MEMORANDUM FOR THE RECORD FROM: Lenore … o MEMORANDUM FOR THE RECORD FROM: Lenore Nakama SUBJECT:...

o o MEMORANDUM FOR THE RECORD

FROM: Lenore Nakama

SUBJECT: Expiration of Pump Installation Permit for Well No. 1123-04

On July 30, 2002, a Dr. Pennyneil called for Michael Edwards to confirm that they received our certified letter and to let us know that a pump was NOT installed in the well. They instead hooked up to the City's municipal water system.

BENJAMIN J. CAYETANO GOVERNOR OF HAWAII

CERTIFIED MAIL

STATE OF HAWAII DEPARTMENT OF LAND AND NATURAL RESOURCES

COMMISSION ON WATER RESOURCE MANAGEMENT P.O. BOX 621

HONOLULU. HAWAII 96809

July 25, 2002

RETURN RECEIPT REQUESTED

Mr. Michael Edwards Sustainable Kauai P.O. Box 1208 Kilauea, HI 96754

Dear Mr. Edwards:

Notice of Expiration Pump Installation Permit for Well No. 1123-04

GILBERT S. COLOMA-AGARAN CHAIRPERSON

BRUCE S. ANDERSON MEREDITH J. CHING

CLAYTON W. DELA CRUZ BRIAN C. NISHIDA

HERBERT M. RICHARDS. JR.

LlNNEL T. NISHIOKA DEPUTY DIRECTOR

Ref:1123-04.let

This is to notify you of the expiration oft~ pump installation permit for the Fountain of Youth Well (Well No. 1123-04) on June 7, 2002. If a pump was installed in the well, please submit an as-built drawing of the installed pump and complete and return the attached Well Completion Report Part II, as required under Standard Permit Condition 5. Please also return a validated copy of the permit (copy enclosed).

If no work was performed under the permit, we would appreciate notification in writing at the above address, by telephone at 587-0218, or by email (www.state.hi.us/dlnr/cwrm).

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

LN:ss Enclosure

cieJ.og LINNEL T. NISHIOKA Deputy Director

/

o o MEMORANDUM FOR THE RECORD

FROM: Lenore Nakama SUBJECT: Cancellation of PIP A for Well No. 1123-04

Per Steve Goldberg, OK to cancel the PIPA portion of the application.

Called Michael Edwards of Sustainable Kauai on 7119102 and left a message that the permit expired. Since we didn't receive executed permit or start of work notice, we're assuming that the pump was not installed and that .we would be sending a letter notifying Mr. Edwards that the permit was cancelled. If a pump has been installed, I asked Mr. Edwards to call me.


TIMOTHY E. JOHNS CHAIRPERSON

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

DAVID A. NOBRIGA

/

HERBERT M. RICHARDS, JR.

REF:CWRM-SS


Dear Mr. Edwards:



HONOLULU, HAWAII 96809

JUN 15 2000

Pump Installation Permit Fountain of Youth Well (Well No. 1123-04)

lINNEL T. NISHIOKA DEPUTY DIRECTOR

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.

The permittee, well operator, and/or well owner are responsible for all conditions of the permit. This includes ensuring that the pump installation contractor submits a completed Part II of the Well Completion Report form (enclosed) within sixty (60) days after the pump installation work is completed. Be advised that you may be subject to fines of up to $1000 per day for any violations of your permit conditions starting from the permit approval date.

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

IMPORTANT - Pump installation shall not commence until a fully signed permit is returned to the Commission. Except for the monthly water use report form, please provide copies of all the information in this packet to your pump installation contractor.

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

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

Aloha,

~.AOJ O((r '--11{"'~M. JOHNS ] Chairperson .

Enclosure

PUMP INSTALLATION PERMIT Fountain of Youth Well. Well No. 1123-04

/

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 Fountain of Youth Well (Well No. 1123-04) at Lot 7 of Puu Pane Subdivision, Kauai,TMK 5-1-5:106, subject to the Hawaii Well Construction 8. Pump Installation Standards (1/23197) which include but are not limited to the following conditions:

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

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

The pump installation permit shall be for installation of a 25 gpm capacity, or less, pump in the well.

The permittee, well operator, and/or well owner shall provide and maintain an approved meter or other appropriate means for measuring and reporting withdrawals and water levels, and appropriate devices or means for measuring chlorides and temperature. These data shall be measured monthly and reported to the Commission on a monthly basis, on forms provided by the Chairperson (attached).

The proposed use shall not adversely affect existing or future legal uses of water in the area, including any surface water or established instream flow standards. This permit or the authorization to pump water from a well shall not constitute a determination of correlative water rights. The permittee, well operator, and/or well owner are notified and by this provision understands that the quantity of water taken from the well could be reduced by the Commission in the future. This permit is not a commitment that the pump capacity permitted here or even some lesser amount is guaranteed in the future.

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

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

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

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

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

Date of Approval: June 7, 2000 Expiration Date: June 7, 2002

. JOHNS, 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 and the pump installer have Signed, dated, and returned the penn it to the Commission. I also understand that non-compllance with any permit condition may be groundS for revocation and fines of up to $1000 per day starting from the permit date of approval.

Permittee's Signature: Date: ____ _

Printed Name: Firm or Title: ________________ _

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

Printed Name: Firm or Title: ________________ _

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

Department of Healthl Safe Drinking Water & Wastewater Branch Kaual Department of Water Supply

.. _ 0Ei/07/2000 8088280778

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o o IWCR 1.Checkf'or,'W.UNo. 1123 .. 04(suNeY:to.re~lJlationrl1emO) .. .\

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

Step-Drawdown Test: acceptable followed wePI Stds analysis attached proposed pump cap o.k.

Aquifer Pump Test: acceptable followed wePI Stds T & S analysis attached

Well Interference: estimated Steady-State

drawdown at 1-mile radius is _-:---:--_ ft. analysis attached

D II D l!l D ~ D

~ ~

D ~ D ~ D rI

D D

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

2. Construction Check Mitch Ohye [L/V (initial)

data complete followed wePI Stds wellphys.dbf updated welaplic.dbf updated

Yes No

D D D D

If no. describe deficiency

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06/01/2000 14:34

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8088260202 DRUPRNEIKNSULTING

!, II!I"II'!!ilM:)f'RiBt"" *~~,,'uN "'11I'~1\11'4·.!~'1!'·.1'''''!"'' IU,'" COMMISSION ON WATER RESOURCE MAINA':;~I:""I:N Department of land and Natural Resources

WELL COMPLETION REPORT

3. Drilling Company: 6(\ <; tS --W-A:-t-~-£'(S 1"'" ti=8s ·;-TNC --.- - ------4.Na~ o( driller whoperfo ,r we . ..., ~ 1M M 0 fo3 5. Type of rig/construction: ,.J:l.~~' Q/J~~~ ____ ---:_"=,"",,I'""-:::~_ e. Date(s) well Construction and pu,mp tests if any) completed: ~~~~L-_ 7. GROUND ELEVATION (referen~ to mean sea level, msl): ~q]. '2. 4 ft.

PAGE 01

Well Bench Mark (description/location): 'W LU...II&; ':2.~"l ~ 0;' Elevatllonl'msn: -='-'-IL~ 8. DRILLER'S LOG: Please attach geologic log (if avaf:ablo or if required by permit)

Depths (ft.) Rock Description, W~ter Level, Dates, etc. Depths (ft.)

