OF HAWAII TOTAL • ,.., ABERCROMBIE GOVERNOR OF HAWAII WILLIAM J. AILA, JR. CHAIRPERSON STATE OF...

laAND OF HAWAII TOTAL • ... ,..,

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NEIL ABERCROMBIE GOVERNOR OF HAWAII

Mr. Bahman Sadeghi Island Dairy, Inc. P.O. Box 2626 Kamuela, HI 96743

Dear Mr. Sadeghi:

STATE OF HAWAII DEPARTMENT OF LAND AND NATURAL RESOURCES

COMMISSION ON WATER RESOURCE MANAGEMENT P.O. BOX621

HONOLULU; HAWAII 96809

March 30,2011

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

6016-0l.cpi

Certificate of Pump Installation Completion for Island Dairy Well Well No. 6016-01 CTMK 3-9-001:002)

We are pleased to inform you that the Pump Installation work permitted for the Island Dairy Well (Well No. 6016-01) is complete and acceptable and welcome you as a new member to the community of well owners and ground water users in Hawaii. This certificate of pump installation completion allows you to commence pumping your well for reasonable & beneficial water use.

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

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

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

3. In the event that the well operator and/or landowner changes, the Commission shall be notified prior to the change.

4. In the event the benchmark in the concrete base of the well is altered in any way, an updated version of the Well Elevation page of the Well Completion Report Part I shall be submitted to the Commission. If a licensed surveyor had estimated the original benchmark elevation then a licensed surveyor must establish the new benchmark elevation. The Well Elevation portion of the Well Completion Report Part I can be obtained by contacting Commission staff or at www.hawaii.gov/dlnr/cwrm/forms.htm.

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Mr. Bahman Sadeghi Page 2 March 30,2011

5. Your approved pump has a capacity of 90 gpm at a head of 1310 ft. In the future, pump replacements of equal or lesser capacity will not require an additional permit from the Commission, but will require the submission of a Well Completion Report Part II by the licensed pump installer. If the pump replacement is greater than the existing pump, you will need to apply for a new pump installation permit.

6. The landowner shall cause the well operator to maintain the installed meter or other appropriate means for measuring and reporting withdrawals and water levels, and appropriate devices or means for measuring chlorides and temperature. These data shall be measured monthly and reported to the Commission on a monthly basis, on forms provided by the Chairperson (attached), in accordance with §13-168-7, HAR. Blank water use report forms are also available at www. hawaii.gov/dlnr/cwrm/resources _permits.htm

7. The proposed use shall not adversely affect existing or future legal uses of water in the area, including any surface water or established instream flow standards. The authorization to drill a well and/or install a pump shall not constitute a determination of correlative water rights. The landowner and well operator are notified that the quantity of water taken from the well and/or the pump capacity could be reduced by the Commission in the future.

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

If you have any questions, please contact Ryan Imata of the Commission staff at or toll-free at (Hawaii), (Kauai), (Maui), or

(Lanai & Molokai).

RI:ss Encl: Water Use Report Forms

Sincerely,

WILLIAM M. TAM Deputy Director





HONOLULU, HAWAII 96809

March 30, 2011


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



6016-0I.cwc

Mr. Bahman Sadeghi Island Dairy, Inc. P.O. Box2626 Kamuela, HI 96743

Dear Mr. Sadeghi:

Certificate of Well Construction Completion for Well No. 6016-01 (TMK 3-9-001:002)

We are pleased to inform you that the Well Construction work permitted for the Island Dairy Well (Well No. 6016-01) is complete and acceptable and welcome you as a new member to the community of well owners and ground water users in Hawaii.

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

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

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

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

4. In the event that the well operator and/or landowner changes, the Commission shall be notified prior to the change.

5. In the event the benchmark in the concrete base of the well is altered in any way, an updated version of the Well Elevation page of the Well Completion Report Part I shall be submitted to the Commission. If a licensed surveyor had estimated the original benchmark elevation then a licensed surveyor must establish the new benchmark elevation. The Well Elevation portion of the Well Completion Report Part I can be obtained by contacting Commission staff or at our website at www .hawaii.gov /dlnr/cwrm/resources _permits.htm.

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

If Y-OU have any questions, please contact Ryan Imata of the Commission staff at 5 87-025 5 or toll-free at (Hawaii), (Kauai), (Maui), or (Lanai & Molokai).

RI:ss

Sincerely,




Dear Mr. Sadeghi:




March 30, 2011

After-the-Fact Pump Installation Permit Island Dairy Well (Well No. 6016-01)



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.


We acknowledge receipt on March 21, 2011, ofthe fine payment for the violation of installing a pump without a permit. With this submission of your violation fine, your After-theFact Pump Installation is approved. However, because the original pump installer is no longer in business, and standard pump installation permit conditions are not pertinent, the issuance of a physical permit is not necessary. Rather, we will be issuing Well Construction and Pump Installation completion certificates which describe your responsibilities after the installation of the pump.

If you have any questions, please call Ryan Imata of the Commission staff at or toll-free at (Hawaii), (Kauai), (Maui), or (Lanai & Molokai), extension 70255.

RI:ss Enclosure

Sincerely,

WILLIAM J. AILA, JR. Chairperson

COMMISSION ON WATER RESOURCE MANAGEMENT (03/2011)

FROM: -·~_____,~<...----___ DATE: 5 (4 o

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CHONG,R. DANBARA, S. FUJII, N.

-(-HARDY, R. _± HOAGBIN, S.

ICE, C. IMATA, R.

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KIMURA, J. OHYE, L.

_2_ TAM,W .. UYENO, D. YODA,K. YOSHINAGA, M.

SUSPENSE DATE:

FOR:

__ Approval Signature Information

PLEASE:

See Me Review & Comment Take Action Type Draft

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D&TMENT OF LAND AND NATURAL RESOU& DOCUMENT NO · .. UAC OR ATTACHED WORKSHEET DATE· March 21 2011

' SRC/ COST

F YR APP D OBJ CTR PROJECT PH ACT AMOUNT NAME/DESCRIPTION (WANG INPUD

s 11 326 c 1564 0752 (1) $150.00 Island Dairy, Inc.

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

TOTAL $150.00

REMARKS: LINE (1) Fines for Well No. 6016-01 (Island Dairy Well) LINE (2) LINE (3 LINE {4) LINE {5) LINE {6) LINE {7) LINE {8) LINE {9) LINE {10)

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FROM:

TO:

CHONG,R. DANBARA, S. FUJII, N.

T/ HARDY,R. 't.--7HOAGBIN, S.

ICE, C. IMATA, R. KIMURA, J.

COMM.ION ON WATER RESOURCE MANAGE2T (01/2011)

DATE: "'£... f, _, I i l SUSPENSE DATE: ----------

INIT. TO:

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KUNIMURA.I. OHYE, L. OSHIRO, K. TAM,W .. UYENO, D.

___ YODA,K. YOSHINAGA, M.

I NIT: FOR:

Approval 3 Signature

Information

PJ_EASE:


~ TypeFinal File

__ Xerox_ copies


WILLIAM J. AILA, JR. INTERIM CHAIRPERSON




March 1, 2011

WILLIAM D. BALFOUR, JR. SUMNER ERDMAN NEAL S. FUJIWARA

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


Ref:60 16-0 l.act


Dear Mr. Sadeghi:

Notice of Commission Action Island Dairy Well (Well No. 6016-01)

This letter serves as your official notice of action taken by the Commission on Water Resource Management (Commission) on the subject application. By a unanimous vote of the Commission at their meeting on February 16, 2011, the Commission:

A. Found Island Dairy, Inc. in violation ofHAR §13-168-12(a).

B. Imposed a fine of $150 on Island Dairy as summarized in Exhibit 3 of the submittal, payable within 30 days.

C. Approved the issuance of an after-the-fact pump installation permit for the Island Dairy Well (Well No. 6016-01), subject to the standard conditions in Exhibit 4 ofthe submittal, and the following special conditions:

1. That the permit will be issued after the fine described in Item B is paid by the applicant.

Additionally, we will be issuing a certificate of well construction and pump installation completion uponTeceipt of your fine. Failure to submit the fine and continued pumpage of this well may result in further fines of up to $5,000/day.

RI:ss

If you have any questions, please contact Ryan Imata of Commission Staff at

Sincerely,


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STAFF SUBMITTAL

for the meeting of the COMMISSION ON WATER RESOURCE MANAGEMENT

February 16, 2011 Honolulu, Oahu

Island Dairy, Inc.

WILLIAM J. AILA, JR. INTERIM CHAIRPERSON

WILLIAM D. BALFOUR, JR. SUMNER ERDMAN NEAL S. FUJIWARA


WILLIAM M. TAM OEPUTY DIRECTOR

APPLICATION FOR AN AFTER-THE-FACT PUMP INSTALLATION PERMIT Island Dairy Well (Well No. 6016-01)

APPLICANT:

Island Dairy, Inc.

P.O. Box 2626

Kamuela, HI 96743

DESCRIPTION:

Location: (See Exhibit I)

BACKGROUND:

Pump Installation: 90 gpm for Irrigation use TMK 3-9-001:002, Hawaii

LANDOWNER:

State of Hawaii

1151 Punchbowl Street

Honolulu, HI 96813

Dimensions: (See Exhibit 2)

On November 28, 2000, a Well Construction Permit was issued to Island Dairy, Inc. (See Exhibit 5)

On February 13, 2002, Turner Well Drilling, as licensed contractor to Island Dairy, Inc., submitted a Well Completion Report Part I describing the construction of the well and a request to send him an application for a Pump Installation Permit.

On February 25, 2002, staff advised Turner Drilling that the Well Completion Report Part I was deficient because the report did not include the required plot plan and elevation report.

Soon thereafter, Turner Drilling stopped doing business in the State of Hawaii and never filed the missing information .

ITEM C2

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Staff Submittal February 16, 2011

In February of2004, the Commission on Water Resource Management (CWRM) adopted the revisions to the Hawaii Well Construction and Pump Installation Standards. Among other things, through this adoption, the CWRM allowed concurrent permit issuance of Well Construction and Pump Installation Permits to licensed well drillers only.

On February 13, 2009, as part of a routine pump replacement, Derrick's Well Drilling inquired about the well, to which staff replied that no pump installation permit was ever issued, and that an after-the-fact Pump Installation Permit application would need to be submitted.

On February 18, 2009, Island Dairy, Inc., with the assistance of Derrick's Well Drilling, submitted an incomplete application for an after-the-fact Pump Installation Permit.

On March 18,2009, Derrick's Well Drilling submitted a revised application for an after-the-fact Pump Installation Permit, which included pump tests and a Well Completion Report describing the installed pump. Staff requested the plot plan and elevation report to be submitted as part of the application.

On May 26, 2009, the plot plan and elevation report were submitted by Derrick's Well Drilling.

ISSUES/ANALYSIS:

VIOLATION:

HAR §13-168-12(a) states that:

No well shall be constructed, altered, or repaired and no pump or pumping equipment shall be installed, replaced, or repaired without an appropriate permit from the commission.

Discussion with Derrick's Well Drilling indicated that a pump was installed in the well prior to their replacement of the pump. A follow-up conversation with Bahman Sadeghi oflsland Dairy indicated that the original pump was installed by Turner Drilling. Mr. Sadeghi stated that he assumed that the permits were obtained by Turner Drilling and that he now wants to make sure that everything is in compliance.

Derrick's Well Drilling merely replaced what they thought was a legally permitted pump. Replacement of a pump does not require a pump installation permit. Therefore, Derrick's Well Drilling should not be held responsible for the initial violation.

Staff considers both Island Dairy, Inc. and Turner Drilling to be responsible for knowing that a pump installation permit was required. However, since Turner Drilling is no longer in Hawaii, the only entity to find in violation is Island Dairy, Inc.

FINE CALCULATION:

Staff adheres to the CWRM's penalty policy G-01-01, which is summarized in Exhibit 3.

Minimum Penalty:

An initial minimum penalty figure for daily fines for settlement purposes is based on the following:

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Staff Submittal

I. 2. 3.

February 16, 2011

Finding of violation = $250 per day/incident Occurring in Water Management Area = $250 per day/incident Repeat Violation = $250 per day/incident (A repeat violation is deemed to occur when the party has previously been found to be a violator by the Commission. A repeat violation is tied to the party involved and is irrespective of the nature of the violation.)

In this case, for Island Dairy, Inc., the finding of violation warrants an initial base fine of $250 per day/incident fine. The area is not a Water Management Area and this is not a repeat violation for Island Dairy, Inc.

Mitigation Component:

Mitigative factors can be considered in the recommendation of any fine or alternative penalty. Presence of one or more mitigative factors can reduce or eliminate the fine or alternative penalty recommendation. Mitigative factors include but are not limited to: insignificant impact on the resource, attempt to remedy the violation without notice, good faith effort to remedy violation once noticed. self reporting in a timely manner, and diligent and speedy effort to remedy the violation once noticed.

Staff considers the timely submission of an after-the-fact Pump Installation Permit immediately upon finding that there was no permit issued was a good faith effort to remedy the violation once noticed, and deserves a $100 mitigation component.

Gravity Component:

Gravity factors can be considered in the recommendation of any fine or alternative penalty. Presence of one or more gravity factors can enhance the fine or alternative penalty recommendation. Gravity factors include but are not limited to: significant risk of or actual damage or harm to the water resources or the environment, multiple or repeat violations of the code or regulations, evidence that the violator should have known about the violation, refusal to correct the violation once noticed,failure to meet deadlines as set by the Commission or its staff

Staff does not consider any gravity components to be applicable in this case.

Duration:

Because no gravity components were found and compliance (the initial application sent in less than 30 days from the first conversation), no daily component is being applied. Rather, the fine is being calculated for a one-day duration.

Therefore, staff is recommending a fine of$250- $100 = $150, for Island Dairy, Inc.

AGENCY REVIEW AND COMMENTS

Copies of the application were sent to the Department of Health's Safe Drinking Water and Wastewater Branches. Additionally, notice of the application was published in the Commission's monthly bulletin .

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Staff Submittal February 16, 2011

No objections to this application were submitted. However, the State Department of Land and Natural Resources' Land Division has indicated that a water lease is required but ~as not yet been obtained by the applicant. A copy of the final pump installation permit will be forwarded to the Land Division for their follow up.

RECOMMENDATION:

That the Commission:

A. Find Island Dairy, Inc. in violation ofHAR §13-168-12(a) .

. B. Impose a fine of$150 on Island Dairy as summarized in Exhibit 3, payable within 30 days.

C. That the Commission approve the issuance of an after-the-fact pump installation permit for the Island Dairy Well (Well No. 6016-01), subject to the standard conditions in Exhibit 4, and the following special conditions:

1. That the permit will be issued after the fine described in Item B is paid by the applicant.

Exhibit(s): 1. (Location Map)

Respectfully submitted,

(p1~ WILLIAM M. TAM Deputy Director

2. (Proposed Well Section) 3. (Penalty Calculations) 4. (Standard Pump Installation Permit Conditions) 5. (Well Construction Permit)

APPROVED FOR SUBMITTAL:

fh/PJ-J~f WILLIAM J. AILA, JR. Interim Chairperson

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• EXHIBIT 1 - LOCATION MAP

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7. AS-BUlL T PUMP SECTION (Please attach as-built If different from diagram provided below)

Bench mark elevation surveyed to nearest 0.01 ft.= ~ft. mean sea level

Elevation of top of chase tube 536.2 ft. mean sea level

Pump intake depth = 576.8 ft. (referenced to bench mark}

Chase tube depth = 568.3 ft. ¥---+-- (referenced to bench mark}

EXHIBIT 2- WELL SECTION

If airline installed, bottom of airline elevation = n/a ft. mean sea level

WCR2 Form 2126107 Pagt~2 of 2

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A B c D E F G H J K L M N 0 p a R DAILY FINES DURATION CALCULATION

Compli!rlce Finding of Occurring Repeat within 30 Total Subt!Xal fine

Item violation inWMA violation Grallity Mtigative TOTAL DAILY Total Days days duration of Alternate i:lrone No. of Subtotal No. Descrij:iion (min$250) (min $250) (min$250) component oomponent FINES start date End date Tolled No. of days ()'ell/no) violation settlement incident incidents fines

\""'!"" -... ,...."' Installation of

1 ]Jll_m_p $250 $0 $0 $0 -$100 $150 0 1 $150 1 $15C

TOTAL FINES $151;

NOTES A ltemNo B Descri j:iion -description of the violation, see submittal text for specific rules violated C Finding of violation (min. $250)- where there is a violation, there is a minimt.rn daily fine of $250 D Oa:urring in WMA (min. $250) -When the violation is in a designated Water Management Area, there is a minimum additional daily fine of $250 E Repeat violaion (min. $250)- Wlen the lliolatlr has committed violations in the pas~ there is a minimt.rn additional daily fine of $250 F Gravity component- alloNs for the increase of the daily fine G Mitigative component - allows for the decrease of the daily fine H TOTAL DAILY FINES- the sum of the values in columns Cthrough G I Start date- the date where calculation of daily fines begins (date ofnctice of violation, or permit approval, or permit flAiy signed, or violation occurred, or CWRM order) J End date- the date of the end of the violation or latest CWRM meeting or completed permit application K Days tllled- the amount of days that are tllled, to be subtracted tom the tctal duration of the violation L No. of days - calclAated bel1Neen start and end dates and subtracting the tolled days M Cornpli!rlce will in 30 days (~shlo) - if the applicant complies with the Commission staff's notice of violation requirements within 30 days N T!Xal duration of violation- if there was compliance with staff notice of violation within 30 days, the duration shall be one ( 1) day. If there was no compli!rlce with staff notice of violation within 30 days,

the duration shall be the tltal days of the violation. HONe~>er, gravity drcumstcr1ces C!rl increase the t!Xal days even if the 30 day complianre is met. 0 Al1emate set11ement (yes I no)-.., anemate set11ement in lieu of the daily fine was recommended P Subtotal fine for one incident- per incidentfine a No. of inciden1s -of violation that oa:urred t>r this investigation R Subtotal fines -the subtltal of fines, calculated by multiplying (per incident fine) • (no. of incidents)

EXHIBIT 3- FINE CALCULATIONS (PENALTY POLICY G-01-01)

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STANDARD PUMP INSTALLATION PERMIT CONDITIONS

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 Island Dairy Well (Well No. 6016-01) at TMK 3-9-001:002, Hawaii, subject to the Hawaii Well Construction & Pump Installation Standards (HWCPIS - February 2004) which include but are not limited to the following conditions:

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

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

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

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

The pump installation permit shall be for installation of a 90 gpm rated capacity, or less, pump in the well. This permanent capacity may be reduced in the event that the pump test data does not support the capacity.

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

The permittee shall install an approved meter or other appropriate means for measuring and reporting withdrawals and appropriate devices or means for measuring chlorides and temperature at the well head.

Well Completion Report Part II shall be submitted to the Chairperson within sixty (60) days after completion of work (please contact staff or visit www.hawaii.gov/dlnr/cwrm/resources _permits.htm for current form).

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

The pump installation permit application and, if relevant, any related staff submittal approved by the Commission are incorporated into this permit by reference.

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

Any variances from the HWCPIS shall be approved by the Chairperson prior to invoking the variance.

The work proposed in the pump installation permit application shall be completed within two (2) years from the date of permit approval, unless otherwise specified. The permit may be extended by the Chairperson upon a showing of good cause and goodfaith performance. A request to extend the permit shall be submitted to the Chairperson no later than the date the permit expires.

13. The permittee, its successors, and asSigns shall indemnity, 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.

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

EXHIBIT 4- STANDARD PUMP INSTALLATION PERMIT CONDITIONS

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e WELL CONSTRUCTION PER. ·tsland Dairy Well, Well No. 6016..01

In accordance with Department of Land and Natural Resources, Commission on Water Resource Managemel')t's Administrative•RQI§l~ •. Section 13-168, entitled 'Water Use, Wells, and Stream Diversion Works", this document permits the constnfetion and testing of lsl~nd Dairy Well (Well No. 6016-01) at Kamuela, Hawaii, TMK 3-9-1: 002, subject to the Hawaii Well Construction & Pump Installation Standards (1/23/97) which include but are not limited to the following conditions: if

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1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

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

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

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

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

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

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

The following shall be submitted to the Chairperson within sixty (60) days after completion of work: a. Well completion report, (attached- Part I, Well Construction Report). b. Elevation (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, wel.l operator, and/or well owner shall comply with all applicable laws, rules, and ordinances; non-compliance may be grounds for revocation of th1s perm1t.

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 apP,roval or if work is suspended or abandoned for six (6) months, unless otherwise specified. The work proposEKI 1n the well construction perm1t application shall be completed within two (2) years from the date of permit approval, unless otherwise specified. The permit may be extended by the Chairperson upon a showing of good cause and good-faith performance. A request to extend the permit shall be submitted to the Chairperson no later than three (3) months prior to the date the permit expires. If the commencement date is not met, the Commission may revoke the permit after giving the permittee, well operator, and/or well owner notice of the proposed action and an opportunity to be heard.

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

12. The permittee, its successors, and assigns shall indemnify, defend, and hold the State of Hawaii harmless from and against any loss, liability, claim, or demand for property damage, P.6rsonal injury, or death arising out of any act or omission of the applicant, assigns, officers, employees, contractors, and agents under this perm1t or relating to or connected with the granting of this permit.

13. Spedal "'""'"ons m lhe alta"""""""' Uansmlltall- a<e lnoo<pooated herun by refe~~' a Date of Approval: November 20, 2000 TIMOTHY E. JOHNS, Chairperson t Expiration Date: Novem~er 20, 2002 Commission on Water Resource Management

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

Permittee's Signature: L ' pi'VI · Date: 4{1 't{ 0 I

Printed Name: BAH,..._}~~ Firm or Tille: T<i>LM.l!) !:lA't1!:Y ; '!

Driller's Signature: ~ C-57 License#: d.'d§"'l1- a~: ----"!t;:=--_._2_·-.... <2'-'--1--Printed Name: ~R'A-n~ \\,Rn.G=& Firm or Title: _O~lU=.JY\~G-o::.la..._,...---'-----c:>---.,.:,---Please sign both copies of this permit, return one to the Chairperson, and retain the other for your records.

Attachment c: USGS

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

EXHIBIT 5- WELL CONSTRUCTION PERMIT

-

LINDA LINGLE GOVERNOR OF HAWAII

LAURA H. THIELEN CHAIRPERSON

SUMNER ERDMAN NEAL S. FUJIWARA

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

STATE OF HAWAII KEN C. KAWAHARA, P.E.

