ25 or more people at least 60 days per year or has 15 or more service connections) and must receive Director of Health approval prior to Its use to comply with Hawaii Administrative Rules (HAR). Title 11, Chapter 20, Rules Relating to Potable Water Systems, §11-20-29.

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

If the well is used to supply both potable and non-potable purposes in a single system, the user shall eliminate cross-connections and backflow connections by physically separating potable and non-potable systems by an air flap 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 ?~ located near the p.roposed welllli~. (information attached). ~ lVD I 0"" ~;.I.;;;. .J (.. -:J

~~ c. __ Other relevant DOH rules/regulations, information, or recommendations an! ~ ( .. ': $--:::

- ~. . No comments/objections

Contact Perso,n: ~,vi ~ Signed: d tJ.-41 }) .

Phone: ~4~' ,\

Date: "] if I -2o<?fR ) ..

. ~~- .~\

;

."'\

A septic tank system record/file has been found in our files:

Tax Map Key number

Septic Tank File #

Applicant Name

Submit Plan Date

Plan Approval Date

Inspection Date

. System Approved for Use Date

System

Disposal Via

# of Bedrooms

. Vj (qC()

A septic tank system record/file has been found in our files:

Tax Map Key number

Septic Tank File #

Applicant Name

Submit Plan Date

Plan Approval Date

Inspection Date

System Approved for Use Date

System

Disposal Via

# of Bedrooms

4-\ '5}oo

o o . BENJAfflIN J. CAYETANO TIMOTHY E. JOHNS

CHAIRPERSON GOVERNOR OF HAWAII

TO:

FROM:


COMMISSION ON WATER RESOURCE MANAGEMENT RECEIVED

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



P.O. BOX 621 HONOLULU, HAWAII 96809

........... '; SAFE DRINKING WATER BRANCH


JUN 2 f.

William Wong, Saf:_~2~~i~) ~ate~ .. B~~Ch ,

Timothy ~. Johns, Chairperson ( ~kre,.0· O/l,- r','> Commission on Water Resource ¥a~a~ment ,,'

~~Jj 1-4-



We would appreciate your comments on the captioned application for any conflicts or inconsistencies with the programs, plans, and objectives specific to your department. Please respond by returning this cover memo form by July 14. 2000.


LN:ss Attachment( s)

RESPONSE:

[ I This well qualifies as a source which will serve as a source of potable water to a public water system (servinQ 25 or more people at least 60 days per year or has 15 or more service connections) and must receive Director of Health approval prior to Its use to comply with Hawaii

/' Administrative Rules (HAR), Title 11, Chapter 20, Rules Relating to Potable Water Systems, § 11-20-29.

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

[ I

[ I

[ I

[ I [ I

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



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Phone: __ .~_t::-=-·~~~_~·~~~_L_~_ay=-----:-:;

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Date: .~:~~ ~ \,:J ---------~~~~>~, .. ~)~~-~ .. ---..~.~--

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~::pe3d:r;~ I~ .s: 6o"-I)J~ (~.4-f/J t{)/f7?5-L) 5:YJ~I-~ tc)/£.L A/pi 5'"'L~-P"G ~~~.6

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Dear Mr. Goldberg:




JUN 2 G 2000





Well Construction I Pump Installation Permit Application for Well No. 1224-01

We acknowledge receipt, on June 21, 2000, of your completed well construction I pump installation permit application for the Gina Well (Well No. 1224-01). You can expect your application to be processed within ninety (90) days from this date.

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

If you have any questions about your permit application, please contact Lenore Nakama of the Commission staff at 587-0218 or toll-free at 274-3141, extension 70218.

LN:ss

c: Aloha Associates

Sincerely, /;

/~ ~i . /) /, y··-f/ C);l~J 0/ \'--

L1NNEL T. NISHIOKA Deputy Director

BENJAMIN J. CAYETANO TIMOTHY E. JOHNS GOVERNOR OF HAWAII CHAIRPERSON

TO:

FROM:





William Wong, Saf:p.~J~~i~\ ~at~:.~~79Ch

Timoth.y ~. Johns, Chairperson (1ft\1::..~.:J. 0 /t. f.r~· Commission on Water Resource ¥a~a~ment C

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





We would appreciate your comments on the captioned application for any conflicts or inconsistencies with the programs, plans, and objectives specific to your department. Please respond by returning this cover memo form by July 14, 2000.


LN:ss Attachment(s)

RESPONSE:

[ 1

[ 1

[ 1

[ 1

[ 1

[ 1 [ 1

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

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

If the well is used to supply both potable and non-potable purposes in a single system, the user shall eliminate cross-connections and backflow connections by physically separating potable and non-potable systems by an air Qap 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).