I~to~ ~Uu TNJ~!ut}/ SLto2L~~~~-+U! I~-"-- to :r:r.. er;:z.l4Lk.:~ -.:.!JL to.JJ.L -4~tLLJIItoi~.ot:I!.~mJ.!UId~~i'f.A.

(If mom spece Is IJ88dud, oontinUfI on back.)

9J Total depth of well b~1ow ground:· . c200 ft_ 10. Hole s~e: /"1 II Inch dla. from 0 ft. to aOO

_~_~_ inch dla. from ft. to ____ _ _____ Inch dia. from fl to ____ ~

11. Casing installed:~in. 1.0. x in. wall solid section to IIIJ ~in. 1.0. x In_ wall perforated section to ~

12. Annulus:

Casing Material/Slot Size: ~ _____ ~ ___ _

Grouted from ItlJ ft. below ground to l (/ s&J.. ft. Gravel packed from _____ ft. below ground to ft.

13. Initial water level: '10' ft. below ground. Date and time of measurement: _-.. ....... =---c~"-#--" 14. Initial chloride: ppm Date and time of sampling: ------1f------15. Initial temperature: DF Date and time of measurement: __ -+-___ _ 16. PUMPING TESTS: Reference p.oJnt (RP.) used: , which elevation is +-~ __

(1) step-Drawdown Test Date It rfJ ~ (2) Long-term Aquifer Test Date -+-__ _ Start water level ft. below R. P. Start water level End water level ft. below R.P. End water level

17. Pump Test Procedures data & graphs (12117/97 SDPID & CRPTD FOtmS) attaetleCl? _ Yti ~ 18. As-built drawings attached attached? _ Yes _ No 19. back of this

belowR.P. below R.P.

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05/01/2000 14:34 8088250202 DRUPRNEIKNSULTING MAV~30-ee le;09 AM P~TER TAYLOR INC tJ:II7U "' .. ,.. 00::00"'0

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PAGE 02

I .m-=-CASING-- ---- --- ---r - ----- --------

WELL ELEVATION WELL II 1123-04

OWNBI.:MICHABL BDW ARDS

T .M.K.( 4 )S-I-OS:I06

PETRR

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LlCBNSSI) paOPES IONAL LAND SvltVBYOa No.91~'

~' .B~CH 14~"'~ US1!D: WELt. SITS (f12U-03jBLBVATJON 0' ~lS.'O·

-----------

05/01/2000 14:34 8088250202 DRUPRNE I KNSULT I NG PAGE 03

. "-......

May 31, 2000

Dear Mr. Edwards:

This letter is to document for you the relationship between Barry Simmo sand oasis Water Systems, Inc.

Mr. Simmons is our RME, Responsible Managing Employee, he is not Bj subcontractor, and is employed by us 'as our Well Drilling SpeEialist and operates ~nder our

contractors'license. I

Please let me know if you need any additional information.

