ROUTE SLIP FOR WELL COMPLETION REPORT ACCEPTANCE …o commission on water resource management route...

o COMMISSION ON WATER RESOURCE MANAGEMENT

ROUTE SLIP FOR WELL COMPLETION REPORT ACCEPTANCE 10124108

FROM: RYAN

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

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

ICE,C. IMATA, R.

-3-KAWAHARA, K.==

WELL NUMBER 1253-01

DATE: 10/27/08

KIMURA, J. KUNIMURA, I. beROUX, E. MILLS, D. OHYE,L.

-4-0HYE,M.

SAKODA, E. SWANSON, S. UYENO, D. YODA, K. YOSHINAGA, M.

WELL NAME

application type BOTH / 1 DRILLER ACKNOWLEDGE 2CWC ~ 3CPI ~ 4 WELLCHECK ~G> 5 WURFORM

NOTES: DRILLER Rod Diamond

Milolii 1

SUSPENSE DATE:

Approval -3-Signature -4-lnformation

Diamond Construction and Water Well Drilling 23379

TMK

phone fax cell

PUMP CAPACITY WELL OWNER LANDOWNER

HCR#3 Box 14073 Keeau 966-4129 966-4129 987-8100

o o o o

HI 96749

PLEASE:

See Me -1-Review & Comment

Take Action Type Draft

-2-Type Final File Xerox copies

LINDA LINGLE GOVERNOR OF HAWAII

Mr. Rod Diamond

o o

STATE OF HAWAII DEPARTMENT OF LAND AND NATURAL RESOURCES

COMMISSION ON WATER RESOURCE MANAGEMENT P.O. BOX 621

HONOLULU, HAWAII 96809

October 31, 2008

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

Dear Mr. Diamond:

Well Completion Report Parts I & II for Well No. 1253-01

LAURA H. THIELEN CHAIRPERSON

KEN C. KAWAHARA, P.E. DEPUTY DIRECTOR

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

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

We received your W~ll Completion Report Parts I & II for the Milolii 1 Well (Well No. 1253-01) on June 2, 2008 «nd acknowledge that they are complete.

This completes your obligation under the well construction and pump installation permits. Certificates of well construction and pump installation completion will be issued to the well operator/landowner and you will receive a copy of each. These certificates transfer responsibility of specific aspects of well usage and maintenance from you to the well operator/landowner.

If you have any questions, please contact Ryan Imata of the Commission staff at 587-0255 or toll-free at 974-4000 (Hawaii), 274-3141 (Kauai), 984-2400 (Maui), or 1-800-468-4644 (Lanai & Molokai), extension 70255.

RI:ss

c: Peter Vana

Sincerely

Wf7H 1't

KEN C. KAWAHARA, P.E. Deputy Director

/


Mr. Peter Vana Aloha Water Company 756 Kekuanaoa St. Hilo, HI 96720

Dear Mr. Vana:

o o




October 31, 2008 I

Certificate of Pump Installation Completion for Milolii 1 Well (Well No. 1253-01) (TMK 8-8-009:054)


MEREDITH J. CHING JAMES A. FRAZIER NEAL S. FUJIWARA 1"/

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

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

KEN C. KAWAHARA, PE. DEPUTY DIRECTOR

1253-01.cpi

Weare pleased to inform you that the Pump Installation work permitted for the Milolii 1 Well (Well No. 1253-01) is complete and acceptable and welcome you as a new member to the community of well owners and groundwater users in Hawaii. This certificate of pump installation completion allows you to commence pumping your well for reasonable & beneficial water use.

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

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

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

3. In the event that the well operator 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/cwrmlforms.htm.

o o

Results

Well Depth Theoretical Thickness of Aquifer 82 1/4 Aquifer Thickness 20.5 Depth of'Welt6e!ow'SeaLe.vel ".' ':":' -4;8 oka~ SectionZ:2

Well Casing Minimum Wall Thickness

Material pvc plastic Minimum Thickness per standards no requirement Wall T/fl'ckness Provided '.

'.: .' .:. o no standard Section 2.4(b) , Minimum Length of Solid Casing

90% of ground to top of aquifer 47.34 LelliJtll· 01 $OIid.C8smg<ProVide.d .... . ;. ..' "::::':::;::'.: ': .,.' 54,6 oKay' ' ... ".

..•. ·S~ipn~.4{c):i C&$jng Ma'teHal SGh'OdOle,4O 'in comPti.nee' SjCtiori 2.4{d} . (1'0,. PVC' QhIy- check for 200' limit) (' okay Section 2.4(d)

Annular Space Depth of Grouting

Calculated Depth of Grouting 1.4 Depth of Grouting provided 41 okay Section2.6(c)

Minimum Annular Space required 1.5 Thickness of Annular Space 1.75 okay Section 2.6(d)

/

M{MO and ROUTE ~LlP (ver. 04/0312008) 0 06/12/08

I WCR 1 Check for Well No. 1253-01 (survey to regulation memo)

1. Pump Tests Check Diane England;;i? ~itial)

Step-Drawdown Test: followed WCPI Stds analysis attached

Constant Rate Test: followed WCPI Stds analysis attached

Potential Well Interference:

Potential Stream Impacts:

Additional Testing or Data Required:

Pump Test Comments Attached:

Proposed Pump Capacity is OK.:

Yes

0 0

0 0

o

o

o

o

No

0 ro gpm no test required 0

0 ~pm no test required 0

2. Well Log Check Geology Code for Well ndex: '(D Fm Name: [ D. England @timitial)

3. Construction Check Mitch Ohye (initial) Ye, No

data complete Jh/ 0 followed Special Cond &elevation~~/' 0 well database updatedy 0

R. Torres ~(initial) If no. describe deficienc(v -t: tw 1__" ' -5 ' . e- 't1If" ':.I~ - ,~

("" ," ? ~~'df+.(,'~'V ( , D~ ft w-~ ~ 5lf,~

VI jJJr \.w..c..( ~ 2'

Latitude Longitude

NAD27 \:~\ , '. -I 1\ ;., S·{ f)~ ",' .:,--\ J ,

NAD83 i \ .. ~1 .'"""' I~\ I ,

\ ;..-. v I '- .. , .-~

4. ChareRY~ ____ (initial) take action based on above analysis

ATTACHMENTS FOR PUMP INSTALLATION PERMIT (2x):

1 COVER LETTER

2COUNTY COMMENTS (DWS/SMA)

3DOH COMMENTS

4DLNR COMMENTS (LD/OCCUDHP)

5WCR 1 Accept

6WELL CON ST. COMPLETION CERTIFICATE

__ not necessary - only WCP or BOTH.

} To be sent to driller/pump installer

<------ To Landowner

} Staff internal checks

5. Roy (initial) check (Entered WCR 1IWCCC accept date into database) 6. Susan Hoagbin (initial) finalize 7. Ken (initial) signature 8. Mitch (initial) signature (Entered PIP issue date if attached/required) 9. Char~RY~ile

State of HaJiii 0 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 wor1<:. For assistance, please consult the Hawaii Well Construction and Pump Installation Standards or call the Regulation Branch at 587-0225. For updates to this form or additional information, please visit our website at httpJ/www.state.hi.usldlnr/cwrml

For Official Use Only: /

R~:~F1VFn

B JUN2 A9: I

1. State Well No.: 1253-01 Well Name: Milolii #1 Island: Hawaii 2. Address: 756 Kekuanaoa St., Hilo, HI 96720 Tax Map Key: 8-8-009-054 3. Drilling Company: Diamond Drilling and Pump

4. Drilling method used during construction: ~ Rotary 5. Date Well Construction (drilled, cased, grouted) completed: 4-29-08 Fill out attached Driller's Log

MonIhIDayIYear

In addition to the drillers log, if a geoIogk log was prepared, please submit with this form.

6. Was the subject well cored? DYes. No

7. Step-Drawdown Test completed? • No DYes Attach Step-Drawdown Test Form (12117/97 SDPTD Form)

8. Constant Rate Aquifer Test completed? • No D Yes Attach Constant Rate Aquifer Test Form (12117/97 CRPTD Form)

Water Level Data: Reference Point Depth to Water Level Date /Time of

9. 10.

11. 12. 13. 14.

15. 16.

Elevation Water (ft.) ft. above msI Measurement

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

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

Chloride: 4850 ppm. Temperature: 64 *F

As-built section filled in completely

Ground= 56.6 itmsl

Ground= 56.6 ft.msI

If this reference point is not the bencbmark, the difference between the benchmark and this point is: it

54.6 54.6

54.6

=

Attach photograph of well and concrete pad showing benchmark on concrete pad. GPS coordinates provided in degrees, minutes, seconds

2 4-23-08 m 2 4-23-08 pm

2 4-23-08 m

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.) Remarks:

Measurements were done at low tide, 8in. rise and drop at tides.(12 pm)

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

Signature ___ ---"-p __ ~ __ iC_~ __ , _____ _ 5-3-08 Date: =================== weR1 Form 6112107 Page 1 of 5

o 13. As-BUIL T WELL SECTION (Please eltach e&-buiIt if different hom diegl'em provided betlw)

Elevation at top of casing ~ ft .• msr (to nearesfO.01 fl)

8 in.

Minimum of 2' Radius & 4· Thick Concrete Pad

Ground Elevation: 54.6 fl. msI Benchmark elevation:

5,U 0 ft. mal"

(Survey to 'nearest 0.01 fl)

GroUting method: ~Positive "displacement

x Other

Total Depth

59.4 ft.

Solid Casing Material:

Cement Grout fl (min. 70% of distance from ground elevation to top of water surface or 500 fl. Whichever is less.)

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

~in.

Rock or Gravel Packing:

17 fl Material:

N Crushed Basalt

o Rounded Gravel

Water level Elevation:

_2 ___ fl, msI*

"msI = mean sea level

---\ Solid casing: (~ 90% x (Ground EIev.-Water Level EIev»

Length: 54 _ 6 ft.

Nominal DIameter: 4_ 5 inches in.

WaI Thickness: Schedule 40 in.

