q REGISTRATION OF WELL~ AND
ECLARATION OF WATER U
INSTRUCTIONS: Please type or print. H information is not available or not appUcable. indicate as NlA. Fill out as completely as possi:IIe. sign. and file form with the Division of Water Resource Management. P.O. Box 373. Honolulu. Hawaii 96809. Phone 548-3948 or 548-7543 for assistance.
BAnERY OF WELLS: For a battery of wells. on the surtace. in a tunnel. or In a shalt. submit a registration form for each well together ./ with a single map or plot plan showing layout of wells.
STATE WELL NO.: '312 {g - () '3 ISLAND: .M..4 V I WELL NAME OR DESIGNATION: __ ..:..M..:..!...:..'=L=L,:.::A-:..:,I<:::-____________ _
SOURCE OR STATION NAME (For a battery of wets): _--:-_____________ _
\'\\ \ l ", /\V" (:. ~ i A. WELL OPERATOR B. OWNER OF WELL SITE
Firm name: C· F, Mit./, Irfl Firm name: __ ..:!S.!!A.!!II~~ _______ _
Contact person: _~A-=~=.;:=--____ _ Contact person: _S~,,~If'\.e.~ _______ _
Address: 12 qq S. )If .']!:S IJA- Address: ___ ...:~:.:4:!..:14..t::::.. _______ _
K/It-f:' S"1li/M
Phone: 1-''' 1(,22. Zip: ____ Phone: _______ _
C. WELL LOCATION Tax Map Key: Town, Place, District: _____________ _
Attach USGS "Quad" map (scale 1 :24,000), tax map, or other map showing the well location.
D. WELL DATA For DrIlled W ..... sutxnl "as-bull" drawing. driller's log. end pump test resultS. and complete items below. For Tunnel. and Shalla. submit oonstruc:tlon drawings. plot plan. or sketch map.
G 110 ' ed 10 8S . round elevation (M., sea level): ___ ft. Year drilled or construct : _.!......:.-,_....;;.... __ _ Reference point (Used to measure depth to water): Well contractor: __________ _
Elevation: III ' ft. Description: tof ¥ C'lS"M"
Depth to water (Below reference point): I" 1 ft. Maximum recorded chloride: ·/(,,091> ppm Minimum recorded chloride: $vo'C ppm Maximum chloride in 1987: ppm
E. INSTALLED PUMP DATA
Pump type: 0 Vertical shaft ~ Submersible
Pump capacity: gallons per minute
C · IL'" asing diameter: _____ ~~I=---- In. Solid casing depth (Below glOlMld): ft. Perforated casing depth (::~: ft. Total depth of well: W 5 ') ft.
. >-------_.
Minimum chloride in 1987: ______ ppm
o Centrifugal 0 Other (specify): _____ _
iii ElectriC, L HP 0 Other (specily): ___ _ Power: 0 Die~s. .... P 0 Gas, _ HP
Pump installatio cont etor: ____________ --.;.. ________ ~ __
... (continued over)
For Official Use Only: Date received: "'?-'l- ... tl1 Date accepted: __ --,- ,,, ,. Field checked by: ___ Date: Latitude: 1-D "J1 4t; "HydrologiC Unit: _...,......",.....,--Comments: Longitude: ''2li Zit' 'Z.5 State Well No.: "'11.(,'" O~
Re,.,."ce.: Hawaii· Revised Statutes. Chapler 174C.
Hawaii Administralive Rules. Chapters 13-167 to 13-171.· ,
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NOTE: The purpose 01 the 0ecIanIti0n 01 WBl.er Use Is to obtain informBl.ion necessary for the management of the State's water resources. The Declaration does not confer a legal right to water or Its use.