Sincerely,

~~~-----Benjamin Garfinkle President

I

I I I

Steve Goldberg, Vice President & General MaJiager Batty Wayne SiJnmona, Drilling Specialist, liceDse # C-21458

P.O. Box 535, Kilauea, HI 96754 808-828-6876 FAX 808-828-07 8

06/01/2000 14:34 8088260202 DRUPRNEIKNSULTING PAGE 04

20. Pump Installation Company: _______________ _ 21. Name of person performing woJk: ______ ~ ____ - __ 22. Date Pump Installation Completed: ____________ _

23. PUMP INSTALlATION: Pump Type, Make, Serial No.: _________ -____ Ca,.aCl1M ___ - gpm

Motor type, H.P., Voltage, rPm: ____ ~ _____ ~::__--_----+-----Depth of PUmp Intake Setting ft. below 0 ground D well bench mark Depth to bottom of airline ft. below D ground 0 well bench mark Pumping Head is ft. Type of flow meter: which IJ.e;i:II&Ulre:i

24. As-bLlilt drawings attached attached? _ Yes _ No 25. Other I"8msrk&/comments: (Se6 below)

Pump Installation C~~r (~~~t~ .. ___ -_-__ -. __ -.. ~------- C-57 Uc. No. -----~---l-------.- --. --.------. -- ---. --- .-.---.. --_.--- --- _ .. -- -- .--. _·_------·_-·--·-1- - .. ____ . __

Signature

I AOI,licant (print)

Signature

8.(confd) DRILLER'S LOG (cont'd):

Depths (ft.) Rock Description, Water Level, Dater;, etc.

~ to J!iJ ....J:;,c,~~~~~!5.L ~: 1H '-5~"""If-~-.s.""!.--....,.--:--+-

. 10"

~to.J...QtL ~~~~-#L-------____ 10 _________ - _____________ _ _____ 10 _______________________ __

----~---- ---------------------____ Io~ ~ ___________________ __ ~ __ 10 _______________ ~_ _____ w _____ ________ --____________ __ ____ to _____________ ~ ____________ -

____ w _____ ________ ~--~~----------___ 10 ____ -_. -__ to __________ ~ ______ _ ___ 10 ______ - _____ ~_-__ _____ ro ______________________ ~ ____ __ __ 10 ~ ~ ______________ _

Date ______ ._-+~~. ___ ... _

Date __ ~ __ - __ --~---------1

""--' " ..

Depths (ft.) Rol".k De5cription. Lavel, Dates, etc.

__ to _____________ ~ __ ----------_____ ro _______________ ~-----------_____ to _____________ ~~ ________ -____ to _________ ~ ______ ~~---------

_ to ~_ ------:-----1-------__ to _________ -+ _________ _

_ ~ to _ -~-----__t-------~ ~ -- -------f---------~ to ~ ~---------i------__to __ ____ to ____ -:--------~---------__ to __________ -;. ______ _

_____ to _________ ~ __ "_-+ _____ ~ __ __ _____ to _____ ~ __ ------~----__ ~ _

_____m _____ -----------4----------_ __ to _~ ______ --+ _____ _

_____ to _______________ ~-----------_ __ to _____________ ~----------

\ \ f'lr ~ " 0 L\ YDU ~ \" 1\\ J. Of- '( O\..\-n1-19.& 25. Remarks: ____________ ~ _______ ~ ____ +_-----

'May.25. 2000 11:02AM KAUAI ORGANIC FARMS No.l025 p. 1

P.O. Bax 1535 -*,~1 '~'r". '!!!It ,'i' I"" :.~s.t;~~t.", """I"iIiIItIW! 'IItI"lI'.'I,' '"" IIlHHfftf

F N< 808-828-0778

Oasis Water' Syst£ll"nS';·IIi-;:;·~"

To~ Lenore Frvm: Samantha Geimer

Fax: 808-587"()219

Re: Well No. 1123-04 CC:

• Comments:

Lenore, attached pleclSl! find the signed well construction permit for the above reference well. Please call me if you have any questions or need anyadditionallnform8tion.

Sincerely. .

.sam~~ Samantha Geimer, Office Manager 80'8-635-7671

BENJAMIN J. CAYETANO GOV£IUIOft OF HAW ...

REF:CWRM-SS

Mr. Michael Edwards Sustainable Kauai P.O. Box 1208 Kilauea, Hawaii 96754

Dear Mr. Edwards:

STATE OF HAWAII DEPARTMENT Of lAND AND NATURAL RESOURCES

COMMISSION ON WATER RESOURCE MANAGEMENT PO BOX621


Well Construction Permit Fountain of Youth Well (Well No. 1123-04)

ntOTHY E JOHNS

BRUCE S. ANDERSON ROBERT G GIRAlO BRIAN C NISHIDA DAVID" NOBRIGA.

HERBERT Y. RICHARDS. JR

lINNEl T NISHIOKA DEP\lT'fDIII':ECTOfI:

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

Special Conditions

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

2. The wall thickness of well casing shall be selected in accordance with good design practices applied with due consideration to conditions at the site of the well and shall be sufficient to withstand anticipated fonnation and hydrostatic pressures imposed on the casing during its Installation. grouting, well development, and use. The minimum wall thickness of carbon-steel casings in wells shall confonn to Table 4 and the AWWA standards for water wells (ANSUAWWA Ai 00-90), as may be amended.

3. Standard Condition 2 is modified to exempt the pennittee from the requirements for a pump test

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

I

, Mr. Michael Edwards Page 2 MAR - 9 am

·Permanent pump installation for capacities between 0-70 gpm and where the proposed use is for private individual needs in non-ground-water management areas may be aI/owed prior to the final pump installation permit issuance. When required as a condition of the well construction permit. subsequent pumping tests shall validate the acceptability of the permanent pump. The permanent pump installed prior to final pump installation permit issuance is subject to removal if the testing shows that a smaller pump is required to reduce the potential of affecting neighboring wells and localized upconing at the applicant's well .•

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

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

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

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

Aloha,

~~f!~ Chairperson

Enclosures

WELL CONSTRUCTION PERMIT Fountain of Youth Well. Well No. 1123-04

In accordance with Department of Land and Natural Resources, Commission on Water Resource Managemenfs Administrative Rules. Section 13-168, entitled 'Water Use, Wells, and Stream Diversion WorKs", this document permits the construction and testin~ of Fountain of Youth Well (Well No. 1123-04) at Lot 7 of Puu Pane Subdivision, Kauai,TMK 5-1-5:106 subject to the Hawaii Well Construction & Pump Installation Standards (1123197) which include but are not limited to the following conditions:

1.

2.

3.

4.

.5.

6.

7.

8.

9.

10.

11.

12.

13.

The Chairperson of the Commission on Water Resource Management (CornTWssion). P.O. Box 621. Honolulu, HI 96809. shall be notified. in \llrtting. at least two (2) weeks before any work authorized by this permit commences and staff shal be aIowed to inspect inslallation activities in accordance willi §1~168-15. Hawaii Administrative Rules.

The well construction pem1it shan be tor construction and testing of the wei 0l"Iy. A minimum one-inch diameter monitor tube shaM be ~ installed, in a manner acceptable to the Chairperson, to ac:cuateIy record water levelS. The permitIee. well operator, and/or well owner shall coordinate with the Chai"person and conduct a J)Umping test in accordance with the Standards. (I pump .tes.tlng ~ Is attached). The permittee, well operator, and/or wei owner shan submit to the Chairperson the test results as a basis tor supporting an ~lC8tion 10 instal a permanent pump and wilhdraw water for use. No pennanent pmIp may be installed until a pump installation permit is approved ;nI issued by the Chairperson.

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

The permittee, well operator, and/or wei owner shaft incorporate mitigation measures to ~ent construction debris from entering the aquatic environment, to schedule work to avoid periods d high rainfall, ;nI to revegetate any deared areas as soon as possible.

In the event that subsurface cultural remains such as artifacts, burials or concentrations d sheIs or charcoal are encountered dLling construdion, the permittee. well operator, and/or well owner shall stop work and contact the Department's HisVic Preservation immediately.