Bottom Elevation: -0- fl. msl

Open Gaslng: 0 Perfora1ed DSaeen

Length: _____ 4..:,.:-c:::.8 _____ fl

Nominal Diameter:

wan Thickness:

Bottom Elevation:

()pen Hole:

4 S inches in.

Schedule 40 in.

-48ft .. mst

Length: _____ N..uLL./.c;AL-. ___ fl Oiameter: ____________ in.

-Bottom E\evation: ________ ft .• msI

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

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

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

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

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

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

o Centrifugally Cast Resin Pipe conforming to ASTM 02997

o Reinforced Plastic Mortar Pressure Pipe conforming to ASTM 03517

o Glass Fiber Reinforced Resin Pressure Pipe conforming to AWWA C950

o PTFE Fluorocarbon Tubing conforming to ASTM 03296

o FEP Fluorocarbon Tubing conforming to ASTM 03296

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

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

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

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

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

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

o Centrifugally Cast Resin Pipe conforming to ASTM 02997

o Reinforced Plastic Mortar Pressure Pipe conforming to ASTM 03517

o Glass Fiber Reinforced Resin Pressure Pipe conforming to AWWA C950

o PTFE Fluorocarbon Tubing conforming to ASTM 03296

o FEP Fluorocarbon Tubing conforming to ASTM 03296

weR1 Form 10118104 Page 2 of 5

o DRILLER'S LOG o WELL NUMBER: 1253-01

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

0 to 12 Red Ash mixed with basalt boulders 4-23-08

12 to 50 Basalt

50 to 59.4 Red Ash mixed with Basalt rocks, [email protected], 4850 PPM 4.23.08

to

to

to

to

to

to

to

to

to

to

to

to

to

to

Remarks:

weR1 Form 10118AJ4 Page 3 of 5

o

12'

House

Latitude: N 19 degrees 12 min. (.~51 ) x 60 = 27 SeC

Longitude: W 15-1- degrees 53 min. (.908) x 60 = 5~ s~c.

EONOAVE.

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


Well Elevation Site Photo

Benchmark Elevation est. 54.10

I certify that the eleyation shown aboYe: I) Was done in accordance ,yith acceptable sun'eying practices 2) Is accurate to the nearest 0.0 1ft. 3) Is referenced to mean sea leYel

Surveyor License No. Date


o o / WELL CONSTRUCTION PERMIT

Milolii 1 W.ell, Well No. 1253-01 RECF1VED Note: This permit shall be prominently displayed at the construction site until the work is completed

In accordance with Department of Land and Natural Resources, Commission on Water Resource Manageffl5llt's "-sJl}1iwstrative Rules, Section 13-168, entitled "Water Use, Wells, and Stream Diversion Works", this document permits thMEhn~Ol'andll:~rlg ¥4 Milolii I Well (Well No. 1253-01) at TMK 8-8-009:054, Hawaii, subject to the Hawaii Well Construction & Pump Installation Standards (HWCPIS - February 2004) which include but are not limited to the following conditions:

r(·':':\,i!\.(':~;1J (1) tll..,T"' I, The ChaiTQerson of the Commission on Water Resource Management (Commission), P.O. Box 621, Honolulu, HI 96809'ls'r1an·.h~ nCiWed; 1n',wlitlrig'dt,. ";

least two (2) weeks before any work authorized by this permit commences and staff shall be allowed to inspect installatiom\;ktitities: U1~ccbhla\1\;e\vi~E "~I T § 13-168-15, Hawaii Administrative Rules. ... .' .• , ,,'

2.

3.

4.

5.

o.

7.

8.

9.

10.

II.

12.

13.

14.

15.

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

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

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

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

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

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

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

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

The well construction pennit application and any related staff submittal approved by the Comlnission are incoIporated into this pennit by reference. This pennit is also subject to the HWCPIS. If the HWCPIS are not followed and as a consequence water is wasted or contaminated, a lien on the property may result. Any variances from the HWCPIS shall be approved by the ChaiIperson prior to invoking the variance.

The work proposed in the well construction pennit application shall be completed within two (2) years from the date of pennit approval, unless otherwise specified. The pennit may be extended by the ChaiIperson upon a showing of good cause and good-faith performance. A request to extend the pennit shall be submitted to the ChaiIperson no later than the date the pennit expires.

If the well is not to be used it must be prorerly capped. If the well is to be abandoned during the course of the project then the pennittee must apply for a well abandonment permit in accordance with § 3-168-12(f) prior to any well sealing or plugging work.

The pennittee, its successors, and assigns shall indemnify, defend, and hold the State of Hawaii harmless from and against any loss, liability, claim, or demand for property damage, personal injUl)', 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 pennit.

This pennit shall apply to the location shown on the application only. If the well is to be relocated, the pennittee shall apply for a new well construction/pump installation pennit m accordance with Hawaii Adlninistrative Rules ~ 13-168-12(f).

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

Date of Approval: December 27,2007 Expiration Date: December 27, 2009

LAURA H. THIELEN, Chairperson 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 have signed, dated, and returned the permit to the Commission. I understand that this permit is not to be transferred to any other entity. I also understand that non-compliance with any permit condition may be grounds for revocation and fines of up to $5,000 per day starting from the permit date of approval.

Driller's Signature: ~,1~~L //

C-23379 C-57.License #:

Printed Name: Rod Diamond Finn or Title:

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

Attachment

Date: 4-/1-1 \D r / Diamond Construction and Water Well Drilling

IMEMO and ROUTE ~L1P (ver.04/0312008) o

I WCR 2 Check for Well No. 1253-01 (survey to regulation memo)

1. Pum Tests Check s ecial condition of PIP? Yes!J 0 D. EnglanA7""'--.c:;../ Yes No no. describe~y

Step-Drawdown Test:

followed WCPI Stds analysis attached

Aquifer Pump Test:

o o

followed WCPI Stds 0 T & S analysis attached 0

Potential Well Interference:

Potential Stream Impacts:

Additional Testing or Data Required:

Pump Test Comments Attached:

Proposed Pump Capacity is OK.:

o o ~m no test required

g ~gpm no test required

stream names:

06/12/08

2. Pump Installation Check Mitch Ohye ; i (initial) R. Torres __ (initial) Y!!' No If no. describe deficiency

data complete 0 0 followed Special Cond & Elev. P 0

well database updated '0 0

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

ATTACHMENTS FOR ACCEPTANCE: 1WCR2 ACCEPTANCE LETTER

2PUMP INST. COMPLETION CERTIFICATE

3METER INSTALL. REPORT (IF NECCESSSRY) __ _

4WUR

1" To be sent to driller

J To be sent to landowner/operator

} Staff internal checks

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

5. Susan Hoagbin ____ (initial) finalize

6. Ken ____ (initial) signature

7. Faith Ching (initial) enter into WUR database

8. Chare:RY?ile

State of HaRii 0 COMMISSION ON WATER RESOURCE MANAGEMENT Department of Land and Natural Resources WELL COMPLETION REPORT - PART II Pump Installation

Instructions: Please print in ink or type and send completed report (with attachments, if applicable) to the Com on Water Resource Management, P.O. Box 621, Honolulu, Hawaii 96809. The Commission may not accept incom reports. This form shall be submitted within 60 days of the completion of work. For assistance, please consult the Hawaii Well Construction and Pump Installation Standards or call the Regulation Branch at 587 ~225. For updates to this form or additional information, please visit our website at http://www.state.hi.usldlnr/cwnnl

For Official Use Only:

RECflVFD

JUN 2 A9: I~

1. State wel::1 N:::::o::.:====1=2=5=3-=0=1====w=e:::II::N=am=e:==========MIL===O:-L_I_I #_I ___ --====I=sl=an=d=:====H=a=w=a=ii==~ 2. Address: 756 Kekuanaoa St., Hilo, HI 96720 Tax Map Key: 8-8-009-054

3. Pump Installation Company: Diamond Drillin ~~========~==~--------------------------j

4. Date Pump Installed: 4-23-08 Month /daylyear

5. PERMANENT PUMP INFORMATION

6.

7.

8.

9.

10.

11.

-------------------------------------------------------Pump Type, Make, Selial No.: SUB 1 GRUNDFOS 1 16S07-8

Rated Capacity: 16 gpm at head of: % I &' D t

ft.

Motor Type, H.P., Voltage, rpm: ________ FRANKL ____ IN_I_%_4 HP __ 1_2_3_0_V_I_34_5_0_RP_M ______ __ Pump type (check one):

o Deep Well Turbine

x Submersible

o Centlifugal

Method of flow measurement:

o Rotary o Propeller

o Rotary-Displacement o Reciprocating

o Rotary-Gear o Impulse

X Flowmeter

o Weir

Manufacturer Master Model no. PT 92194 Size % in. --------- ----------~

o Open Pipe 0 Olifice* 0 Other*, explain below *attach schematic

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

Attach the rating curve for the installed pump.

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

Well Owner: SAME

Land Owner: Peter Vana 756 Kekuanaoa St., Hilo, HI 96720 C: 987-1170/935-4243

Pump Installation Contractor (plint) Rod Diamond C-57/C-57a/A Lic. No. Be 23379

Signature Date 5-3-08 WCR2 Form 2123105 Page 1 of 2

----------------------_. ,,-~"''', ,"

7. AS-BUIL T PUAECTION (Please attach as-built if different from Am provided below)

Bench mark elevation s~JY~yed to nearest 0.01 ft. = _._ft. mean sea level

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

............... f .

.... .. _ ........ I.

Pump intake depth = 56 ft. (referenced to bench mark)

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

If airline instaUed, bottom of airline elevation =

NI A ft. mean sea level

WCR2 Fonn 212:w5 Page 2 of 2

" ,

~RAD~NCECURVES o 16GPM <) MODEL 16S

LOW RANGE: 10 -20 GPII OUTLET SIZE: 111. • NPT

16S1CJO..75DS (10 HP) 3450~ RPMP

"i_:.-

.,'

2200

2100

2000

1900

1800

, ,

f i ~

} , .

1700 816S7S68DS (1 iJ2 HP

1600

1500

1400

1300

1200 B16S50-38

1100 1000 -+-,-_l-.,

=F j ; , 900 ~- ~.,~,,~.