TO:

FROM:

SUBJECT:

DEPARTMENT OF LAND AND NATURAL RESOURCES COMMISSION ON WATER RESOURCE MANAGEMENT

P.O. BOX621 HONOLULU, HAWAII 96809

July 14, 2009

Hono~able Chiyome L. Fukino, M.D., Director Department of Health Attention: ~omas See, Chief, Wastewater Branch

DEPUTY DIRECTOR

Stuart Yamada, Chief, Safe Drinking Water Branch Alec Wong, Chief, Clean Water Branch Dr. Keith Kawaoka, Office of Hazard E/al,tion and mergency Response

Laura H. Thielen, Chairperson ~ Q.. ~t.L-. Commission on Water Resource Management

After-The-Fact Pump Installation Permit Applicati n Island Dairy Well (Well No. 6016-01)

Transmitted for your review and comment is a copy of the captioned After-The-Fact 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. Please respond by returninf this cover memo form by Auftust 14,2009. If we do not receive comments or a request for addtttona revtew ttme by thts date, we wt I assume that you have no comments.

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

:::0 RI: ss I I"\(")

Attachment(s) ~i

RESPONSE· Ji ~~::o . m~l"'\

I I

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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 left~ ::J:O~ days per year or has 15 or more service connections) and must receive Director of Health approval orior to its use to comply with Hawaii Adm;;r.r..tive ~ :Z <: Rules (HAR), Title 11, Chapter 20, Rules Relating to Potable Water Systems, § 11-20-29. .• :zO

:II :J»ZI"l'\ 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 servtce Cl;:E Q connections) and if the well water is used for drinking, the private owner should test for bacteriological and chemical presence before initiating s.-use l"l'\>. and routinely monitor the water quality thereafter. However, if future planned use from this source increases to meet the public water system defit11lon :X-t then Director of Health approval is required prior to implementation. c:t ~

.. za ~ If the well is used to supply both potable and non-potable purposes in a single system, the user shall eliminate cross-connections and backflow

connections by physically separating potable and non-potable systems by an air gap or an approved backflow preventer, and by clearly labeling all nonpotable spigots with warning signs to prevent inadvertent consumption of non-potable water. Backflow prevention devices should be routinely inspected and tested.

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

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

[ I 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 deseribed 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

~ontact Person: ~OC:3 'irr S I Jerry Nun-ogawa, Eng. in Hilo

Signed: ~ ~ ... · /)h ~ Date: 7-~-')--J--()--J----J. r· 1 H

DEPARTMENT Of HEALTH WASTEWATER BRANCH

Zl9 JUL 20 Al'l 8 58

Ql C) .. ro

iE V) 1/)

c ~-.,... •

-.; ·;.; :::.0 : ",i I.a.'

... · "'-." -~

""

~:...'

JIJL-20-2009 12:37 From:DOWSAFE OR ERANH 8085864351 P.1'1

TO:

FROM:

SUBJECT:

RECEIVED SAFE DRINKING WATER BRA~~~~!Le"

t1$~ER iF\DII.IAH JUL ,_. 0 Wi"9 IIE-'l. s I'U~ARA ( "-1.11.1 CHIYOME': L FUKNO, MO

STATE OF HAWAII DSPARTMENT OF LA.N0 A. NO NA TURAI, RESOURCES

COMMISSION ON WATER HESOURCE MANAGEMENT PO BOXs:l'

HONOllA.U, HAWAI M809

July 14, 2009

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

DONNA FAY K.IOY08AI<l, P. E LAWRENCE H. IIIIIIKE, M.D., J D

~tuart Yamada, Chief~ Safe Drinking Water Branch Alec Wong, Chief, Clean Water Branch Dr. Keith Kawaoka, Office of Hazard E)ah""tion and me:rgency Response

Laura H. Thielen, Chairperson ~~ (1... a,.,.}t.L-Commission on Water Resource Management

After-The-Fact Pump Installation Pennit AppJic.ati n Island DailY Wen <Well No. 6016·01)

Transmitted for your review and eomment is a copy of the captioned After-The-Fact Pump Installation pennit application.

Please fmd the attached rna~ to locate the proposed well. If you have any questions about this peon it application, request additional information, or request additional review time, please contact Ryan Imata ofthe Commisston staff at

Rbls Attachment(s)

RESPONSE:

{ J

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[ 1

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{ }

lbl! well does DOt qUillil'y l1li 111011m: ICI\'ing a Pllblic water S)'Sielll (strllti le$.11han .'!5 pcopl• Qr mo:Jre l*'!'le at least 6() ~ys per year c.. 15 ..,.,;.,.. <OQIOIIdiODS) AJUI if the wdlwatar is ll$ed (o:r drillki~.t, ll,o, privot.: owner •••aid !Cot IDt bac:!.jologtoall!J'd chemiUI ~" 'b<>for~ imtiatill'g ,wb 111e 8lld routinely monitor die wall!r qvality thcrntier. H~. if future pl111111ed ust &6m !bit souro.e ;,.,..,...,. to meet lho publi~ wator oystcm deliaihon tJJen Oircelor of He.alth :IJIP~VVIII is roqllirtd ILil!!: to &J~~Pletn"'llltiou

lflh~ ~II i511&C4 10 .8\IIIPlll bolb I:'O*'IIble md non-potable p~ in a illlpc .i.Jii&WD, the _, :shall eliminate et<W-~IIQN; a.~d 'b;lddiow COIIIHICtiOn& by Jlbynoally ""P~ )>0141olo ad ...,..,a~a'blo oysiCIII& by 811 att pp or <.nlllJII'OVed bl!Ckflou. prewnt«, &lid by <toarly labelillg liii\CIII• poublelj>iFI$ wilb wuuiDg 9i8na li> prr."!!lt inadvertent coMumptiocm ofno"1'Q1ebJe- -ow pr~iOI! dCVJCI!$ should be rov.hnoly i~ liM le:tei!

I1 doe. not-...- 1ha1 this well w.ll"" uoed mr GGJ>JIIIIlplivc purpo!3>~ ond i~ 1)()1; Sijbj<d to Sal<: Drin~J., Water Rl!pldiQQ•

An ~DES permit is ""'"IRII

Othu nlt\':1111 DOH Nl~llrol!'llat10115, m~~"· ~ re<:ommeadanOM n '~h~.

Ia rile evtftlillallhc location of !Ia well cb«nps bu4 IS Jlill wirbm lk p.tr~ol i!oiwib«< <>~~llli:s "1Jrli108tlon, our diviho• CQQ$ideni tP.: .....,mau; to still bt appll~le. illld we do nolul!!d 1Q --the~ locattOII.

No commeewel>j~~Dllolls

Phone: )8/.,- 4-2{£S Date: 7/-z.c/(-:JS

JUL-20-2009 12:39PM FAX:8085864351 ID:DLNR CWRM PAGE:001 R=94%

07-Zl-2009 12:54pm

TO:

FROM:

SUBJECT:

From-DEPT OF HEA~NVIRONMENTAL MNGMT 8085864352 0 T-395

STATE OF HAWAII DePARTMENT OF LAND AND tiATURAL RESOURCES

COMMISSION Ot.l WATER RESOURCE MANAGEMENT P.0.80XB21

H0N0LUW, I-lAWAII 116808

July 14,2009 'I

Honorable Chiyome L. Fukino. M.D .• Director Department ofHealth Attention: Tomas See. Chief, Wastewater Branch

P.003/006 F-424 '--" "-"""

~1(1-~., LAURA H. THIELEN -N SUMNER ERDMAN NeAl. S. FUJIWARA

CHIYOIIE L. FUKlNO, MO. PONNA FAY It KlVO&AKI, P.E.

LAWAENCI' H. MilKE. M.D, J.D.

KEN C. KAWAHARA. P.E. G""'l'JIMI~

!81l9JUL2t

Stuart Yamada, Chief. Safe Drinking Water Branch JAiec Wong Chief. Clean Water Branch Dr. Keith Kawaoka, Office of Hazard E_;ah.,tion and mergency Response

Laura H. Thielen, Chait'person ~~~ A~AJt,L-Conunission on Water Resource Management

After-The-Fact P~p_lnstallation Permit Applicati n Island Dairy Well (Well No. 6016-01)

Transmiued for your review and comment is a copy of the captioned After-The~ Fact Pump Installation permit application.

We would appreciate your comments on the captioned app1ication for any conflicts or inconsistencies with the progr:ams, plans, and objectives s~ific to your department. Please respond by retorn:y this eover, memo form b:y AufWst 14. 2009. If we do not receive comments or a request for 8dditio review time by thiS date, we WI assume itiit you have no comments.

Please flnd the ana.ched maps to locate the proposed welL lfyou have any questions about this pennit application, request additional information, or request additional review time, please contact Ryan Imata ofthe Commisston staff at

Rl:ss Anachment(s)

RESPONSE: ( l

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( 1

'!'hi& well does 1101 gllalify as'*-" ICIViag a ~JiG w- IY:ItOJIII <-'-llliln :ZS pcoplto ur AIQI'O pooJl!c 8l Just 60 diys pet yaar 01' 15 RJVice uoMC41lioDs) 8lld itiha w~ll water i1111cd tOt dtUalcina.lhc pnvatc awn.or :obouM 1e1t ftw ~eriolopoal aDd doeaiibllll1fCIIIIICC blltot.. initiatillg IIUch..., wii"'OItiMMy IIIQ!Iitor tilt water quality~. Howcvct, it llllurc pJaiiiCd IIIII DO!IIIllil source~ 10 mcet w jlllblic: W<1!11' ayae de6nkHln lh"'! Dinootor of l'kalm approval'' 1eq11i~ adfu: 10 impl~~~~m~laliDn. ·

If die well il; \lliOii 10 iapDly both ()Oiabl,. mil nou-patabla p~ in a &mglc 6)SIIml, 1110 ll&ei sllall eiU.U... -ria"" llld bacldlow OQIIDCIQliolll by pli~lfy 88par&lln( pouble zd o~llll ;I)'II'CDII by ill air pp or ;m app.·o'vtd I>IICicflow pR'VCilltt1 -.I by ~ly labeli1111 ill1 DOllpotable api&om wiib Wllmins &ipi to PJ'ItliB61: inadvMm~t ~wnption <>f 110n-pomble wm.r. Suokflow prcvent1011 ct.VK~C&IIbo~ld ~ I'QIIIiocly iDsjlea.olcl Wlti!INd.

11 dOOi IIO'IIJlPelll' tlw t!w -u will be 11Kd tor COIWQJgplive purpoaea aru! i. not Nbject ro Salts Opqkillll Watet RaguJ;otion&.

~ Nl'DES permit is required.

Orbct I'OIIMDI DOH n!IIIM'epllalioos, iatanQillim, or rtiCOOllnooadati<>nl ilre anackd.

In the tMAllla>ti Iiiii l<>qliQn oftho well Clulaso~ bur lli .rDU wilhi111lu: pi~WI ilcaetibcd on lbili 'lpplicalioa, ow divi.oc~~ coosiw~ IIIII gommmts fO ~II be applio~blc, illld we do not lll!le410 review tbe new loc~ion.

No co•~m!$/OI>ji!QCiona

Contact Person: 12 eef" ~ \A\"("' A- Phone:

;( .... Signed: '12-M-& ~ Date:

OCiC...~tpO

JUL-21-2009 12:52PM FAX:8085864352 ID:DLNR CWRM PAGE:003 R=97%

LINDA LINGLE GOVERNOR OF HA WAil

STATE OF HA WAil DEPARTMENT OF LAND AND NATURAL RESOURCES

STATE HISTORIC PRESERVATION DNISION 601 KAMOKILA BOULEY ARD, ROOM 555

KAPOLEI, HAWAII 96707

LAURA H. TIIIELEN CHAIRPERSON

BOARD OF lAND AND NATURAL RESOURCES COMMISSION ON WATER RESOURCE MANAGEMENT

RUSSELL Y. TSUJI FIRST DEPUTY

KEN C. KAWAHARA DEPUTY DIRECfOR ·WATER

AQUATIC RESOURCES BOATING AND OCEAN RECREATION

BUREAU OF CONVEYANCES COMMISSION ON WATER RESOURCE MANAGEMENT

CONSERVATION AND COASTAL lANDS CONSERVATION AND RESOURCES ENFORCEMENT

ENGINEERING FORESTRY AND WIIDUFE HISTORIC PRESERVATION

KAHOOIA WE ISlAND RESERVE COMMISSION lAND

STATE PARKS

July 21, 2009 LOG NO: 2009.2524 DOC NO: 0907MD14

TO:

FROM:

SUBJECT:

Ken C. Kawahara, P .E., Deputy Director Commission on Water Resource Management PO Box 621 Honolulu, HI 96809

Theresa K. Donham, M.A., Lead Archaeologist- Hawaii Island Section j {~-State Historic Preservation Division ~

Chapter 6E-42 Historic Preservation Review -After-the-fact Well Construction/Pump Installation Permit Application Island Dairy Well (Well No. 6016-01) Ookala Ahupua' a, North Hilo District, Island of Hawaii TMK: (3) 3-9-001:002 (por.)

Thank you for the opportunity to comment on the aforementioned project, which we received on July 17, 2009. We determine that no historic properties will be affected by this project because:

[8J Intensive cultivation has altered the land D Residential development/urbanization has altered the land [8J Previous grubbing/grading has altered the land D An accepted archaeological inventory survey (AIS) found no historic properties D SHPD previously reviewed this project and mitigation has been completed [8J Other: SHPD previously commented on the proposed relocation of Island Dairy to this parcel in

1998; at that time we determined that no historic properties would be affected (Log No. 21281, Doc No. 9804PM03).

In the event that historic resources, including human skeletal remains, cultural materials, lava tubes, and lava blisters/bubbles are identified during the construction activities, all work needs to cease in the immediate vicinity of the find, the find needs to be protected from additional disturbance, and the State Historic Preservation Division, Hawaii Island Section, needs to be contacted immediately at (808) 933-7653.

If you have questions about this letter please contact Morgan Davis at

Aug. 4. 2009 9:19AM 0 ~o.3165 P. L

liNDA LINGLE ~OJIGP'NJ/JNNI. RECEIVED

LAURA, H. TI11EL!:N 014NRtEUOk

TO:

FROM:

SUBJECT:

Rl MENT OF HEALTH

·lOOt JUL 20 A II: lf

STATE OF HAWAII HEER OFFICE DEPARTMENT OF LAND AI'IO NATURAL RI:'SOURCES

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

HONOLULU, HAWAII !lll809 .. July 14, 2009

Honor:able Chiyome L. Fukino, M.D., Director Department ofHealtb Attention: Tomas See, Chief, Wastewater Branch

SUMNeR eftllMAN NEA\.8. FIJJIWAAA

CHIVOME L FUKINO, M.D. DONN~!. FAY K K1VOSAKI, P.E.

LAWRENCE H.IIIPKE, M.O., J.D.

Stuart Y amado, Chief, Safe Drinking Water Branch Alec Wong, Chief, Clean Water Branch

./Dr. Keith Kawaoka, Office of Hazard Ejal~on and mergency Response

Laura H. Thielen, Chairperson k.J~ ~,(__ Conunission on Water Resource Management

After-The-Fact Pump Installation Permit Applicat' n Island Dairy Well (Well No. 6016-0l)


Please find the attached maps to locate the proposed weJI. If you have any questions about this permit application, ~uest additionill infonnation, or request additiorial review time, please contact Ryan lmata ofthe CommisslOll staff at

RI:ss Attachment(s)

RESPONSE:

[ 1

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ll

( I

I I

l I ( l

Thia ,vcn qualiliii as a ~~e wbich wm serv~ a. • touiOC Qfpotable walar 10 a publio waltH~tem <•cflncd u at<Ving 25 Qr more people aT lean 60 days pee year or baa 1 S or more .set\'i"" OC!nneolioru) ud mutt ~vp Director of Heald. JpprO'olll J!l!gJ: ro ib 'os~ lo compl)' with HaiV•il Admioisl~alhe l'\ulcr (liAR). Tille II, 0.1plcr 20. RulesRelatiAa lo:Polablc WaiOt Sy$111ms, §ll-.20-29.

This well does ~01 q\llllify u uomu .tm'ima a pPblio wa1er syst., (~-oo lc15 tban lS peape or m- people at leas I 60 dayr Jler year (Jt 15 Seovico OOIIDellfiOnJ) md iflbc wtU WilU i111Sl'd Cor drinking, 1lle priYitc owncra•ould res1 for b~t:ltriDlogical aad Cilemical prest~~tal)&f(l1'41 illifilliaes~h us~ and routiAoly monilt>r lht w111cr 'l,ualit~ Thetoal\er. HDwtver, if fullol'e plllmltd urc fiom dti• OO\II"oe> i~erea~c• lo met! the p•blie WILCl ay.tem dbfinition lhen Dire~for of~llh ap~rovall$ required Jar!9! ro iii>J!I•II!enlllion.

It lh~ well ia uacd 10 aupply bolh {IOiablc and noo.-p~l•bl• purpo1111 ina sinale $Y*Iem.lhc wet mall ~liminto CIOIS-C<W~IICiionnud backtlew oonnecliDil~ by pllysiOIIIIy ieparall~i p012~lo 'od non-pot•1ol• SY$to:oTN by an air pp 01 aa *J>Jll!lved back&w pro\ .. Picw. iDd by clearly bibclin: all nonpol.t>lc spigou wiTh W&lli~a sif;lll to preveot inad''M\elll c:o.aullpli()Jl of-1'olablc walcr. &tktiD\v prn-cnlion ~c11i~ $ho\lld b~ routioaly .iDq.-d aad~srea.

It dou nat appear !hat this well will be used for COM~IIIpl;vcpurpoiOI and ia not sabjtclto Safo Drilicing Water P.~l&tioM.

For the appliceal's informa~on, a source o;ofpouible wasu~w•er OOIII•minatil!ll[]l~ [I iS aof located near the prOpQ&ed well aile (inlbnftalion attached).

NJ. NPD!l:S ponnit is rcqui.U.

Otbo. relwaot l:lOH rulcmlfllla!ions, infonnation, ot reGGIJ\mcndaliona arc anathed,

In the evtBI that the loation of the well thu&el b11t is alill Yoilhin lhll ~ dcmibcd co !bit aPPiblltion.. our dilli&ion CCIIUiders ll!c eommmJS lo &till be applica\1~ Md we Jlo nol naed tO review the new looarioo.

~· N~ \lOmmenlalotUeclions

Contact Person: 1(; ch a,_("J Pa.{ MQ.(

Signed: 4c'/JnA..J ~

AUG-04-2009 09:18AM FAX:

Phone: Date: t {J..,I-4 CD::> tt

I

ID:DLNR CWRM PAGE:004 R=95%

Aug. 4. 2009 11:C8AM EOS- 0 ~0. 3170 P. L

TO;

FROM:

SUBJECT:

nECUVEO PARlMENT Of HEAlTH

· ZOdt JUL 20 A U: 11

STATE OF HAWAII HEER OFFICE PEPAR'TMENT OF LAND AND NATlJRAL RESOURCES

COMMISSION ON WATER RESOU.RCE MANAGEMENT P,O. BOX621

HONOLULU, HAWAII 96e09 ,.

July 14, 2009

Honorable Chiymne L. Fukino. M.D., Director Department ofHealth Attention; Tomas See. Chief, Wastewater Branch

SUMNEREROMAN NEAL S. FUJI'NAAA

CHIYOME L. rUKINO, MO. DONNA FAY~ KIVOSAKI, f'.E.

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

KEN C. KAWAHARA, P.E. I)UvyY OlftUJOR

Stuart Yamada. Chief, Safe Drinking Water Branch Alec Wong. Chief, Clean Water Branch

./Dr. Keith Kawaoka, Office of Hazard Ejah,tion and mergency Response

Laura H. Thielen, Chailperson kJ (!.. OJ,Vl.L-Comtnission Qn Water Resource Management

After-The-Fact PuJl1p_ Installation Permit Applicati n Island Dairy Well (Well No. 6016·01)

Transmitted for your review and comment js a copy of the captioned After-The-Fact Pump lnstallation permit application.

Please find the attached ruaps to locate the proposed well. If you have any questions about this pennit application, request additional information, or request additional review time, please contact Ryan Imata ofthe Commission staff at

RI:ss Attachment( s)

RESPONSE: ( l

( )

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This well q.alifies ti a to- wbich wilhcrve as asc111~ o( pollblo water 10 a puhlit wa~e~ ,y11m1 (de filled as set1/ine ls ~more JICOplc atleasl ~0 days per~ or hn 15 or more servit4 conutC~i0111) 1114 mllit receive Dillllc1or ot trcallll approvallrl!!: 10 iu. P:K> 10 oomply wilh Hawaii Mminiilr8tive ltuler (HAR), TiUell, CbapUr 20, Rulcl Rclali~g to Pctable WJlcr SyBICDU, § 11-20·29.

Thit well dou I>Cl 'lll*lily 1\s 1 sourQC actving apubli" '"~lorayafm (serves less Ibn is p.oplo ormorcpccploatle:ut60 d~YJper yeu or IS.setlliti! ~tioD5} 111d if lbc well water is llHd for drittkinr.lh~ piv.ate o-er •bollld 1~ for bll\lariolo&icalllld ohemitalpuunc6 b&fwe iniliatine: II1Dil DJC md routinely moai•or !he wuor C~_Hiily lbeieaft&r. Ht.wo\-er, it fururc planned uu from •hi• ooiiiCc iDcreues to maet lhe publiD IYaiDr ayctem dewulion then Oii\ICIIClr ofHeallh appronl •~ te~llirod uW; lo implemEBialiw..

It~ w~U ia used lo tllpply boll! potable and non-potable purp01oin 1 ainc,lc aystcm, lhf ~~tor sh•ll climinllo crcu-coaaeetloa$ •nd baoldlow oolllleclitm!: by pkYsio1Uy lcp&rstina; ,.ouble and noa-palablc ayatoms b)' aa ai. pp or m approved bacldlow pl'e'val.lor. and by cloarl:r labeli"i •II DOll· polablo•piiJPfa with Ml'nina sii'!IIO pmrent iaadvetteill -.""'plion ot11011-polable Wlllll". Baal~ flow prcvm.li.on devitet shDUid be rOlllincly inspecred and ~&£tea.

It da&S n(llllppOR lhllllhta weD waJ be used for ~nmmptivo purpo!.ti and is not l~qjccl 1o Safe Dtiakins W•er ~gulariooa.

For the llpplicllll'~ informllioo, a SObltll otpotoibl, WIIIC\Vater C41"1tallli~atianl)i$ r I ilaollocaled ilea( ill& propond well iii~ (i•lbm~atlOq •li.ched).

AnNPDE:$ pmnit i1n:quird.

Other Jele""'ll bOH rulcahcgubtiOI>S, i.f0111111i00. cr ICC4liVIM.daliOII$ are JtllciiCd.