The proPOSed well construction shaI not adversely affect existing or futLn! legal uses of water in the area, irdJding any surface water or estabtished instream flow standards. This permit or the authoriz:alion to construct the wen shaD not constituIe a determination d axreIative water nghts.

The following shall be submitted to the Chairperson within sixty (60) days after oompletion of WOIX: ~. Well compIeIion report. (attached - Part I, Wei ConstructIon Report).

b. Elevation (referenced to mean sea level, msI) SU"Yey by a Hawai-licensed surveyor. c. As-built sedionaI drawing of the well. d. Plot plan and map showing the exact location d the wei. e. Complete p!6I'4ling test records, induding time, pumping rate, drawdown, chloride content, and other data.

The permittee, well operator, and/or wei owner shall comply with aR applicable laws, rules, and ordinances; non-compIiance may be grounds tor revocation of this permit

The well consIrudion oenrit appljcation is incoroorated into this permit by reference and is subject to the Hawaii Wf!j ConstnJc\ion & ~ InsIaIa1ion Standards (January 23, 1997; HWCPIS). If the IiWtPIS are not followed and as a consequence waIer is wasted or contaminated, a lien on the property may result.

The permit may be revoked by the Commission if worIt is not started wiIhin six (6) months after the date of approval or if work is suspended or abandoned for six (6) monfils, unlesS otherwise speCified. The WOIX proposed in the wei consIrudion permit application shall be rompIeted within two (2)rtC from the date d permit approval, unless otherwise specified. The permit may be extended by the ~rson upon a showing d good cause and good-faith ~1Ce. A request to extend the permit shaD be submitted to the Chairperson no later than three (3) months pnor to the date the permit expires. • the COI'IVTIEllICet11ent dale is not met. the Commission may revoke the permit after giving the permittee, well operator, and/or wei CNmer notice clthe proposed action and ., opporIIrity to be herard.

If the wen is not to be used it must be property capped. If the wei is to be abandoned then the permittee, wei operator, andIor wei owner must apply for a well abandonment permit in accordance will § 1 ~ 168-12(1) prior to any wei ~ or plugging worIt.

The permittee, its successors, and assigns shall indemnify, defend, and hold the State d Hawai hannIess from and against any loss, lability, claim, or demand for property damage, peISOIl8I injury, or death arising out d any act or 0ITissi0n d the applicant, assigns. officers, employees, contractors, and agents under this permit or /elating to or connected with the granting d this permit

Special conditions in the attached CXNer transmittal letter are incorpora1ed henWl by reference.

dii@~t Date of Approval: March 7, 2000

March 7, 2002 TIMOTHY E. JOHNS, Chairperson Commission on Water Resource Management Expiration Date:

I have read the conditions and terms of this pennlt and understand them. I accept and agree to meet these conditions as a prerequisite and underlying condition of my ability to proc:ee<I and understand that I shall not commence worl< until I and the driller have signed, dated, and returned the J]8nnit to the CommIssion. I also understand that non-compliance with any pennlt condition may be grounds tor revocation and fines of up to $1000 per day starting from the pennit date of approval.

Permittee's Signature: _____________ _ Date: ______ _

Printed Name: ______________ Firm or Title: _______________ _

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

Printed Name: ______________ Firm or Title: ______________ _

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

Attachment c: USGS

Department of Health! Safe Drinking Water, Wastewater, and Clean Water Branches Kaual Department d'Ntllti!f Supply

/

Well No. Well Name Applicant

1123-04 Fountain of Youth Michael Edwards

SECTION 1: WELL LOCATION INFORMATION

Island

Aquifer System

Aquifer Sector

KAUAI

LIHUE

KILAUEA

data

Date of Review Reviewer

Proposed Use

Proposed Withdrawal

System Sustainable Yield

2/15/00 RRI

Irrigation

10000 17

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

Elevation at top of casing Ground Elevation

Cement Grout

Rock Packing

Hole Diameter Total Depth

Estimated Head Calculated Aquifer Thickness

County Water Supply (YIN ?)

m.s.!.

m.s.!.

____ ft., m.s.!.

17999 ft.

Solid Casing Material

Designation

Length

Diameter

Wall Thickness

Casing

Material Designation

Length

Diameter

Wall Thickness Openings

Open Hole

Length

Diameter

ft. in.

SECTION 3: CHECKLIST (values to check are shaded)

Well Depth

Theoretical Thickness of Aquifer

1/4 Aquifer Thickness

Depth of Well below Sea Level

Well Casing Minimum Wall Thickness

Material County or Non-County

Minimum Thickness per standards Wall Thickness Provided

Minimum Length of Solid Casing

90% of ground to top of aquifer

Length of solid casing Provided

Casing Material

Annular Space

Depth of Grouting

Calculated Depth of Grouting

Depth of Grouting provided

Thickness of Annular Space

Steel

17999 ft. 4500 ft.

10 ft.

non-county #N/A in. 0.313 in.

-35.1 ft. 300 ft.

ASTMA53

-27.3 ft. 210 ft.

3 in. -----

okay (refer to HWCPIS Section 2.2)

#NJA (refer to HWCPIS Section 2.4 c)

okay (refer to HWCPIS Section 2.4 d)

okay (refer to HWCPIS Section 2.4 e)

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

okay (refer to HWCPIS Section 2.6 c)

okay (refer to HWCPIS Section 2.6 d)

Page 1


TIMOTHY E. JOHNS CHAIRPERSON

Fee( /':

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

LI I.j -. DAVID A. NOBRIGA ,i- ~ERBERT M. RICHARDS, JR.

! Li~NEL T. NISHIOKA

STATE OF HAWAII DEPUTY DIRECTOR

TO:

DEPARTMENT OF LAND AND NATURAL RESOURCES COMMISSION ON WATER RESOURCE MANAGEMENT

P.O. BOX 621 HONOLULU, HAWAII 96809

FEB I 7 2000 Dean Y. Uchida, Administrator Land Division .

FROM: Linnel T. Nishioka, Deputy Director /~iJJ/\ ;r-{) Commission on Water Resource ManagemenUIV1v • U ~ Well Construction/Pump Installation Permit Application Fountain of Youth Well (Well No. 1123-04)

SUBJECT:

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

We would appreciate your comments on the captioned with regard to the programs, plans, and objectives specific to your division. Specifically, Item 9 on the application has been added per your request concerning water lease/permits administered by your division. Please respond by returning this cover memo form by March 3, 2000.

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

LN:ss Attachment(s)

RESPONSE: c j c> ..."

A. "Y~ter lease/permit is required of this applicant and an application for such will be recf';e~ied by ¥~ divIsion. '; '.~.)

[ ]

: ,.' :./ ' f',:) . (.::::>

PCJ{ A water lease/permit is not required of this applicant.

[ ]

[ ]

:J'::' -A water lease/permit has been obtained by the applicant through lease no, ___ ~~ __ -=-__ Other relevant Land Division rules/regulations, information, or recommendations are att~Che=d.

~ -; -. ..-~

No objections

: 11

[ ]

~}{ Other comments: The application indicates the TMK to be 5-1-05: 106, however, the TMK map provided indicates the TMK is 5-1-05:52, which is probably correct as the Kauai ownership situs does not show TMK: 5-1-05:106 existing.

G Basedton TMK:5-1-05:52, the oriainal source of title is Contact Person: ary Mar ln Pnone: _...:.1...:.U=-4~L.=-=-I ______ _

Signed: ~ -n&.JZ(;::: . Date: FEB 28m

Land Commission Award 8559-B:38 issued 1845 to 1850.

' " ... 8 .) I

~:j~ BENJAMIN J. CAYETANO ; 0 • \~IMOTHY E JOHNS

GOVERNOR OF HAWAII CHAIRPERSON

TO:

FROM:



HONOLULU, HAWAII 96809

FEB I 7 2000

Honorable Bruce S. Anderson, Director Department of Health

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