HP

. ,

800 81~~ (~.~ 700 -,

, t

-, . ,

600 ~1&S20-18 (2 ~ , ; :

SOO ' 316S15-14 {1 1/2 HP~" ' ,

400 ~16S1o-10 (1 tar

300 =t16S07-a (3/4 HP

200

100

o

,-=116505-5 112 HP

I , . . , , =4 ' .

I

o 2 4

, =--'~

6

OC BW'-IUIIa:18ID2D ... CIWtCIIEB E.a.106I'M SEE IDJEL 108

; ~

.} ~ ~

F-~~;

-

. , -. , .

, '

, , , , ,

8 10

CAPACITY (GPM)

, . ! i !i:

i •

; <: :

. -~ , + . "

} !

. ,

, , -:~-i"'{ . '

12 14 16

~ .. I'l.t;,"?-o\

i 1

"

;,-

t ; • , ' . ,

• i , , , ~ ; ! ,

, .

~:.:

18 20

V\,\ \..O\,....\ \ l

Ail ....... w .... to ISO ... 1918 (E)"" A ............ ...,. .. il2 fast.

. :.,.:.

. ....

.;i;----------------------------------------------------..t,-';!;:::~' GRUNDPOS·~ 4-17

crUMP INST ALLA TION PERMIT 0 I Milolii 1 Well, Well No. 1253-01

Note: This permit shall be prominently displayed at the site until the work is completed , PJ:"I"'r=~'II:'n In accordance with Department of Land and Natural Resources, Commission on Water Resource Mlh1I:tgeinent~\ ,,- ",,:

Administrative Rules, Section 13-168, entitled "Water Use, Wells, and Stream Diversion Works", this document permits the pump installation for Milolii 1 Well (Well No. 1253-01) at TMK 8-8-009:054, Hawaii, subject to the HawaiiJ¥.ell Construction & Pump Installation Standards (HWCPIS - February 2004) which include but are not limited to the following W!tdi~ 2 A 9 . I.

2.

3.

4.

5.

6.

7.

8.

9.

10.

II.

12.

The Chairperson to the Commission on Water Resource Management (Commission), P.O. Box 621, Honolulu, HI 96809, shall be

~otified: in wri.ti~~, a~ least two (2) w.eeks before any work. ~overe.d .by th.is permit commences and staff shall be ~~r~~;i~~N W,\ i;-;? InstallatIOn actIvItIes In accordance WIth § 13-168-15, Hawan AdmInIstratIve Rules. f\f~;=,~,j' ;(.~L" i; 1;,;',(, E: "

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 12 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 ~IJd 'Jppropriate devices or means for measuring chlorides and temperature at the well head.

Well Completion Report Part II shall be submitted to the Chairperson within 60 days after completion of work. This form can be obtained by contacting staff or on the internet at www.hawaii.gov/dlnr/cwrm.

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

The pump installation permit application and any related staff submittal approved by the Commission are incorporated into this permit by reference. This permit is also subject to the HWCPIS. If the HWCPIS are not followed and as a consequence water is wasted or contaminated, a lien on the property may result. Any variances from the HWCPIS shall be approved by the Chairperson prior to invoking the variance.

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

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

Date of Approval: December 27, 2007 December 27, 2009

LAURA H. THIELEN, Chairperson Commission on Water Resource Management Expiration Date:

] have read the conditions and terms of this permit and understand them. ] accept and agree to meet these conditions as a prerequisite and underlying condition of my ability to proceed and understand that] shall not commence work until] and the pump installer have signed, dated, and returned the permit to the Commission. ] understand that this permit is not to be transferred to any other entity. ] also understand that non-compliance with any permit condition may be grounds for revocation and fines of up to $5,000 per day starting from the permit date of approval.

Installer's Signature: </L/? ~57' C-57a, or A License #: C-23379 Date: 4/2l' b9 ( / -f4'44 Diamond Construction and

Printed Name: Rod Diamond Firm or Title: Water Well Drilling


Attachments

CHINO. , CHONQ, "

- DANIIAAA, a. ENGLAND. 0 FUJII. N.

--:;- HARDY I R. -2-HOAGBIN. S.

ICE.C. -4-IMATA. R.

KIMURA. J.

............. ~,t ::1;", MJAA,1

- :- ~HYt,M , IAKODA. t.

- . --SWANSON,S.

W --UYENO,D. '-YODA.K.

'_'__ :::: YOSHINAGA, M.

WELL NUMBER I 't-S') -0 I WELL NAME /Vl1 10 I,' I. t-. t

application type BOTH 1 WCP COVER LETTER ~ 2 WCP -.:.s.4.. 3 WEll CHECK PRINTOUT .....::.L-

4 PIP COVER lETTER 5 PIP

COMMENTS: 6 SOWB 7 WWB 8 CWB 9 lO

10 HP 11 lUC 12 OCCl 13 SMA

NOTES: DRILLER TMK PUMP CAPACITY WELL OWNER LANDOWNER COMMENT DEADLINE

~I ~ -2S-

)(

---y-- in co~s tion district --v- in cons ion district --;<:::"" in sm

BC-23379 o

16 o o

( I

I~


Ref: 1253-01.wcp

Mr. Rod Diamond

o o




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

Dear Mr. Diamond:

Well Construction Permit Milolii 1 Well (Well No. 1253-01)



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

KEN C. KAWAHARA, PE. DEPUTY DIRECTOR

January 9, 2008

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 a permanent pump. As part of the Chairperson's approval, the following special conditions were added and are part of your permit under Permit Condition 13:

Special Conditions

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

Please refer to the Permit Processes Worksheet (transmitted with your acknowledgement letter) for further information regarding the process of drilling a well and installing a pump.

No withdrawal of water shall be made other than for testing purposes until a certificate of pump installation completion has been issued by the Commission.

Please sign both permit originals and return one for our files. For copies of the aquifer pump test worksheet, please call staff or visit www.state.hi.us/dlnr/cwrm/forms.htm.

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

]fyou have any questions, please call Ryan Imata of the Commission staffat 587-0255.

Sincerely.

Wf7h ~

LAURA H. THIELEN Chairperson

Enclosures

c: Peter Vana (with applicable comments - DOH SDWB, WWB USGS HawaiiDWS

/

o 0 WELL CONSTRUCTION PERMIT

Milolii 1 Well, Well No.12S3-01 Note: This permit shall be prominently displayed at the construction site until the work is completed

In accordance with Department of Land and Natural Resources, Commission on Water Resource Management's Administrative Rules, Section 13-168, entitled "Water Use, Wells, and Stream Diversion Works", this document permits the construction and testing of Milolii 1 Well (Well No. 1253-01) at TMK 8-8-009:054, Hawaii, subject to the Hawaii Well Construction & Pump Installation Standards (HWCPIS - February 2004) which include but are not limited to the following conditions:

I.

2.

3.

4.

5.

6.

7.

8.

9.

10.

II.

12.

13.

14.

15.

The Chail"Eerson 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 pennit commences and staff shall be allowed to inspect installation activities in accordance with § 13-168-15, Hawaii Administrative Rules.

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

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

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

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

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

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

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

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

The well construction pennit application and any related staff submittal approved by the Commission are incorpornted into this pennit by reference. This pennit is also subject to the HWCPIS. If the HWCPIS are not followed and as a consequence water is wasted or contaminated, a lien on the property may result. Any variances from the HWCPIS shall be approved by the Chairperson prior to invoking the variance.

The work proposed in the well construction pennit application shall be completed within two (2) years from the date of pennit approval, unless otherwise specified. The pennit may be extended by the Chairperson upon a showing of good cause and good-faith perfonnance. A request to extend the pennit shall be submitted to the Chairperson no later than the date the pennit expires.

If the well is not to be used it must be prorerly capped. If the well is to be abandoned during the course of the project then the pennittee must apply for a well abandonment pennit in accordance with § 3-168-12(1) prior to any well sealing or plugging work.

The pennittee, its successors, and assigns shall indemnitY, defend, and hold the State of Hawaii hannless from and against any loss, liability, claim, or demand for property damage, personal injury, or death arising out of any act or omission of the applicant, assigns, officers, employees, contrnctors, and agents under this pennit or relating to or connected with the granting of this pennit.

This pennit shall apply to the location shown on the application only. If the well is to be relocated, the pennittee shall apply for a new well construction/pump installation pennit m accordance with Hawaii Administrative Rules § 13-168-12(1).

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

Date of Approval: December 27, 2007 Expiration Date: December 27, 2009


I have read the conditions and terms of this permit and understand them. I accept and agree to meet these conditions as a prerequisite and underlying condition of my ability to proceed and understand that I shall not commence work until I have signed, dated, and returned the permit to the Commission. I understand that this permit is not to be transferred to any other entity. I also understand that non-compliance with any permit condition may be grounds for revocation and fines of up to $5,000 per day starting from the permit date of approval.

Driller's Signature:

Printed Name: Rod Diamond

C-57 License #: C-23379 ---";....:::.::;.,,;;.,.~----

Date:

Diamond Construction Firm or Title: and Water Well Drilling


Attachment

/

•


Ref: 1253-01.pip

Mr. Rod Diamond

o o




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

Dear Mr. Diamond:

Pump Installation Permit MiloIii 1 Well (Well No. 1253-01)

LAURA H. THIELEN CHA.IRPERSON



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

KEN C. KAWAHARA, P.E. OEPUTY DIRECTOR

January 9, 2008

Enclosed are two (2) originals of your approved Pump Installation Permit for the captioned well(s) that authorize permanent pump installation work for your well(s). As part of the Chairperson's approval, the following special conditions were added and are part of your permit under Permit Condition 11:

Special Conditions

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

2. Attached for your information are copies of the Department of Health's (DOH) review comments. Please note DOH's requirements related to discharge of emuent from well drilling and testing activities.