In the tve~~llhat the location ot 1ht: well chan&es bill i& alill within Ike parcel des~ribe(! 0t11hi1 applicatiOD, oUI divisica comiden the commenrs to ~nill b~ •PI'IioJblc, 110d we do noll!aed 1o review lht new locatich.

pcj' No vommenta/oij~ol\5

Contact Person: if{~ c.h a..rcl Pul m.CLy

Signed: ~/tvui ~

AUG-04-2009 11:07AM FAX:

Phone:

Date: J/J~d,J,crtJ'\ I

ID:DLNR CWRM PAGE:004 R=95%


TO:

FROM:

SUBJECT:

ftEC£/VE LAND D!Vt

1009 JUL 11 A

Morris Atta, Administrator Land Division

July 14, 2009

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

After-The-Fact Pump Installation Permit Applica ion Island Dairy Well (Well No. 6016-01) TMK 3-9 01:002



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 understand there is a Lease No. 5586 associated with this well but do not know if this includes water lease considerations. We would appreciate your comments on this issue and any other comments for the captioned application with regard to the programs, plans, and objectives specific to your division. Please respond by returning this cover memo form by August 14,2009. If we do not receive comments or a request for additional review time by this date, we will assume you have no comments.

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

RI:ss Attachment(s)

RESPONSE:

kll

[ ]

[ ]

[ ]

[ ]

[ ]

.,C"') A water lease/permit is required of this applicant and an application for such will be requested by~ ~0 division. o ~

~-~-., A water lease/permit is!!!!! required of this applicant.

~ ~:·.rrt:;.;<1 ~ ff'~·c-. ~ ~~~

A water lease/permit has been obtained by the applicant through lease no. ----------=-'=--- ~ o ~ .oQ y~O -$ ~~ Other relevant Land Division rules/regulations, information, or recommendations are attached.

No objections

Other comments:

,. -_::;...\ .. ~c; The water source under this application is State-owned 1~ ~ encumbered by General Lease No. S-5586 issued to the Applicant, Island Dairy, Inc., The lease contains a mineral/water reservation in favor of the State.

Contact Person: ~ Phone: ___________ _

Gary ~1artin

Date: JUL 'L 4 2009


Mr. Derrick Moreira

0 • STATE OF HAWAII



July 14, 2009

•

Derrick's Well Drilling and Pump Service P.O. Box 2187 Keeau, HI 96749

Dear Mr. Moreira:





6016-0latf.ack

After-The-Fact Pump Installation Permit Application for Well No. 6016-01

We acknowledge receipt, on May 26,2009, ofyour completed After-The-Fact Pump Installation permit application and filing fee for the Island Dairy Well (Well No. 6016-01). You can expect your application to be processed within ninety (90) days from this date.

If you have any questions about your permit application, please contact Ryan Imata of the Commission staff at or toll-free at (Hawaii), (Kauai), (Maui}, or (Lanai & Molokai}, extension 70255.

RI:ss Attachment

c: Island Dairy

Sincerely,

NC.~~ eputy Dir::L~R

LINDA LINGLE GOVERNOR OF HAWAJI


TO:

FROM:

SUBJECT:




July 14, 2009

Hono~able Chiyome L. Fukino, M.D., Director Department of Health Attention: Tomas See, Chief, Wastewater Branch


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

KEN C. KAWAHARA, P.E. DEPUTY otRECTOR

Stuart Yamada, Chief, Safe Drinking Water Branch Alec Wong, Chief, Clean Water Branch Dr. Keith Kawaoka, Office of Hazard E/al,tion and mergency Response

Laura H. Thielen, Chairperson kJ {!.. ~,L-Commission on Water Resource Management

After-The-Fact Pump hlstallation Permit Applicati n Island Dairy Well (Well No. 6016-01)

Transmitted for your review and comment is a copy of the captioned After-The-Fact Pump hlstallation 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. Please respond by returnin~ this cover memo form by Au5ust 14. 2009. If we do not receive comments or a request for addttlona review time by thts date, we wt I assume that you have no comments.

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

Rl:ss Attachment(s)

RESPONSE:

[ 1

[ 1

[ 1

[ 1

[ 1

[ 1

[ 1 [ 1

[ 1

This well qualifies as a source which will serve as a source of potable water to a public water system (defined as serving 25 or more people at least 60 days per year or has 15 or more service connections) and must receive Director of Health approval prior to its use to comply with Hawaii Administrative Rules (HAR), Tide 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 usc 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 .m: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-connections and backflow connections by physically separating potable and non-potable systems by an air gap or an approved backflow preventer, and by clearly labeling all nonpotable spigots with warning signs to prevent inadvertent consumption of non-potable water. Backflow prevention devices should be routinely inspected and tested.

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

For the applicant's information, a source of possible wastewater contamination [ )is [ ) 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:


COMMISSION ON WATER RESOURCE MANAGEMENT

Morris Atta, Administrator Land Division


July 14, 2009

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

After-The-Fact Pump Installation Permit Applica ion Island Dai:ry Well (Well No. 6016-01) TMK 3-9 01:002






We understand there is a Lease No. 5586 associated with this well but do not know if this includes water lease considerations. We would appreciate your comments on this issue and any other comments for the captioned application with regard to the programs, plans, and objectives specific to your divi~ion. Please respond by returni~~ this cov_er m.emo for~ by August .14, 2009. If we do not receive comments or a request for additional review time by this date, we wtll assume you have no comments.

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

Rl: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!!!!! required of this a_pplicant.

[ ] 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: --------

LINDA LINGLE GOVERNOR OF HAWAH

TO:

FROM:

SUBJECT:




July 14, 2009

Dr. Puaalaokalani Aiu, Administrator Historic Preservation

Morgan Davis Historic Preservation

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

After-The-Fact Pump Installation Permit Applic ion Island Dairy Well (Well No. 6016-01) TMK: 3- -001:002






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 August 14,2009. 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 Ryan Imata of the Commission staff at 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.

RI:ss Attachment(s)

RESPONSE:

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

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

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

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

Signed: _____________ _;_ ____ _ Date: ---------

Initial Benchmark: Found 1 "s Iron Bar flush in concrete pedestal at · wellhead located on TMK(3) 3-9..{)()1:042 . ~~::r'1 Elev. = 640.58 feet. (Hi1o Tidal Datum). ( Reference: Dept. ofWater Supply 4A&-Built' Plans; 0' okala Production Well & Supporting Facilities, Job 93-581, State Well No. 6017-05, dated August 3, 2007

Local Benchmark: Set 'Mag' Nail & Disc., flush in concrete well-pad. Elev. = 53420 feet.

Benchmark Elevation ~~t_:.or-.,

I'J: zo·~o'M-4 .. tAh 1M• ar,• M.f"

(W6~ M)

I certify that t.lw elevation shown above:

-\0

. I

~Jzoo~ l.iccnsc No. Date

~· 4{30/t.IJfO

CO~ION ON WATER RESOURCE MANAGEMENT • ROUTE SLIP FOR NEW APPLICATIONS

FROM: RYAN DATE: 24-Mar-09 SUSPENSE DATE:

CHING, F. KUNIMURA, I. --FUJII, N. NAKAMA, L. --GOODING, K. -- -4-0HYE, M.

1 HARDY,R. i4 --SAKODA,E. --HIGA, D. ==SWANSON, S. --r-HOAGBIN, S. UYENO, D.

ICE, C. --YODA, K. -5-IMATA, R. -- --YOSHINAGA, M.-

1 Approval -3-Signature -4-lnformation

3 KAWAHARA,K.==

WELL NUMBER 6016-01 WELL NAME Island Dairy

0 WELL CONSTRUCTION ~ PUMP INSTALLATION ~

ATTACHMENTS FOR APPLICATION ~CESS lNG- Both applicant & staff generated 1 TRANS. LETIER

2 P!=RMIT PROCESS TABLE

3 CWRMMAP

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

1:= ---ry--v-

~ MLS PRINTOUT ----v-DCCA LICENSE SCREEN PRINTOUT --:r

31-Mar-09

PLEASE:

See Me -1-Review & Comment

Take Action --Type Draft acknow letter -2-Type Final, label file folder, update People. db -5-File --Xerox copies

WUP Number NA

D WUPA

10 BACKGROUND CHECK

11 $25 FEE DEPOSIT SLIP

12 DHP/CDUP/SMA pre-screen --7 ----"7 (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)

FOLDER: D MA9E 1'4EVO FirE P'OLBER, ATTACHED

~ FILE FOLDER ALREADY MADE, IN Ell& CAR!NfiT

INCOMPLETE ACTION DATES:

DATE ACTION . ~· .

(~c.. f/,/, 'c.._uJ dr,/~ 'YH7I ckAv, qbpcd= lzli""~ ~s.;-<d/s~ w/ slilf; '(k,., fA ~ alAN' Y(>b /\,; ~ -·

fZv: lt.\tM..-~ ______________ \._.;... (A.cv · ol~

--------------- rt~ ?~ IJAe-.

e • COMMISSION ON WATER RESOURCE MANAGEMENT

FROM: RYAN

CHING, F. FUJII, N. GOODING, K.

-1-HARDY, R. HIGA,D.

-2-HOAGBIN, S. ICE, C.

-5-IMATA, R.

3 KAWAHARA,K.==

ROUTE SLIP FOR NEW APPLICATIONS

DATE: 24-Feb-09

KUNIMURA, I. NAKAMA, L.

-4-0HYE,M. --SAKODA, E.

SWANSON, S. --UYENO, D.

YODA,K. YOSHINAGA, M.-

SUSPENSE DATE:

1 Approval -3-Signature -4-lnforrnation

WELL NUMBER 6016-01 WELL NAME Island Dairy

0 WELL CONSTRUCTION 0 PUMP INSTALLATION

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

2 PERMIT PROCESS TABLE

3 CWRMMAP

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

MLS PRINTOUT DCCA LICENSE SCREEN PRINTOUT

3-Mar-09

PLEASE:

See Me -1-Review & Comment --Take Action --Type Draft acknow letter -2-Type Final, label file folder, update People.db -5-File

Xerox copies

WUP Number NA

D WUPA

11 $25 FEE DEPOSIT SLIP

12 DHP/CDUP/SMA pre-screen (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)

FOLDER: D D

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

INCOMPLETE ACTION DATES:

DATE ACTION

FROM: ROY

TO:

CHENG, C. CHING, F. CHONG, A. DANBARA, S. ENGLAND, D. FUJII, N. HARDY, R. HOAGBIN, S. ICE, C.

-+--- IMATA, R. _ KAWAHARA, K.

KIMURA, J.

CaiSSION ON WATER RESOURCE MANgMENT

DATE: MAY 2 6 2fl00

INIT. TO:

KUNIMURA. I. MILLS, D. OHYE, L. OHYE, M. OSHIRO, K. SAKODA, E. SWANSON, S. TORRES, R. UYENO, D. YODA, K. YOSHINAGA, M.

I NIT:

SUSPENSE DATE:

FOR:

__ Approval Signature Information

(11/08)

PLEASE:


__ Type Final File

__ Xerox_ copies

.. TMENT OF lAND AND NATURAL RESOUR. DOCUMENT NO · .. UAC OR ATTACHED WORKSHEET DATE· March 18 2009 I

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

s 09 326 c 1026 0752 (1) $25.00 Wailani Drilling Services, Inc.

" " " " " " (2) $25.00 Derrick's Well Drilling

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

TOTAL $ 50.00

REMARKS: LINE (1) TMK: 4-1-002:010 LINE (2) Island Dairy Well LINE (3 LINE (4) LINE (5) LINE (6) LINE (7) LINE (8) LINE (9) LINE (10)

STATE OF HAWAII DEPARTMENT OF JltND AND NATURAL RESOURCES COMMISSION O.ATER RESOURCE MANAGEMEN. APPLICATION FOR A WELL CONSTRUCTION I PUMP INSTALLATION PERMIT

ror UITICial use umy;

Instructions: Please print in ink or type and send complel8d application with attactments to the Commission on Water Resource Management, P.O. Box 621, Honolulu, Hawaii 96809. Application must be accompanied by 6 9 M1\R 1'8 A)Q : 4 4 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 For further informailion and updates to this application form, visit htlp:Jiwww.hawaii.gov/dlnr/cwnn.

WELLLOCAnoNINFORMATION 1. STATE WELL NO. (If already assigned) 2. WELt.~ 6016-01 lslanct.Qiry Well

3.1SLAND Hawaii

4.TMK 3

The following be atlached befOre this ~ is accepted as complete (check off If atlached): 181 Portion of7.5-Minute Series USGS~ map (acale 1:24,000) with wei location labeled and Include the name of the quad map 181 Property tax map, showing well locatiOn referenced to established property boundaries 0 Photograph of the proposed well site 181 A schematic diagram showing the well site, access road and proposed welllnliaslruclure 0 For du wells, attach a rad with aoss section · and llnlsh

5. WELL OPERATOR'S NAME/COMPANY Well Operator's Contact 6. LANDOWNER'S NAME/COMPANY Island Dai , Inc. Bahman Sad hi SOHnsland Dai , Inc. Well Operator's MaiHng Address PO Box2626 Kamuela, HI 96743

Landowner's Mailing Address PO Box2626 Kamuela, HI 96743

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

PROPOSED WELL CONSTRUCTION PROPOSED PUMP INSTALLATION 7. Proposed Work 0 Construct New Well 0 Modify Existing Well 0 Abandon/SeaiW~I

8. Construction Type 0 Drilled DOug 0 Shaft 0 Tunnel

10. Proposed Work 11. Proposed Pumping Rate, gpm 0 Instal New Pump (gallons per minute) 181 Replace Pump 90

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

9. Is this well rt of a of wells? 0 Yes No 54,000

9 1

Landowner's Contact Bahman Sad hi

Landowner's E-mail

2

13. Method of flow measurement 181Fiowmeter 0 Other (explain)

14. Proposed Surveyor name and Hcense number (a surveyor Is required for all Well Construction Pennlts and may be required for some Pump Installation Pennlts)

TBA

PROPOSED USE SITE PHOTO 0 15. Municipal (water systems serving greater than 25 individuals or 15 service

connections

forcatUe

OTHER LEGAL REQUIREMENTS "l8qllited, items 21. ancJ 22. must be obtained before the Commission can · 21. Conservation District Use Permit (COUP) D Well is in Conservation District

0 Required, COUP# date approved---0 Not Required (attach documentation from OCCL) .._--------------------1 181 I have not checked with OCCL about whether or not a COUP is raquifed. I understand that checking with OCCL prior to making this application

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

0 Well is not in Conservation District 0 I have not checked if well is in or out Conservation District. I understand that checking if the well is in a Conservation District may expedite my review.

I further understand that issues raised de or result in denial of the rmit issuance or revocation of the it after it is issued. 22. Special Management Area Permit (SMAP) 0 Required, SMA# date approved 0 Not Required (attach documentation from applicable County~age~---q~) 181 I have not checked with the county about whether or not an SMA Permit is raquifed. I understand that checking with the County prior to making this

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

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

from the HPD. 181 I have not consulted with the HPD regarding potential impacts of well consbuction activities on historic sites. I understand that checking with the HPD

prior to making this application may expedite my review. I further understand that issues raised by this agency may delay or result in denial of the rmit issuance or · of the · alar it is · · the · d nd use is attached.

Additional remarks, explanations, etc. (attach additional sheet if more space is needed) Denick's Well Drilling was not the original pump installer, we installed laoement pump due to an emergency (original pump failure). Prior to installation we contacted and advised CWRM of this matter.

NOTE: Signing below indicates that the signatories understand and swear that the infonnation provided is accurate and true to the best of their knowledge. Further, the signatories understand that upon perml 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 80 days after the completion date of the permitted work; 3) in the event that the application is not completed conectly, any permit may be suspended until the item is brought in to compliance, and any work done while the

it is in su nsion rna result in fines of to 24. WELL DRILLER (Must be tiled out If applic::alion Is fOr Well Conslruc:tion)

Derrick's Well Drilling & Pump Svc C-:--=2:-:800~1---::-:-----

~*!ft8 ~name C-57 Uoense No.

)~. · ~rrick Moreira 3/16/2009 l1llb,ite Print Date

25. PUMP INSTALLER (llullt be tiled out if appllcalion Is fOr Pump Installation)

Derrick's Weft Drilling & Pump Svc --"-Ci:-:::2:-:800::-::::1=-=-=-=--=--

~ -,. ·. = ~~··__,.J C-671C-57a/A License No. ~ "''~ Derrick Moreira 3/16/09 Signature Print Date

Ookala"---Access to Island Dairy

Well Site

Well elevation estimated 576'

Approximate 5000'

from well site to Island Dairy lllSeiVior

Dairy I.-voir elevaCion eslimale 13111

-La: 19"36'4? n.;;;:::.._. U4':fl'll"

~~=~=· =coneretle==photos=·==~=-=m=lplftld=.=·=we=._·__.l[ '-r::._AD83_. _·· _;: ~_: m_degrees_degn!l_. -""-!IQ_':_.':n.n_~_-::_sec __ ---'--1-'----------t SKETCH OF WELL LOCATION

(Referenced to permanent landmark, i.e. building, road, fence, etc.) Provide Ultitude and LongiUde of weJI referenced to NAD83 to neaf89t second

Site Plan.pdf

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Document (2).pdf

State of Ha!ii • For Ofllclal Use Only:

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

tnstrucllona: Please print in ink or type and send completed report (with attachmenls, if applicable) to the Commisaion on Water Resource Management, P.O. Box 621, Honolulu, Hawaii 96809. The Commission may not IKlQ8Pt Incomplete reports. This form shall be submitted within 60 days of the completion of work. For assistance, please consult the Hawaii WeB Construdlon and Pwnp Installation Standards or call the Regulation Branch at &87.0225. For updates to this form or additional information, please visit our website at http://www.state.hi.us/dlnr/etmn/

09 MAR 18 AIO : ~ 9

1. State Well No.:6016-01 Well Name:Island Dairy Well lsland:Hawaii

2. Address: PO Box 2626 Kamuela, ill 96743 Tax Map Key:3-9-1:002

3. Pump Installation Company: Derrick's Well Drilling & Puml! Services LLC

4. Date Pump Installed: 2/19/2009 month/day/year

5. PERMANENT PUMP INFORMATION

Pump Type, Make, Serial No.: Submersible, Goulds SRW AHC, 97720

Rated Capacity: 90 gpm at head ot 1310 ft.

Motor Type, H.P., Voltage, rpm: Centripro, SOHP, 460V, 3400RPM

Pump type (check one):

0 Deep Well Turbine 0 Rotary OPropeller ~ Submersible 0 Rotary-Displacement 0 Reciprocating 0 Centrifugal 0 Rotary-Gear 0 Impulse

6. Method of flow measurement:

181 Flowmeter Manufacturer Macrometer Model no.08-01521-60 Size 3"

0 Other, explain and attach schematic

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

8. Attach the rating curve for the installed pump.

Attach photograph of well clearly showing the benchmark on the concrete pad, the well head, and the 9. method of flow measurement.

10. Well Owner Company Island Dairy Inc Contact Bahman Sadeghi

Address PO Box 2626 Kamuela, ill 96743

Phone Fax

11. Land Owner Company Island Dairy Inc/SOH Contact Bahman Sadeghi

Address Same

Phone Same Fax

12. Remarks Permit application submitted after the fact Pump installed due to Dairy completely out of

water.

Pump Installation Contractor {print) Derrick Moreira C-57/C-57a/A Lie. No. C-28001

Signature 0 ~ ~ Date March 16, 2009

7. AS-BUlL T Pl,IMP SECTION (Please attach as-built If diffeTent from diagram provided below)

Bench mark elevation surveyed to nearest 0.01 ft. = ~ft. mean sea level

Elevation of top of chase tube 536.2 ft. mean sea level

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

Chase tube depth =~ft. otr---+-- (referenced to bench mark)

If airline installed, bottom of ailtine elevation = nla ft. mean sea level

WCR2 Form 2/26107 Page 2 of 2

STEP-DRAWDOWN PUMP TEST DATA (not required for wells producing < 100,000 gpd or 70 gpm)

SDPTD Form 1012112004

Pumped Well No. G?o1 42 - o 1 Observation Well No. ________ _

Pumped Well Name (:p (dlAcv( D~ v-1

Distance between Obs. & Pumped Well __ ft.

Target Q l 6V gpm Reference pt. for depth to water ft. msl

Static Water Level @ start of test ft. msl water level measurements by: ~ electrical sounder [J pressure transducer [J airtine

START TEST Date: .3 ( l t ( !4 Time of day: ~ ~ 4S:A.~Yt

Flow Meter Reading Start: \S"f 4 I 1 i'D gallons

,~,., -- .

-Aetat Depth. ~ PumpinJ rsc r; SJapaed ···. I . to s ... ;>Or •. ~-· 1'ime .·· water.· Q EC<·_." F t t . -~ (at-3 ·01',

.· ( ...... .··-....... -· •JIIIIPt)

~··· i·-·C·c ~-··

(fnQI) (mfnl .f);tft) . 0.'1 ft) (p)_ .·· •.• fllgft)

-45 Pf"l./6 53J. . .J[) 0 . Start test/ Step 1

-30 oq~& 5.3J...)-.O 0 . -15 oq,s t5BJ.)...o 0 .

0 ()411/) S..3J..38 If Jr3o 1

Start pump . ~ 1 0'101 sJ;..Jf ,I( J I~() . 1-ti 1.5 ()'}..) )._ 5-?:A. ~y . 18' /bD ;)_];).. . -+3 2 oe:}~j .~.~ J-. .. ~rr .f'j I?;{) . 1+4- 2.5 o4J4 S3J-..1J<[" .tf /o{) J().s-.

ltib 3 A43v ,5:~A lJ'( . IS" /~0 . -t~ 4 1?1..3? ~~;...,~Y ·If /?J() . lfio 5 tJIJ4P ).3A~f . If. Joo . -i-j5' 6 t'~ls- O:.:U.3f .ff /,30 J.-71.£4 .

f+-U 7 ~() 53_J...3'i 'If /?JI) . +~t; 8 M.s-5' ...S"3 .. L~P ·If Ia" 7o.v.

kf-30 10 /t!Jt:>O 5a->-.dV IY j~l} . /tJ 4,.-,pJ IPw r-

t65"' 15 ft9a' 5dJ.41 ,dJf /45 w ....... . ~~ ;J. &l.h&./ ~

-r% 20 /t'lt? 63~.4-1 • J-t Jds- ;L-71 ,

7f7.1 .