Water use data are recorded: 0 Daily 0 Weekly 0 Monthly o Other (Describe): _______ ------Method of measurement: 0 Flow Meter 0 Orifice
o Other (Desc:rbe): _________ ~----_
Quantity of Use (Report metered or eitimated monthly water use from the well described on the reverse side of this form. for the c:aIendar ~ 1Q83 through H187. For R battery 01 weIIB which •• not individually melered. but which are connected to a single meter or other measuring device. report total use lrom ;:.,., battery.):
WATER USE, IN GALLONS X 1000
1983 ~ 1985 1986 1987 Januarv I I Februarv ~ I March Aoril May l June I JulY I AlJnll~t J Seotember rr.tnhAr .... t D~c:r"lUCJr , I ANNUAL '1. ~
Minimum day's use: 0 gallons Maximum day's use: __ =~:...~;;;;....;o::...;:::o~_ gallons Typical times of usage: ___ .... :...:flo.,.Jt! .... &<L..<.J..:.;.A1.~"'o:;;... __________________ _
Type of Use (Check aI category boxes that apply and pnwicIe additional informBl.ion as indicated.):
Category
o Municipal (Including MOrts, hotels. businesses)
o Domestic (systems NfVing 25 people or less)
til Irrigation
o Industrial
o Military
o Other
Addition'll Informption
Number of service connections: __________ _
Acres Irr@ed: ____ ...-------------Crop(S): U Sugar 0 Pineapple
o Other (speCify): ___ ......---------Non-Crop: [i1 Landscape 0 Golf Course
o Other (s.Q..9cHy): __ __..--------Method: iii Drip U Furrow lEI Sprinkler
o Cooling 0 Manufacturing 0 Mill o Other (specify): ____________ _
Specify (livestock. aquaculture, etc.): _ .......... ________ _
I declare that the contents of the above Declaration of Water Use are, to the best of my knowledge and belief, true, correct, and complete.
Water User's Signature: C ~ 11-~-Printed Name: C. ' P. M Jt.t. Ag Firm or Title (Well Operator, etc.): Well t?WN-r" - -of¥:C.~ •
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January 29, 1985
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t1r. Chester Mill~r c/o Valley Real Estate Company 2439 South Kihei Road l02-A Kihei, Maui, HI 96753
Dear Mr. Miller:
Enclosed is the Well Drilling Permit for State Well No. 3726-03. Also attached is a reimbursement check (State Warrant G 164568) in the amount of $100.00. This fee is only required for applications in ground water control areas. The location of Well No. 3726-03 is not in a ground water control area. Thus, your application fee is being refunded to you.
If you have any questions concerning this matter, please feel free to contact our office.
NII:ko Enc.
'" " ve,' y truly ,ours, , \ \ ! )
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~uu,~u TAGOMORI ~ Manag r-Chief E ineer
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G 164568 G 0164566
* STATE 0.. HAWAII * HONOWW. HAWAII 000923
EXACTLY DOllARS
~ 1213
,ClHrS , PAY.- $*******100:00
***** ************ ******************ONE HUNDRED AND 00/100 DOlLARS
PAY TO THE ORDER OF
CHESTER F P. O. BOX YUMA
, VOID DATE: JUNE 30, 1986 For and Charge Same To
I GEIERAl FUID Fiscal Year 1984-1985
VOUC HER: 030404
, 4 MlPll~R 2063
85364 AZ
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GEORGE R. ARIYOSHI GOVERNOR OF HAWAII o o
STATE OF HAWAII
DEPARTMENT OF LAND AND NATURAL RESOURCES
P. O. BOX 621
HONOLULU. HAWAII 116809
WELL DRILLING PERMIT
for
State Well No. 3726-03 Kihei, Maui, Hawaii
SUSUMU ONO. CHAIRMAN BOARD OF LAND & NATURAL RESOURCES
EDGAR A. HAMASU
DEPUTY TO THE CHAIRMAN
DIVISIONS: AQUACULTURE DEVELOPMENT
PROGRAM AQUATIC RESOURCES CONSERVATION AND
RESOURCES ENFORCEMENT CONVEYANCES FORESTRY AND WILDLIFE LAND MANAGEMENT STATE PARKS WATER AND LAND DEVELOPMENT
TO: Mr. Chester Millar clo Valley Real Estate Company 2439 South Kihei Road 102-A Kihei, Maui, Hawaii 96753
In accordance with Chapter 166 of Title 13, "Rules for the Control of Ground Water Use in the State of Hawaii," your application to drill State Well No. 3726-03 is approved subject to the following conditions:
1. A Driller's Well Completion Report (enclosed) shall be submitted to the Division of Water and Land Development within 60 days after completion of the well.
2. Pumping test data shall be submitted to the Division of Water and Land Development within 60 days after testing of the well.