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

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

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

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

Sincerely,

W/iH ~

LAURA H. THIELEN Chairperson

Enclosure

c: Peter Vana (with applicable comments - DOH SDWB, WWB) USGS HawaiiDWS

I

- OPUMP INSTALLATION PERMI'O Milolii 1 Well, Well No. 1253-01

Note: This permit shall be prominently displayed at the site until the work is completed

In accordance with Department of Land and Natural Resources, Commission on Water Resource Management's Administrative Rules, Section 13-168, entitled "Water Use, Wells, and Stream Diversion Works", this document permits the pump installation for Milolii 1 Well (Well No. 1253-01) at TMK 8-8-009:054, Hawaii, subject to the Hawaii Well Construction & Pump Installation Standards (HWCPIS - February 2004) which include but are not limited to the following conditions:

I. The Chairperson to 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 work covered by this permit commences and staff shaH be allowed to inspect installation activities in accordance with § 13-168-15, Hawaii Administrative Rules.

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

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

4. The pump installation pennit shall be for installation of a 12 gpm rated capacity, or less, pump in the well. This pennanent capacity may be reduced in the event that the pump test data does not support the capacity.

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

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

7. Well Completion Report Part II shall be submitted to the Chairperson within 60 days after completion of work. This fonn can be obtained by contacting staff or on the internet at www.hawaii.gov/dlnr/cwnn.

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

9. The pump installation permit application and any related staff submittal approved by the Commission are incorporated into this permit by reference. This permit is also subject to the HWCPIS. If the HWCPIS are not followed and as a consequence water is wasted or contaminated, a lien on the property may result. Any variances from the HWCPIS shall be approved by the Chairperson prior to invoking the variance.

10. The work proposed in the pump installation pennit 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 perfonnance. A request to extend the permit shall be submitted to the Chairperson no later than the date the permit expires.

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

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

Date of Approval: Expiration Date:

December 27, 2007 December 27, 2009

Wf'rM ~


I have read the conditions and terms of this permit and understand them. I accept and agree to meet these conditions as a prerequisite and underlying condition of my ability to proceed and understand that I shall not commence work until I and the pump installer have signed, dated, and returned the permit to the Commission. I understand that this permit is not to be transferred to any other entity. I also understand that non-compliance with any permit condition may be grounds for revocation and fines of up to $5,000 per day starting from the permit date of approval.

Installer's Signature:

Printed Name: Rod Diamond

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

Diamond Construction and Firm or Title: Water Well Drilling


Attachments

/

Re: Milolii 1 and 2 Wells o o

"Rod Diamond" <[email protected]>

To [email protected]

01107/200803:27 PM

Hi Ryan,

cc

bcc Subject Re: Milolii 1 and 2 Wells

Yeah I can exlplain this. Miolii #1 is the picture in the foreground and Miolii #2 is in the far back ground. They are near by each other.

I hope that this is what you were looking for. Just kinda killed two birds with one stone.

Mahalo, Lorrie On Jan 7, 2008 2:56 PM, <[email protected]> wrote: : Happy New Year Lorrie!

Page 1 of 1

The DOH comments came back and they've asked why the photo is the same for the two applications despite the different parcels. Can you explain this?

; Thanks,

Ryan

https:llwebmail.hawaii.gov Imail/rimata.nsf/3 8d46bfSe8fD8834852564b500 129b2cl dd08158... 1/8/2008

o o

Results

..f- DEC-20-2007 15:19 From:DOWSAFE WATER BRANH 8085854351 To:808 587 0219 P.l.']

" "

RECEfVED ' / SAFE DRINKING WATER BRANCH

LlNIl" liNGlE Q(WI.iRUQROf ~A'HA.

DEC - 4 '}~tft.r LAUAA H. THIELEN _"-' "~I CMAiRPfRSON

t.lEREiIlITH J. CHING

lo '1 ~=:iA:W~~ 'It fl CIII"'()~ L. FUIIINO. M.O " ~ l" OONNA FAY I( KIYOSAKI, ".E. r LJ\WRENCE 101. MIlKE. M.O" J.O,

"'EN C. I(AWAHAAA, P.E. STATE OF HAWAII :' DUlrrYCII"II!:CTDI"I

O~PARTM~NT OF LANO AND NATURAL. RESOURces COMMISSION ON WATER RESOURCE MANAGEMENh-::----:----::-;--:--:-;;:::;;--""'::.";:---

P.O. !\OU2l In General: ~ 1t..0~- 01 HONOLULU. HAWAO 96!l09

November 30,2007 Q ;: zqo4rc

use = PDnv;~-t1C." 4"

location = B-1J.l=. I Mi lut; i (above)(below)UIC hne.

TO: Honorable Chiyome L. Fukino, M.D., Director Department of Health

6'lfr(DJ'.. on w grd. elev. ='?;o' U"";h"-

Attention: Director's Office l-larold Yee, Wastewater Branch

FROM;

V£tuart Yamada, Safe Drinking Water Branch Alec Wong, Clean Water Branch

Laura H. Thielen, Chairperson ~ Commission on Water ResoW'Ce Management

well dia. = &'" well depth ==' ~o

~n~lDict~

SUBJECT: Well ConsuuctloniPump Installation Permit Application Milolii I Well (Well No,lliJ·QH

Transmitted fot your review and conunent is a copy of the captioned Well Construction/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 returning this C()ver memo form bv December 27,2007. If we do not receive comments or a request tor additional review time by this date, we will asswne that you have no comments.

Please find the attached maps to locate the proposed well. If you have any questions about this pennit application. requeSl addjtional information, or request additional review time, please contact Ryan lmata of the Commission staff at 587-0255.

RI:ss Attachmen1(s)

RESPONSE:

: J

: )

: 1

: J

.1

X . 1

:' J

·")lis wC:!1t qu.111ftC~ ~$ a !{)'uNO whiGh win ~.lfV" a& a 30Ul"f:~ cfpowbl8 ""aler tc a publt: wst~r &ysti.r"111 (afiRd» lerv1ng2S or mo~ptf:QPlB alle8st 6Q da!1S p;r YC<lr orhils I ~ or moll: serv~~ COliIItlClioIlR) and mU~1 receive Direclor of H~mhh 3pproval ~ Ie) ils ule to comply .... ith Ha .... aii Admimstl'llliV€ R"~ filAR). Title 11. Chapcor ;zO. RIPI .. f\~latilt~ 10 >'olable Walc.Symml. ~11.20·29.

Th;~ w~IJ d~ ,~ q.~I;f'y n. ~o.ro" ~.rv"tli a publk w~l<r S~£I~I)' (tcrvc. kss Ihan 2~ people cr more people at least 60 days per year or I S service eo._olio ... ) &.", ;flhc well wore, 0; \1,.<:1 (Qr dnnk'~!l. II", pri"'~I' Qwne. ~h ..... ld 1<6\ for \;>.cleriologi""l.nd clwmic.>1 pre$ •• ce berore initial ins ...... $&

~lId reuh.ely .~ .. il(1l' Ih~ waltr QIlaJiIY Ihereafter. However. iff.t.", "lmUJod use trom this sotm:~ in<:NlUII:S 10 nv:CI II\¢ public walct syswm wlinilioll \J~~ Oin:<tllr ofH""Jtb "11J)'1I"~II$ rcquin:d ~ 10 illlplementation.

If the weIll. u,ed l" ,upply bol~ "olo1>l~ J\\Q "O"·Vol.I;>,. ).'vll'o", In ... inSlc .y,lo'n, rhe ulll, $h~U "Ii"';~~'. <"'$$--"O~""o'i(t\1$;;>tId t>~'*o.()W cO.DIe.tiDn> by physlc.lly '''Pamt;ng ",,,,,bl( Md ,,,.,,t·Il~I~bJ,: $Y61e~\S by~" air g.ap or 3\\ spPfO""d backnow prov.Dt.r, ~.d by oloEll"ly l'b<!li~g oIl n., ... pol,,\>I. 'r;~ols wilh w~nllnl! ~j~ns to "",vent il1.~v"rl""1 """sumpli,,. of "<'n'rol~bk wat~r. Backflow pr:veillion devices 500uld be lOutin.:iy illSll"Glcd aud 12~led.

An NI'Dl:S pennil is ruquired,

Ocher /1:h::v~nt OOH rljl.I;I"'SU~1tilll\s. ;"f(Jrll\;\u(Jl~ or 1"C~0ll1mcndaliOIl5 IIC al13chcd.

I., lhe CVCll\ rh3t the io,arion ofll-e w~1l d,'\1Bo, bllt is ,tlli withi~ lho p •• (C.J (je,cribed 011 Ihis .p"Ji.~ion .. (Jur diVISion coasi,j.!ts Ihe o(ntilll"nt, l() ~hJ1 b • llP\lhe~hle, and we do not J1eed 10 review the 'lew local iD".

~o commenu!ol\i<:clio11S

Contact Person: ~~ _____________ _ Phone: ______ _

Signed: ___ ~.....;J.;:::::;;?"7~~ _______ _ (7

Date: _______ _

J

OEC-20-2007 03:31PM FRX:8085864351 IO:OLNR CWRM PRGE: 001 R=94:~

DEC-20-2007 15:19 From:DOH/SRFE WATER BRANH 8085854351 , To:808,5870219

~

CWRM Application Source; Miloii I Well (State Well No. 1253-01)

Safe Drinking Water Branch Engineering Section

See attached private water wells info~ffiQtion sheet.

comment: The site photos provided on the APPLICATION FOR A WELL CONSTRUCTION/PUMP INSTALLATION PERMIT for Milcii I Well and Miloii II well are identical despite both of them being on different parcels. please explain.