-Hl6 25 /iJI5 63;A 41 . d-1 /t/.5 . t-m 302

~llH ~J-1.3 , ..l3 14-s- " . +55" /0,)5 613.1.~ .)..!;) /lf!T c2f!>tf 7[). I · -

H-Vo /Od_o Ls:3;.. '-& .,_~ 14£_ 61JJiu . I& dnp~ j,)A} r. +t;.c;- /t?c?;~- 6"J.~ ,.)5 /6s- . ~<bfd ch.a.H~ 1 , v

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~~-.-if ACtual '~-·--.. Elapsed .,.,..-. Time

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+ 1o lo4o -+1.1:1 l o4s-

-+rr- {0§5

--1-~0 llOO

e .

Depth DraWdOwn to s .....

<;.= ~ ..... It) O.'lft)

!33J ,..ft., 2u {5."JJ.4h -~

~.4~ ·J-s !5~-l...~ . 2.-5

~'7Sx 45 .zo

SDPTD Fonn 1012112004 ·. -.. --· --

I PunvJfng raf8 Q

(atleelt3 Cf

.Datltmuu. ..... ~-

~: ~·=-.:'·' ...., ((pit)

_•c

toS"

too lo6 l!J?r ~15 7tJ.')....

15.F . , -

,

Deplh to

water

~ o.~ JlJ

1 starting pumping rate Q

4

0

SDPTD Fonn 1012112004 ~~~~' ~ --' -~ ~ ~ ~ c c ~:;

.oa.ta ln1NStlbte:fl ~ Temp. 0~W811 ~"F~ l:J~-

or _ .. c ~

Max possible duration, water level or qua'"!~~~ stabHize for anv 24 uerioa Begin recovery data next page Flow meter reading at end ~umped period: ff/.07 rtJ gals

2 minimum length of step period of constant pumping rate 3 minimum mandatory Chloride (Cr) measurement/sampling at end of every step 4 Use same ending drawdown figure as start for recovery

SDPTD Fonn 1012112004

..... f; ' .... , y

··~···. ~· Water s \ raw t t

·.·~ . ~ Q ac ..........

.... · (ndn). . (nifn) . · O;lft) 0.111) {lf.lm) .~

0 0 0 Pump off, start ntc:OV8f'Y

...,_., 1 /1 o I 6CJJ . .J..1 'of' 0

-f).. 1.5 I I P J. $~)..;5/ ( ~ tj 0

+o 2 II"':?; <5} J...yj • t:) 9 0

+4 2.5 lltJ4 1~)-.)$1 .()tj 0

t-5 3 JJ~~ ~~,). ~ .p'} 0

I+& 4 I I Pv .~!J>)...~ ~tJ 'I 0

-11 5 II tJ7 I S<J .J.. • .J-1 . () 'l 0

-+<{ 6 }ItJf S:~.J-~CJ ·dCJ 0

f'j() 7 /II tJ . 4TitJ.P/ .t)'J 0

-+t'5 8 ,,,.s- cSJa.» .(}? 0

10 0

15 0

20 0

25 0

30 0

40 0

50 0

60 0

70 0

80 0

90 0

100 0

150 0

200 0

250 0 ~ 80% rec:owry achieved • C 80% recowry not achieved

END TEST Date: if/tt/rJfj Time of day: It: t.,s-~ ADDITIONAL REMARKS:-------------------

Person In charge~ test lJ!rinl):' ~ /l1.h"L-#?•::., Signature: ~~ ~ The signature allow indicates that the data reported on this fonn Ia ac:curate and true to the best of the person's knowledge who operated this pump test

CONSTANT-RATE PUMP TEST DATA (not required for wells producing < 50 gpm)

Pumped Well No. CP o I, ~ u I Observation Well No.

CRPTD Fonn 1012112004

Pumped Well Name A r /Af1d( ])..._it:J Distance between Obs. & Pumped Well ft.

Target Q 18: gpm Reference pt. for depth to water ft. msl

Static Water Level @ start of test ft. msl Water level measurements by: .£J electrical sounder 0 pressure transducer 0 air1ine

STARTTEST Date: <11tii1J2 Time of day: /~ : OCJ a I

Flow Meter Reading Start: fl t, o lte gallons

... {mlO)···

-45

-30

-15

0

+t 1

t-10 1.5

1-~tJ 2

.(-t,}() 2.5

HIJ 3

+.:57) 4

t-ffiJ 5

f1fl 6

+'frZJ 7

-t-f?p 8

-ftt?b 10

1+11/) 15

i+tH20 +-lf125

-lr)t/P30

~~t>t'40 +~bo50

#.u60

(mJtt)

//IS"

lidO

It 4/S' /J.•/}1) h

ld-011

/()...{()

I~

IU-.3{)

/;;tt/.,()

lo>6"'0 /){~()

OttO

IJttUJ

t!JtolJ

{) t4o tJ/67)

/)~()

~d t? t?

o4~t'J tJ..:)tJCJ

~(j() t?

~7()0

_.. ... to

IMlter

·~··· CM1l)

SCJ.J. .}J/

.SJJ..c/s' S(}J.. 'IS .58J-.46

~dc).4~ s-3;.4'1

.~~.J . .Jo J:[}J, .Jo

I~.JdS"

S~J . .tl

o3J.-~o

.5)J.3i)

6;);. . .-~i)

~3 1-. ,;;ly

c;;!? J-, ,Ji)

.g~_fl>

SJJ,l)/

.£}J-.OI

I.§)J.()~

·. ·'.:>

(~rtl!I'Jd to t1l'illlMl

Oi'UI) .

0.00

... . jfp

-.jt,

- ./(p

- I.S

-. 15"

- II

I - orp

I

-.t)f

-- '6 I

-~OJ

+. 6{

-f./)fj

-t-. I o -f • .l._s f-. J-K

--r- ,}-3

Start test

SO Pll~ • Start pump/Cf taken

ISS

los ts-.s-1s-s los Is<""