III/DAVIDA. NOBRIGA ~ ~ ~ ~ERBERT M. RICHARDS, JR.

LlNNEL T. NISHIOKA DEPUTY DtRECTOR

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

Timothy E. Johns, Chairperson Commission on Water Resource Management

SUBJECT: Well Construction Permit Application Fountain of Youth Well (Well No. 1123-04)

d?(]J. rIf-t Transmitted for your review and comment is a copy of the captioned well application.

We would appreciate your comments on the captioned application for any conflicts or inconsistencies with the programs, plans, and objectives specific to your department. Please respond by returning this cover memo form by March 3. 2000.


LN:ss Attachment( s)

RESPONSE:

[ 1

[ 1

[ 1

[ 1

[ 1

This well qualifies as a source which will serve as a source of potable water to a public water system (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.

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 rer year or 15 service connections) and if the well water is used for drinking. the private owner should test for bacteriological and chemica 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 m:!m: to Implementation.

If the well is used to supply both potable and non-potable purposes in a single system, the user shall eliminate cross-connections and backflow connections by physically separating potable and non-potable systems by an air 9ap or an approved backflow preventer, and by clearly labeling all non-potable spigots with warning signs to prevent inadvertent consumption of non-potable water. Backflow prevention devices should be routinely inspected and tested.

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

For the applicant's information, a source of possible wastewater contamination [ ]ls [] Is not located near the proposed wtll-alte (information attached). ~).. ,-. ., ,-.~

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

No comments/objections NO H c..otds 0' c', -r\ ": r'fj , t;)

'oj) _ .. ,l' l--

-:::~. CO . -Contact person:\..O~\II_"":"---I ..... \,,_~_t(;_· _______ Phone: ~2ff4~ -0 . ':1

Signed: ~ 01. . fMN Date: _-_2~.~z.4~~--rzc«I=_ -_ +-....;.. .. :,~.~. :~~===~:.:. == :i -- .==\ t:J;)

~~-\ i~;~\ G1' .. \

o BENJAMIN J CAYETANO ~"'-

TIMOTHY E .101M

TO:

FROM:

BRUCE S. AHDERSOIN ROBERT G. GIRALO

REGEL§.;:= SAFE DRINKING1Ym.~_H


COMMISSION ON WATER RESOURCE MANAGEMENT po. BOX 621


FEB 17 2000

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

William Wong, Safe Drinking Water Branch

FEB ,,',' ,..,~ro

t..:, t:.lJu

Commission on Water Resource Management U \\y' U Il-SUBJECT:

Timothy E. Johns, Chairperson ;-{}.D f, i\)?t Well Construction Permit Application Fountain of Youth Well (Well No. 1123-04)

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

We would appreciate your comments on the captioned application for any conflicts or inconsistencies with the programs, plans, and objectives specific to your department. Please respond by returning this cover memo form by March 3, 2000.


LN:ss Attachment(s)

RESPONSE:

( )

~ [ )

'Ik [ )

This well qualifies as a source which will serve as a source of potable water to a public water system (~ 25 or more people at least 60 days per year or has 15 or more service connections) and must receive Director of Health approval D!'IM to lis use to comply with Hawaii Mministrative Rules (HAR), Title 11, Chapter 20, Rules Relating to Potable Water Systems, §11-20-~

or 15 service connections) and if the well water is used for drinking, the private owner should test tor .. and chemical This well does not qualify as a source serving a public water system (serves less than 25 people or ~ least 60 days per year

presence before initiating such use and routinely monitor the water qualitY thereafter. However, if future use from this source mcreases to meet the public water system definition then Direcklr of Heafth approval is requited i2I12!: to III'1plemeU1ation.

If the well is used to supply both potable and non-potable purposes in a single system, the user shaft eliminate a'OSIHXlI'Ineclions and back1low connections by physically separating potable and non-potable systems by an air gap or an approyed bacIdIow preventer, and by clearty labeling all non-potable spigots with warning signs to prevent inadvertent consumption of non-potable water. Back1Iow 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. :;ry c:~

For the applicanfs information, a source of possible wastewater contamination [ lis [] Is not located near tfW!1~ ~ ~e (information attached). ~:::; :;~ ~

Other relevant DOH rules/regulations, information, or recommendations are attached. '~ 0 ~ No comments/objections _,. " " co

Contact Person: William Wong

Signed: {/1(/:ft£f)fln~

,)' " Phone: 5B6?~~B '" ' ?i

------~~~~2~~y----~.-.--~·~

Date: 02/~tQO..c.. --------~~~-~'·,----~cn~-----

c The Department of Health, Clean Water Branch has the following comments:

1. For Well-Drilling Activities

Any discharge to state waters of treated process wastewater effluent associated with well drilling activities is regulated by Hawaii Administrative Rules, Chapter 11-55, Appendix I, effective September 22, 1997. Treated process wastewater effluent covered by this general permit includes well drilling slurries, _ _ lubricating fluids wastewaters, and well purge wastewaters. This general permit does not cover well pump testing. The applicable Notice of Intent Forms and filing fee shall be submitted at least thirty (30) days before the start of discharge to the Department of Health, Clean Water Branch at 919 Ala Moana Boulevard, Room 301, Honolulu, Hawaii 96814-4920 or P.O. Box 3378, Honolulu, Hawaii 96801-3378. Inquiries may be directed to the Clean Water Branch at (808) 586-4309 or by fax at (808) 586-4352.

2. For Well Pump Testing

The discharger shall take all measures riecessary to prevent the discharge of pollutants from entering state waters. Such measures shall include, if necessary, containment of the initial discharge until the discharge is essentially free of pollutants. If the discharge is entering a stream or river bed, best management practices shall be implemented to prevent the discharge from disturbing the clarity of the receiving water. If the discharge is entering a storm drain, the discharger must obtain written permission from the owner of that storm drain prior to discharge. Furthermore, best management practices shall be implemented to prevent the-discharge from collecting sediments and other pollutants prior to entering the storm drain.

JS/cr

BENJ,.t,MN J CAYETANO ~aF_


Dear Mr. Edwards:

STATE OF HAWAII DEPARTMENT OF LAND AND NATURAl RESOURCES


HONOlUlU. HAWAII 96809

FEB 17 2Ol)

TIMOTHY E. JOtIIS

BRUCE S. ANDERSON ROBERT G GIRALD BRIAN C. NISHDt. DAVID 1<. NOBRIGA

HERBERT M. RICHARDS. JR

LIINEL T. NISHIOKA IIEPVTY~

Well Construction I Pump Installation Permit Application for Well No. 1123-04

We acknowledge receipt, on February 14, 2000, of your completed well construction! pump installation permit application for the Fountain of Youth Well (Well No. 1123-04). You can expect your application to be processed within ninety (90) days from this date.

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

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

IN:ss

Sincerely,

CAteJdX-LlNNEl T. NISHIOKA Deputy Director

BENJAMIN J. CAYETANO GCWEftNOR 0* KAWAI

TNOTHY E JOHNS

TO:

FROM:

STATE OF HAWAII DEPARTMENT OF lAND AND NATURAl RESOURCES


HONOlUlU. HAWAII 96809

FEB 1 7 2COO

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

William Wong, Safe Drinking Water Branch

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