Underground Injection Control (UIC)

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

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

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

OEC-20-2007 03:31PM FAX: 8085864351 IO:OLNR CWRM PAGE:002 R=94%

"" DEC-20-2007 15: 19 From: DOW SAFE .WATER BRANH 8085864351 To:808 587 0219

, " " ,

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

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

U.S. ENVIRONMENTAL PROTECTION AGENCY (EPA) RECOMMENDATIONS

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

OTHER CaNT AMINANTS

Water testing can be very expensive. Itis important that you spend time to identity what other potential contaminants may be of concern. Please refer to the EPA website on PriVate Drinking Water Wells at httpjlwww.epa.gcv/safew~/Qrivatewelis/whatyoucando.html for more helpful information. Be awar~ of what and how you use and dispose of household and garden chemicals, Also determine the location of nearby septic t.anks or cesspools,. and agricultural or industrial activities in the area. General information on known Chemical contamination of ground water in Hawaii can also be found at the OOH website wvvw.hawaii.!Jov/health/environmentalfwaterisdwb/conmaps/pdf/oonmaps05.pdf

LABORATORIES

Local commercial laboratories can be found in the yellow pages of the telephone book under "Laboratories, Analytical." Whenever pOSSible, utilize a laboratory that is certified or approved for the specific drinking water tests and carefully follow their instructIons for collecting, storing, and transporting the samples. Just be sure to ask the lab to use EPA approved methods for drinking water analysis. A li5t of labs certified or approved by the Department of Health can be found at www.nawaii.Qov/health/enyironmeotal/waterlsdwbfsdwb/pdfLIesting%20labs.pdf.As lab certification status changes constantly, confirm their status when you contact the lab. Please note that the list is limited to currently regulated contaminants in publiC water systems.

RESULTS

Once the lab provides you with the test results, you will be in a better position to determine if your well water is safe to drink or what contaminant you need to treat for. Generally. you should compare the results with Federal (www.epa.gQ¥isafewater/mcl.html) and State (ytNW hawali,gQlJlhealth/environmentalJwaterlsdwb/sdwb/pdf/State%.20MCLOOf) drinking water standards. Where your test results are greater than the State or Federal maximum contaminant levels, your well water should be considered as uns@f! for consumption.

DEC-20-2007 03:32PM FAX: 8085864351 ID:DLNR CWRM PAGE:003 R=94\


TO:

FROM:

SUBJECT:

o o DFC - 4


MEREDITH J. CHING JAMES A. FRAZIER

" NEAL S. FUJIWARA t ~,..\ CHIYOME L. FUKINO, M.D. J.lL : vv DONNA FAY K. KIYOSAKI, P.E. l?V". LAWRENCE H. MilKE, M.D., J.D.




November 30,2007

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

vHarold Yee, Wastewater Branch Stuart Yamada, Safe Drinking Water Branch Alec Wong, Clean Water Branch

Laura H. Thielen, Chairperson 11 Commission on Water Resource Management

Well Construction/Pump Installation Permit Application Milolii I Well (Well No. 1253-01)


:::;"