l~s J-?P 1t.3.

~~~

Iss-IS:">

IS:~ cJ?Zi 71.7.

/~

lr-r ISS

/sx· /s:c;-Iss-

I..S"S

CRPTD Fonn 10121112004 ,,.__..cr Adual· .·.~ DnM\fOWn I e.r: ·.~·. ~ to s Pumping Temp. time tin'le water

·~ - -"F t t Q EC cr or

(nearest tona11'81t •-·c Rematk8 .,..) fmin) 0.1 ft) 0.1 ft) (Opm) ~) (mgl}

--~-~ 70 otDo 5J~.I/ ..f-.t J. Is-s- 3to (,1.~-

~80 oqoo 6'3J.-~3 -f-.OJ t5S ~()~ ";.')....

~lJO 90 l.ooo b~~-.J/P - .D1 l"lh' '~I I [5.2)1'181/L {,/. J • lL~a.~

fHoflo100 I4~.J.Ll.-l .~t/7 f(ptp,q. .

tl.-00 -. '2. I. 1:).'1

ff-1~ 150 11-00 ((.. 5JJ.,4( - .tz_ 1~5 La a-t lSs-aJ)Ik . {,{,.(;-. ll d1--oll.~

-l--1fl7 200 0(00 §j)-.~3 - ._f- 1~"3: .~a-4 lp~-

~250 o2-fJo ~J-.L3 +.v 1!7.6 . ~.1D /,t,.'j .

~00 300 o;;IJo 531J.. fD I+ lq 15£ .3.3d. l~t .... f· ft4,hp400 i>Jio l.t;a;..o -+.24 Is-.;- .~~4-

1

1~1£.&· cr sample taken

~1/Jl/1 500 {)6CJt7 S31.qt; .+-.21+ ,,~ :~~~ ~ M.J· JI_Awo"J

i-4--JoiP600 {)(eOt? l"'l.~..2. 0 +.2A L.,-ll o.?o lt,s.~-

~u®700 01t>i> St~d-.1)5 +.24- ts-s- a#-1 b!o.~ · IHuo 800 {)rNJ sa;;...~ -tti ls5 ocJ

1

_k_1_._k ll 4vu....t~ 56 ..... lft112o9oo nCloo b-2JJ..J.PJ 0 1h-z) r1(.;t t., ~-' • IJ..t~Jo1 000 ll>o o 5".3J.. h ~ -.oq I !iS cJiq

I

h&A-· cr sample taken

~-t1m1500 JLOO l7""8 (!).. it> -. II I_~ ,,~J-,~-1

b__[ .0. cr sample taken

tt.J4b2000 1 too n lc'73J-..~ -: "" ·~~

1

r:J~q ~Pall• 1,1.f· ··I 0 elvov..s

2500 I

U- tlJ)\A) ~ I~ "'])I 1 cr sample taken Gh.1. tn .... ,~ , ... '"' .

3000 J .._) 1 cr sample taken . 4000

l cr sample taken . 5000

1 cr sample taken

6000 1 cr sample taken .

7000 l cr sample taken .

8000 I cr sample taken .

9000 I cr sample taken .

10000 Max possible duration, water level or quality did not stabilize for any 24 Deriod

~ Begin recovery data next page

0 Flow meter reading at end of pumped period:

i:.2 ~~~m gals

1 Chloride sampling required 2 Use same ending drawdown figure as start for recovery

CRPTD Fonn 1012112004

C'iii'' t

!rnlnl.

+ 0 0 0 . Start recovery

0

1.5 0

0

2.5 0

0

0

0

0

0

0

0

0

20 0

25 0

30 0

40 0

50 0

60 0

70 0

80 0

90 0

100 0

150 0

200 0

250 0

END TEST Date: <.3/t.A./" ,l Time of day: /-<. : ~

ADDITIONAL REMARKS:------~-----------

Person In charge of ~nt): ~ IYI h'lt-< ~ Signature: ~ ~ The signature above lndlcatel that the data reported on this form Ia accurate and true to the bast of the perwn's knowledge who opereted this pump teal

••••

GloiHd Pumpe and Equipment Denicks Wfitllf Wei Dairy Pump Unlt

Selection list: -

Pump: 5RWAHC-23 Type: User CUI'IIe Syneh speed: - rpm

Speed: 3450 rpm Dla: 3.881n

PUMP OATA SHEET 02110109

S8111Ch Crihlria: Flow: -us gpm

Cui'Vff tiM!: 00000003 Ml Fluid: WBIM at 80 ~f SG: 1

SpecifiC Speeds: Na.:- Ns$:-

Dimensions: Sudfon: -In

Pump Limits: T~:-"F Pressure: -Pili g 5Phere size: ~ In

Power: -hp Eye aree: - fn2

Motor: -hp ~:NEMA ~;-Enelost.lre: TEFC Frame: -Sizing a~ter~a· Max Power on Design CufW

rt 3.88" -Data Point - 1400 Flow: 90 us gpm He.l: 1311 ft 1200

Elt.77'1Co

Power: 38.8 hp 1000

NPSHr. 9ft 800

-Design CuMt-Shuloff Head: 1472 ft eoo

Shutoff dP: 836 psi

Mtl Flow; -us gpm 400 N lO

BEP:79%efr p

'@110USgpm s 10 H

NOL Pwr: 46.1 hp r @140USgpm 0

-- MaxCuMt-

~------------~ USgpm

Perforrnanctt Evaluation:

Flow Speed USgpm rpm

89.6 3450 67.2 3450 44.8 3450

PUMP-FLO 2004 top 15 stages ductile .-on

\liscosly. 1.105 cP

NPSHa: -It

-----75

Head Pump Power NPSHr ft %elf trp ft

975 73.8 44.4 12.7 1178 78.8 42.1 11.2

1313 71 38.5 6.92 1388 71.5 32.6 6.36 1411 67.5 23.5 6

HaKI: -tt

Vapor J)I1JIIIUN: 0.~3 Plli a Atm PI8S$UI'e: 14.7 psi a

90GPMO 1311'TDH

100 125

%eff

90

80

70

eo

llO

o40

SOh p

STATE OF HAvAi A DEPARTMENT OF !rHo AND NATURAL RESOURCES .,

For Official Use Only:

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 orD ~ Water Resource Management, P.O. Box 621, Honolulu, Hawaii 96809. Application must be accompanied by 6 copies and a non-refundable filing fee of $25.00 payable to the Dept. of Land and Natural Resources. The Commisaion may not accept incomplete applications. For assistance, call the Regulation Branch at For further information and updates to this application form, visit http://www.hawaii.gov/dlnr/cwrm.

FEBI8 PI·OI

f-'Oil~·:ISS!CN DN Wf,T[~. • '. ,.\ .. ,.. ~\ 1"

f~~ r· .. :__; , · :, , ,_,1 , • ··t 1, \ • ~--~ 1.,_ 1 i

WELL LOCATION INFORMATION 1. STATE WELL NO. (if already assigned)

6016-01 2.WELLNAME

Island Dairy Well 3.1SLAND Hawaii

4.TMK 3

The following be attached before this application is accepted as complete (check off if attached): 0 Portion of7.5-Minute Series USGS topographic map (scale 1:24,000) with well location labeled and include the name of the quad map 0 Property tax map, showing well location referenced to established property boundaries 0 Photograph of the proposed well site 0 A schematic diagram showing the well site, access road and proposed well infrastructure 0 For dug wells, attach a grading plan with cross section profiles showing existing and finish grades

9 sec

5. WELL OPERATOR'S NAME/COMPANY I Well Operator's Contact 6. LANDOWNER'S NAME/COMPANY I Landowner's Contact Island Dairy, Inc. Bahman Sadeghi State of Hawaii/Island Dairy, Inc Bahman Sadeghi Well Operator's Mailing Address PO Box2626 Kamuela, Hl96743

Well Operator's Phone I Well Operator's Fax

I Well Operator's E-mail

Landowner's Mailing Address PO Box2626 Kamuela, HI 96743

Landowner's Phone I Landowner's Fax J Landowner's E-mail same

PROPOSED WELL CONSTRUCTION PROPOSED PUMP INSTALLATION 7. Proposed Work 8. Construction Type

0 Drilled 1 0. Proposed Work 11. Proposed Pumping Rate, gpm 13. Method offlowmeasurement

~Flowmeter 0 Construd New Well 0 Modify Existing Well 0 Abandon/Seal Well

~ Install New Pump (gallons per minute) 0 Dug 0 Shaft

0 Replace Pump 90 · 0 Other (explain)

0 Tunnel

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

~--------------------~ 12. Proposed Amount of Withdrawal, gpd (gallons per day) 54,000

14. Propoeed Surveyor name and license number (a surveyor Is required for all Well Construction Pennlts and may be required for some Pump Installation Pennlts)

PROPOSED USE 0 15. Municipal (water systems serving greater than 25 individuals or 15 service

connedions)

0 16. Domestic- Number of units to be served:

0 17. Industrial (describe)

~ 18. Irrigation{_ describe crop and no. of acres) Water supply for cattle 0 19. Military (describe) 0 20. Other (describe)

OTHER LEGAL REQUIREMENTS If required, items 21. and 22. must be obtained before the Commission can tegaHy issue a pennit: 21. Conservation District Use Permit (COUP) 0 Well is in Conservation District

SITE PHOTO

1. Unprotect document 2. Insert photo here 3. Protect document 4. Fill in form 5 . File save as

0 Required, COUP# date approved---0 Not Required (attach documentation from OCCL) .._-----.-----------------1 ~ I have not checked with OCCL about whether or not a COUP is required. I understand that checking with OCCL prior to making this application


0 Well is not in Conservation District 0 I have not checked if well is in or out Conservation District. I understand that checking if the well is in a Conservation District may expedite my review.

I further understand that issues raised may delay or result in denial of the permit isfuance or revocation of the permit after it is issued. 22. Special Management Area Permit (SMAP) 0 Required, SMA# date approved 0 Not Required (attach documentation from applicable County-ag-en-cy....,.) ~ I have not checked with the county about whether or not an SMA Permit is required. I understand that checking With the County prior to making this

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

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

from the HPD. . ~ I have riot consulted with the HPD regarding potential inpads of well constJvction activities on historic sites. I understand that checking with the HPD

prior to making this application may expedite my review. I further understand that issues raised by this agency may delay or result in denial of the permit issuance or revocation of the permit after it is issued. Additionally, the history of past land use is attached.

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 contrador shall submit to the Commission a well completion/abandonment report within 80 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. 24. WELL DRILLER (Must be filled 001 if application is for Well Construction)

Derrick's Well Drilling & Pump Svc C-::::--=2=-80;-:0_1_-:-:----~ business name C-57 License No.

~ ~rrick Moreira 211212009 Signature Print Date

25. PUMP INSTALLER (Must be filled 001 if application is for Pump Installation)

Derrick's Well Drilling & Pump Svc -:::::C-=-2==8::::-00::::1:-:-:--:-:---:-:--business name C-57/C-57a/A License No.

~ ~ Derrick Moreira 2112109 ignature Print Date

• OF 5TATE OF HAWAII t-or umc1a1 use unl}f:

COMMISSION OWATER RESOURCE MANAGEMENT-

•

• "" ~ DEPARTMENT O~J.A~D AND NATURAL RESOURCES

APPLICATION FOR A WELL CONSTRUCTION I PUMP INSTALLATION PERMIT qc r c t\f'=" r")

' \ - ' ._ - j ·-

Instructions: Please print in ink or type and send completed application with attachmenls to the Conwnlssion on Water Resource Management, P.O. Box 621, Honolulu, Hawaii 96809. Application must be accompanied by 6 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 apprtcations. For assistance, call the Regulation Branch at 587~225. For further information and updates to this application form, visit hUp:Jiwww.hawaii.gov/dlnr/cwrm.

WELL LOCATION INFORMATION 4.TMK 1. STATE WELL NO. (if already assigned) 2. WELL NAME

6016-01 Island Dairy Well 3.1SLAND Hawaii 3 9 1 ------zaw sec

The following be attached befole this application is accepted as complete (check off if attached): 181 Portion of7.5-Minu118 Series USGS topographic map (scale 1:24.000) with well location labeled and include the name of the quad map 181 Property tax map, showing well location referenced to established property boundaies 0 Photograph of the proposed well site 181 A schematic diagram showing the well site, access road and proposed well Infrastructure 0 For du wells, attadl a with cross section · and finish

5. WELL OPERATOR'S NAME/COMPANY Well Operator's Contact 6. LANDOWNER'S NAME/COMPANY Island Dai Inc. Bahman Sad hi SOH/Island Dai , Inc. Well Operator's Mailing Address PO Box2626 Kamuela, Hl96743

Landowner's Mailing Address PO Box2626 Kamuela, Hl96743

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

PROPOSED WELL CONSTRUCTION PROPOSED PUMP INSTALLATION

Landowner's E-mail

2

7. Proposed Work 0 Construd New Well 0 Modify Existing Well 0 Abandon/Seal Well

8. Construction Type 0 Drilled

10. Proposed Work 11. Proposed Pumping Rate, gpm 0 Instal New Pump (gallons per minute)

13. Method of flow measurement 181Fiowmeter

0Dug 0 Shaft 0 Tunnel

181 Replace Pump 90

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

0 Other (explain)

9. Is this well rt of a of wells? 0 Yes No 54,000 14. Proposed Surveyor name and license nwnber (a surwyor Is required for all Well Construclion Pennlts and may be requirad for some Pwnp

Installation Pennlts) TBA

SITE PHOTO

for cattle

OTHER LEGAL REQUIREMENTS "18qUired, items 21. snd 22. must be obtained befot8 the Commission can Issue a 21. Conservation District Use Permit (COUP) 0 Well is in Conset'Vation District

0 Required, COUP# date approved ___ 1.--------------------.....f 0 Not Required (attach documentation from OCCL) 181 I have not checked with OCCL about whether or not a COUP is required. I understand that checking with OCCL prior to making this application


0 WeH is not in Conservation District 0 I have not checked if well is in or out Conservation District. I understand that checking if the well is in a Conservation District may expedite my review.

I further understand that issues raised ma dela or resul in denial of the it issuance, or revocation of the · after it is issued. 22. Special Management Area Permit (SMAP) 0 Required, SMA# date approved 0 Not Required (attach documentation from applicable County-=--agency-~) 181 I have not checked with the county about whether or not an SMA Permit is required. I understand that checking with the County prior to making this

application may expedite my review. I further understand that issues raised by this agency may delay or result in denial of the permit issuance, or revocation of the rm1t after It is Issued.

23. State Historic Preservation Division (SHPD) of the Department of Land and Natural Resources 0 1 have consulted with the HPD regarding potential impacts of well conslruclion activities on historic sites. I have attached applicable documentation

from the HPD. 181 I have not consulted with the HPD regarding potential impacls of well constructiofl activities on historic sites. I understand that checking with the HPD

prior to making this application may expedite my review. I further understand that issues raised by this agency may delay or result in denial of the it issuance, or revocation of the it after It is issued. · the of land use is attached.

Additional remarks, explanations, etc. (attach addlional sheet if more space is needed) Derrick's Well DrHiing was not the original pump installer, we installed placement pump due to an emergency (original pump failure). Prior to installation we contacted and advised CWRM of this malter.

NOTE: Signing below indicates th8t the tignatories understand and swear that the information provided is accurate and true to the best of their knowledge. Further, the signatories understand that llpon permit approval: 1) the proposed work is to be completed within two (2) years of the approval dlla; 2) the contrac:tor shall submit to the Commission a-well completion/abandonment report within 10 days after the completion date of the permlllld work; 3) In the event that the appliCation is not completed correctly, any permit may be suspended until the item is brought in to complianc:e, and any WOitl done whle the

it is In su ion result in fines of to 24. WELL DRILLER (Must be filled out if application is for Well Construction)

Derrick's Well Drilling & Pump Svc C-=-·-=28=-=00,-,---1_,..,..---__ _ ~business name C-57 License No.

~ ~rrick Moreira 3/1612009 Signature Print Date

25. PUMP INSTALLER (llust be filled out if appbtion is ror Pump Installation)

Derrick's Well Drilling & Pump Svc -=Ci~2==800=1=-=-=-~-=--~business name C-57JC..5781A License No.

'/ _/ ~ ~ Derrick Moreira 3/16/09 Signature Print Date

Ookala

Accass to Island Dairy

;.,_, ______ ....,.~;..... .. ...

Well elevation estimated 576'

ApproximatB 5000'

from well site to Island Dairy reservior

Dairy .-wir elevalion estimate 13111

ISland

' llRiry La: 19"36'45"

a;=..,..... 1S4"f7'11"

I Atfach photos of~ wei I [ NAD83: I ~-::and='=' concrete=,='=='=IJacl=, =======-~ ~,..,.=.:_,_· _:_~.w_~_degrees_rees_go_~_-_,:_.-_::_sec __ --L._'---------1

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

Provide Latitude and LongitUde of welt referenced to NA083 to nearest second

Site Plan.pdf

,

e

<' ~:~ ~

: ~ # .. -oiii/IK:

l

~ I

I

,, iJ ' ! ,.

1 / ,.

f

.. ,., .. ,

Document (2).pdf

Global Pumps and Equipment Oerritk$ Woter Well • PUMP DATA SHEET 02110109

Dairy Pump Unit

S&leetion list -

Pump: 5RWAHC-23 iype: UMr Cul'\fl& Synell Speed; - rpm

Speed: 3450 rpm Ola· 3.88ln Curve file: 00000003 .CN

Specific Speeds: Ns:-

DimensiOns: Suction: - in

Pump limits: Tempen!lture: - •F ~ure: -pill g Sphflre size: - In

Power: -hp Fye area:. -- in2

Momr -hp Slandard: NEUA. Spwd; -EI'ICiooore; TEFC . Frame: -Sizing crit8ria· Max PoiNer on Design CuM!

- D11ta Point -· Ftow: 90 US gpm

HINIIl: 1311 fl

Elf: 77%

Power: 38.8 hp

NPSHr.9ft

- Defiiyn Curve -Shutoff Head: 147:1' ft

Shutoff dP: 536 Pili Min Flow: ·- US gpm

Rf:P: 79% e1'f @110USgpm

NOL Pwr: 45.1 hp @140USgpm

-- Max Curve-

fl 3.8!1"

1400

1200

1000

800

400 N 20 p s H 10

r

L---------....1 US gpm

Performance Evaluation·

Flow Speltd USgpm rpm

134 3450 112 3450 li9.6 3450 67 2 3400 44.8 3450

PUMP·flO 2004 top 15 stages ductile 11011

Head ft

975 1176 1313 1386 1411

Search Criteria~ Flow: ·- US gpm

Fluid: Watet ttt 60 ''f SG: 1 Vi9COS~; 1.105 cP

NPSHa; -It

HMd~ -ff

Vapor preSIIIJre: 0.2563 Pili a Atm Pf'M$Ure: 14.7 Pti a

Adwnced Criteria: none speclfled

75

Pump Pow NPSHr %aff hp ft

73.8 44.4 12.7 78.8 42.1 11.2

n 36.5 8.9~

71.5 32.5 6.36 fiHi 23.5 6

90GPM@ 1311'TOH

100 t25

%eff

90

BO

70

61}

50

40

SOh p

?f)

State of Hai:A e ') COMMISSION ON WATER RESOURCE MANAGEMENT Deparbnen\ of Land and Natural Resources

For Offacial Use Only:

WELL COMPLETION REPORT - PART I Well Construction

Instructions: Please print In ink or type and send completed report (with attachments, if applicable) to the Commission on Water Resource Management, P.O. Box 621, Honolulu, Hawaii 96809. The Commission may not accept incomplete reports. This form shall be submitted within 60 days of the completion of work. For assistance, please consult the Hawaii Well Construdion and Pump Installation Standards or caU the Regulation Branch at For updates to this form or additional information, please visit our· website at http:Jiwww.state.hi.ualdlnr/cwnnl 1

1. State Well No.: 6016.01 Well Name: Island Dairy Well Island: ....;H:....:.;a::..;;w~a;;;.;;il;__ __

2. Addrf:'ss: Kamuela Tax Map Key: 3-9-1:002 ~~~~~-----------

3. Drilling Company: l"usnea t'u\,llu,s 4. Drilling method used during contruction: M Rotary o Percussion o Other (describe)

5. Date Well Construction (drilled,cased,grouted) completed: I A- \ -0 \ Attach Driller's Loa (7126199 DL Form) monthldayJyear

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

,: 7. W~ tt}e subject welfcored? o Yes D( No

8. Initial water-level encountered 5 d.B ft. below ground Date and time of measurement

9. Step-Drawdown Test completed? ad No 0 Yes Attach Step-Drawdown Test tonn (121171117 SDPTD Fonn)

10. Constant Rate Aquifer Test completed? • No 0 Yes Attach Constllnt Rate Aquifer Test tonn (121171117 CRPTD Fonn)

Parameters prior to pump test:

11. Water-level: \D .01 ft. above msl Date and time of measurement: '

12. Chloride: Wo ppm Date and time of sampling:

13. Temperature: __ __.bol.l& __ • ____ oF Date and time of measurement

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

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

I • :\ -o a /orati monthlday/year time

1·3•0) AI!OOA month/day/year time !.:A: o), 10~67A

y/year time

16. 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: lockable cover, threaded coupling, etc.)

17. Remarks:

Licensed Driller (p~fil. Signature

Signature

Permittee (print}

Signature

C-57 Lie. No. _ ___.'4._.'lliL.IoiSL...;9;a.,.1""----

Date __ .._1-_.&J_ ... _o~A.----

WCR1 Form 9129100

14. AS-BUILT V &eCTION (~lease attech as-built ifdiffarent.agram providad below)

Elevation at top of casing ~·11 ft., msl* Minimum of 2' Radius & 4" Thick Concrete Pad

Ground Elevation: ~~? .. 41tt., msl

(to nearest 0.01 ft.)

Bench mark elevation:

~ft.,msl* (Survey to nearest 0.01 ft.)

Total Depth

hoo ft.

Cement Grout: ~00 ft. (min. 70% of distance from ground elevation to top of water surface or 500 ft., whichever is less.)

Annular space between hole and casing (min.3j:

3 in.

Rock or Gravel Packing:

'lao ft. Material: a Crushed Basalt a Rounded Gravel

Water Level Elevation:

/.0 .o, ft. msl*

*msl '"' mean sea level

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

with applicable standards.

Solid Casing: (C!: 90% x (Ground Elev.-Water Level Elev))

Length: .5/a :l . So ft.

Nominal Diameter: 8 in.

Wall Thickness: • ~SO .in.

Bottom Elevation: A) . S ~ ft., msl I

Open Casing: Jll( Perforated a Screen

Length: ~ ft.

Nominal Diameter: S in.

• ~-:'0 Wall Thickness: _ ~.!!- in.

Bottom Elevation: ' l. :$ :!a ft., msl

Open Hole: Length: _____ ....._ ______ ft.

Diameter: ----------- in. Bottom Elevation:-------- ft., msl

Solid Casing Material: Carbon Steel: compliant with (check one or mora):a ANSIIAWWA C200 a API Spec. 5L I(ASTM A53 Q ASTM A 139

And compliant with (check one Qf' mora): a ASTM A242 a Type E a Type S W Grade B a Other Stainless Steel: (check one): a ASTM A409 (production wells) a ASTM A312 (monitor wells)

ABS Plastic conforming to ASTM F480 and ASTM D1527: (check one) a Schedule 40 a Schedule 80 PVC Plastic conforming to ASTM F480 and (ASTM 01785 or ASTM 02241): (check one): a Schedule 40 a Schedule 80 a Schedule 120 Thermoset Plastic: (check one) a Filament Wound Resin Pipe conforming to ASTM D2996

a Centrifugally Cast Resin Pipe conforming to ASTM D2997

Open Casing Material:

a Reinforced Plastic Mortar Pressure Pipe conforming to ASTM D3517 a Glass Fiber Reinforced Resin Pressure Pipe conforming to AWWA C950

a PTFE Fluorocarbon Tubing conforming to ASTM D3296 a FEP Fluorocarbon Tubing conforming to ASTM D3296

Carbon Steel: compliant With (check one or mora):a ANSIIAWWA C200 a API Spec. 5L ·~TM A53 a ASTM A 139

And compliant with (check one or mora): a ASTM A242 a Type E a Type s •Grade B a Other

Stainless Steel: (checkOI'II!I): . :, • aASTM A409 (production wells) aASTM A312 <,monitor welts)

ABS Plastic conforming to ASTM F480 and ASTM D1527: (check one) · ., · · · a Schedule 40 a Schedule 80 PVC Plastic conformiiJg to ASTM F480 and (ASTM D1785 or ASTM D2241): (check one): a Schedule 40 a SP.ledule 80 a Schedule 120

Thermoset Pl~stic: (check one) a Filament Wound Resin PiPe conforming to ASTM 02996 a Centrifugally Cast Resin Pipe conforming to ASTM D2997 a Reinforced Plastic Mortar Pressure Pipe conforming to ASTM D3517

a Glass Fiber Reinforced Resin Pressure Pipe conforming to AVNJA C950

a PTFE Fluorocarbon Tubing conforming to ASTM D3296

0 FEP F1uorocarbon Tubing conforming to ASTM D3296

MEMO and R~TE SLIP

1. Pump Tests Check Glenn Bauer fi (initial) Yes No

Step-Drawdown Test:

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

Aquifer Pump Test:

followed WCPI Stds 0 T & S analysis attached D

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

analysis attached D

D D D

D D

D

• 02120/02

If no, describe deficiency

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

2. Construction Check Mitch Ohye tc;J (initial}

data complete followed WCPI Stds well database updated

t -']...-~, o17

If no, describe deficiency

Yfs' N0~o 3. Charley/Lenor-~---- (initial) take action based on above analysis ~ . '1-,,_~,ov

ATTACHMENTS FOR PUMP INSTALLATION PERMIT:

1 COVER LETTER

2PERMIT (2x)

3DOH COMMENTS

4LAND DIV. COMMENTS

5WCR2FORM

&WURFORM

4. Roy (initial) check 5. Subia (initial) finalize 6. Linnel (initial) signature 7. Charley/Lenore/Ryan File

not necessary- only WCP.

o be sent to applicant

' C ~\ld 1vvVU"V ~ · flo+ l1l~ !- £lt,v . ~l{J"'.\-

January 22, 2002

A TURNER DRILLING & PUMP • Wi>.O. BOX 6941, IDLO, ID 96720

HAW All LICENSE #22597

Ms. Linnel T. Nishioka, Deputy Director State of Hawaii Department of Land and Natural Resources Commission on Water Resource Management P.O. Box621 Honolulu, ID 96809

RE: ISLAND DAIRY

Dear Ms. Nishioka:

Rc ,...., ,_, '\' 1- D ,j '• - ~

ID! m \3 A\\: 11

·ti'·"'' '" '·,

,c-....~ ! \.~.~ tt. t:

c~·''·=-·r.T

Please send an Application for Permanent Pump Installation for the Island Dairy well.

If you have any questions, please give me a call at

Sincerely,

FT:lab

January 22, 2002

A TURNERDRILLING&PUMP A ~.0. BOX 6941, HILO, HI 96720 W

HAW Ail LICENSE #22597

Ms. Linnel T. Nishioka, Deputy Director State of Hawaii Department of Land and Natural Resources Commission on Water Resource Management P.O. Box621 Honolulu, HI 96809

RE: ISLAND DAIRY

Dear Ms. Nishioka:

~ TEE 13 All : I 7

As described in Section 2.9, a "step..drawdown test'' is not required for wells proposed for production less than 100,000 gallons per day or 70 gallons per minute.

Proposed use of this well is 25,000 gallons per day and 50 gallons per minute.

A test pump is installed in this well for chloride content testing.

If you have any questions, please give me a call at

Sincerely,

FT:Jab

State ofHa~ • For Off"leial Use Only:

COMMISSION ON WATER RESOURCE MANAGEMENT Department of Land and Natural Resources ... WELL COMPLETION REPORT - PART I Well Construction

Instructions: Please print in ink or type and send completed report (with attachments, if applicable) to the Commission on Water Resource Management, P.O. Box 621, Honolulu, Hawaii 96809. The Commission may not accept incomplete reports. This form shall be submitted within 60 days of the completion of work. For assistance, please consult the Hawaii WeU Construction and Pump Installation Standards or caU the Regulation Branch at 687..0225. For updates to this form or additional information, please visit our website at http://www.state.hi.us/dlnr/cwrm/

1. State Well No.: 6016.01 Well Name: ....:..;:;ls..:..::;la;.;;.;n.;;;.d-=D-=a..:..::;lry~W;;;_;;e;.;;.;ll;..._ _____ Island:

2. Address: _K;;....;;a.:;;;m=u.;;;..;el;.;;a ______________ Tax Map Key: 3-9-1: 002

3. Drilling Company: l"usn.ea 'I\ e,'ll"''S 4. Drilling method used during contruction: g Rotary o Percussion o Other (describe)

Hawaii

5. Date Well Construction ( drilled,cased,grouted) completed: I'd- \ - 0 \ Attach Driller's Log (7126199 DL Form) monthlday/year

In addition to the driller's log, if a geologic log was prepared, plfiiiSfl aubmlt with this form •

. 7. WS$ the subject wen·cored? o Yes (,1( No

8. Initial water-level encountered 5 a_a ft. below ground Date and time of measurement

9. Step-Drawdown Test completed? Df No 0 Yes Attach Step-Drawdown Test tonn (12117197 SDPTD Form)

·10. Constant Rate Aquifer Test completed? • No 0 Yes Attach Constant Rate Aquifer Test fonn (12117197 CRPTD Form)

Parameters prior to pump test: 11. Water-level: \D .D) ft. above msl Date and time of measurement:

12. Chloride: ~ ppm Date and time of sampling:

13. Temperature: __ _....6...,&-· ____ oF Date and time of measurement:

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

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

16. 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: lockable cover, threaded coupling, etc.)

17. Remarks:

C-57 Lie. No. ---l.~'l.._S.w..;:q._,,__ ___ _

Date __ .a..I-_......J_ .. .Joo~Ou)..__ __ _

Signature

Permittee (print)

Signature Date •(u,{ol. WCR1 Form 9129100

14. AS-BUILT .L SECTION (Please attach as-built if diffe1ente diag~em provided below)

Elevation attop of casing .;~.11ft., msl* (to nearest 0.01 ft.)

niAft'IAhor·. J'fX in.

t--.L.--.j Minimum of 2' Radius & 4" Thick Concrete Pad

Bench mark elevation:

~ft.,msl* (Survey to nearest 0.01 ft.)

Total Depth

"00 ft.

Cement Grout: '100 ft. (min. 70% of distance from ground elevation to top of water surface or 500 ft., whichever is less.)

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

3 in.

Rock or Gravel Packing:

~ ft. Material: a Crushed Basalt Q Rounded Gravel

Water Level Elevation:

/0.0) ft. msl*

*msl = mean sea level

Ground Elevation: ~7 .. +7n., msl

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

with applicable standards.

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

Length: 51? :l . So ft.

Nominal Diameter: B in.

Wall Thickness: • ~SO .in.

Bottom Elevation: g) , 5 3 ft., rnsl

Open Casing: )(Perforated Q Screen

Length: Ly) ft.

Nominal Diameter: 8 in.

• ~ ... o WaiiThickness: _ ~~- in.

Bottom Elevation: 'l. :S ~ ft., msl

Open Hole:

Length:------------- ft.

Diameter: ------------ in.

Bottom Elevation: ft., rnsl

Solid Casing Material: Carbon Steel: compliant with (check one or mo~e):Q ANSVAWWA C200 Q API Spec. 5L I(ASTM A53 Q ASTM A139

And compliant with (check one QT mo~e): Q ASTM A242 Q Type E 0 Type S 'JI Grade B 0 Other

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

ABS Plastic confonning to ASTM F480 and ASTM D1527: (checlc one) 0 Schedule 40 0 Schedule 80

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

Thermoset Plastic: (check one)

Open Casing Material:

Q Filament Wound Resin Pipe conforming to ASTM D2996

Q Centrifugally Cast Resin Pipe conforming to ASTM D2997

Q Reinforced Plastic Mortar Pressure Pipe conforming to ASTM D3517

Q Glass Fiber Reinforced Resin Pressure Pipe conforming to AWWA C950

Q PTFE Fluorocarbon Tubing conforming to ASTM D3296

0 FEP Fluorocarbon Tubing conforming to ASTM D3296

Carbon Steel: compliant with (check one or m01e):O ANSVAWWA C200 0 API Spec. 5L )i(ASTM A53 0 ASTM A 139

And compliant with (check one or mo~e): 0 ASTM A242 0 Type E 0 Type S •Grade B 0 Other

Stainless Steel: (check one): · ~ • OASTM A409 (production wells) OASTM A312 (monitor wells) ABS Plastic confonning to ASTM F480 and ASTM D1527: (check one) · .. , · · · 0 Schedule 40 0 Schedule 80

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

Thermoset Pl~stlc: (d,eck one) . 0 Filament Wound Resin PiPe conforming to AS'TM 02996

0 Centrifugally Cast Resin Pipe conforming to ASTM D2997

0 Reinforced Plastic Mortar Pressure Pipe conforming to ASTM D3517

0 Glass Fiber Reinforced Resin Pressure Pipe conforming to AWWA C950

0 PTFE Fluorocarbon Tubing conforming to ASTM D3296


._

· .. APr.20. 2001 11:54AM No.9925 · p.

.ro:

PAGZS:

F!OM:

M!tDOK GOLD DliRIES, INC. 1 1 M!J • .ROAC AVENUE

Hl~O. KAWAI! ~6720

TelePhone: (BOB) 93!:1 ·54S1

F~c~Lmile: (808J q61~J246

0

Da 1: e. __ Y_...'/_r~_{_CJ_l __ _

HAMI._.R ...... ~r-aAA~_..;~_&\...;;.....~----·-= _____ _

Fin __ w_J: ___ ~---·~--'-~~~-~~~~~~ .. ~--------City ____ ~----~------------~-----------------

R! =. l:~t~ 6 w-tRQ ~ ~ ______ iAcl~d!~a ~=ver sAeet.

N .\..~:S: ~W\Wr.. :; (;\ ~ I. ) 'l s LAN b DAtR..y I

Pbane (806) 'f~O- 09'f/

. . 't'~J;S H!SSJ..G! IS · !~lT!~'D!!) OU.L! FOl T~:::: us:: Of T::!! !~fD!v!DtU.L 0:?.. · "5ffit! TO r;i!C:r"I1' IS .. \DDR!SfiD:-l'.HD~i'-i! CO'if.rATirtNjOi.:-!.tTION r.::r! IS . P:t'rfii.ZG'ZD. CONf!!lE~T!.U .. iNDUZffi" FlOH D!SC:.osii'R! O'!fffi 11~t.tC~3L! t.A.',.·. !1 ·Ti! l~J..DEl or nr!s ~SS.!GZ :rs No~ nz !n!~tl5-E:D R!C!.:PI:::1f=r:-o~ T!Z 2X?!.OTI:2 Oi AG2~T R.ESl'OH S!3I.E FIJi D!!.I7D!:!G nt:::: MISS!Gt IO r.=_!t !]T!~TDE:J i.!CI:!l::!i1', !OU !..i.::: EZl.Z::!! :IO~!!!Z:J !E.~! .Ali! 0! S SZ..~!~ .~ 'l'!O~r, u: .Stl!3'CJ':'!O N 0 :'i COP!!:rl'G Ot T!:S CO\'!i!mf! .. CATIOl( IS S!l!C::!.! ti~·il:3!:'!D. r:: !CU U7'! i.!·CZ:!1!D !~!S· c~l-!Mt~ICA'!ION !! ::i3.0l. n.Z.l..S2 ~fC!!::! OS !~!D!J.!!!.! 3! !n.z::;-:w::. A.N'Z: lE'!'!JJ~ r.n: Ol!GI:i.!.L :-!:iSSA.G'Z IO O'S !'!' 'mE !.201! !.D!li!SS 7!A ~3 · tJ. S •. PCS'!~.t.. SC:J.7!C'Z. '!'~A.:i':t !00'.

~- ~ ~-~-~-----------.:.... _____ ___;,._

. ; .. APr.20. 2001 11:54AM MEADO~~~L~_E~ .. ~! ~~u!J~.~~I ~O~RMIT No.9925 p . 2

Qand Daiwy Well, Well No. 6016-01 0 In accordance with Department of Lend and Nature! Resources, Q:Jmmission on Water Resource Managemenfs Administrativo Aulos, Section 13-168, entitled "Water Use, Wells, and Stntam Diversion Works". this document permits the construction and testing of Island Dairy Well (Well No. 601&-01) at Kamuela, Hawaii, TMK 3-9-1: 002, subject to the Hawaii Well Construction & Pump Installation Standards (1/23197) which include but are not limited to the following conditions:

1.

2.

3.

4.

5.

6.

7.

e.

9.

10.

11.

12.

13.

The Chairperson of the Commission on Water Resource Management (Commission), P.O. Box 621, Honolulu, HI 96609, shall be notified, in writing, at least two (2) weeks before any worlt authorized by this permit commences and sla1f shall be allowed to inspect in&tallation activitie& in accordance with §13-168-15, Hawaii Admlnlstrallw Rules. ·

The well constructiOn permit shflll be for construction and testing of the well only. A minimum 1114-inch diameter monitor tube 5hall be permanentlr installed. in a manner acceptable to the Chairperson. to accurately record water levels. The ~ittee. well operator, and/or well owner shal coordinate with the Chairperson and conduct a pumping test in accordance wtth the Standards (a pump testlflg worksheet Is attJchtc:t). The Pfi'Mittee, well operator, and/or well owner shall submit to the Chairperson the test resultS as a DMis tor supporting tm applicatiOn to install a pe.rmflnent pump and withdraw water for use. No permanent pump may be installed until a pump installation permit is approved and iesuecl bY the Chairperson.

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

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

In the event that subsurface cultural remains such as arlifzlcts. burials or concentrations of shells or llharcoal 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 exi:~ting or future legal uses of water in the area, including any surface water or established instream ftow slllndards. This permit or the authorization to construct the well shall not constitute a determination of correlative water rights. ·

The following shall be &ubmit\ed to the Chairperaon within llixty (60) days after oompletion of work; a. Wall (X)InP,Iellon report, (attached - Part I, Well Construction Report). b. Elevation (referenCed 10 mean sea level, msl) survey by a Hawaii-licensed surveyot. c. A&-built sectional drawit~S~ of tl'le well. d. Plot plal'l and map shO'!VIng the eM~ct location of the well. e. Complete pumping test racords, including Ums, pumping rate, drawdown. chloride content and other data.

~~b~or~ ='r· and/or well owner &hall comply wtth all applicable laws, rules, and ordinances: non.ampliance may be grounds

The well construction permit application is iniXl!'porated into this perm1t by reference and is subject to the Hawaii Well COI'IstructiOn & Purnp 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 praperiy RillY mutt.

The permit may be revoked by the Commission if~· is not started within six (6) months after the date of •ppro~l or if work is suspended or abandoned for six (6l months. unless otherwise specified. The work proposed in the well conttrucliOI"' J)e!l'nlt a~lication shall be complalad within two (2) ~ from the date of permit flpproval, unless otherwise specified. The permit may be axtandad by the ChaifiMirson upon a showing of good cause and goad-.faith ~rlorrnance. A request to ex\end the permit Ghall be submltuid 10 tho Chairperson no later than three !3) monltls prior to the date th8 pem'!it expire&. If the commencement date Is not mat, the Commission may revoiCe the permit after giving the permittee, well operator, and/Or well owner notice of the propoeed acUon 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 tha permittee, well operator, and/or well owner must apply for a well abandonment permit in aoconlance with §13-188-12(1) prior to any well seaUng or plugging work.

The permittee, its successor.~. and assigns shall indemnify, defend, and hold the State of Hawaii harmless from and against any loss. liability, claim, or dem;ind for proparty damage, eersonal injury, or ile8th arisino out of any act or omi$Sion of the appHcant, assigns, officers. employees. contractors, and agents under this perrn1t or relating to or connected wllh tha granting of this permit.

Special conditions in the atlad1ed cover transmittal letter are incorporated herelf'l by reference .. ~ ..... r~ · .. · . ......

~-- . •'

i . , :r.·. /I ...

• i

Date of Approval: November 20, 2000 Expiration Date: November 20, 2002

TIMOTHY E. JOHNS; Chairperson Commission on Water Resource Management

1 have rud tho conditions and terms of this permit.and u"derstand them. I accept and agree to meet then conditions as a prerequisite and underlying condition of my ability to proceed and undel'ltand that I ehall not commence work until I and the driller have &lgnod, dated, and returned tho permit to the 1Eiuion. 1 understand thet non-compliance with any permit condition may begtounds fot revocation and finu of up to $1000 per day from it date of approv•L

Permittee'sSignature: L. '(J,__ Date: lf{l'\{ot Printed Name: ~HM~ S~~e&'-1 r Firm or Title: 1~L(\-tJ,D i)AI ~y

I

Driller's Signature: ----------~-- C-57 License#:-----Date;~------Printed Name; --------------~ Firm or Title:--------------

Please llgn both copiN or tills P"""it, f8tllm oneiD the Ch•irpetSon, and retain til a other for your tecorrls.

Atlirdvnant c: USGS

Oepertment of HaaMhl Sale Drinking Water. Wa•tewahlr, and Clean Weier Srpnchea H~Weli Depertmant af Welar Supply

APR-20-2001 02:27 PM TURNER DRILLING & PUMP 0

TUR.NBlt DRILLING .t PUMP P.o; BOX 694l,lULO. HJ 96720

982..a2SS

Q

California License NS22037 Nevada License *41661 Hawaii *22597

FAX COVER SHEET

TO: RYAN IMATA CWRM

FROM: NAOMI TURNER TURNER DRILLING A PUMP

SUIU: ISLAND DAIRY

PAGES: 2

DATE: 4-lO..Ol

Ryan:

Here is our signature for the Well Construction Permit for Island Dairy. We are now giving ow- 2 week notification that drilling will commence by May 4,. 2001.

·""~ at Ist.nd Dairy is faxing his signed copy within the hour. Please .~1 me with a verification of receipt.

Thanks!

P. 01

-WELL CONSTRUCTION PERMIT

t 4 • . 5.

i e.

7 •

..

I 'i I; I •,

:? 8.

ii r

'1.: 10.

1.~ i ':

. u.

i: ·~ II' 1& ~--~--· .. ---·---·---.. -~.a~

·.~ 0.. o1 AppnJR!~ NcNMibM' ao,IOOO TIMOTHY E. JOHN$, CI'IIII'JMnOn r-! l!xphlllan c.-= Navulber 20, 11102 Carnmisllion an Watar Resourct~' MaNgement

...• ,....., .. _....,..,...,..:::1: ... .......,..._. IUIIIJII.,..IIIIJIWID.....t-aan•-••Prr:?l '01 llftlll

·.~ ==-~~-=-~:-- ... =:::-.:==•· .. e:..-::.==~====·== \ --............. ., .............. '"""" .... ~""" .....

~ :: Perrriittee't S4gnakw8: Data------1'! ; Prtntad Nama: Firm or Title: I• __, ______________________ _

!1 ·:.on~Wasv-n: _. __ vo7Uoeneer~;U../lsfz DaCB: ¥-'?~~ f: ]; Printlld Nama: · Firm or Ttue:--r;.,utiM~It. 1lfitl;tJ' 1'1: ,.... .......... ., ....................... ~ ........................ )llU .......

:: t;,; AlllcMellt . '

,; L• C; :;:.......,~ .... IM!IIing--....... ,.,11'111 OINn Wllct lllnchll