Contact Person: Phone: -------------------------------------- -------------------------Signed: Date: ------------------------------------------------- -----------------------------


TO:

FROM:

SUBJECT:

,




Dean y, Uchida, Administrator

Land Division .·-f~.'·Q'1 ,\ -,:K Linnel T. Nishioka, Deputy DirectoU'/Vl 'j J. iJ': I .. Commission on Water Resource Management

Well Construction/Pump Installation Permit Application Gina Well (Well No. 1224-01)


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



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. Please respond by returning this cover memo form by July 14. 2000.


LN:ss Attachment(s)

RESPONSE:

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

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

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

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

[ ] No objections

[ ] Other comments:

Contact Person: Phone: ------------------- ------------Signed: Date:

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

DEPARTMENT OF U\NO NO Wl-TI..MI.. RESOlRCES

roell· NT "". UAC OR AiliiIAO£O hORKS

IF SRCI COST ~ YR I>PP o 08J CTR PROJEC PH ACT o G_ .9.9 .9QQ Q lQ~§ Ql.?_ ----- -- --- (1) 25.00

GJ).9_ ~.9.9_ 9 lQ~£ Q]~- ------ -- --- (2) 25.00

G_ b.9_ .9.9.9 C 1026 075 ----- (3) 25.00 -- ---G P.901 09~ I~I~ 075 ------ -- -- (4) 25.00 G - 1m 'U75 25.00

TOTAl 125:-00-

Rf1oAAKS: LINE (1) WET.T. NO 1721-0'; (Wr.pA/PIPA)

LINE (2) WELL NO. LINE (3) WELL NO.

1224-01 <WCPA/PIPA)

1121-01 (WCPA/PIPA)

*'ET DATE: 6/22/00

NoIME/DESCRIPTION' (WN¥:. It-PUT)

_~~ITR@rn~~ __________

_~K~~~~~~ __________ _~U1.~~.!~~~I.!! _________ .

PATRICIA MACDONALD --U)l;STI: wAlER SiSlERS. '1m:'.-----.

LINE LINE

(4) WELL NO. 1123-05 (WCP4PIPA (5) WELL NO. 1324-02 (WCPA/PIPA

State of Hnaii . 0 For Official Use Only:

COMMISSION~ WATER RESOURCE MANAGEMENT Department of Land and Natural Resources APYLICA'tION FOR PERMIjT EVWell Construction andlor tlff,ump Installation

Instructions: Please print in ink or type and send completed application with attachments to the Commission n f' J1 !~,! t 3 on Water Resource Management, P.O. Box 621. Honolulu. Hawaii 96809. Application must be accompanied by V.J ",I'

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.

. '. '. p\Z: t 6

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For further information and updates to this application form. visit http://www.state.hi.usldlnr/cwrm. .f'J !.. ... , \ r-.,'- \.i V: . T :1,

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APPLICANT INFORMATION: {Fill out all three. if applicable. and place a check next to ~he primary contactpi~-~ '; " '.~ i Hi::;-1. (a) ~ WELL OWNER: t\\Dba Asc:cclCi.:\e5 Contact Person: G\f),O-- Phone: ~03-~28·0qlf4

MailingAddre~D()at- 3--20 1.000 LL..G K\'\uucn.. I \-\\ Qb'1e± Fax: . ~ 1.'& - o~ Z- :3 E-mail: -f

(b) D LANDOWNER: Same} Contact Person: Phone: _______ _

Mailing Address:

(e) L:~CTOR. {) ~ \D PifC/l-- c:= Pe""".$lc:Ue.- Ph.... 'i?-t'-ni' Mailing Address: p~~,.. 5~ t\,,\~ \£' 9, '1S'1 Fax: ~':l.$"- -0 11 e E-mail: LiC#:)'( - 58

WELL & PUMP INFORMATION: (Please fill in the diagram on the back of this form.), '"

2. WELL NAME: C""")l qa-.. Island: -=-H~A..U...Ct..Y.J~~=-______ _ Address L\-59\ \O\u.Awa.lSd, ~lO:[email protected] Map Key: 5 - ;l - 13 : OJ

tt.l Zone Sec Plat ~~cel Attach the relevant portion of (a) a 7.5-Minute Series USGS topographic map (scale 1 :24.000) and include the name of the quad map. and (b) a property tax map. showing well location referenced to established property boundaries.

3. PROPOSED WORK: ~ Construct New Well

(check all that apply) D Modify Existing Well.