,~S 0:3:: ,-- ._-......

~~~ ~.~ ~.~~ .. :e: =---:~> r:n-f ........ ~ --• ..t'~ ... ,......." .,..

Transmitted for your review and comment is a copy of the captioned W ell Co~tructioWfllm1p 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 returning this cover memo form by December 27,2007. Ifwe do not receive comments or a request for additional review time by this date, we will assume that you have no comments.

Please find the attached maps to locate the proposed well. If you have any questions about this permit application, request additional information, or request additional review time, please contact Ryan Imata of the Commission staffat 587-0255.

RI:ss Attachment( s)

RESPONSE:

[ 1 This well qualifies as a source which will serve as a source of potable water to a public water system (defined as serving 25 or more people at least 60 days per year or has 15 or more service connections) and must receive Director of Health approval prior to its use to comply with Hawaii Administrative Rules (HAR), Title 11, Chapter 20, Rules Relating to Potable Water Systems, § 11-20-29.

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

[ 1 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.

[ 1

[ 1

[ 1 [ 1

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 ~s II is pot 1~~~POSQ~~te~~:iO~ ~ m1 .uc& J

An NPDES permit is required. I ') I ~ J r -Other relevant DOH rules/regulations, information, or recommendations are attached. M- ~()"Thn~ ~\,{A ~ • 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

Conta~~~n:: Darw. fti~sa (n ~ Signe~~

Phone: G.::t:l- tq ~ Date: /0).-10-°7

c o

(: ."

o Q LINDA LINGLE

GOVERNOR OF HAWAII RECEIVE.D ", LAURA H. THIELEN CHAIRPERSON

l • 11"1 r) "'! (' 10\..1 r:'· '·1,' I·:: , ... MEREDITH J. CHING JAMES A. FRAZIER NEAL S. FUJIWARA

CHIYOME L. FUKINO, M.D. 'Q<IIINA FAY K KIYOSAKI, P.E. ~WRENCE H. MilKE, MD, J.D.

STATE OF HAWAII KEN C. KAWAHARA, PE.

DEPUTY DIRECTOR

TO:

FROM:

SUBJECT:

~.j ~ , .

DEPARTMENT OF LAND AND NATURAL RESOURCES

COMMISSION ON WATER RESOURCE MANAoGEMENT P.O. BOX 621


November 30, 2007

Morris Atta, Acting Administrator Land Division

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

Well Construction/Pump Installation Permit Application Milolii I Well (Well No. 1253-0]) TMK 8-8-009:054

. 'f;ES '.11

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

We would appreciate your comments on the captioned application with regard to the programs, plans, and objectives specific to your division. Please respond by returning this cover memo form by December 27, 2007. Ifwe do not receive comments or a request for additional review time by this date, we will assume you have no comments.

Please find the attached maps to locate the proposed well. If you have any questions about this permit application, request additional information, or request additional review time, please contact Ryan Imata of the Commission staff at 587-0255.

RI:ss Attachment(s)

RESPONSE: c:::l

[ ] ~:~~~.lease/permit is required of this applicant' and an application for such will be re~rd by O~ -:::; {f} ("')

A water lease/permit is not required of this applicant. /n~~ .-=c~ en

::a P1 o rn -[ ]

[ ]

[ ]

A water lease/permit has been obtained by the applicant through lease no. j~ T; .< CD .C

Other relevant Land Division rules/regulations, information, or recommendations are ~<iied. --I

No objections S? ~ J --i

f11 o

rxI Other comments: OriginAL source of private title is Grant 3723 issued prior to statehood.

Contact Person: __ -->.G ..... a ..... r--:ly'--'M ..... a;.&.r ..... t .... l..L.· Du-________ _ Phone: ~5d'o8r.7'-"-'\>O"+q~21±---,

Signed:_"-~----=--_-+-_~"--_--=-=~=-_____ _ Date: DEC 5 2007

FROM: KEN

TO:

ANAKALEA, P. CHING, F. CHONG,R. DANBARA, S. ENGLAND, D.

_fUJII, N. _V_I-! HARDY, R.

HOAGBIN, S. ICE, C. IMATA, R.

INIT.

-

CO~,lSSION ON WATER RESPURCE MANA!.1ENT (6/07)

DATE: AUG 3 1 2fJJ/

TO:

-----KAWAHARA, K. KIMURA, J. KUNIMURA.I.

INIT:

\L-\L-

NAKAMA,L. ~

OHYE,M. ~ SAKODA, E. SWANSON, S. UYENO, D. YODA, K. YOSHINAGA, M.

"""'-;:;:::-II.. \~t J- ('-'ir §{, ( IJ\J.-{.V ,---

SUSPENSE DATE: -------

FOR:

Approval fiignature

-:7 Information

PLEASE:

See Me / Review & Comment

-r Take Action Type Draft

__ Type Final File Xerox _ copies

~ ~ ~ ~ l'LS"?> -0\ ~ov ~ kJ~ ~4~ ~J~lL -~ \Gt02 ~ -DlC;\ ... O':>:~~""'-~ No Iik :

, ,

() ()

COMMISSION ON WATER RESOURCE MANAGEMENT ROUTE SLIP FOR NEW APPLICATIONS

FROM: RYAN ----------------

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

-1-HARDY,R. ! --HIGA,D.

2 HOAGBIN, S. ICE,C.

-4-IMATA, R. --

KUNIMURA, 1.-

DATE: 4-Sep-07

NAKAMA, L. NAKANO, D.

-3-0HYE,M.

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

SUSPENSE DATE:

1 Approval -1-Signature -3-lnformation

WELL NUMBER \" <) J ..{) ""

D WELL CONSTRUCTION

WELL NAME Milolii 1

D PUMP INSTALLATION

ATTACHMENTS FOR APPLICATION PROCESSING - Both applicant & staff generated 1 TRANS. LETTER ~ 2 PERMIT PROCESS TABLE '"

3 CWRM MAP .....2S..... 4 APPL. FORM (11 COPIES) V 5 USGS MAPS (11 COPIES) ---:;-6 TAX MAPS (11 COPIES) ---;;r 7 PARCEL OWNER VERIF. ~ MLS PRINTOUT 8 CONTRACTOR VERIF. ----v- DCCA LICENSE SCREEN PRINTOUT 9 ALL INFO FILI.!;OJfL .. ".--

11-Sep-07

PLEASE:

See Me -1-Review & Comment

Take Action --Type Draft acknow letter -2-Type Final, label file folder, update People.db -4-File --Xerox copies

D BOTH

10 BACKGROUND CHECK --"'-T25FEEDEPOSIT SLIP

12 DHP/CDUP/SMA pre·scre.n

~-=:::::::" fJ 0- ,;., W I v" S ~

FOLDER: [ZJ MADE NEW FILE D FILE FOLDER AL

INCOMPLETE ACTION DATES:

DATE

map printout http://gis.hicentral.com/website/parcelzoning/Viewer.htm.,or INGRID'S SMA/CD MAP) map printout http://luc.state.hLus/luc_maps.htm., or INGRID'S SMA/CD MAP)

ER, ATTACHED Y MADE, IN FILE CABINET


Mr. Rodney Diamond

o o




November 30, 2007

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

Dear Mr. Diamond:

LAURA H. THiElEN CHAIRPERSON

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

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


1253-01.ack

Well ConstructionlPump Installation Permit Application for Well No. 1253-01

We acknowledge receipt, on September 28,2007, of your completed Well ConstructionlPump Installation permit application and filing fee for the Milolii I Well (Well No. 1253-01). You can expect your application to be processed within ninety (90) days from this date.

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

By this acceptance letter, we are also notifying the well operator/landowner that water may not be pumped for purposes other than testing until the certificate of well construction/pump installation completion letter is issued to the well operator and landowner. Additionally, the permitted pump capacity described on the pump installation permit may be reduced in the event that the pump test does not support the capacity. No certificate of pump installation will be issued until the Commission has determined that the pump capacity will not have adverse effects on the aquifer, other nearby wells, or streams. In other words, you may need to remove the pump and install a smaller pump at the Commission's discretion before you can withdraw water for purposes other than testing.

If you have any questions about your permit application, please contact Ryan Imata of the Commission staff at 587-0255.

RI:ss Attachment

c: Peter Vana

Sincerely,

WfiH 1't

KEN C. KAWAHARA, P.E. Deputy Director

o o LINDA LINGLE

GOVERNOR OF HAWAII LAURA H. THIELEN

CHAIRPERSON

TO:

FROM:




November 30, 2007

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

Harold Vee, Wastewater Branch Stuart Yamada, Safe Drinking Water Branch Alec Wong, Clean Water Branch

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




KEN C. KAWAHARA, P.E. OEPUTY DIRECTOR

SUBJECT: Well ConstructionlPump Installation Permit Application Milolii I Well (Well No. 1253-01)

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

We would appreciate your comments on the captioned application for any conflicts or inconsistencies with the programs, plans, and objectives specific to your department. Please respond by returning this cover memo form by December 27. 2007. Ifwe do not receive comments or a request for additional review time by this date, we will assume that you have no comments.

Please find the attached maps to locate the proposed well. If you have any questions about this permit application, request additional information, or request additional review time, please contact Ryan lmata of the Commission staff at 587-0255.

RI:ss Attachment(s)

RESPONSE:

[ I

[ I

[ I

[ I

[ I

[ I

[ I [ I

[ I

This well qualifies as a source which will serve as a source of potable water to a public water system (defined as serving 25 or more people at least 60 days per year or has 15 or more service connections) and must receive Director of Health approval prior to its use to comply with Hawaii Administrative Rules (HAR), Title II, Chapter 20, Rules Relating to Potable Water Systems, §11-20-29.

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

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

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

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

An NPDES permit is required.

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

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

No comments/objections

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


TO:

FROM:

SUBJECT:

o o


COMMISSION ON WATER RESOURCE MANAGEMENT P.o. BOX 621


November 30, 2007

Morris Atta, Acting Administrator Land Division

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

Well Construction/Pump Installation Permit Application Milolii I Well (Well No. 1253-01) TMK 8-8-009:054






Transmitted for your review and comment is a copy ofthe captioned Well ConstructionlPump Installation permit application.

We would appreciate your comments on the captioned application with regard to the programs, plans, and objectives specific to your division. Please respond by returning this cover memo form by' December 27, 2007. Ifwe do not receive comments or a request for additional review time by this date, we will assume you have no comments.

Please find the attached maps to locate the proposed well. If you have any questions about this permit application, request additional information, or request additional review time, please contact Ryan Imata ofthe Commission staff at 587-0255.

RI:ss Attachment( s)

RESPONSE:

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