~~~;; ._..n ;J.,. .. at_.~

: ~· . . ..

..

:.·'1' ,.

!MMISSION ON WATER RESOURCE MANAGEME"

FROM:...:...R:.:.Y.:...;AN:..;__ ____ _ DATE: _ __...!..;..\ +{-"k'"'\'-'/....,,:..:b;....._ __ SUSPENSE DATE:

ltill..

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

LUM,A. 3 Approval -3-Signature

4 Information 1 HARDY,R. ~

HIGA,D. :..L --HIRANO, E.

NAKAMA,L.

NAKANO,D. ~ -3-NISHIOKA, L.

4 OHYE, M. ~ \\'1A,oJ SAKODA,E. ~

-2-SUBIA,S. ICE, C. ~IMATA,R. -JINNAI,R.

==SWANSON, S.

--KUNIMURA,I.--UYENO, D.

--YODA,K. - --

WELL NUMBER ~OIC,. , 0 I

~ WELL CONSTRUCTION

WELL NAME

ATTACHMENTS FOR WELL CONSTRUCTION PERMIT: 1 COVER LETTER ~

2 PERMIT (2x) _d._ TO BE SENT TO APPLICANT 3PUMPTEST + 4 DOH COMMENTS 5 LAND DIV. COMMENTS 6WCRFORM --

FOR OFFICE USE ONLY

D PUMP INSTALLATION

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

TO BE SENT TO APPLICANT

k\cr(r:_:. -( U((Jtf.. 'Dt.\ lLu0Ll

L\L. -* ~- 'l.-t 0C\ 1 L 6.>'\~ t..:> ~ \\-14 -oo )

\tV

PLEASE·

See Me 1 Review & Comment

Take Action __ Type Draft

_2_Type Final 5 File

Xerox __ copies

STATE OF HAWAII/ DEPARTMENT OF LAND AND NATURAL RESOURCES I COMMISSION ON WATER RESOURCE MANAGEMENT GROUND WATER WELL INDEX I SUMMARY

ISLAND CODE 18 Coordinates Physical Data Elevations in feet (msl)

Total Bottom Bottom Bottom

Aquif Year Case Depth Solid Perf of Hole Static Head

Well No. Well Name Code Owner/User Drilled Latitude Longitude Type Diain. ft. Ground Casing Casing

6017-04 Kaula Gulch Tun4 80202 Laupahoehoe Su 200048 1551723 TUN 640

6017-05 Ookala Hawaii Dws 1995 200048 1551714 ROT 12 700 641 4 -59 -59 7.67

6117-01 Ookala Shaft 80202 Laupahoehoe Su 1937 200108 1551716 TUN 600 300 -300 6

Tuesday, November 21, 2000

Initial Pump Test Result

Specific Installed Cl- Temp Capacity T Capacity Use

UNU

20.0 336 E+05 .36 MUN

10 17.8 3.57 IND

•

Page 1 of 1

.. WELL CONSTRUCTION PERMIT A ~sland Dairy Well, Well No. 6016-0T'

In accordance with Department of Land and Natural Resources, Commission on Water Resource Manag~fs Administrative·R~. Section 13-168, entitled 'Water Use, Wells, and Stream Diversion Works", this document permits the constnMion and tesq of lsltlnd Dairy Well (Well No. 6016-01) at Kamuela, Hawaii, TMK 3-9-1: 002, subject to the Hawaii Well Consb\iiCtiOn & Pump Installation Standards (1/23/97) which include but are not limited to the following conditions: iJ 1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

The Chairperson of the Commission on Water Resource Management (Commission), P.O. Box 621, HonolulU, HI 96809, shaH be notified, in writing, at least two (2) weeks before any wor1< authorized by this permit commences and staff shall be allowed to inspect installation activities in accordance with §13-168-15, Hawaii Administrative Rules. ··

The well construction permit shall be for construction and testing of the well only. A minimum 1114-inch diameter monitor tube shall be permanenUv installed1jn a manner acceptable to the Chairperson, fo accurately record water levels. The~. well o~rator, and/or w, .. , .. owner shalf coordinam with the Chairperson and conduct a pumping test in accordance with the Standards :(a ·pump testing wo~t. .. attached). The pEtrmittee, well operator, and/or well owner shall submit to the Chairperson the test results as a basis for supp(:jtti'ftg application to lnstan a ~nent pump and withdraw water for use. No permanent pump may be installed until a pump installation permit is approved and issued by the Chairperson.

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

The permittee, well operator, and/or well owner shall incorporate mitigation measures to prevent construction debris from entering the aquatic environment, to schedule wor1< 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 wor1< 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 establislied 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 wor1<: 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 drawin~ of the well. d. Plot plan and map shOWing the exact location of the well. e. Complete pumping test records, including time, pumping rate, drawdown, chloride content, and other data.

The permittee, well operatpr, and/or well owner shall comply with all applicable laws, rules, and ordinances; non-compliance may be grounds for revocation of this perm1l

The wen construction ~rmit application is inQQJPOrated 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 wor1< is not started within six (6) months after the date of apP.roval or if wor1< is suspended or abaridoned for six (6) months, unless otherwise spec;ifled. The wor1< ~ 1n the well construction perm1t application shall be completed within two (2) years from the date of permit approval, unless otherwise specified. The permit may be extended by the Chairperson upon a showing of goOd cause and good-faith performance. A request to extend the permit shall be submitted to the Chairperson no later than three (3) months prior to the date the permit expires. If the commencement date is not met, the Commission may revoke the permit after giving the permittee, well operator, and/or well owner notice of the proposed action and an opportunity to be heard.

If the well is not to be used it must be properly capped. If the well is to be abandoned then the permittee, well operator, and/or well owner must apply for a well abandonment permit in accordance with §13-168-12(f) prior to any well sealing or plugging wor1<.

12. 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, eersonal injury, or Cleath arising out of any act or omission of the applicant, assigns, officers, employees, contractors, and agents under this perm1t or relating t6 or connected with the granting of this permit.

13. ..... .. """"'""' ,, ... _,.,. .. """"". _ ... _ ... ,.,, ., .... ~~. a Date of Approval: November 20, 2000 TIMOTHY E. JOHNS, Chairperson t Expiration Date: November 20, 2002 Commission on Water Resource Management

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

L , P~. ujl't{ol Permittee's Signature:_.:._ ____ ....... _______ Date: __ •..1.-'------

Printed Name: ~tl...-l~~ FinnorTiUe: T<1.Lftf0!} J)!I<Q.Y -·· Driller's Signature: ~ C-57License #: :),':)S<\'1 ~: ~5==--~-.... 2-~ ... Jf~'~f--

t: R-An"-. \\,9-n. G:i2.. Firm or Title: _O~U>::x.Jn~G-~a~~~o,.-;,-;-, ...... __ c; ___ · ·c+~·--Printed Name:

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

Attachment c: USGS

Department of Healthl Safe Drinking Water. Wastewater, and Clean Water Branches Hawaii Department of Water Supply

..... -· J --;

BENJAMIN J. CAYETANO GOVERNOR Of HAWAII

Mr. Bahman Sadeghi Island Dairy, Inc. P.O. Box 2626 Kamuela, HI 967 43

Dear Mr. Sadeghi:


COMMISSION ON WATER RESOURCE MANAGEMENT P.O.BOX621


NOV 2 8 2000

Well Construction Permit Island Dairv Well (Well No. 6016..01)

TIMOTHY E. JOHNS ~

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

HERBERT M. RICHARDS, JR.

LINNEL T. NISHIOKA DEPIIIY DIAECTOR

6016-01.wcp

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 requiremer:"JtS related to discharge of effluent from well drilling and testing activities.

2. Please be aware that your proposed driller is not yet licensed in the State of Hawaii and needs to obtain a license to drill prior to signing the permit. No work shall commence unless a copy of the permit has been fully signed by both permittee and driller.

3. The annular space shall be in compliance with Section 2.6d of the Hawaii Well Construction and Pump Installation Standards.

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 April15, 1998 Declaratory Ruling No. DEC-ADM98-G5, which states that:

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

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 retum to us your signed well construction permit.

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

IMPORT ANT - 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

•

Mr. Sadeghi Page2

(enclosed) within sixty (60) days after the well construction work is completed. Be advised that you may be subject to fines of up to $1000 per day for any violations of your permit conditions starting from the permit approval date.

If you have any questions, please call Ryan lmata of the Commission staff at or toll-free at (Hawaii), (Kauai), (Maul), or (Lanai & Molokai) extension 70255.

~~·· ~ ~ .• JOHNS t

Chairperson

Enclosures

-/

.WELL CONSTRUCTION PERMI. Island Dairy Well, Well No. 6016-01

In accordance with Department of Land and Natural Resources, Commission on Water Resource Managemenfs Administrative Rules, Section 13-168, entitled 'Water Use, Wells, and Stream Diversion Works", this document permits the construction and testing of Island Dairy Well (Well No. 6016-01) at Kamuela, Hawaii, TMK 3-9-1: 002, subject to the Hawaii Well Construction & Pump Installation Standards (1/23/97) which include but are not limited to the following conditions:

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

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

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

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

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

In the event that subsurface cultural remains such as artifacts, burials or concentrations of shells or charcoal are encountered during construction, the permittee, well operator, and/or well owner shall stop work and contact the Departmenrs 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 foliowing 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, weiJ operator. and/or well owner shall comply with all applicable laws, rules, and ordinances; non-compliance may be grounds for revocation of th1s perrmt.

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 aperoval or if work is suspended or abandoned for six {6) months, unless otherwise specified. The work proposed 1n the well construction permit application shall be completed within two {2) years from the date of permit approval, unless otherwise specified. The permit may be extended by the Chairperson upon a showing of good cause and good-faith performance. A request to extend the permit shall be submitted to the Chairperson no later than three (3) months prior to the date the permit expires. If the commencement date is not met, the Commission may revoke the permit after giving the permittee, well operator, and/or well owner notice of the proposed action and an opportunity to be heard.

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

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

13. Spedal """'"""' '" lhe ........ """"' """""'"" ~ ...... '"axpomted he<ei" by refe~' a Date of Approval: November 20, 2000 TIMOTHY E. JOHNS, Chai'P"rson t Expiration Date: November 20, 2002 Commission on Water Resource Management

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

Permittee's Signature:. _____________ _ Date: ______ _

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

Driller's Signature:

-Printed Name:- ··

--------------C-57 License#: _____ Date: ______ _

Firm or Title:----------------

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

Attachment c: USGS

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

Nov-20-00 10:12am

TO:

FROM:

SUBJECT:

0

STATE OF HAWAII 015PNn'UENTOF LAND ANO NATUFW. RESOURCES

COMMISSION ON WATER RESOURCE MANAGEMENT 1".0.11Q)(112'1

HOIIgLIJLU. H4WAII ~

NOV 15 am

Honorable Bruce s. AndBf'£00, Director Oepar1ment of Health Attention: Dennis Tulang. Wastewater Branch

Wilr.am Wong, Safe Drinking Waf« Brandl

Tmothy E. Johns. Chairperson '>{?.;J) 1 ~ "" Commission on Wattlr Resource Management()/' \:...U' U_/\-" V wen Construction/Pum~ Permit Application Island Qalry Weir <Well . 6016-01>

Transmlttect for your review and comment is a copy of tha captioned well applk:adon..

F-075

IIAlJISS.ANDSI:SOM ..,..,G......, . IIIWC c......,_ DAIIIDA..,..._

HfMI!R'I" II,.RICHMDS. Jlt.

UNNELT.~ ...,....,_...

We would appreciate your c;arntnents on the captioned applicatiM far any cohfllcts or ir1Con8i$tende$ with th• programs, plans, and~ specific to your depar1menL Please respond by returning this cover ~...!m9 form by NOV~20DO. ·

Please find the atr:ached maps to loc:ate tile propQSed wen. If you have any~ about 1his permit application, request edditionaJ information, or request additional ~time, contaet ~ lmata of the Commi$5ion stafl' at 587..()255. .

Rl:ky Attachment(s)

"RESPONSE: []

( J

(l [) Na-~-

Contact Ptncn: d&:.!/rt!' J.' ~9

~Md; ~~~~ Phone:

Date: /I /z.o /oo

,, . 'I

I 1

I

I ;I I

HOV-20-00 05:36 PM HACD&DOH-WWB "r·o ............ ~ .. .c:. ...... -

STAT£: OF HAWAI!

8085864300 &U · aDa!iiC:loll!l

:lEPAATUiNT Of l.Aio!D .oi.NO W. 'T'.'RAL AIIOC.'~"ti ~OMMISSION ON WATER RESOURa MANAOiiiiFNT

P.-'.IOlt'l:l H"~(II.ULJ.IIolN.IIoQ tiiiiQ8

·FACSIMILE TRANS.MITT AL .. ·.TO. . ·~---. .. .

( ~ Rvan lnmt._ ..... )

___ _. ... ,. . ~. ~"'.,

·!fc'~ttt•o I Lori K~~ ·-·--·. ··- .. ~· ....... -...... -

F'iiX Nurnb~r: IM3701&4300

Notet.''..::om"'erma:

....... ~ .. -....... • ...... ~·•·r•·-~·-O~te; Novtmbet 17, 2000

Pages lncludl~ H•der~ 2-Subjc;:ct: lslan4 Dairy Wtll

~~"~"· ... ....,.!VJN "l!fl!fl'l' 'S toltA.D •o~~,~~e~"

!;oW"&! A ltl&l-: "JA .... er'"' ·~~ :A. U~;N(L•.~

~~SIIIIIID-.

Ml apolog~:. I~ a~inlll fl:ll' yc.ur immediate dlttt"~' t)n this well constructiatl pamit 8P~D~tk;n. You c:.gn tu:.. 11'1• ttll)•.' oaok \D rne. No n...-:11'1'\all. Thenk!;.

P.c. lOX 621. tiONOWW • ...wAll DIIIOO

P.01 1/7

P.02 NOV-20-00 05:36 PM HACD&DOH-WWB rtov-a .. ge l? US I'ROM•VATOR!:fiOURC!i! l"'OT f"~t 11'1

TO;

F"ROM:

SUOJEC.T~.

STATE OF HAWAII CIPAJm,'EI'If OF 1.A1oD .U\D NA.':'UIIAL. ..0~

COMMISSION ON WA"n;R RUOURCI MNC.lGF..MENT 'Q lOUt~ MON:LUI.IJ, M'1MII SGM

PfJ( 1 5 Z'lOO

Tran1mltted for your revir.tW and comm.n t. a copy of~ captioned well application.

'rluOtt~.· •. JOt ... -~TNI~ --

Ww ~ld ~reciatt your oommenft on· the captioned apptlcalorl for er~y eQI"'ftlcts or rn'.lOnGittonaieG wtth ttl~ prograrM, piMI, 1ncs OOitcllvM apltCIIIc to your Clepattmtnt. .,._ ... NaP!na WIJJLe:D.iM.Jbl& C'-9.~!1' mtmp finD atYNr!IO)W 3_7. !9RQ..

PIMM fmd the .-.~ mep• tQ toc.te tne propoMd well. If YOU neve anv ~=iont; about lh• J*111lt 11J)piic:BtlorJ. r~•t additio.., irtrotnl•c". or reque~st addltloru!l nwtew tit"~•. e ooroot RVJn m•ta [.)(If-. Comi'T1iD1011 sr&ff at S8Ni2S5.

Rl:t:J ,,,.Tm!llflt.l "' ----·-··--·---·----------· RESPONSE: r i

~ I

{ I

. , .. r: Ct··~~~~·"'~ltlfg-~. )'(. .. __,.,__.... . Con~ P.::ruon: -~Ill_-~-. ~\ V\Cl~ Pnon

•v~/1.¥ Cafe: \ l .. UJ .. 1IJ)O

BENJAMIN J. CAYETANO GOVERNOR OF HAWAH

• STATE OF HAWAII



FACSIMILE TRANSMITTAL

To: Mel Hamano I Lori Kajiwara From: Ryan lmata

Company: Department of Health (SDWBIWWB)

Fax Number: 64370/64300

Phone Number:

Notes/Comments:

Date: November 17, 2000

Pages Including Header: 7

Subject: Island Dairy Well

TIMOTHY E. JOHNS CHAIRPERSON

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

DAVID A. NOBRIGA HERBERT M. RICHARDS, JR.

LINNEL T. NISHIOKA DEPUTY DIRECTOR

My apologies for asking for your immediate attention on this well construction permit application. You can fax the reply back to me. No need mail. Thanks.

P.O. BOX 621, HONOLULU, HAWAII 96809 PHONE: (808) FAX: (808) EMAIL: [email protected]. hi. us

BENJAMIN J. CAYETANO G<7lfERNOR OF HAWAII

TO:

FROM:

SUBJECT:

• STATE OF HAWAII


P.O.BOX621 HONOLULU. HAWAII 96809

,. 15 2000

Dean Y. Uchida, Administrator ~ Land Division Q!:f2J Linnel T. Nishioka, Deputy Director • . · Commission on Water Resource Managemen

Well Construction/Pump Installation Permit Application Island Dairy Well (Well No. 6016-01)

TIMOTHY E. JOHNS c...........,.,


HERBERT M. RICHARDS. JR.


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 application with regard to the programs, plans, and objectives specific to your division. Please respond by returning this cover memo form by November 17. 2000.

Please find the attached mars to locate the proposed well. If you have any questions about this permit application, request additiona information, or request additiona review time, please contact Ryan lmata of the Commission staff at

Rl:ky Attachment(s)

RESPONSE:

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

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

[ ] A water lease/pennit has been obtained by the applicant through lease no. -----------

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

[ ] No objections

[] Othercomments: ~-~ ~

Contact Person: f!be7 rl ,4-,Cp!V Phone:

Signed:_---S-~---'--..:::.....:::::~-~------'-=-· ___ _

-------------- ·-------------------------·--·--·- ·--- --

-

~-------------------=========-----·-' !) Ol

- . :.' ~~

.• , .. ·.·-t::~

·". //;-·---~·-.

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·' .. 1!

'. \ . ' \\

.. \ .. ····,·

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\

0

·. · ..... ·-··1' -

....... _,.____, c•·-:=-~ .::r- •· ,.,

, ........ c .... , •• ..,

r

0

... - ...... --?·

-

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:!