3. Monthly pumpage records shall be submitted after the well is put into production.
4. Upon completion of the well, submit an "as-built" drawing of the well and a map showing the exact location of the well.
5. The applicant comply with all applicable rules, ordinances, and laws.
Enc. Driller's Report Form cc: USGS
Dept. of Health Maui DWS
LsUSUli~ Chairperson of the Board
ViELL VHILLING PERMIT
for
State Well No. 3726-03 Kihei, Maui t Hawaii
TO: Mr. Chester Millar clo Valley Real Estate Company 2439 South Kihei Road l02-A Kihei. Maui, Hawaii 96753
In accordance with Chapter 166 of Title 13, "Rules for the Control of Ground Water Use in the State of Hawaii," your application to drill State Well No. 3726-03 is approved subject to tn~ following conditions:
1. A Driller's Well Completion Report (enclosed) shall be submitted to the Division of Water and Land Development within 60 days after completion of the well.
2. Pumping test data shall be submitted to the Division of Water and Land Development within 60 days after testing of the well.
3. rvlonthly pumpage records shall be submitted after the well is put into production.
4. Upon completion of the well, submit an "as-built" drawing of the well and a map showing the exact location of the well.
5. The applicant comply with all applicable rules, ordinances, and laws.
Date of Issuance
Enc. Driller's Report Form cc: USGS
Dept. of Health Maui DWS
SUSUMU ONO Chairperson of the Doard
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GEORGE R. ARIYOSHI
GOVERNOR OF HAWAII
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STATE OF HAWAII DEPARTMENT OF LAND AND NATURAL RESOURCES
DIVISION OF WATER AND LAND DEVELOPMENT
January 7, 1985
MEMORANDUM
P. O. BOX 373
HONOLULU. HAWAII 96809
TO: Mrs. Anne Furuuchi
FROM: Edgar Hamasu, Acting Chief
SUSUMU ONO. CHAIRMAN
BOARD OF LAND & NATURAL RESOURCES
EDGAR A. HAMASU
DEPUTY TO THE CHAIRMAN
DIVISIONS: AQUACULTURE DEVELOPMENT
PROGRAM AQUATIC RESOURCES CONSERVATION AND
RESOURCES ENFORCEMENT CONVEYANCES FORESTRY AND WILDLI FE LAND MANAGEMENT STATE PARKS WATER AND lAND DEVELOPMENT
SUBJECT: Reimbursement of Well Drilling/Modification Permit Application Fee
On December 20, 1984, a check in the amount of $100.00 was deposited by the Department of Land and Natural Resources. This check was for a Well Drilling/Modification Permit Application fee and was issued by Mr. Chester F. Miller. The fee is unnecessary and thus, we wish to reimburse Mr. Miller the $100.00. Please issue the check and return to the Division of Water and Land Development. We will then mail the check back to Mr. Miller with an explanation as to why it is being returned.
If you have any questions regarding this matter, please contact Manabu Tagomori at ext. 7619.
NI:ko
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EDGAR HAMASU
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FISCAL OFFICE lOG #_t7l.e
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Route Slip WATER RESOURCES Ej FLOOD CONTROL BRANCH
From: Date: File in: --~------ ------ -------------------
~....--Manabu Tagomori
"--_ Albert Ching
Daniel Lum ---- George Matsumoto
Nobu Kaneshiro --Tom Nakama --Paul Matsuo
~ ~ Edwin Sakoda .
K Neal Imada _j)///LLI~~'~ /'.
, 7 _'~~oe Menor _ wtJi.. HAJ. ,
_ ;- Jon Hor~o
-- Mitchell Ohye
-- Kay Oshiro Doris Hamada --
Please
For
Take action by _______ _ Review & comment Draft reply by ___ _ Type draft Type final Xerox Mail
copies
Acknowledge receipt
Approval Signature Information
Robert Chuck Jane Sakai ___ Bill Koyanagi Richard Jinnai ____ Takeo Fujii
James YoshilIDfD
-----------
---Elsie Yonamine
~--------
---------
----___ Yoshi Shibuya
----------
I-cul"udry 1 ~U3 ·,: ,. i! o o /.l
STATE OF HAWAII . ,,,.'~r{::D DEPARTMENT OF LAND AND NATURAL RESOURCES . ~
P, 0 I BOX 621 p. rei, "2 HONOLULU" HAWAII 96809" 1:.[, 0 ,:11D: 10
DEPARTMENT MASTER APPLI CAT ION, :~9RM "it', i:£,? & '-"- . ,.I_~'i/'iI:.NT
(Print or Type)
FOR DLNR USE ONLY Reviewed by Date A
ttj \ .. ''"$'" Accepted iJy <.., / ~-, Date ~'" ""1 X <'.":'.