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

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

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

[ ] No objections

[ ] Other comments:

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

Signed: ____________________ __ Date: --------------


TO:

FROM:

SUBJECT:

o o




November 30, 2007

Melanie Chinen, Administrator Historic Preservation

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

Well Construction/Pump Installation Permit Application Milolii I Well (Well No. 1253-01) TMK 8-8-009:054



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


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

We would appreciate your comments on the captioned application with regard to the programs, plans, and objectives specific to your division. Please respond by returning this cover memo form by December 27, 2007. Ifwe do not receive comments or a request for additional review time by this date, we will assume you have no comments.

Please find the attached maps to locate the proposed well. If you have any questions about this permit application or request additional review time, please contact Ryan Imata of the Commission staff at 587-0255. 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: ---------------

Professional and Vocational Lice;,ing (PVL) - powered by eHawaii.gov 0 Page 1 of 1

Professional and Vocational Licensing (PVL) Search - General Licensee

GENERAL LICENSEE

L1C ID: CT-23379 Active/Inactive: ACTIVE

NAME: RODNEY K DIAMOND

TRADE NAME:

STATUS: CURRENT, VALID & IN GOOD STANDING

ENTITY: INDIVIDUAL BUSINESS CODE: SOLE OWNER

ORIG L1C DATE: 10/12/2001 EXPIRE DATE: 09/30/2008

CLASS PREFIX: BC SPECIAL PRIVILEGE:

RESTRICTION: EDUCATION CODE:

BUSINESS ADDR: HCR #3 BOX 14073 KEAAU HI 96749

MAILING ADDR:

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

587-3295.

License information on this site reflects information in the Professional and Vocational Licensing Division as of November 28, 2007; howevE applications and forms are subject to standard processing time, and the information here does not reflect pending changes which are being reviewe The site is updated daily, Monday through Friday, except holidays. The State of Hawaii makes no guarantees as to the accuracy of the information accessed, the timeliness of the delivery of transactions, delivery the correct party, preservation of the privacy and security of users and makes no warranties, including warranty of merchantability and fitness for particular purpose. User is advised that if the information obtained herein is to be reasonably relied upon, user should confirm the accuracy of SUI

information with the provider thereof.

http://pvl.ehawaii.gov/pvlsearch/app?_a=d&_f=n&lictp=CT &licno=233 79&off=&nm=R... 11/28/2007

Search Results o o Page 1 of 1

Copyright ©11/28/2007 by Hawaii Information Service

Assessed Values reflect tax year 2007.

Search criteria: TMK Taxkey 3-8-8-9-54

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

re3-8-8-9-54 Milolii Beach F 88- VANA,PETER TR 2 1 7,500 sqft 480 7/26/1982 AS $11,200 Lots 1564 Subdivision EDND

AVE

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

http://webre2.hawaiiinfonnation.comlREsearchIHIS/Searchisearch_PUB.asp?NOCACH...11/28/2007

Well Background Check

Approved Well No. Well Name

3586-22 Hale Akala

Applicant

Raymond Carl Echt Jr.

Well Construction Driller Pump Inst. Type Issued Signed WCR1 Accept

Isle of Lombard Stafford M. Lombard

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BOTH

BOTH

BOTH

BOTH

BOTH

BOTH

BOTH

BOTH

BOTH

BOTH

BOTH

BOTH

BOTH

BOTH

BOTH

BOTH

o

11/18/2002

11/14/2003

~/2004

3686-18 Trita Ganga

3281-02 Kai Puka

3687-50 Mergez

3688-18 Musgrave

3686-19

3486-06

Kan-Sha

Ooh

Uli Kai

Kaylee

Hala Kahiki

Kawaiola

3586-23 Ends

Honu

Ninini

3586-24 Aunty Jan

3688-05 Love

3688-06 Raven

3500-02 Nichols

4/14/2004 3687-10 Fenn

6/4/2004 3688-07 Webb

6/14/2004 3688-08 Lien

8/27/2004 3586-04 Dennis

8/31/2004 3687-13 Camp

10/21/2004 3787-05 Bartlett

12/23/2004 3686-04 Connie

1/3/2005 3687-16 Duley

Tuesday, September 04,2007

John Hanor

Clifford Schommer

Barnaby Vergara

Harold Musgrave

Davild Miller

Kathleen Boyd

Susan Tolley & Scott Burnha

Kevin Bernard Rafferty

Charles Eugene Beier

Ed Perry

Frank Crabtree

Raymond Doblick and Katheri BC-23379 BC-23379

Brett LaSorelia BC-23379 BC-23379

Richard Cottini 1 Holly Cox

David Love

Dennis Rofkar

Greg Nichols

Isaac J. Fenn

Charles Webb

Oran & Sandra Lien

Ardis Dennis

Richard & Teresta Camp

Michael Bartlett

Connie Bouchard

Robert Duley

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BOTH 11/27/2002 712912004 3/24/2005 5/18/2005

BOTH 11/17/2003 1216/2003 10118/2005 10/18/2005

BOTH 411912004 7/13/2004 7/612005 9/1212005

BOTH 4/23/2004 9/13/2004 3/24/2005 5/18/2005

BOTH 6/912004 7/19/2004 3/24/2005 5/11/2005

BOTH 7/14/2004 7/27/2004 61712005 9/1212005

BOTH 9/23/2004 10/29/2004 61712005 9/1212005

BOTH 9/2112004 11/1/2004 3124/2005 5/18/2005

BOTH 10/26/2004 10/29/2004 312412005 5/18/2005

BOTH 11712005 1/27/2005 3/24/2005 5/18/2005

BOTH 11712005 211/2005 61712005 9/1212005

Pump Installation Issued Signed WCR2 Accept

6/3/2005 12117/2004 3/24/2005 5/18/2005

7/20/2006 9/20/2006 10/18/2005 10/18/2005

11n/2005 11/8/2005 71612005 9/12/2005

6/312005 212212005 3/24/2005 5/18/2005

7/20/2006 9/20/2006 3/24/2005 5/11/2005

111712005 11/8/2005 61712005 9/1212005

111712005 1118/2005 61712005 9/1212005

6/3/2005 6/4/2005 3/24/2005 5/18/2005

6/312005 12123/2004 3/24/2005 5/18/2005

6/312005 3/10/2005 3/24/2005 5/18/2005

111712005 11/8/2005 61712005 9/1212005

Page 1 0/5


1/312005 3786-01 Gapp

1/3/2005 3388-01 Hendershot

2/21/2005 3688-10 Wallace

31712005 3587-08 Oliver

31712005 3686-05 Gibson

31712005 3587-07 Hendershot 2

6/212005 3586-06 Oh

6/2/2005 3688-12 Harrison

6/2/2005

Q2/2005

3688-11 Hyitt

3588-02 Jobst

6/212005 3787-06 Lucky Me

8/8/2005 3687-18 K&J

8/8/2005 3180-02 Morningstar

10/18/2005 3486-02 Campbell

111712005 3686-07 Ariel

111712005 3586-07 Family

12/1/2005 3686-09 McWell

12/2/2005 3586-09 Helenihi

12/2/2005 3687-20 Tour

~2/2005

'-13/2005

12/3/2005

3687-21

2385-01

2485-03

Jennings

Epperson

Hosteler

12/3/2005 3687-23 Takeda

12/3/2005 3686-12 Terry

12/3/2005 3586-10 B. Bells

12/3/2005 3686-11 Zaulocki

1213/2005 3687-19 Suncloud

1213/2005 3686-10 Wishing

Tuesday, September 04, 2007

Applicant Well Construction

Driller Pump Inst. Type Issued Signed WCR1 Accept Pump Installation

Issued Signed WCR2 Accept

John Gapp

Carolyn Hendershot

William & Marietta Wallace

Patty Oliver

Judith Gibson

Carolyn Hendershot

Shelley & Jeffery Hecht

Victor Chris Harrison

Carolyn Hendershot

Russel & Joan Jobst

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

Regina M. Lutz and Kayrene L BC-23379 BC-23379

Kenneth Spence

Steve Shaffer

BC-23379 BC-23379

BC-23379 BC-23379

Christopher & Marta Campbell BC-23379 BC-23379

Bruce Martin

Gary & Meng-Ju De Vine

Eugene McElroy

James Helenihi

Charles Tour

Scott Jennings

Peter Epperson

Winna Marie Hosteler

Basil Takeda

Roy & Bonnie Terry

John Acree

Paul & Tamara Zaulocki

Scott Suncloud

Clifford Schommer

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BOTH

BOTH

1/6/2005 1/15/2005 3/24/2005 5/18/2005

1/612005

BOTH 212312005 2126/2005 6nt2005 9/1212005

BOTH 31712005 3/9/2005 6nt2005 9/1212005

BOTH 3nt2005 3/9/2005 7/6/2005 9/1212005

BOTH 3/30/2005 4/412005 6nt2005 9/1212005

BOTH 6/8/2005 6/13/2005 7/612005 9/12/2005

BOTH 6/812005 6/13/2005 7/612005 9/1212005

BOTH

BOTH

6/8/2005 6/13/2005 3/30/2006 3/30/2006

6/812005 6/13/2005 10/18/2005 10/18/2005

BOTH 6/812005 6/13/2005 7/612005 9/1212005

BOTH 8/24/2005 9/1212005 10nt2005 10nt2005

BOTH 1/11/2006 1/1212005 1/27/2006 1/27/2006

BOTH 11n/2005 11/10/2005 11/21/2005 11/21/2005

6/3/2005 2125/2005 3/24/2005 5/18/2005

11nt2005 11/8/2005 6nt2005 9/1212005

11nt2005 11/8/2005 6nt2005 9/1212005

11nt2005 1118/2005 7/6/2005 9/1212005

11nt2005 11/8/2005 6nt2005 9/1212005

6/8/2005 6/13/2005 7/612005 9/1212005

6/8/2005 6/13/2005 7/612005 9/1212005

6/8/2005 6/13/2005 3/30/2006 3/30/2006

6/812005 6/13/2005 10/18/2005 10/18/2005

6/812005 6/13/2005 7/612005 9/1212005

8/24/2005 9/26/2005 10nt2005 10nt2005

1/11/2006 111212005 1127/2006 1/27/2006

11 nt2005 11/9/2005 11/21/2005 11/21/2005

BOTH 11/10/2005 11/17/2005 11/21/2005 1112112005 11/10/2005 11/17/2005 11/211200511/21/2005

BOTH 11/10/2005 1111412005 11/21/2005 11/2112005 11/10/2005 1111412005 11/21/200511/21/2005

BOTH 1211/2005 1212212005 12114/2005 12/14/2005 1211/2005 1213/2005 12114/200512114/2005

BOTH 121212005 1216/2005 12114/2005 12114/2005 121212005 1216/2005 12114/2005 12114/2005

BOTH 121212005 12114/2005 12130/2005 12130/2005 121212005 12114/2005 12130/200512130/2005

BOTH 121212005 121212005 12114/2005 12114/2005 121212005 121212005 12114/200512114/2005

BOTH 12115/2005 1/15/2006 3/30/2006 3/30/2006 12115/2005 1/15/2006 3/30/2006 3/30/2006

BOTH 12115/2005 ~ 12115/2005" " , BOTH 12115/2005 1/24/2006 213/2006 213/2006 12115/2005 1/24/2006 213/2006 213/2006

BOTH 12115/2005 12115/2005

BOTH 12115/2005 1/512006 1/11/2006 1/11/2006 12115/2005 115/2006 1111/2006 1/11/2006

BOTH 12115/2005 1/312006 1/11/2006 1/11/2006 12115/2005 113/2006 111112006 1/11/2006

BOTH 12115/2005 12120/2005 12130/2005 12130/2005 12115/2005 12120/2005 12130/2005 12130/2005

BOTH 12115/2005 1/412006 1/11/2006 211712006 12115/2005 219/2006 2117/2006 211712006

Page 2 0/5

Approved Well No. Well Name Applicant

12/3/2005 3688-14 Nielsen Greg Nielsen

12/3/2005 3787-08 Nailoa Roger Pogline

12/3/2005 3687-22 Schneider Klaus Schneider

12/3/2005 3687-26 #58 Tri Coast Development LLC

12/3/2005 3687-25 #57 Tri Coast Development LLC

12/3/2005 3586-11 T Moore Thomas H. Moore

12/3/2005 3687-24 P Moore Paul P. Moore

3/30/2006 3586-12 Erickson John Erickson

Bachman Christine Bachman ~0/2006

YO/2006

3686-14

3688-15 Young Hwa Joun Young Hwa Joung

3/30/2006 3686-13 Wohlschagel

3/30/2006 3687-27 King

4/13/2006 3384-01 Mydell

4/13/2006 3585-04 My Dream

Fred Wohlschlagel

Thomas King

Wayland Lum

Jeff Hecht

4/13/2006 3687-31 Awa Puhi Springs Sean Paul Lai

4/13/2006 3687-33 Joyous Lake

4/15/2006 3587-09 Makai

4/15/2006 3589-03 R&B

4/15/2006 5408-01 Bigpus II

~5/2006

~3/2006 811712006

3687-34 PPLC

3487-03 #242

3587-10 Akana

8/17/2006 3586-14 Piilani

8/17/2006 6116-01 D & D

8/17/2006 3585-05 Malat

8/17/2006 3687-38 Charlie

8/17/2006 3686-16 Summer