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/

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. ·-... :-~.:; · ...... ~· ,•;.•.··· :·, . -.~.· .-.... ·-~\.; ..... ;....:.. .. : ............... ,

- .. .. - -

-

BENJAMIN J. CAYETANO GOVERNOR OF HAWAII

Mr. Bahman Sadeghi Island Dairy, Inc. P.O. Box 2626 Kamuela, HI 967 43

Dear Mr. Sadeghi:

• STATE OF HAWAII


P.O.BOX621 HONOLULU, HAWAII 96809

NOV 15 2000

TIMOTHY E. JOHNS CHo\IIOPERIION



LINNEL T. NISHIOKA llEJOUTY DIIECTCR

6016-01.ack

Well Construction/Pump Installation Permit Application for Well No. 6016-01

We acknowledge receipt, on October 31,2000, of your completed Well Construction/Pump Installation permit application and filing fee for the Island Dairy Well (Well No. 6016-01). You can expect

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

If you have any questions about your permit application, please contact Ryan lmata of the Commission staff at or toll-free at (Hawaii), (Kauai), (Maui), or (Lanai & Molokai) extension 70255.

Rl:ky

M,l y{J (__)I]_~J. U Jq_

LINNEL T. NISHIOKA Deputy Director


TIMOTHY E. JOHNS c........,.,..

TO:

FROM:




NOV 15 2000

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

William Wong, Safe Drinking Water Branch

Timothy E. Johns, Chairperson '>Q. ~n ~ rl 0 Comm1ssion on Water Resource Management() t1) '\:._))' U /\'---- V


DAVID A. NOBRIGA HERijERT M. RICHARDS, JR.


SUBJECT: Well Construction/Pump Installation Permit Application Island Dairv Well (Well No. 6016-01)

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 November 17.2000.

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

Rl:ky Attachment(s)

RESPONSE:

I 1

[ 1

I 1

I 1

I 1

I 1 I 1

This well qualifies as a source which will serve as a source of potable water to a public water system (defined as serving 25 or more people at least 60 days per year or has 15 or more service connections) and must receive Director of Health approval.ll!!m 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 wafer 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 .ll!!m 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:



HONOLULU. HAWAII 96809

NOV 15 2000

Dean Y. Uchida, Administrator ~ Land Division ~ .

Linnel T. Nishioka, Deputy Director , Commission on Water Resource Managemen

Well Construction/Pump Installation Permit Application Island Dairv Well (Well No. 6016-01)

TIMOTHY E. JOHNS CIWRPERION




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 application with regard to the programs, plans, and objectives specific to your division. Please respond by returning this cover memo form by November 17, 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 additiona review time, please contact Ryan lmata of the Commission staff at

Rl:ky 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: ________ _

• • BENJAMIN J. CAYETANO

GOYERNOROF HAWAII TIMOTHY E. JOHNS

CHAIRPERSON

TO:

FROM:




NlW 15 2000

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

William Wong, Safe Drinking Water Branch

Timothy E. Johns, Chairperson ~',{).I\ rl . {)v Commission on Water Resource ManagementU'' \:..).)' U/\'---- U


OAVIDA. NOBRIGA HERBERT M. RICHARDS. JR.


SUBJECT: Well Construction/Pump Installation Permit Application Island Dairy Well (Well No. 6016-01)

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 November 17.2000.

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

Rl:ky Attachment(s)

RESPONSE:

[I

[ l

[I

[I

[I

[I

[I

This well qualifies as a source which will SEHVe as a source of potable water to a public water system (defined as servin9 25 or more people at least 60 days per year or has 15 or more service connections) and must receive Director of Health approvalm:!2!: to 1ts use to comply with Hawaii Administrative Rules (HAR), Title 11, Chapter 20, Rules Relating to Potable Water Systems, §11-20-29.

This well does not qualify as a source serving a public water·~ (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 dririklng, the ~te owner should test for bacteriological and chemiCal presence before initiating such use and routinelY. monitor the water qual thereafter. However, if future planned use from this source Increases to meet the public water system definition then Director of Hea approval is required IZil2l: to Implementation.

If the well is used to supply both potable and non-potable purposes in a sinale system, the user shall eliminate cross-connections and backflow connections by physically separating potable and non-potable syslems by an air 11ap or an approved backflow preventer, and by clearly labeling an non-potable spigots with warning signs to prevent Inadvertent consumption of non-potable water. Backflow prevention devices should be routinely inspecte<l and tested.


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



Contact Person: ________________ _ Phone: ______ _

Signed: __________________ _ Date: ______ _

ISLAND DF HAWAII TOTAL • 2411 IIQD _ .... ......... ,....,~

l~=r.t-1

.. MISSI~N ON WATER RESOURCE MANAGEME. ROUTE SLIP FOR NEW APPLICATIONS

FROM: RYAN DATE:_.....LJ!Iy/'-'lz..+-{00~:...._-- SUSPENSE DATE:

__ BAUER, G. __ CHING, F.

FUJII,N.

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

_S_IMATA, R. JINNAI, R.

===KUNIMURA, I~

__ LUM,A. __ NAKAMA, L.

NAKANO, D. --

3 NISHIOKA, L. ~ 4 OHYE, M.

:::::sAKODA,E. ~ _2_SUBIA, S. ·~· __ SWANSON, S.

UYENO, D. :::::YoDA, K. --

WELL NUMBER (pOlv _0 I WELL NAME

3 Approval -3-Signature

4 Information

~ WELL CONSTRUCTION 6(1 PUMP INSTALLATION

1 TRANS. LETTER 2 CWRMMAP 3 APPL. FORM (3X) 4 USGS MAPS (3X) 5 TAX MAPS (3X) 6 OWNERVERIF. 7 CONTRACTOR VERIF.

FOLDER:

./ --:;;r-----;:;::"""

-:7 ~ ~~ ,·s~ - ..,,·,, f'-'t" '.-')

D MAKE NEW FOLDER l;i!J. FOLDER ALREADY MADE 1 A\"\"~ .

INCOMPLETE APPLICATION DATES:

DATE ACTION

•·

-------PLEASE:

See Me 1 Review & Comment

__ Take Action Type Draft

-2-Type Final 5 File

Xerox __ copies

~cui .h (v1h Obt.\ ~ ~ \?iv· v-rvv~~

\/l.lA$L- '\ \.IJ<,_., ~~ tto~.s ~o-tk- b> y'\.'\...Q.. s::..::::.

~ \ ~ ~\-v OoH p'lY hrJ_ ~Je

·~ Y/tV •

ev~ ~,._L- ~ !;), v • , .,. ., 1- • ~ "'~ . "'-7-" ,. -,.,h..!- c H>

t>~ s~~ e.-~ l,_.t~ _) .

FROM:-'-R __ Y-'-A_N _____ _

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

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

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

WELL NUMBER

0 WELL CONSTRUCTION

1 TRANS. LETTER 2 CWRMMAP 3 APPL. FORM (3X) 4 USGS MAPS (3X) 5 TAX MAPS (3X) 6 OWNER VERIF. 7 CONTRACTOR VERIF.

D MAKE NEW FOLDER

.. MISSION ON WATER RESOURCE MANAGEME.

DATE: ________ SUSPENSE DATE:

LUM,A. NAKAMA, L. NAKANO, D.

-3-NISHIOKA, L. -4-0HYE,M.

SAKODA, E. -2-SUBIA, S.

SWANSON,S. UYENO, D. YODA, K.

WELL NAME

3 Approval -3-Signature -4-lnforrnation

D PUMP INSTALLATION

PLEASE:

See Me -1-Review & Comment --Take Action --Type Draft -2-Type Final -5-File --Xerox copies

D FOLDER ALREADY MADE

Search Results • • CopyrigltfU/3/2000 by HaWaii Information Service

Assessed Values reflect the year 2000 .

• PUBLIC RECORD DATA TMK # 3-3-9-1-2

Lessee:

Page 1 of 1

Lessor: STATE OF HAWAII Tax Payer: STATE OF HAWAII

Tax Bill: Tenure: Govt Owned

Assessed Value Land: $765,400

Buildings: $0 Total: $765,400

Exemption $765,400

$0 $765,400

Size 125.19 ac

o sq ft

Semi-Annual Tax: $0.00 Buildings: 0 Dwellings: 0 PITT Code: 500 Zoning: A-20A Land Use: 0 Nbhood Code: 3967 Subdivision: Kalwlkl Sugar Company

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

http://webreseareh.hawailinformation.com/REseareh/Asp/Functions!Pro~earchTMK.alp 11/3/2000

• State ofHawaii

Department of Land and Natural Resources LAND DIVISION Honolulu, Hawaii

MEMORANDUM

TO:

FROM:

SUBJECT:

Mr. Timothy E. Johns, Chairperson Board of Land and Natural Resources

1/ean Uchida, Administrat~~ (/.and Division

Request for Chairperson's Signature as Landowner Island Dairy Well, Well No. 6016-01

As you know, each application for permits issued by the Commission on Water Resource Management requires the signature of the landowner of the property involved. On behalf of the applicant, may we have your signature on the attached permit applications, which entail the use of State-owned land?

I have attested to the State's ownership of the property covered in the application, as indicated below. Your signature would allow the permit application to be filed and processed. It would not represent an endorsement of the applicant's proposal or an approval for the use of State land; both approvals would be sought by the applicant under separate actions later.

Please return this memo and the permit application to the Water Commission when you're through. Thank you.

Attach.

AFFIRMATION

I hereby affirm that the State of Hawaii is the owner of that certain parcel of land identified as:

TMK 3-9-01:2 located at Ookala on the island of Hawaii

Dated _O_C_T_3_1 _2_00_0 _

I I I ~ I l

, Appendix 9. 6 -

•

• State of Hawaii

Department ofLand and Natural Resources LAND DIVISION Honolulu, Hawaii

MEMORANDUM

TO:

FROM:

SUBJECT:

Mr. Timothy E. Johns, Chairperson Board ofLand and Natural Resources

iean Uchida, Administrat~~ (jand Division


As you know, each application for permits issued by the Commission on Water Resource Management requires the signature of the landowner ofthe property involved. On behalf of the applicant, may we have your signature on the attached permit applications, which entail the use of State-owned land?



Attach.

AFFIRMATION

I hereby affirm that the State ofHawaii is the owner of that certain parcel ofland identified as:

TMK 3-9-01:2 located at Ookala on the island of Hawaii

Dated __ O_C_T_3_1_2_DO_,s' __

coASION ON WATER RESOURCE MANA.ENT (10/99)

OCT 3 I 2000 FROM: _ ____.L ... IN.,..N.,..E.,L--. _____ DATE: _________ SUSPENSE DATE _______ _

TO:

_BAUER, G. _CHING, F. _ DANBARA, S. _,FUJII, N. _t/ H HARDY, R. ft _HIGA,D. _HIRANO, E. _ICE,C. ~/ JIMATA, R. RV" _JINNAI, R. _ KUNIMURA, I.

TO:

_LUM,A. _NAKAMA, L. _NAKANO, D. _ NISHIOKA, L. _OHYE,M. _SAKODA,E. _SUBIA,S. ._SWANSON, S. _UYENO, D. _YODA,K.

_Approval _Signature

Information

PLEASE:

See Me Review & Comment Take Action

_Type Draft _Type Final -/-File _Xerox_ copies

..


LAND DIVISION P.O. BOX 621


OCT 31 2000

TO: Ms. Linnel T. Nishioka, Deputy Director Commission on Water Resource Management

FROM: .hean Y. Uchida, Administrat~~ _ t[and Division l:'" ' - - -y

AQUACULTURE DEVELOPMENT PROGRAM

AQUATIC RESOURCES BOATING AND OCEAN RECREATION

CONSERVATION AND

RESOURCES ENFORCEMENT CONVEYANCES

FORESTRY ANO WILDLIFE HISTORIC PRESERVATION

LAND DIVISION

STATE PARKS

WATER RESOURCE MANAGEMENT

SUBJECT: Your Request in Connection with Well No. 6016-01, Island Dairy, Ookala, Hawaii, Tax Map Key: 3-9-01: 2

We have processed the Island Dairy pump installation permit for the Chairperson's signature as requested by your attached memorandum of October 27, 2000.

The subject State-owned land is located in the agricultural district and is encumbered by General Lease No. S-5586 issued to the applicant.

Should you have any questions, please call Gary Martin at

-BENJAMIN J. CAYETANO

GOVERNOR OF HA.WAII

TO:

FROM:

SUBJECT:



HOocrLU~7WAI20009

Mr. Dean Uchida, Administrator

Land Division ® A'f Linnel Nishioka, Deputy Director · U /}-_ Commission on Water Resource Manage ent


TIMOTHY E. JOHNS CtwRPERSON


DAVID A. NOBRIGA HERBERT M. RICHARDS, JR.


(()

C; 0

We previously transmitted this letter to you on July 18, 2000, but have not yet received a response. As such, we would appreciate your expeditious routing of this application for the Chairperson's signature.

The attached permit application entails the use of State-owned land and, accordingly, requires the signature of the Chairperson as the landowner. Here, we are requesting your help in affirming the State's ownership of the property and, thereafter, routing the application to the Chairperson for his signature. (We have enclosed the appropriate transmittal memo that contains the affirmation statement.)

Please note that the Chairperson's signature on the permit application completes the application and allows it to be accepted for processing by the Commission. The signature neither represents an endorsement of the applicant's proposal nor an approval for the use of State land; both approvals would be sought by the applicant under separate actions later.

Please inform us if the proposed project is in the Conservation District and, if so, whether the requirements of Chapter 343 have been met.

Lastly, please inform us of the contact person at Land Division who is responsible for transmitting the attached original applications to the Chairperson's office.

Rl:ss Attachment

COMMISSION ON WATER RESOURCE MANAGEMENT (10/99)

FROM:. __ _J~~.,..:.:t.tk\:::..:.....!... ___ DATE:. __ lo.:.....L.(\~~~{_01)~-- SUSPENSE DATE. ______ _

TO: INIT.

_BAUER, G. _CHING, F. _ DANBARA, S. _FUJII, N. __l_ HARDY, R. 1, _HIGA,D. _HIRANO, E.

ICE, C. ""'"if I MAT A, R _ _JINNAI, R. _ KUNIMURA, I.

,A. KAMA, L. KANO,D. HIOKA,L.

_OHYE,M. ~ _SAKODA,E.· ~SUBIA,S. _SWANSON, S. _UYENO, D. _YODA,K.

_Approval _Signature

Information

PLEASE:

See Me Review & Comment Take Action

_Type Draft _Type Final

File _Xerox_ copies

I hta'~tk- ~ f?LV ~ {6~ 1\t~S ~~

~.fl.-~ _..;...., 1W J,.._ ~·


TO:

FROM:

SUBJECT:

• STATE OF HAWAII


P.O.BOX621 HONOLULU, HAWAII 96809

OCT 2 7 2000


Land Division ~ ~~

Linnel Nishioka, Deputy Director

1

• U ~ Commission on Water Resource Manage ent


TIMOTHY E. JOHNS



LINNEL T. NISHIOKA DEPUTY CIAECTCR

We previously transmitted thi~ letter to you on July 18, 2000, but have not yet received a response. As such, we would appreciate your expeditious routing of this application for the Chairperson's signature.

The attached permit application entails the use of State-owned land and, accordingly, requires the signature of the Chairperson as the landowner. Here, we are requesting your help in affirming the State's ownership of the property and, thereafter, routing the application to the Chairperson for his signature. (VVe have enclosed the appropriate transmittal memo that contains the affirmation statement.)




Rl:ss Attachment

--·--------- ·---------------------·-----·---·--·- ··-- ..

........ ··-. . . . •...... . . , .... · .. ----~r------------------------------------------------------------------------------------------------------------------------------------------------·==================--;-0~-·-

.. :.• !li~

1!!1

- --

\ \. '· \ \ ~.

I'UW-411

-- --

0

..

·~ ., N-.-.:1 ,6 .. ~~ .::r-c.,.

, .... , .. .., r

.. ......

·'• ... ·· / j . ...

\

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

:I

,J· u

..

{IIA .. IJ •••J

- ... - ...

.....

' I f

, Appendix

•


To: Mel Hamano I Harold Yea

• • STATE OF HAWAII



FACSIMILE TRANSMITTAL

From: Ryan lmata

Date: October 17,2000

TIMOTHY E. JOHNS CHAIRPERSON

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



Company: Department of Health (SDWBIWWB)

Fax Number: 64370/64300 Pages Including Header: ¥ <;"

Phone Number: 64258/64294 Subject: MacFarms Wells

Notes/Comments:

Please review as soon as possible. Sorry for the rush.

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

• State ofHawaii

Department of Land and Natural Resources LANDDMSION Honolulu, Hawaii

MEMORANDUM

TO:

FROM:

SUBJECT:

Mr. Timothy E. Johns, Chairperson Board of Land and Natural Resources

Dean Uchida, Administrator Land Division


As you know, each application for permits issued by the Commission on Water Resource Management requires the signature of the landowner of the property involved. On behalf of the applicant, may we have your signature on the attached permit applications, which entail the use of State-owned land?



Attach.

AFFIRMATION

I hereby affirm that the State of Hawaii is the owner of that certain parcel ofland identified as:

TMK ______ located at------- on the island of ____ _

By: ________ _

Land Division Administrator

Dated _______ _

0

/JA I•A/'VJ lA~~ . .._ ... ······------···-----~-·-~-·--·--. -~*1 .... ·········---~-·~--~

--····- ·------- .... --~-~.f-. --~- ... --..-0~

~~-~eAI~

~~:~or. .. ~.

REMA.RKS:

DATE: 8/

( 1) 25.00 ------ --~~d_Diarh~ll£:....--------(2) _____ _ -----------------------(3). _____ _

----------~---------(4). _____ _ --------------------TOTAL 25.00

'#iXs1arid Dairy Inc. Well

1621

511-10111213

DATE f ... :llf•bO

! ~SvTHE t>L.NR 1 --~ ORDER OF·-!::...._:~.:J-L...:..------------------__..~

~ ry.:;~ -a.,u. r or,,'1> .c::: FU'St Hawaiian Bank KAMUELA BRANCH KAMUELA SHOPPING CENTER 87-11811 MAMAI.AHOA HWY.

eKAMUElA, HAWAII 96743

DOLLARS (!1=::=.-,.,..,.., .....

CtMISSION ON WATER RESOURCE MANAGEMEN. ROUTE SLIP FOR NEW APPLICATIONS

FROM: RYAN DATE: 7 ~~00 TO: . INIT. FOR:

SUSPENSE DATE: -------

PLEASE:

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

NAKAMA, L. -- --3 -Signature ~.A. 3 Approval

-1-Review & Comment

-1-HARDY,R. ~ HIGA, D. --UHIRANO, E. ICE, C.

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

KUNIMURA, 1.-

KANO, D. := e;;lnformation HIOKA, L • ..1............

_4_0HYE, M. \/'-' . ,,q...ov _SAKODA, E. ~

2 SUBIA, S. --SWANSON, S. --UYENO, D. --

YODA,K.

WELL NUMBER ~0 I (p - 0 \ WELL NAME

gj WELL CONSTRUCTION


FOLDER: D MAKE NEW FOLDER 0 FOLDER ALREADY MADE

INCOMPLETE APPLICATION DATES:

DATE ACTION

6ZI PUMP INSTALLATION

7?/1 q) ~,:uJ

--Take Adion --Type Draft -2 -Type Final -5-File --Xerox copies

FROM: RYAN

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

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

-5-IMATA, R.

JINNAI, R. KUNIMURA, 1:-

WELL NUMBER

D WELL CONSTRUCTION


D MAKE NEW FOLDER

-MMISSION ON WATER RESOURCE MANAGEMQ

DATE: ________ SUSPE,NSE OATE:

LUM,A. NAKAMA,L. NAKANO, D.

-3-NISHIOKA, L. -4-0HYE,M.

SAKODA, E. -2-SUBIA, S.

SWANSON,S. --UYENO, D.

YODA, K.

WELL NAME

-- ..

3 Approval -3-Signature -4-lnformation

D PUMP INSTALLATION

PLEASE:

See Me -1-Review & Comment --Take Action

Type Draft -2-Type Final -5-File --Xerox copies

D FOLDER ALREADY MADE

Well No. Well Name Applicant

6016-01 Island Dairy Well Island Dairy Inc.

SECTION 1: WELL LOCATION INFORMATION

Island

Aquifer System

Aquifer Sector

HAWAII

E. MAUNAKEA

PAAUILO

data

Date of Review

Reviewer

Proposed Use

•

Proposed Withdrawal

System Sustainable Yield

f!#IJ!!!J#f! RRI

Irrigation

42000 60

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

Elevation at top of casing

Ground Elevation

Cement Grout

Rock Packing

Hole Diameter

Total Depth

Estimated Head

Calculated Aquifer Thickness

County Water Supply (Y/N ?)

m.s.l.

m.s.l.

-ft.,m.s.l. 287ft.

-SECTION 3: CHECKLIST (values to check are shaded)

Well Depth Theoretical Thickness of Aquifer 287ft.

71.75 ft.

Solid Casing

Material

Designation

Length

Diameter

Wall Thickness

Casing Material

Designation

Length

Diameter Wall Thickness

Openings

Open Hole

Length Diameter

ft. in.

1/4 Aquifer Thickness

,~i?f~fNI!~it~~~' .,,:~f ' ,, :>~;;lf,tli:1P'X ' 9kJY:< :Y:"' (refer to HWCPIS Section 2.2)

Well Casing

Minimum Wall Thickness

Material County or Non-County

Minimum Thickness per standards

-~~··· Minimum Length of Solid Casing 90% of to top of aquifer

Steel non-county

0.250 in. ·;:;;q:;;fqifi~if okay · · (refer to HWCPIS Section 2.4 c)

.~INt.· ~t'c":i:~'i''~.~ · (refer to HWCPIS Section 2.4 d)

(refer to HWCPIS Section 2.4 e)

Annular Space

Depth of Grouting

Calculated Depth of Grouting

~~ft~tr~:r,.,··

If the eel/above reads #NIA, reference HWCPIS)

Page 1

. > (refer to HWCPIS Section 2. 6 c)

............ (refer to HWCPIS Section 2. 6 d)


TO:

FROM:

SUBJECT:

• STATE OF HAWAII


P.O. BOX621 HONOLULU, HAWAii 96809

JUL 18 2000


TIMOTHY E. JOHNS CIWRI'ERION




Land Division ~

Linnel T. Nishioka, Deputy Director /""~ J. Q -Commission on Water Resource Ma~~rJent Request for Chairperson's Signature as Landowner Island Dairy Well

The attached permit application entails the use of State-owned land and, accordingly, requires the signature of the Chairperson as the landowner. Here, we are requesting your help in affirming the State's ownership of the property and, thereafter, routing the application to the Chairperson for his signature. 0/'le have enclosed the appropriate transmittal memo that contains the affirmation statement.)