/6 ' 4" ".;" Do eke t/ F i 1 e No. ----r",.--~,Q::_"---;0;:--
180- Day Exp. ~/ "?,..r, <1.,.. EIS Required ~o ~" PH Required~<" .. Board Approved -----4~"6"-.Disapproved Well No.
I. LANDOWNER/WATER SOURCE OWNER (If State land, to be filled in by Government Agency in control of property)
II. APPLICANT (Water Use, omit if applicant' is 1 an'downer)
Name Sau....( --~~~----------------
Name Chester Millar Address
Address _P_.O_._BO_X_2_06_3 ___ } pyefeYI'U
Yuma, Arizona 85364 MAI'J~ A,lkt!r
c/o Va J1f't Rf~ i £SJ.c.k CO;"'1"""1
2~1i $''0. KIHE.I ~o ~ ;0,. A
J( IH£' .MAti ( HI. q fD'1 S"3 -------------
Telephone No. 602-783-1891
SIGNATURE C.+' vU~
Telephone No.
Interest in Property ___ _
(Indicate interest in property; submit --\,/ritten evidence of this interest) ~,I~t Date
,do ~ • /U--tL ~G;JvV
~~ IYI W ~ lO 0 III.. TYPE OF PERMIT(S) APPLYING FOR
*SIGNATlJRE
Date
( ) A. State Lands
( ) B. Conservation District Use
{ } C. Withdraw Water From A Ground Water Control Area
( ) D. Supply Water From A Ground Water Control Area
Gut) E. Hell Drill ing/ModificatL2IL_ Roger Post Aki Library Anne Maude Dean Barbara
file in ____ --:-____ _
To Carol For 12 ().J A- bQ - 1 -
*If for a Corporation, Partnership. Agency or Organization, must be signed by an authorized officer.
IV. WELL OR LAND PARCEL LOCATION REQUESTED
.
District
Island Maui -------------------------County ~laui -----------------------Tax Map Key 11-2-1-5:79
Area of Parcel 9.92 acres , (Indicate in acres or
sq. ft.) Term (if lease)
,,,,,,,,,,,,,,,~_,,,_"''l<_11 "A ... "i;a:_._ai._'_ .. 1I_ ..... If'It.~IIt_. _ • ...;.., _._·_-r_....;....------..;....;.;..~..;.;.· ..... ' , ............ ' d '.~,""'J:t.,;.:t;'.';":;1.",~~C::.f." ..•• ~'"'.~.,"'""~~_." .~'-'>-"""".-.---'- _.-'-
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V. Environmental Requirements
Pursuant to Chapter 343, Hawaii Revised Statutes, and in accordance with Section 1:30B of the EIS Regulations for applicant actions, an Environmental Assessment of the proposed use must be attached. The Environmental Assessment shall include, but not be limited to the following:
A. Identification of application;
B. Description of proposed use and statement of objectives;
C. Description of affected environment, intluding appropriate maps and plans to show location, topography, site improvements, existing utilities and vegetation and archaeological/historical sites, if any. (See page 5, section I).
D. General description of the technical, economic, social' and environmental characteristics of the proposed use.
NOTE: The Environmental Assessment may be substituted in lieu of the information required above.
A. Chester F. Millar
B. Source 'of water needed for household use as well as such agricultural planting that may be done in future. (Property is zoned for agriculture)
C. No environmental impacts are forseen other than increased greenery. Topography is gently rising, brown-colored lava slope now covered with thin growth of scrub brush and occasional small tree. Owner plans to construct home with such driveways and grading as may be warranted. No historical monuments or archaeological sites exist on the property~ A power line now extends along the west
boundary.
D. A water well costing perhaps $20,000 is planned. No power or water lines will run outside of the subject property.
2 -
o o INFORMATION REQUIRED FOR ALL USES
I. Description of Parcel
A. Existing structures/Use. (Attach description or map).
B. Existing utilities. (If available, indicate size and location on map. Include electricity, water, telephone, drainage, and sewarage).