DAVID A. NOBRIGA HERBERT M. RICHARDS. JR

l~El T. NISHIOKA DEPUTY .....,.,""

Commission on Water Resource Management V 1'\.Y' U Il-SUBJECT:

Timothy E. Johns, Chairperson ;-{]D f, /h?t Well Construction Permit Application Fountain of Youth Well (Well No. 1123-04)

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

We would appreciate your comments on the captioned application for any conflicts or inconsistencies with the programs, plans, and objectives specific to your department. Please respond by returning this cover memo form by March 3, 2000.


LN:ss Attachment( s)

RESPONSE:

( I

[ I

( I

( )

( I

( I ( I

This well quailies as a sowce which will serve as a source of potable water to a pubic water system (servinu 25 or more people at least 60 days per year or has 15 or more service connections) and must receive Director d HeaIh appi'ovaI DrkK to its use to comply wilh Hawaii Administrative Rules (HAR). Title 11. Chapter 20, Rules Relating to Potable Water Sysaema, §11-20-~

This well does not qualify as a source serving a public water system (serves less than 25 people or ~ least 60 days per year or 15 service cannedions) and if the wei water IS used for dririking, the private owner ahciuIcr teat for ~=;;; and chemical == '::.t ~~':' :=':'~~V;=J='~=='ia~~: impIemen~ this source

If the well is used to~both and non-potable purposes in a single system. the user shall eliminate cross-<::OOnectiona and backftow c:onnec:tiona by ph' separating potable and nOn-potabIe systemS by an air pP or an approved backIIow pnwenter, and by clearly labeling" e spigots with waming signs to prevent inadvertent conswnption of non-potable water. BacIdIow prevention devices shoulil be routinely inspected and tested.

" does not appear 1hat this well will be used for consumptive purposes and is not subjed to Safe Drinking Water Regulations.

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

Other relevant DOH ruleslregulations. information, or recommendations are attached.

No commentslobjections

Contact Person: __________________ Phone: ...,--_________ _

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

BENJAWmNJ.CAYETANQ QCMJUOOA Of HAWAII

STATE OF HAWAII DEPARTMENT Of LAND AND NATURAL RESOURCES

COMMISSION ON WATER RESOURCE MANAGEMENT po. BOX 621

HONCllI.A.U. HAWAII 96809

FE: I 7 rJJJ

TIiIOTHY E. JOHNS ..-BRUCE S. ANDERSON ROBERT G. GIRAlD IIRIAH C. NISHIDA MV1D A NOBRIGA

HERBERT lot RICHARDS. JR.

I.JIiNEl T. NISHIOKA .....,.,..-.cr""

TO: Dean Y. Uchida, Administrator Land Division

FROM: Linnel T. Nishioka, Deputy Director /~iJJ~ W Commission on Water Resource Managemenl)"'" 1 v . U ~

SUBJECT: Well ConstructionlPump Installation Permit Application Fountain of Youth Well (Well No. 1123-04)

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

We would appreciate your comments on the captioned with regard to the programs, plans, and objectives specific to your division. Specifically, Item 9 on the application has been added per your request concerning water lease/permits administered by your division. Please respond by returning this cover memo form by March 3, 2000.


LN:ss Attachment(s)

RESPONSE:

[ ] A water lease/permit is required of this appicant 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 1he applicant through lease no. ________ _

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

[ ] No objections

[ ] Other comments:

Contact Person: ________________ Phone: __________ _

Signed: ___________________ Date: __________ _

OOClfJENT N). _ ....

U\C OR ATTAO£O ~RKSt£ET .."" . DATE: 2}17 IOU SRCI COST

F YR PPP DOBJ CTR PRruECl PH ACT N-'()lM' N&ME/PESCR IPT Ja-I"_(}If#:; n.pUT)

Ie .no ,ODD C 1020 0152 ---- -- --- (1) 25 QQ --~~------------- -- --- - ---- ---- ----- -- --- (2) ----------------------- -- --- - --- ---- ----- -- --- (3) ---------------------- -- --- - ---- ---- ------ -- --- (4) -------------------

TOTAL 25.00

REJ-4ARKS: LIN: (1) Well No. 1123-04 (WCPA/PIPA) I

LINE (2) , LINE (3)

,

LINE (4) I I

Well Background Check Well Construction Pump Installation

Approved Well No Well Name Applicant

2/11/97 1120-26 Steve's Steve Goldberg

10/5/98 5841-01 Kikiaola Milohae Limited Part.

Driller Type Issued Signed WCR1 Accept Issued Signed WCR2 Accept

C-21457 BOTH 3/4/97 9/9/98 6/22/99 6/22/99 7/6199'"'''' t 'VOL," ""~ '( l ~v lJ. ~.c",

C-21457 BOTH 1017198 12/8/98 9127/99 10/12/99 10/15/99 .' ,

11/12/98 1120-30 Moloaa Ranch 1 Moloaa Bay Ranch C-21457 BOTH 11/17/98 12/28/98 6122199 6/22/99 7/6/99~' ; , ' V~(~'-

2/24/99 1123-03 Scoratow Jay Scoratow C-21457 BOTH 3/4/99 9/8/99 12114/99 12/14/99 1112100 '2-/..,/ :'l DO 3/15/99 1222-03 Lokahi Gardens Teresa Goldberg C-21457 BOTH 3/17/99 6/8/99 12114/99 12/14/99

10/1/99 0520-01 RWR Ronald W. Russell C-21457 BOTH 10/6/99 12/9/99

( J

()

Thursday, January 27, 2000 Pagel 0/1

Tom Nance Water Resource Engineering

o

Ms. Linnel T. Nishioka - Deputy Director Commission on Water Resource Management Department of Land and Natural Resources State of Hawaii P. O. Box 621 Honolulu, Hawaii 96809

Dear Ms. Nishioka:

o

Well Construction Permit Application for a Small Capacity Well in Kilauea. Kauai

January 21, 2000 00/043 (00-02)

Enclosed please find a well construction permit application, accompanying maps, and $25 filing

fee for a small (25 GPM) well to be constructed in the Puu Pane Subdivision in Kilauea, KauaL The

applicant and landowner is Sustainable Kauai, a non-profit Hawaii corporation. Since the subdivision lot

was purchased in December 1999, I have also included a copy of the deed conveying the property to

Sustainable KauaL

Because the well's anticipated usage of 10,000 GPD is quite modest, I am hoping that the permit

application can be approved administratively to facilitate proceeding with the work. Feel free to

contact me if you have any questions. Thank you for your attention to this matter.

Sincerely,

~~U-Tom Nance

Enclosures

cc: Michael Edwards - Sustainable Kauai

680 Ala Moana Boulevard. Suite 406 • Honolulu, Hawaii 96813-5411 • Phone: (808) 537-1141 • Fax: (808) 538-7757· E-mail: tnwre@aloha,net

State of Ha~i o For Official Use Only:

COMMISSION ON WATER RESOURCE MANAGMENT Department of Land and Natural Resources APPLICATION FOR PERMIT 1-6-00 R[r~~\t~-,.,· • Well Construction or ,)( Pump Installation 00-02

Instructions: Please print in ink or type and send completed application with attachments to the Commission ~,.., , .I ,. 2.1 P 2' 5 2 on Water Resource Management, P.O. Box 621, Honolulu, Hawaii 96809. Application must be accompanied by U'-' oJ,,,.,. '1 3 copies and a non-refundable filing fee of $25.00 payable to the Dept. of Land and Natural Resources. The Commission may not accept incomplete applications. For assistance, call the Regulation Branch at 587-0225. (Also, please check our website at - http://www.hawaii.gov/dlnr/dwrm/dwrm.html) '1(":'1(" "'! '.' A'''''' "",

.. , ,-

I

APPLICANT INFORMATION: (Fill out all three, if applicable, and place a check next to the primary contacq,;.~ ,

1. (a). WELLOWNER: Sustainable Kauai Contact Person: Michael Edwards

,,-;: I,'" ·'~}'('t,20~

Phone:B08-826-0 10 1

Mailing Address: P. O. Box 1208 Kilauea, kauai, Hawaii 96754

Fax: 808-826-0202 E-mail: --------:-;--;--;--..,,--;=-r-

(b) D LAND OWNER: _-=.S..:.;u_s_t_a_i n_a_b_l_e_K_a_u_a_i ___ Contact Person: _M_i c_h_a_e_l_E_d_w_a_r_d_s __ Phone~08-826-0101 Mailing Address:.---,,...,,-=--=-=-=-=-_________________________________ _

Fax: 808-826-0202 E-mail: ----------~~~-

CONTRACTOR: Oas; s Water Systems, Inc. Contact Person: Steve Gol dberg Phone~08-828-6876 ..--~---~~~---