8/17/2006 3686-15 Lamberson 1


James Foster

Levi McKay

Roy & Bonnie Terry

Gary Hajek

Christian Pearson

Timothy Housman

Amy Akana

Arruda Properties

Dean Schmitz

Chris Malat

Thomas Mullen

Douglas M. Keown

John Lamberson



BC-23379 BC-23379

BC-23379 BC-23379

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BC-23379 BC-23379

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BC-23379 BC-23379

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BOTH 12115/2005 119/2006 1127/2006 1/27/2006 12115/2005 119/2006 1127/2006 1/27/2006

BOTH 12115/2005 1/24/2006 213/2006 213/2006 12115/2005 112612006 21312006 213/2006

BOTH 12/15/2005 1211912005 12130/2005 12130/2005 12115/2005 12119/2005 12130/2005 12130/2005

BOTH 12116/2005 3/312006 3/30/2006 3/30/2006 12116/2005 3/312006 3/30/2006 3/30/2006

BOTH 12116/2005 3/112006 3/30/2006 3/30/2006 12116/2005 3/112006 3/30/2006 3/30/2006

BOTH 12115/2005 1/512006 1/11/2006 1/11/2006 12115/2005 1/512006 1/1112006 1/11/2006

BOTH 12116/2005 12/2212005 12130/2005 12130/2005 12116/2005 1212212005 12130/2005 12130/2005

BOTH 4/612006 4/17/2006 4/24/2006 4/24/2006

BOTH

BOTH

4/612006

4/5/2006 4nt2006 4/24/2006 4/24/2006

BOTH 4/6/2006 4/1212006 4/24/2006 4/24/2006

BOTH 4/612006

BOTH 4/18/2006 4/20/2006 5/312006 5/3/2006

BOTH 4/18/2006 4/20/2006 5/312006 5/3/2006

BOTH 4/18/2006 4/20/2006 5/312006 5/3/2006

BOTH 1211/2006 1218/2006 12120/2006

BOTH 4/26/2006 5/112006 5/8/2006 5/8/2006

BOTH 4/26/2006 5/512006 5/30/2006 5/30/2006

BOTH 4/26/2006 11/27/2006 1212012006

BOTH 6/19/2006

BOTH 6/19/2006 6/20/2006 6/28/2006 6/28/2006

BOTH 8/24/2006 9/21/2006 10/5/2006 10/5/2006

BOTH 8124/2006 10/10/2006 11/612006

BOTH 8124/2006 121112006 12120/2006

BOTH 8/24/2006 4/1212007 5/3/2007

BOTH 8/24/2006 9/27/2006 10/5/2006 10/5/2006

BOTH 9111/2006 9/27/2006 10/5/2006 10/5/2006

BOTH 8124/2006

4/612006 4/17/2006 4/24/2006 4/24/2006

4/612006

4/5/2006 4nt2006 4/24/2006 4/24/2006

4/612006 4/1212006 4/24/2006 4/24/2006

4/612006

4/18/2006 4/20/2006 5/312006 5/3/2006

4/18/2006 4/20/2006 5/312006 5/3/2006

4/18/2006 4/20/2006 5/312006 5/3/2006

1211/2006 1218/2006 12120/2006

4/26/2006 5/112006 5/8/2006 5/8/2006

4/26/2006 5/512006 5/30/2006 5/30/2006

4/26/2006 11127/2006 12120/2006

6/19/2006

6/19/2006 6/20/2006 6/28/2006 6/28/2006

8/24/2006 9/21/2006 10/5/2006 10/5/2006

8/24/2006 10/10/2006 11/612006

8124/2006 121112006 12120/2006

8/24/2006 4/1212007 5/3/2007

8/24/2006 9/27/2006 10/5/2006 10/5/2006

9/11/2006 9/27/2006 10/5/2006 10/5/2006

8124/2006

Page30f5


8131/2006 3486-04 Lagadon

8/31/2006 3687-37 Kipukawai

8/31/2006 3586-13 Deeter

8/31/2006 2385-02 Kakela Akai

8/31/2006 3586-15 Merlin Mac

8/31/2006 5106-01 Bugado

9/8/2006 3687-39 Kalanikoa

9/8/2006 3787-09 All's

liiO/2006

\10/2006

3586-17 Turtle

6953-03 Paoo-Gray

11/20/2006 3586-16 Monica II

11/20/2006 2780-01 Mary's Well

12126/2006 3586-18 R & R

12/26/2006 3588-03 Chong-Tim

12126/2006 3687-42 Sophinos

12/26/2006 3687-40 Hawkins

12/26/2006 3687-41 Kipuka

Applicant

Jason T. Lagadon

Marq Simms

Paul Allen Deeter

John & Sherry Williams

Gerard & Gail Madie

Justin Bugado

Glenn Severance

Don & Sylvia Hashimoto

Mical Simon

Joel Gray

Joseph O'Sullivan

Michael Chroman

Roy & Rosemary Hollowell

Dana Chong-Tim

Valerie Maria Robertson

George Hawkins

Dane D. Silva

2117/2007 0037-01 Honolua Stoops David Stoops

3/13/2007 3486-05 Makuu Ranch Huliauakea Wilson

",3/2007

~3/2007 4959-23

3786-03

Greene Family Tr Rob Ledson

Barvaria 1

3/13/2007 3688-16 Dick & Jane

3/13/2007 3586-21 Kodhi

5/18/2007 3257-01 Honalo Kai

5/18/2007 5407-01 Kay-Mount

5/18/2007 3687-48 Kula

5/18/2007 3687-47 Carlee

6/25/2007 3686-17 Beach House


Jeffrey J. Spaur

Lynn R. Young

Kenneth Davis

Michael B. Stewart

Paul B. Mount II

Curt Albrecht

Edward Fuhrmann

Christine Bachman


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BOTH 10/5/2006 10/1212006 11/6/2006

BOTH 10/5/2006 10110/2006 11/6/2006

BOTH 10/5/2006 10/16/2006 11/612006

BOTH 10/4/2006 11/10/2006 1212012006

BOTH 10/3/2006 10/10/2006 11/612006

BOTH 10/5/2006

BOTH 1016/2006 10/20/2006 11/612006

BOTH 10/6/2006

BOTH 12/8/2006

BOTH 121812006 3/1/2007 5/3/2007

BOTH 12114/2006 12120/2006

BOTH 121812006 1/10/2007 218/2007

BOTH 211/2007

BOTH 211/2007 4116/2007 5/3/2007

BOTH 21112007

BOTH 211/2007 411212007 5/3/2007

BOTH 21112007 4117/2007 5/312007

BOTH 3/9/2007 5/212007 6/1212007 8/24/2007

BOTH 4/25/2007

BOTH 3/14/2007

BOTH 4/26/2007 6/412007 8/31/2007

BOTH 4/26/2007

BOTH 4/26/2007 6/412007 8/31/2007

BOTH 6/2212007

BOTH 6/2212007 8/6/2007 8/31/2007

BOTH 6/2212007 8/31/2007

BOTH 6/2212007 8/6/2007 8/31/2007

BOTH


10/5/2006 10/1212006 11/6/2006

10/5/2006 10/10/2006 1116/2006

1015/2006 10/16/2006 11/612006

10/4/2006 11/10/2006 12120/2006

10/3/2006 10/10/2006 11/6/2006

10/5/2006

1 01612006 1 0/20/2006 11/6/2006

10/6/2006

121812006

1218/2006 3/1/2007 5/3/2007

12114/2006 12120/2006

121812006 1/10/2007 218/2007

211/2007

21112007 4/16/2007 5/312007

21112007

21112007 4/1212007 5/3/2007

21112007 4117/2007 5/3/2007

3/9/2007 5/212007 6/1212007 8/24/2007

4/25/2007

3/14/2007

4/26/2007 6/412007 8/31/2007

4/26/2007

4/26/2007 6/412007 8/31/2007

6/2212007

6/2212007 8/6/2007 8/31/2007

6/2212007 8/31/2007

6/2212007 8/6/2007 8/31/2007

Page 4 0/5

Approved Well No. Well Name Applicant

8/3/2007 3587-12 Jazzy Rose Robert Oerbshire

8/3/2007 3587-13 Ghiotio Rober Ghiotio

o

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BC-23379 BC-23379 BOTH

BC-23379 BC-23379 BOTH 8/24/2007


8/24/2007

Page 5 0/5

DOCUMENT NO.: DE:OTMENT OF LAND AND NATURAL RESOU~

UAC OR ATTACHED WORKSHEE T DATE: S b eptem er 4, 2007

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

S 08 326 C 1026 0752 (1 ) $25.00 Jackson Keesling Sesnon TTEE

" " " " " " (2) $25.00 PeterVana

" " " " " " (3) $25.00 Peter Vanna

(4)

(5)

(6)

(7)

(8)

(9)

(10)

TOTAL $ 75.00

REMARKS: LINE (1) Hale Nowai Well LINE (2) Milolii#1 Well LINE (3 Milolii#2Well LINE (4) LINE (5) LINE (6) LINE (7) LINE (8) LINE (9) LINE (10)

· i

STATE OF HAW~ Q' DEPARTMENT OF LAND AND NATURAL RESOURCES COMMISSION ON WATER RESOURCE MANAGEMENT

APPLICATION FOR A WELL CONSTRUCTION I PUMP INSTALLATION PERMIT 07

For Official Use Only:

RECS1VE::D

~UG 31 AS: 38

Instructions: Please print in ink or type and send completed application with attachments to the Commission on waterC O~:~ \ ~ 5\ e N ON ': / ,\ i E~ Resource Management, P.O. Box 621, Honolulu, Hawaii 96809. Application must be accompanied by10 copies and a ~t-r ~ i .,·t- k,': I' .t . < ;.; \II~I r refundable filing fee or $25.00 payable to the Dept. or land and Natural Resources. The Commission may not ~L"; .. ",,,._ r 'f '.", .t· ,_I Ilil I incomplete applications. For assistance, call the Regulation Branch at 587-0225. For further information and updates to this application form, visit http://www.hawaii.gov/dlnr/cwrm.

10. Proposed Work. X InslaN New Pump. o Replace Pump

Same

Same

Construction Permits and may be required for some

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

X 16 Domestic Number of units to be served:

7. Industrial

Rodney K Diamond Print

966-4129

C-57/C-57aJA License No.

8/22107 Date

E-mail

Rodnev K Diamond Print

HeR #3 Box 14073 Keaau HI 96749

966-4129

landowner's E-mail

C-57IC-57aJA License No.

8/22107 Date

E-mail

/

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• o o WCPI App. Form 10105104

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

Hole Diameter: 12 inches.

Elevation at top of casing 31_ ft., msl* , Minimum of Z Radius & 4" Thick Concrete Pad (to contain benchmark ~.fl------'-----ooj"I-----. __ surveyed to nearest 0.01 ft.)

... , ---~---- -... ___ "".0;;;1 '>]1 r.k """" E",_ 3O_ft, msr

! I?:' ~\""', 1 ' , , ... ~.=:- HAWAII W:~~~~~~~~~TION AND

'.,'- ~.~:·I PUMP INSTALLATION STANDARDS

:.' :.:.;.:1", to ensure that your as-built is in compliance with • applicable standards.

Cement Grout: .22...ft. (min. 70% of distance from I

I ground elevation to top of : ,(J.:}

..... ''''''', water surface or 500 ft.,

whichever is less.) -+ ; .... ! Solid Casing: (= 90% x (Ground Elev.-Water Level Elev»

Grouting method: OPosilive

Displacement

x Other

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

Total Length: 2S ft.

Nominal Diameter: 6 in.

Wall Thickness: S40 in.

_3_ Bottom Elevation: -O- ft., msl*

in.

Total Depth

~feet.

Open Casing: • Perforated Of Screen Rock or Gravel Packing: Total Length: ____ -"S'--______ ft,

_8_ ft. Nominal Diameter: __ ....::6=---_____ ,in.

Material: Wall Thickness: ____ S=--'-4""0 _____ in. x Crushed Basalt

o Rounded Gravel Bottom Elevation: -S ft .. msl*

I II

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

Estimated Water Level Elevation: t---- Open Hole:

Est. 2in. ft. msl* i Length: __ -'-'N!£A..!-______ ft,.

--'---------._------ l--J .1 Diameter: ____________ i,n.

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

Bottom Elevation:

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

Solid Casing Material:

ft., msl*

Carbon Steel: compliant with (check one or more): oANSl/AWWA C200 o API Spec. 5L o ASTM A53 o ASTM A139 And compliant with (check one or more): 0 ASTM A242 (or A606) 0 Type E 0 Type S 0 Grade B 0 Other

Stainless Steel: (check one): 0 ASTM M09 (production wells) 0 ASTM A312 (monitor wells) ABS Plastic conforming to ASTM F480 and ASTM 01527: (check one) 0 Schedule 40 0 Schedule 80 PVC Plastic conforming to ASTM F480 and (ASTM 01785 or ASTM 02241): (check one):. Schedule 40 0 Schedule 80 0 Schedule 120 Thermoset Plastic: (check one) 0 Filament Wound Resin Pipe conforming to ASTM 02996

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

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

And compliant with (check one or more): 0 ASTM A242 (or A606) 0 Type E 0 Type S 0 Grade B 0 Other Stainless Steel: (check one): 0 ASTM A409 (production wells) 0 ASTM A312 (monitor wells) ASS Plastic conforming to ASTM F480 and ASTM 01527: (check one) 0 Schedule 40 0 Schedule 80 PVC Plastic conforming to ASTM F480 and (ASTM 01785 or ASTM 02241): (check one):. Schedule 40 0 Schedule 80 0 Schedule 120 Thermoset Plastic: (check one) 0 Filament Wound Resin Pipe conforming to ASTM 02996

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

WCPI App. Form 10/05/04

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ROUTE SLIP FOR WELL COMPLETION REPORT ACCEPTANCE …o commission on water resource management route...

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