C. Existing access. (Provide map showing roadways, trails, if any. Give street name. Indicate width, type of paving and ownership).
D. Vegetation. (Describe or provide map showing location and types of vegetation. Indicate if rare native plants are present).
E. Topography; if ocean area, give depths. (Submit contour maps for ocean areas and areas where slopes are 40% or more. Contour maps will also be required for uses involving tall structures, gravity flow and other special cases).
F. If shoreline area, describe shoreline. (Indicate if shoreline is sandy, muddy, rocky, etc. Indicate cliffs, reefs, or other features such as access to shoreline).
G. Existing covenants, easements, restrictions. (If State lands, indicate present encumberances).
H. Historic sites affected. (If applicable, attach map and descriptions).
II. Description: Describe the activity proposed, its purpose and all operations to be conducted. (Use additional sheets as necessary).
III. Corrunencement Date:
Completion Date:
IV. TYPE OF USE REQUESTED (Mark where appropriate)
1. Permitted Use (exception occasional use); DLNR Title 13, Chapter 2, Section ; Subzone __ _
2. Accessory Use (accessory to a permitted use): DLNR Title 13, Chapter 2, Section ; Subzone ---
3. Occasional Use: Subzone ----4. Temporary Variance: Subzone ----5. Conditional Use: Subzone ----
- 3 -
Area of Proposed Use ~ ~ (Indicate in acres or sq. ft.)
Name & Distance of Nearest Town or Landmark
Boundary Interpretation (If the area is within 40 feet of the boundary of the Conservation District, include map showing interpretation of the boundary by the State land Use Commission).
Conservation District Subzone County General Plan Designatio-n-------------
~.
v. FILING FEE
1. Enclose $50.00. All fees shall be in the form of cash, certified or cashier's check, and payable to the State of Hawaii.
2. If use is commercial, as defined, submit additional public hearing fee of $50.00.
INFORMATION REQUIRED FOR CONDITIONAL USE ONLY
I. Plans: (All plans should include north arrow and graphic scale).
A. Area Plan: Area plan should include but not be limited to relationship of proposed uses to existing and future uses in abutting parcels; identification of major existing facilities; names and addresses of adjacent property owners.
B. Site Plan: Site plan (maps) should include, but ·not be limited to, dimensions and shape of lot; metes and bounds, including easements and their use; existing features, including vegetation, water area, roads, and utilities •
. C. Construction Plan: Construction plans should include, but not be limited to, existing and proposed changes in contours; all buildings and structures with indicated use and critical dimensions (including floor plans); open space and recreation areas; landscaping, including buffers; roadways, including widths; offstreet parking area; existing and proposed drainage; proposed utilities and other improvements; revegetation plans; drainage plans including erosion sedimentation controls; and grading, trenching, filling, dredging or soil disRosal.
D. Maintenance Plans: For all uses involving power transmission, fuel lines, drainage systems, unmanned communication facilities and roadways not maintained by a public agency, plans for maintenance shall be included.
. E. Management Plans: For any appropriate use of animal, plant, or mineral resources, management plans are required.
F. Historic or Archaeological Site Plan: Where there exists historic or archaeological sites on the State or Federal Register, a plan must be submitted including a survey of the site(s); significant features; protection, salvage, or restoration plans.
II. Subzone Objective: Demonstrate that the intended use is consistent with the objective of the subject Conservation District Subzone {as stated in Title 13, Chapter 2}.
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o o DESIGNATED GROUND WATER CONTROL AREA
APPLICATION FOR: (check one) PERt1IT TO WITHDRAW WATER FOR BENEFICIAL USE PERMIT TO SUPPLY WATER FOR BENEFICIAL USE
Fill out, sign page 1, send application with pertinent attachments to Department of Land and Natural Resources, P. O. Box 621, Honolulu, Hawaii 96809. A nonrefundable filing fee of $100 is required, excepting military, federal, state, and local government agencies.