D Abandon/Seal·

1.t Install New Pump·

D Modify Pwnp·

·State Well No.: (if unknown. please call Commission at 587-0225)

4. CONSTRUCTION: 'IJ Drilled DOug D Shaft D Tunnel

I~ this well part of a battery of wells? DYes):{No (Please desaibe)

5. PROPOSED PUMP INFORMATION: Rated Pump Capacity: 25 \e-=to ? 0 \,4..:,

gallons per minute

Pump Type (Check one):

D Deep Well Turbine

.,s Submersible

D Centrifugal

D Rotary

D Rotary-Displacement

D Rotary-Gear

6. PROPOSED USE: (check all that apply)

D Municipal (including hotels. stores. etc.) f Domestic (individual. noncommercial water system)

D Irrigation (crop) -----------------------D Military

D Propeller

D Reciprocating

D Impulse

D Industrial

D No. of Dwelling Units:

D No. of Acres:

D Other (explain):

7. (a) PROPOSED AMOUNT OF WITHDRAWAL: ---,"-::...'~S..L! =-uv:..,.',;:...J --r------ gallons per day

(b) METHOD OF FLOW MEASUREMENT: r' .Flowmeter Ii7open-pipe D Weir D Orifice ------------------------...,,' OTHER IMPORTANT INFORMATION:

D Other(explain)

8. LEGAL REQUIREMENTS: D COUP D SMAP D EIS DEA ~ne D Other (explain)

9. REMARKS, EXPLANATIONS:

(if more space is needed, please attach additional sheet)

I understand that approval of this application attaches the following standard conditions: 1) the proposed work is to be completed within two {2) yea~ of the approval date; 2) the contractor shall submit to the €ommission a well completion/abandonment report within 60 days after the completion date of the permitted work; 3) monthly water use data shall be submitted to the Commission; 4) such approval shan not constitute a determination of correlative water rights and shall not guarantee the pump capacity or future use up to the permitted pump capacity.

~n .. ct~~ Signature

Date ,--5-00

For official use only Latitude _______ Aquifer System No. Longitude State Well No.

WCPIPA Form 512100

-IU. ,..n.VI""V.:tI:.LI ... .:;;. ........ ~W;;;'" I IVIlI {""-/tJ.:t.:i~ tl(!(1c.;u :x.;lIt;;tfIlCfU(" " UITrtfltllll HUH1 Ult1t.:/rt:1f" I--"VVrUf:1U VttlVW/

,I, Hole Diameter: t3'b.. in. ,111",\

Elevation at top of casing ~., msl*~. !--j~--. ..... Minimum of 2' Radiu~"(~' Thick ::;oncrete Pad (to contain benchmarX J--+- _;;- surveyed to nearest 0.01 ft.>-

>~~) .I - Ground Elevation: ::SOO ft., msl*

Please refer to the C---,"'»"" ! Cement Grout: 1'= ft. ! (min. 70% of distance from

ground elevation to top of water surface or 500 ft.,

HAWAII WELL CONSTRUCTION AND PUMP INSTALLATION STANDARDS to ensure thafyour as-built is in compliance


whichever is less.) ~'

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

Solid Casing: (~90% x (;nd Elev.-Water Level Elev»)

Total Length: V\' ft.

Nom;",' O;omotec. ~~ ;". ~ in. Wall Thickness: 0 in.

Bottom Elevation:'ti ft., msr Rock or Gravel Packing:

Total Depth

___ ft. .,.,-:-:--:-:_ ft. Material:

Open Casing: wrrerforated 0 Screen

o Crushed Basalt ' Total Length: 60 ft.

o Rounded Gravel .' 6" Nominli!1 Diameter: --1~-:--------- in.

Wall Thlckness: 5c.h ,{O in.

Estimated Water Level

Elevation:

Bottom Elevation:. ,u 10; ft., msl*

note: Neither bentonite nor mud should be used in

____ ft. msl* saturated zone during drilling

Open Hole:

Length: _---'/UOL.--=-IU....:::..-"c...~ ____ ft. Diameter: _____________ in.

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

Bottom Elevation: _______ _

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

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

Example: Estimated + 2 ft, Water Level Elev. -+ Bottom Elevation otWell Limit = (2 - ll~) = -18.5 ft.