(c)D Mailing Address: P. O. Box 535 Kilauea, Kauai, Hawaii 96754

Fax: 808-828-0778 E-mail: _____________ Lic#: C-21457

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

2. WELL LOCATION/NAME: "Fountain of Youth" at Puu Pane

(circle one:CC-57,JC-57a, or A)

Island: Kaua i

Address _L_o_t_7_of_P_u_u_P_a_n_e _S_u_b_d_i_v_i _s_i o_n_"_' -_K_i_l a_u_e_a_,_K_a_u_a_i __ Tax Map Key: 5-1-05: 106

Attach the relevant portion of (a) a 7.5-Minute Series USGS topographic map (scale 1"=24,000'), and (b) a property tax map, showing well location referenced to established property boundaries .

3. PROPOSED WORK: (Check aI/ that apply)

• Drill New Well D Deepen ~Install New Pump

D Modify Existing Well D Redrill D Modify Pump

D Abandon/Seal· D Replace Pump

• Well No.: ______ Be sure to complete and submit well abandonment report upon completion of work"

4. CONSTRUCTION: D Dug D Bored D Driven • Drilled D Radial

Is this well a part of a battery of wells? DYes • No (Please describe,,)

5. PROPOSED PUMP INFORMATION: Rated Pump Capacity: ____ 2_5 _______ 9allons per minute

Pump Type (Check one):

D Deep Well Turbine

• Submersible

D Centrifugal

6. PROPOSED USE: (Check aI/ that apply)

D Rotary

D Rotary-Displacement

D Rotary-Gear

D Propeller

D Reciprocating

D Impulse

D Municipal (including hotels, stores, etc.)

D Domestic (individual, noncommercial water system)

Powered by:

D Diesel

D Gas 3

• Electric, rated horsepower: _____ _

D Industrial

No. of Dwelling Units: ________ _

D Irrigation (crop) _____________ _ No. of Acres: _---::::--~-,.-:---___;__:::--:--

D Military • Other (explain): Irrigation and Potable

7. (a) PROPOSED AMOUNT OF WITHDRAWAL: __ 10-,,_0_00 ___ gallons per day Use on 7.86-Acre Lot

(b) METHOD OF FLOW MEASUREMENT: • Flowmeter D Open-pipe D Weir D Orifice D Other(explain)

OTHER IMPORTANT INFORMATION:

8. PENDING ACTIONS: DCDUA D SMA DEIS DEA • NONE D Other (explain)

9. REMARKS, EXPLANATIONS:

(If more space IS needed, please attach additional sheet)

I understand that approval of this application attaches the following standard conditions: 1) the proposed work is to be completed within two (2) years of the approval date; 2) the contractor shall submit to the Commission a well completion/abandonment report within 30 days after the completion date of the permitted work; 3) monthly water use data shall be submitted to the Commission; 4) such approval shall not constitute a determination of correlative water rights and shall not guarantee the pump capacity or future use up to the permitted pump capacity.

Signature!-L.~c..!!I~~~CElCl9~~

Date /- 9- fJe; ::::::::'!E~-Date /- (J -0

Field Checked By ________ _ Longitude _______ _ Aquifer System Name ~\ L-1\V8\ I Lli h.l L ').DID

Date Latitude State Well No. \ 11 ;) - 0 4

j( ~~~ ~ "L-!rs/o-o. 1{JU.o,,,'M, WCPIFORM (9/13/99)

~'lIJ ~h .. ! 1:1) "

t I I 1

11. PROPOSED WELL SECTION ¥-~ Hole Diameter: \ 2- in.

Elevation at top of casing 402 ft., msl* . \ ~ •

(Survey to nearest 0.01 ft.) .. , -I'.~ b'

l :'.';'. '. '~" t ... :J 'I"~ .;~.

I /Y\' , • \ .'

I l~"':'" I l·. j • • ~

Minimum of 2' Radius & 4" Thick Concrete Pad

Ground Elevation: 400 ft., msl*

Please refer to the

! r< I:~ :::

! >II>

HA WAil WELL CONSTRUCTION AND PUMP INST ALLA TION STANDARDS

I': .': (>.

, '.

W Qj > II> ..J

Cement Grout: 210 ft. (min. 70% of distance from ground elevation to top of water surface or 500 ft., whichever is less.)

I'." :'.

", .C1. .. 1::-· .. ·:·

~I//

'. {" . . .,; .'. " .. \

Solid Ca.sing: k 90% x (G~~nd jlev.-Water Level Elev)) Matenal: __ ee Material Standard: I IV! A!:>.:l

'\' " <- ..

, .' .. ' ,\:

'01 c· ::I' 0:

Length: 300 Diameter: 6 in. Wall Thickness:B • 3125 in.

ft .

. '\.' • .c\..

Minimum annular space between hole and casing 2! 3"

;,". :" ":.":\'.

\" ", ~i Bottom Elevation: __ .... 1",U-"-_____ ft .. msl*

l None Rock or Gravel Packing: ____ ft.

I

,I· Material: D Crushed Basalt

I' .'

f~~ ~:" /\ ! 1 (\/'\ !Ii;'; :r)C

" "

:. "·1 < .. :. i .:: :'1

'i, )(/i ( III

rJ;)!

";1

X' ~! o o

'" 1\1

D Rounded Gravel Open Casing: • Perforated D Screen

Material: ____ ---'S7ft~~~~r'l....,.., ....... -----Water Level Elevation: __ N_I_A_ ft. msl* ~i ~

Material Standard: _-'/:r:\S~T*'M'-'-. -'P'-'-\5""'3"'--___ _ Length: ____ --=-10""~------ ft. Diameter: in.

I +-

Wall Thickness: ___ -><. ..... ",3""'1-'=2""5'--___ in. Openings: sq. in.lL.F. Bottom Elevation: 0 ft., msl*

Open Hole: 10 Length: -----....:1j"72T------ ft.

j Diameter: _____ ~<-------- in. Bottom Elevation: __ -......... l"'O _____ ft., msl*

t

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

Bottom Elevation of Well Limit = (Water Elevation _ 41 x Water L~vel ElevatiOn)

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

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

Solid Casing Material:

Steel: compliant with (check one or more): D ANSIIAWWA C200 D API Spec. 5L. ASTM A53 D ASTMA139

And compliant with (check one or more): D ASTM A242 • Type E • Type S • Grade B D Other _______ _

Stainless Steel: (check one): D ASTM A409 D ASTMA312

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

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

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

Open Casing Material:

D Centrifugally Cast Resin Pipe conforming to ASTM D2997

D Reinforced Plastic Mortar Pressure Pipe conforming to ASTM D3517

D Glass Fiber Reinforced Resin Pressure Pipe conforming to AWWA C950

D PTFE Fluorocarbon Tubing conforming to ASTM D3296

D FEP Fluorocarbon Tubing conforming to ASTM D3296

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

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

Stainless Steel: (check one): D ASTM A409 D ASTMA312

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

D ASTMA139

D Other ------------------

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

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

D Centrifugally Cast Resin Pipe conforming to ASTM D2997

D Reinforced Plastic Mortar Pressure Pipe conforming to ASTM D3517

D Glass Fiber Reinforced Resin Pressure Pipe conforming to AWWA C950

D PTFE Fluorocarbon Tubing conforming to ASTM D3296

D FEP Fluorocarbon Tubing conforming to ASTM D3296

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LAND COURT SYSTEM After Recordation, Return by: Mail ( X ) SUSTAINABLE KAUAI PMB 106 BOX 3600 PRINCEVILLE HI 96722

TYPE OF DOCUMENT:

2S~ ~d " q q i./ bd. 05 '( (,O~ ?l/, ·<e LV \J JJ j L - go ?y ,

<Sc.VI.'lN ~ ho: '111)t- lS--u ~~ k (SoB-J ~;) h - ~~c)CJ

171{ \y"\le v,' l/f ) \-f- L

( I L " S q ) I 0> V 1/ 1< a. ~ ),

REGULAR SYSTEM Pickup ( )

TG: 398810 TGE: 99-462-0386-0007-1

Lisa L. R. Wall

WARRANTY DEED

PARTIES TO DOCUMENT:

GRANTOR: DA VID HASSENMILLER and NANCY J. HASSENMILLER" husband and wife PU'U PANE ASSOCIATES LLC, a Hawaii limited liability cqmpany

GRANTEE: SUST AINABLE KAUAI, a Hawaii nonprofit corporation PMB 106 Box 3600 Princeville. Kauai, Hawaii 96722

T AX MAP KEY FOR PROPERTY;

(4) 5-1-05: 106 Lot 7

{W:\DOCS\lOS4\3\W0040182.DOC}

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WARRANTY DEED

KNOW ALL MEN BY THESE PRESENTS:

DAVID HASSENMILLER and NANCY J. HASSENMILLER, husband and w~e, whose mailing address is 24736 Travis Lakeside Cove, Spicewood, Texas 78669, and puru PANE ASSOCIATES LLC, a Hawaii limited liability company, whose mailing address is P. ol Box 518, Anahola, Kauai, Hawaii 96703, hereinafter collectively called the "Grantor", in consideration of the sum of Ten Dollars ($10. 00) and other good and valuable consideration to the Grantor paid by SUST AlNABLE KAUAl, a Hawaii non-profit corporation, whose mailing address is PMB 106 Box 3600, Princeville, Kauai, Hawaii 96722, hereinafter called the "Grantee", the receipt of which is hereby acknowledged, does hereby grant and convey unto the Grantee, as a tenant in severalty, its successors and assigns, the property described in Exhibit "A II attached ~ereto and incorporated herein by reference ("Subject Property").