1. REQUESTED BENEFICIAL USE OF WATER: Domestic Municipal Mil itary _ Agricultural Other - -
Industrial
(specify)
Appropriately describe nature and purpose of requested use: * ______ _
Proposed commencement date of water use:
2. REQUESTED AMOUNT OF WITHDRAWAL OR SUPPLY: Average Annual mgd; Maximum Month mgd; ~~ximum Day mgd. Appropriately describe schedule or times of taking requested withdrawal:
3. NATURE AND TERM OF REQUESTED PERMIT: _ Temporary Permanent Requested period of permit _____________ _
4. PROPOSED SOURCE OF WATER SUPPLY: Existing source Modification of existing source New Source
Briefly describe existing or proposed source and any related facilities and submit map, plot plan, and plans or drawings of source of supply:
If construction work is proposed for new or modified existing source, give: 'Commencement Date Completion Date --------------
5. ASSESSMENT OF REQUESTED WATER USE OR SUPPLY: In a separate attachment to this application, applicant must provide a written assessment addressing the desirability of issuing the requested permit, including such considerations as the availability of water, the beneficial purpose of the proposed water use, and the impact if any, of the proposed water use on eXisting permitted uses, preserved uses, and individual household uses •.
* Use additional sheets as necessary.
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o o APPLICATION FOR (check one)
WELL DRILLING PERMIT WELL MODIFICATION PERMIT
Instructions: Send completed application and attachments to the Department of Land and Natural Resources, P.O. Box 621, Honolulu, Hawaii 96809.
Reference: Chapter 166, Department of Land and Natural Resources.
Is the well located in a Designated Ground Water Control Area? Yes X No
If "yes ll , application must be accompanied by a Water Use and/or Water Supply Permit and a non-refundable filing fee of $100 payable to the Department of Land and Natural Resources. However, if application is for minor modification of well, filing fee may be waived. If IInoll, no filing fee is required. Filing fee is waived for federal, state, and county government agencies.
1. WELL NAt1E AND/OR LOCATION: N£ COY'heY of fJ rOf~ .. 1:i:; Attach a plot plan shm'ling well location referenced to established property boundaries.
2. PROPOSED DRILLING COMPANY: to be determined -------------------------------3. PROPOSED WORK: x Drill new well Deepen Redrill Alter Seal
_ Abandon = Install new pump-=- Replace pump _ Modify pump
Fi 11 in the di agram and bri efly descri be the proposed \'lOrk (use back of for if necessary):
To drill well to provide water ~ agriculture irrigation. ttMA. I'G~'i#twiJ iJ£.<
4. PROPOSED USE: Municipal Military ~Agricultural LDomesti~_Disposal- Other (specify) ___________ _
Industrial
5. PROPOSED AMOUNT OF WITHDRAWAL: Check most appropriate box and fill in amount.
~Daily 24,000Gallons -._ Monthly _Gallons quarterly
6. PROPOSED PUMP OR FLOW CAPACITY 50 Gallons per minute -----
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--------------~-<-'-" --------------'
o o CONSERVATION DISTRICT USE APPLICATION
I. All persons must submit an application and have it approved prior to the initiation of any new, change in existing, or, expansion of land use within the Conservation District, except as provided in Subchapter 13-2-4 of the Department of land and Natural Resources Administrative Rules. If a properly submitted application is not acted on within one hundred and eighty (180) days, the landowner may automatically put the land to the use(s) proposed. This is the normal processing time.
All applications must be signed by the landowner prior to submission to the Department of Land and Natural Resources. No application shall be considered submitted when the information r,equired in the application is incomplete.
All applications are subject to the State and Federal environmental requirements. Any requirement must be satisfied prior to Board approval. The rules and regulations relating to the environment may be obtained at the Office of Environmental Quality Control. For information, call 548-6915.
All applications are subject to County Special Management Area requirements. Any requirement must be satisfied from your County prior to Board approval.
A public hearing is required for: 1) all commercial uses; 2) for any conditional use in the P Subzone; or 3) any use which the Board determines is of , substantial public interest.
Complete the application in the following manner:
. 1. For permitted, accessory, occasional use, or temporary varia~ce, complete pages 1-3 only;
2. For conditional use, complete pages 1-4.
All correspondence will be directed to the applicant. Submit eighteen (18) copies of the completed application and all attachments. Reduc~ or fold attachments to 8!a" x 11". Mail application and attachments, to: Department of land and Natural Resources, P. O. Box 621, Honolulu, Hawaii 96809. For information call 548-7519.
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