Solid Casing Material: Carbon Steel: compliant with (check one or more):D ANSUAWWA 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 5 0 Grade B 0 Other


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

ft., msr

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

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

o Centrifugally cast Resin Pipe confonning to ASTM 02997

o Reinforced Plastic Mortar Pressure Pipe confonning to ASTM 03517

o Glass Fiber Reinforced Resin Pressure Pipe confonning to A'WINA C950

o PTFE Fluorocarbon Tubing confonning to ASTM 03296

o FEP Fluorocarbon Tubing confonning to ASTM 03296

Open Casing Material: Carbon Steel: compliant with (check one or more):D ANSUAWWA 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): a ASTM Meg (production we!!s) 0 ASTM A312 (monitor wells)

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

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

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

o Centrifugally Cast Resin Pipe confonning to ASTM 02997

o Reinforced Plastic Mortar Pressure Pipe confonning to ASTM 03517

o Glass Fiber Reinforced Resin Pressure Pipe confonning to A'WINA C950

o PTFE Fluorocarbon Tubing confonning to ASTM 03296

o FEP Fluorocarbon Tubing confonning to ASTM 03296

UNITED STATES DEPARTMENT OF THE INTERIOR

GEOLOGICAL SURVEY 159

0

25' 458000m.E, 22' 30" 22'14'30" r----.. -.--........... ----+---............. ---+-~ .. -............. :c: ________ ........... _._+ _____ , ........ ________ ......... __ -----........ -----~-.............. ------.. + .... --~-----................ -------.~.~: .. ~~-114

120

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LAND COURT AFTeR RECORDATION, RETURN BY: I xx 1 MAil

ALOHA ASSOCIATES 2000 LLC Michael Zapara 318 North Carson Street, #214 Carson City, Nevada 89701

TITLE OF DOCUMENT:

WARRANTY DEED

PARTIES TO DOCUMENlf":

REGULAR SYSTEM J ~ICKUP TO:

GRANTOR: ALPHA MANAGEMENT LLC, a Hawaii limited liability company P.O. Box 1174

GRANTEE:

PROPERTY DESCRIPTION: 4591 Kuawa Road

Kilauea, Hawaii 96754

ALOHA ASSOCIATES 2000 LLC, a Nevada limited liability company clo Mlchael Zapara 318 North Carson Street, #214 Carson City, Nevada 89701

Kilauea, Kauai, Hawaii 96754

TAX MAP KEY: (4) 5·2·013·001

o o WARRANTY DeED

C THIS WARRANTY DEED, made this :2.. day of February ,200.£,..., by ALPHA

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MANAGE.MENT LLC, a Hawaii limited liability company, with its principal place of business and address being P.O. Box 1174, Kilauea, Hawaii 96754, hereinafter called the "Grantor", In favor of ALOHA ASSOCIATES 2000 LLC, a Nevada limited liability company, with its principal place of business and address being c/o Michael Zapara, 318 North Cars.on Street, #214, Carson City, Nevada 89701, hereinafter called the "Grantee".

WITNESSETH:

That for TEN DOLLARS and other valuable consideration paid by the Grantee, the receipt of which is hereby acknowledged by the Grantor, the Grantor does hereby grant, bargain, sell and convey unto the Grantee, in fee simple, forever:

All of that certain real property described in Exhibit "A", attached hereto and ma~e 51 part hereof.

And the reversions, remainders, rents, issues and profits thereof, Ind all of the estate, right, title and Interest of the Grantor, both at law and In equity, therein and thereto;

TO HAVE AND TO HOLD the same, together with all buildings, improvements, rights, easements, privileges and appurtenances thareon and thereto belonging or appertaining or held and enjoyed therewith, unto the Grantee according to the tenancy herein set forth, forever.

AND, in consideration of the premises, the Grantor hereby covenants with the Grantee that the Grantor is seized of the property herein described In fee simple; that said property is free and clear of and from aU liens and encumbrances made or suffered by Grantor, except for the lian of real property taxes not yet by law required to be paid, and except as may be specifically set forth hereinj that the Grantor has good right to sell and convey said property, as aforesaid; and, that the Grantor will WARRANT AND DEFEND the same unto the Grantee against the lawful claims and demands of all persons, except at! aforesaid.

This conveyance and the warranties of the Grantor are expressly declarad to be in favor of the Grantee, and its successors and .8.ign8,.

The terms "Grantorll and "Grantee", as and when used herein, or any pronouns used in place thereof, shall mean and include the masculine, feminine or neuter gender, the singular or plural number, Individuals, partnerships, trustees or corporations and their and each of their respective lueeeuors. neira, personaJ representatives, successors in trust and assigns, according to the context

1/ tll/lI/lIl/l/I/1/1l/

111111111111111111111111

11111/1111111/11111///1/

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8W1M"11NG POOl: . / ___ J

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ALOHA A 4591 SSOICATES Kuawa

HI 96754 Road,

2000, LLC Kilauea ,

TMK 5-2-13-01

."'--~~ ...... ~--.• ------.-.