AND the reversions, remainders, rents, issues and profits thereof, and all of the estate, right, title and interest of the Grantor, both at law and in equity, therein and thereto.

TO HAVE AND TO HOLD the same, together with the improvements ther~on and all rights, easements, privileges and appurtenances thereunto belonging or appertaining qr held and enjoyed therewith, unto the Grantee according to the tenancy herein set forth, forever!.

!

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The Grantor hereby covenants with the Grantee that the Grantor is lawfully seiised in fee simple of the Subject Property described herein and has good right to sell and convey' the same; that the same are free and clear of all encumbrances except as set forth herein and except for the lien of real property taxes not yet required by law to be paid; and that the Gtantor will W ARRANT AND DEFEND the same unto the Grantee against the lawful claims and demands of all persons, except as aforesaid.

The Grantee does hereby accept and approve the Declaration Of Covenants, ~onditions And Restrictions Of The Pu'u Pane Subdivision {"Restrictive Covenants"} and the Declaration Of Grant And Reservation Of Easements For Pu'u Pane Subdivision, as amended ("Dedlaration of Easements "), both of which are described in Exhibit" A" , and covenants and agrees, as,a covenant running with the Subject Property, to observe and perform all of the terms and conditions contained in the Restrictive Covenants and Declaration of Easements applicable to tpe Subject Property and to be observed and performed by Grantee as the owner of the Subject ~roperty.

The Grantee does further covenant and agree, as a covenant running with tihe Subject Property, that the Subject Property shall be owned, occupied, used and enjoyed pursuant to, and shall otherwise be subject to. the terms, conditions, restrictions, covenants, easements and

{W:\DOCS\1054\3\W0040182.DOC)

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reservations set forth in the Restrictive Covenants, the Declaration of Easements, and all other matters set forth and described in Exhibit "A".

The Grantee confinns that it has inspected the property being conveyed and specifically attest that it is purchasing the property on an "AS IS" basis, with a full understanding that only Grantee and not the Grantor will be responsible for any and all imperfections, defects, obsolescence, wear and tear, and all other conditions of said property and hereby waives any claim hereafter against the Grantor for breach of express or implied warranty as to the condition of the property.

This conveyance and the respective covenants of the Grantor and the Grante~ shall be binding on and inure to the benefit of the Grantor and the Grantee, respectively. the terms "Grantor" and "Grantee" as and when used herein, or any pronouns used in place thereof, shall mean and include the singular or plural number, individuals, partnerships, tru~tees and corporations, and each of their respective heirs, personal representatives, successors at¥! assigns. All covenants and obligations undertaken by two or more persons shall be deemed to be joint and several unless a contrary intention is clearly expressed herein. '

This Warranty Deed may be executed in counterparts. Each counterpart shall be executed by one or more of the parties hereinbefore named and the several counterparts shall constitute one instrument to the same effect as though the signatures of all the parties are upon the sa.me document.

IN WITNESS WHEREOF, the Grantor and Grantee have caused these presents to be duly executed on this .{.)~r day of ~f/'Yl8f)C) , 1999. .

GRANTOR:

{W:\DOCS\1054\3\W0040182,DOC}

DAVID HASSENMILLER

~

s;\~~V1A~ MICHAEL M. DYER . His Attorney-in-Fact

NANCY J. HASSENMILLER

gylrC,--w~1· MICHAEL M. DYER Her Attorney-In-Fact

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GRANTEE:

{W:\DOCS\lOS4\3\W0040182.DOCj

o PU'U PANE ASSOCIATES LLC, a Hawaii limited liability company

By V\.--<-- ,;). :'0 k- .• tl-~ EFFREY S. LINDNER

Its Member

SUSTAINABLE KAUAI, a Hawaii nonprofit corporation

Its Secretary/Treasurer

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STATE OF HAWAII ) ) SS.

COUNTY OF KAUAI )

On this ;) 7 day ofJXCFJlIbPIL-' , 1999, before me personally appeared MICHAEL M. DYER, to me personally known, who, being by me duly sworn, did say that he is the Attorney-In-Fact of DAVID HASSENMILLER, duly appointed under the unrecorded Special Power of Attorney dated August 8, 1998, and that the foregoing instrument was exec*ted in the name and behalf of DAVID HASSENMILLER by said person as his Attorney-ln~Fact, and acknowledged the instrument to be the free act and deed of said DAVID HASSENMILLER.

~ame otary: ~otary Public, State of Hawaii.

My commission expires:

Karajean Stokesbary Expiration Date: October 10,2003


COU~TY OF KAVAI

On this /)- 7 _ day of J-::teerYlf-3EJ2 ... ,· , 1999, before me personallr appeared MICHAEL M. DYER, to me personally known, who, being by me duly sworn, did sa~ that he is the Attorney-In-Fact of NANCY 1. HASSE~MILLER, duly appointed under the unrecorded Special Power of Attorney dated August 8, 1998, and that the foregoing instrument was executed in the name and behalf of ~ ANCY J. HASSE~MILLER, by said person as her Attorney-In-Fact, and acknowledged the instrument to be the free act and deed of said NANCY J. HASSENMILLER.

Name of tary: ~otary Public, State of Hawaii.

My commission expires: __________ _

Karajean Stokesbary Expiration Date: October 10, 2003

{W:\DOCS\ l054\3\W0040 1 82.DOCl

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COUNTY OF KAUAI )

On this {) -, day of J;£(!Ern8t?'(L.· ,1999, before me appeared JEFFREY S. UNDNER, to me personally known, who, being by me duly sworn, didl say that he is a Member of PU'U PANE ASSOCIATES LLC, a Hawaii limited liabilid company ("Company"), and that said instrument was signed on behalf of said Company by autl}ority of its Board of Directors, and the said Officer acknowledged said instrument to be the free att and deed of said Company.

Name of ary: Notary Public, State of Hawaii.

My commission expires: _________ _

Karajean Stokesbary Expiration Date: October 10, 2003

STATE OF HAWAII ss:

COUNTY OF KAUAI

On this ,9 -, day of .]);eEJ'YJ/3e1Z.· , 1999, before me appeared DR. PENNY NEIL and MICHAEL EDWARDS, to me personally known, who, being ~y me duly sworn, did say that they are the President and Secretary ITreasurer, respectively, of SUSTAINABLE KAUAI. a Hawaii nonprofit corporation, and that said instrument w~s signed in behalf of said corporation by authority of its Board of Directors, and the said officers acknowledged said instrument to be the free act and deed of said corporation.

Name ofN ry: Notary Public, State of Hawaii.

My commission expires: ------

{W:\oocS\i054\3\WOO40182.DOCI Karajean Stokesbary fX'pirmion Date: October 10,:2003

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MEMORANDUM FOR THE RECORD FROM: Lenore … o MEMORANDUM FOR THE RECORD FROM: Lenore Nakama SUBJECT:...

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Transcript of MEMORANDUM FOR THE RECORD FROM: Lenore … o MEMORANDUM FOR THE RECORD FROM: Lenore Nakama SUBJECT:...