Rl:ss Attachment

State of ~aii • COMMISSIO~N WATER RESOURCE MANAGEMENT Department of Land and Natural Resources APPLICATION FOR ·PERMIT H Well Construction or 12( Pump Installation


""f ., ·-·· 1\/. r- (' 1"'\ . t._.~ ,.- ' " ~-~ ·'

:'O·D JUN 19 Instructions: Please print in ink or type and send completed application with attactunents to the Commission on Water Resource Management, P.O. Box 621, Honolulu, Hawaii 96809. Application must be accompanied by 3 copies and a non-refundable tiling fee of $25.00 payable to the Depl of Land and Natural Resources. The Commission may not accept incomplete applications. For assistance, caD lhe Regulation Branch at For further information and updates to this application form, visit http://www.state.hi.usldlnr/cwrm. IN'·· ';' i< ,., : \It·~··~ i w r\ ru~ APPLICANT INFORMATION: (Fill out an three, it applicable, and place a check next to the prima.y contact) I~ES'.h ~CE {.!;/ >:1•.(-icHEt I

1.(a)0 WELLOWNER:1'~LANh /)Ad:_,, INC· ContactPerson: 8AAHAN rAf)f.ii,tf( Pnon!.toV'lC,o-ot:t f..{

Mailing Address: ?! 0 ' 8 01<. 2-C. '2.~ 1---!./«~~=.:.:~IA.LJ=£1=-.L• --=...H.:..::T=---_'}~..:6:.....2~:...4:..._.~-.-----------Fwc ---------- ·------ E-mail: ----------------..;..

(b) 0 LAND OWNER: ------- Contact Person: -------- Pholltl: ---------

Mailing Address:

Fax: E-mail: --------·-----

i-:10 . ._,_

CONTRACTOR: __lllli.O G@.. \) '?-\ \..\..,w,.f :._.__ Contact Pers'on:

Mailing Address: ."'\) 0 ·~. p "' b '/ i..( I l-/ i I Q /-/ ,

Fax: BoB· '18) Bas~- E-ma~: -----------Lie#: '\~\:DO. ~~':'6·}} = {Ciicte oneC8.jt)C'::S7a, or A)

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

2. WELL LOCATION/NAME: ~ktN/(A I .'ISLI'-N) i)I\•.C.V < ir-JC.. u. I

~ Island: ___..; ______ _

Address ro. Boxtt,U, I ~~~a, H.,e- '~?t'3· Tax Map Key: B -~ -ol : Z.. Attach the relevant portion of (a) a 7.5-Minute Series USGS topographic map (scale 1:24,000), and (b) a property tax map, showing well location referenced to established property boundaries. ·

3. PROPOSED WORK: (Check all 1t1at apply)

18 Drill New Wt:ll

0 Modify E.>Ustinl;j iv .. :u

0 Abandon/Seal •

0 Deellc"

0 Red1ill

0 lnst ... l New Pulllp

0 Modify Pump

0 Replace Pum~o~

• Well No.: ----· _ ti"' su1t: tu cvw~Jh:tt: auU s~.umit well abandonment , .. ..,.,.t ~ll"'" cumpl..:liuu ul .. vii\.

4. CONSTRUCT101i: 0 Dug lXI Drilled 0 Radial

Is ttl is wt:ll ;; part ul a battery ol wt:lls? 0 Yes D No (Please desCiibc:.)

5. PROPOSED PUMP INfORMATION: Ratt::d Pump Capacity: _____ l-L...l!O::..-_______ galluns per lllil,ult:

Pump Type (Chftck oil&)

0 Deep WeU Turbine

0 Submersible

0 Centrifugal

6. PROPOSED USE: (Cfleck al that applY)

0 Rotary-Displal-:1 nt:l 11

0 Rotary-Gear

0 Propdller

0 Reciprocatiug

0 mPulse

0 Municipal (indudi11g tlotu~. stores. !l,C-)

0 Domestic (individual, noncommercial water s;t&t~MJJ)

3 Irrigation (crop) C 0.1\"L.G W A."t=€- t\

0 Military

PoWered by:

D Diesel

0 Gas

l2f Electric, ratt:d hor&ej.IOWer. __ 1-...,\D..._ __ _

0 Industrial

No. of Dwelling Unitli: --------

No. of Acres:------------O.Other (explain): _______ ........, __

7. !,.a) PROPOSED AMOUi'lT OF WITHDRAWAL:

(b) METHOD 9F FLOW MEASUREMENT:

\-,\',),;\)CO gallons per day

.ba Flowmeter 0 Open-pipe 0 Weir 0 Orifice O·Other(explain)

OTHER IMPORTANT INFORMATION:

8. PENDING ACTIONS: OcoUA 0 SMA DEl~ OEA ~NONE 0 Other (explain)

9. REMARKS, EXPLANATIONS:

Signature....::, _________ _

Date --~-=:0_,--'cj::....t>t:>---·--. , . , ..

Field Checked By ----· ------

Date

(d more space IS needed, p!Eiase attaCh add16onal sheet)

Longitude-------

Latitude

Date -----".:J~-~~""'-'.'Q_ .. -....:0~0"----

Aquifer System Name ________ _

State Well No. (Q o I Ce - .:'d

WCPIFORM (3/1/00)

State of Ha.ii • For Official Use Only:

COMMISSION ON WATER RESOURCE MANAGEMENT Department of Land and Natural Resources. APPLICATION FOR ·PERMIT H Well Construction or I)( Pump Installation

'0'00 JUN 19 All : 5 J In · tructlons: Please print in ink or type and send completed application with attachments to the Convnission d ' Water Resource Management, P.O. Box 621, Honolulu, Hawaii 96809. Application must be accompanied by 3 copies and a non-refundable filing fee of $25.00 payable to the Depl of land and Natural Resources. The Commission may not accept incomplete applications. For assistance, call the Regulation Branch at For further information and updates to this application form, visit http:/lwww.state.hi.us/dlnr/cwrm. tN'<':' l\:'\;';:"\l·l \"<\l \~~ t,JtJ APPLICANT INFORMATION: {Fill out all three, if applicable, and place a check next to the primary contact) RESt\ 'CE !)/. \$1c!Y.UI

1. (a)O WELL OWNER: r~LAN.b f>Arlo/r WC· Contact Person: 'BAHHA.N fAi)6(;tf( Phon(fDV9~o-o'} tf...{ Mailing Address: --p! 0 '8o~ 2-G.L.G,. 1 kOJII.tULJC.., 1-f.I" j6?f...3 Fax: E-mail:-------------'-

(b) 0 LAND OWNER: ------------- Contact Person: ----------Phone:-----

Mailing Address:

Fax: E-mail:------=------

(c)O CONTRACTOR: 'Ti > Bn G@. $ ?.\ \..bW~f:, Contact Pers'on: ·t K~•'-\:..:~.1 \3,!\.G- \<.

Mailing Address: ·yo ·~. o ""- b 'I 41 t=/ • I o H, 9 '- :i.] 0 Phone: 8a8-98J8J 6"b'

Fax: BoB· 98) 8~s~- E-mail: ------------ Lie#: \t:i;\f)C). ~~\.XS·y (Cltcle oneCE])C:S7a, or A)


2. WELL LOCATION/NAME: Ooka.io.. / .IS1..~-::i)> f)A11l..f/, t,-..JC.. ' I

Island: ~ Address ro. Boxt~U I ~1!1.1~a I H_b ,~?'1:3· Tax Map Key: 3 - ~ -o I : Z.. Attach the relevant portion of (a) a 7.5-Minute Series USGS topographic map (scale 1:24,000), and (b) a property tax map, showing well location referenced to established property boundaries.

3. PROPOSED WORK: (Check sO that apply)

4. CONSTRUCTION:

18 Drill New Well 0 Deepen 0 Install New Pump

0 . Modify Existing Well 0 Redrill 0 Modify Pump

0 Abandon/Seal • 0 Replace Pump

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

0 Dug 0 Bored 0 Driven 1:81 Drilled 0 Radial

Is this well a part of a battery of wells? 0 Yes 0 No (Please describe.)

5. PROPOSED PUMP INFORMATION: Rated Pump Capacity: ____ /~O~ ____ gallons per minute

Pump Type (Check one):

0 Deep Wen Turbine

0 Submersible

0 Centrifugal

6. PROPOSED USE: (Check sA that apply)

0 Rotary

0 Rotary-Displacement

0 Rotary-Gear

0 Propeller

0 Reciprocating

0 ImPulse

0 Municipal Ondudiog hote~. stores,_~tc.)

0 Domestic (individual, noncommercial water system)

2J Irrigation (crop) C A-l\-L6 W &"t<..:.. ).\ 0 Military

PoWered by:

0 Diesel

0 Gas

l2f Electric, rated horsepower: __ ~.,_\u,D'-----

0 Industrial

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

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

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

7. {p) PROPOSED AMOUNT OF WITHDRAWAL: __ h..l.\'.a.l~J('u.)\.::::CX>:...!·-"----gallons per day

(b) METHOD OF FLOW MEASUREMENT: .£a Flowmeter 0 Open-pipe 0 Weir 0 Orifice O"Other(explaln)


8. PENDING ACTIONS: OcDUA 0 SMA 0EIS OEA ~NONE 0 Other (explain)


(if more space IS needed, Please attaCh addabonal sheet)

rlSN I Coo•

Field Checked By ---· ---

Dale

Longitude ______ _

Latitude

Aquifer System Name _______ _

State Well No. (Q 0 I (p ~ \) \

WCPIFORM (3/1/00)

I

•• PROPOSED WELL SECTION ~·, r

Elevation at top of casing bfi a_ ft., msl* (Survey to nearest 0.01 ft.)

T------------------------·--·

Cement Grout: 500 ' fl _.,:, (min. 70% of distance from 1 ..

.!

Minimum of 2' Radius & 4" Thick Concrete Pad

Ground Elevation: 650 ft., msl*

Please refer to the HA WAll WELL CONSTRUCTION AND. PUMP INSTALLATION STANDARDS ,!

to assure that your conslruction plans are)irl ·' compliance with all existing regulations.

•

ground elevation to top of j water surface or 500 ft., 1

~ ¥----- Solid Casing: (~ 90"/c x Gro.und Elev.-Water Level Elev)) Material: · whichever is less.) J

I Material Stan a~~~~·r--__:o...z..ul!-l.....;;;:a........L... __ Length: · ft.

' ' Diameter: ---~~..o.......,,.-r-,........ ___ in.

Minimum annular space between hole and casing :2: 3"

Wall Thickness: in. Bottom Elevation· fl. msl*

Rock or Gravel Packing: ~ D ft. ---i,

Material: 0 Crushed Basalt 18; Rounded Gravel

Water Level Elevation: fo 6Oft.: msl* -:

OpenHole: ~ Length: ----.32:-l.L------- ft. Diameter: in. Bottom Elevation: fl, msr

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 ~vel Elevation }

Example: Estimated+ 2ft. Water level Elev. -+Bottom Elevation of Wen Umlt = ( 2 • ~) = -18.5 ft.

• 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/\Nell Abandonment reports and referenced to a benchmarl< which has been established by a surveyor licensed by the State:

Solid Casing Material:

Steer! compliant with (check one or m0/8): 0 ANSIIAWNA C200 0 API Spec. 5L lJ' ASTM A53

And compliant with (check one or nJ0/'8): 0 ASTM A242 0 Type E 0 Type S D!f Grade B

Stainless Steel: (check one): 0 ASTM A409 0 ASTMA312

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

0 ASTMA139

0 .other --------

PVC Plastic conforming toASTM F480 and (ASTM 01785 or ASTM02241):-(checkone): 0 Schedule 40 0 Schedule 80

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

On~" ~~~~=l"n M:d~


D Reinforced Plastic Mortar Pressure Pipe conforming to ASTM D3517

D Glass Fiber Reinforced Resin Pressure Pipe conforming to AWNA C950

D PTFE Auorocarbon Tubing conforming to ASTM D3296


Steel: compliant with (check one or more): 0 ANSVA'I'-N'JA C200 0 API Spec. 5L f1{ ASTM A53

0 ASTM A242 0 Type E 0 Type· S IS Grade B And compliant with (check one or nJ0/'8):


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

0 ASTMA139

0 Other ----------------

PVC Plastlceonforming toASTM F480 and (ASTM D1785 or ASTM D2241): (check one): 0 Schedule 40 0 Schedule 80

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


0 Relnfo~ Plastic Mortar Pressure Pipe conforming to ASTM 03517

0 Glass Fiber Reinforced Resin Pressure Pipe conforming to AWNA C950

D PTFE Auorocarbon Tubing conforming to ASTM 03296


\

•• Elevation at top of casing 6~ .1 ft, ~s1• (Survey to nearest 0.01 fl.)

PROPOSED WELL SECTION • _._....___ln.

Minimum of 2' Radius & 4" Thick Concrete Pad

__ 7Tt' -~:.~~1nd E~v~tlnn: 6So fl., msr•

Please refer to the

t

"

j w

Cement Grout: 5CO' ft.-.:. ~

HA WAD WELL CONSTRUCTION 6ffP:i PUMP INSTALLATION STANDARDS ·. to assure that your construction. plans ~an {

compliance with all existing regulations. (min. 70% of distance from 1 B ground elevation t() top of j water surface or 500 ft., 1 whichever is less.) l ~ "'- --·-----

' li w -g

Solid Casing: (<: go• Material::---->.....,.l:ii:IO~....-?~=--,...,...--Material Stan a~r ~;,· .----JU...U-I.:...L.-W~~-Length: -..c;l~i&....,o-~!:::------- ft.

I Diameter: in.

Minimum annular space between hole and casing 2: J"

·::J

e Q.

Wall Thickness: ·· ln. Bottom Elevation· ft., msr•

Rock or Gravel Packing: ~ 0 ft.~ Material: 0 Crushed Basalt

'18( Rounded Gravel

Water Level Elevation: &:, 6 Ott.: msl• -'

)(

i!-0 0> N

Open Hole: Length: -fr ft. O~~er:--~-------~-----in. Bottom Efevatio": ft., msl•

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.tjel Elevation )

f:)cample: Estimated + 2 II. Water level Elev. - Bottom Elevation of Wen Umlt = ( 2 • ~) = -18.5 11.

• 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 CompletionNVell Abandonment reports and referenced to a benchm~rl< which has been established by a surveyor licensed by the State.


Steer! compliant with (check one or more):

And compliant with (check one or more):

Stainless Steel: (check one): 0 ASTM A409

0 ANSIIAW'NA C200

0 ASTM A242 0 Type E

0ASTMA312

0 API Spec. 5L IJ' ASTM A53

0 Type S D'f Grade B

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

0 ASTMA139

0 Other ----------------

PVC Plastic conforming to ASTM F480 and (ASTM 01785 or ASTM·02241 ): '(check ~me): 0 Schedule 40 0 Schedule 80

Thermoset Pl~stlc: (chec;l( one) 0 Filament Wound Resin Pipe conforming to ASTM 02996

Op9n C<!''*"! M=-t~

0 Centrifugally Cast Resin Pipe conforming to ASTM 02997

0 Reinforced Plastic Mortar Pressure Pipe conf~rming to ASTM 03517

0 Glass Fiber Reinforced Resin Pressure Pipe conforming to A'WINA C950

0 PTFE Fluorocarbon Tubl~ conforming to ASTM 03296

0 FEP Fluorocarbon Tuhl"g conforming to ASTM 03296

Steel: compliant with (check one or more): 0 ANSVAI.NWA C200 0 API Spec. 5L r1f ASTM A53

0 ASTM A242 0 Type E 0 TypeS r8 Grade B And compliant with (check one or more):


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

0 ASTMA139

0 Other ___________ _

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

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

0 Centrifugally Cast Resin Pipe conforming to ASTM 02997

0 Reinforced Plastic Mortar Pressure Pipe conforming to ASTM 03517


0 PTFE Fluorocarbon Tubing conforming to ASTM 03296

0 FEP Fluorocarbon Tubing conforming to ASTM 03296

·'· ~ ~ ..

State of Ha\.ii 4t COMMISSION ON WATER RESOORCE MANAGEME.NT Department of Land and Natural Resources APPLICATION FOR PERMIT 8 Well Construction or 12( Pump Installation


'0'0 JON 19 A1\ : 5 J

'

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 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 For further information and updates to this application form, visit http://www.state.hi.us/dlnr/cwrm. IN"\':~ ":l~t:': :··,1 }.~ ~~~~~ W ~JtR APPLICANT INFORMATION: {Fill out all three, if applicable, and place a check next to the primary contact) RES6;. ~CE F/. ::), c;t.~~EH

1.(a)0 WELLOWNER:TstLANb /.)Arl!.?r/NC· ContactPerson: 'BAI-fi-IAN fAi)f£i,tff Phon[foV9Cr,O-O'J ¢..( Mailing Address: ~ 0 · 8 01( U '2.(.,. 1 Ka.nH.J.LiC.. , I-II j6 71/;3 Fax: E-mail: -~-----------'-

(b) 0 LAND OWNER: ------------- Contact Person: ----------Phone:------

Mailing Address:

Fax: E-mail: -------::------

(c) 0 CONTRACTOR: 'Ti>BnGe '\)9-,\\ .. \..,\~C:, Contact Pers·on: ·tK!\>"\'s.:\lJ'RY\.G-\<. Phone: 8a8-·9flJ-8JS"b" MailingAddress: '\)o·~o .... 6941 t-/1/o H, 9':'sJO Fax: <8o8· 98). Sash- E-mail:----------


2. WELL LOCATION/NAME: OokaJo.. / ZSt~) D/t•Al..V, 1,.Jc.. Island: ~ ' I

Address fo · BoxZ{,U, ~M-tuc.ia, H..b ik,?'t3· Tax Map Key: 3 -tt-ol : Z.. Attach the relevant portion of (a) a 7.5-Minute Series USGS topographic map (scale 1 :24,000), and (b) a property tax map, showing well location referenced to established property boundaries.

3. PROPOSED WORK: (Check all that apply)

4. CONSTRUCTION:

IS Drill New Well 0 Deepen 0 Install New Pump

0 . Modify Existing Well 0 Redrill 0 Modify Pump

0 Abandon/Seal • 0 Replace Pump

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

0 Dug 0 Bored 0 Driven lXI Drilled 0 Radial

Is this well a part of a battery of wells? 0 Yes 0 No (Please describe.)

5. PROPOSED PUMP INFORMATION: Rated Pump Capacity: ____ t~O.:.._ ____ gallons per minute

Pump Type (Check one):

0 Deep WeD Turbine

0 Submersible

0 Centrifugal

6. PROPOSED USE: (Check al that apply)

0 Rotary

0 Rotary-Displacement

0 Rotary-Gear

0 Propeller

0 Reciprocating

0 Impulse

0 Municipal Oncluding hote~. stores,_~c.)

0 Domestic (individual, noncommercial water system)

0 Irrigation (crop) C A-1\-lG W !"\1:€- H. 0 Military

Po\vered by:

0 Diesel

0 Gas

l2f Electric, rated horsepower: __ j-.u.Q'----

0 Industrial

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

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

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

7. {.a) PROPOSED AMOUNT OF WITHDRAWAL: __ ~....;~\.....,'d,IYJ~0~..:.00:o.L __ gallons per day

(b) METHOD OF FLOW MEASUREMENT: 1ia Flowmeter 0 Open-pipe 0 Weir 0 Orifice O·Other(explain)


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


(if more space IS needed, J)lease attaCh add1bonal sheet}

1 understand that approval of this application attaches the following standard conditions: 1) the proposed work is to be completed within two (2) years of the approval date; 2) the contractor shall submit to the Commiss~i n a well completion/abandonment report within 30 days after the com. pletion da.te of. the permitted work· 3) monthly water use data shall be submitted · · n; 4) such approval shall not constitute a determination of corr'\lativ(t , water rights and ~;\a;f~ g ara etl the pump capacity or future p to ~pump capacity. .__. • ~ ,.

Well Owner ( ~ L Landowner Contractor ~~~j'~!~~~ ~LAN.b bAi fly I INC... .~ -

Signature Signature Signature · -~·

Date ~/tr"/1>0 Date Date 5- "QQ -oo

Field Checked By -------

Date

Longitude ______ _

Latitude

Aquifer System Name _______ _

State Well No. (o o 1 Ce - 6 \

WCPIFORM (3/1/00)

/

e1. PROPOSED WELL SECTION Hole Diameter: ) '1 in. •

Elevation at top of casing bfi a_ fl, msl* (Survey to nearest 0.01 ft.) Minimum of 2' Radius & 4" Thick Concrete Pad

Ground Elevation: 6So ft., msl*

~--------·---

Please refer to the

Cement Grout: 5CO' fl ~ (min. 70% of distance from 1 ground elevation to top of

i iii

1 3

HAW All WELL CONSTRUCTION AND:; PUMP INSTALLATION STANDARDS to assure that your constnJction plans are.!m

compliance with all existing regulations. ... .!

water surface or 500 ft., whichever is less.)

~ .11----- Solid Casing: (<: 90°

~ iii "0 c

Material: ---->...U:asi::u...,.........,.:::--.,.,..,...--Material Stan a~;..----J.:::.L..U...!!-1-...:o;;t......!.--__ Length: _..czc....u~::r,fit;-------- ft. Diameter: in.

Minimum annular space ·:::~

e Q.

Wall Thickness: ln.

between hole and casing :2: 3" Bottom Elevation· fl, msr

Rock or Gravel Packing: ~ D ft. -----s Material: 0 Crushed Basalt

}E( Rounded Gravel

Water Level Elevation: t, 6 Ott.: msl* -:

>< "#. 0 en N

OpenHole: ~ Length: ____ :::::rr:.....3o..!..._ ______ fl

Diameter: in. Bottom Elevation: fl. msr

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 ~vel Elevation )

Example: Estimated+ 2 rt. Water level Elev. -..Bottom Elevation of Well Umlt = ( 2. 41 ~ C2l) = -18.5 n.

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


Steer! compliant with (check one or more): 0 ANSVAWWA C200 0 API Spec. 5L tJ: ASTM A53

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

Stainless Steel: (check one): 0 ASTM A409 0ASTMA312

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

0 ASTMA139

0 Other --------

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

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


O!l~n ~~!!:IJ'ln M=-tArlal:





Steel: compliant with (check one or more): 0 ANSVAWNA C200 0 API Spec. 5L (}( ASTM A53

And compliant with (check one or more): 0 ASTM A242 0 Type E 0 Type S a§ Grade 8


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

0 ASTMA139

0 Other --------

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

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






'

ISLAND OF HAWAII TOTAL • _,---__ ,_

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OF HAWAII TOTAL • ,.., ABERCROMBIE GOVERNOR OF HAWAII WILLIAM J. AILA, JR. CHAIRPERSON STATE OF...

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