Well Construction Pump Installation

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Well Background Check Well Construction Pump Installation Approved Well No. Well Name Applicant Driller Pumplnst. Type Issued Signed WCR1 Accept Issued Signed WCR2 Accept 7 3903-02 Palms of Paradis Juan Orozco BC-23379 BC-23379 BOTH 4859-08 Stephens Paul & Elanor Stephens BC-23379 BC-23379 BOTH 4806-01 Kim 1 Young Soo Kim BC-23379 PUMP A:TY 4/6/2009 5206-06 Horn Don L. Horn BC-23379 BC-23379 BOTH 7446-05 Well #1 Chad Davis BC-23379 BC-23379 BOTH sc.-J. 4859-09 Ohana First Ohana First LLC BC-23379 BC-23379 BOTH 5653-01 Walls Black Sand Associates, LLC BC-23379 BC-23379 BOTH 3688-27 Marie Robert Paul & Debra Marie De BC-23379 BC-23379 BOTH 1/15/2009 5/912009 7/14/2009 7/14/2009 1/15/2009 5/912009 7/14/2009 7/14/2009 Birdhouse Ted Powell BC-23379 BC-23379 BOTH 7 2385-04 Kohi Gabriele & Kristian Rossoll BC-23379 BC-23379 BOTH 3803-01 Hawaiian Natural Hawaiian Water Holdings Cor BC-23379 BC-23379 BOTH '7 , 3803-02 Hawaiian Natural Hawaiian Water Holdings Cor BC-23379 BC-23379 BOTH ? . 3803-03 Hawaiian Natural Hawaiian Water Holdings Cor BC-23379 BC-23379 BOTH '/ 3803-04 Hawaiian Natural Hawaiian Water Holdings Cor BC-23379 BC-23379 BOTH ? . , 3803-05 Hawaiian Natural Hawaiian Water Holdings Cor BC-23379 BC-23379 BOTH -; 3803-06 Hawaiian Natural Hawaiian Water Holdings Cor BC-23379 BC-23379 BOTH Living Waters Ray & Megan O'Neill BC-23379 BC-23379 BOTH 7 ., Pokemon Chad Saufferer BC-23379 BC-23379 BOTH Tom Thomas Shraishi BC-23379 BC-23379 BOTH .., 0533-04 Honuapo Makai Kenneth & Dale Sugai BC-23379 1 BC-23379 BOTH 3588-07 Buddy Richard & Donna Kolar BC-23379 BC-23379 BOTH -2 5407-04 Lucky Strike William & Yucca Clippinger BC-23379 BC-23379 BOTH 3787-11 Wai Puna Michael Ferry BC-23379 BC-23379 BOTH 9/11/2001 3688-04 Watson Robert Watson C-22597 BC-23379 BOTH 9/20/2001 9/29/2001 3/21/2002 5/20/2002 3/312003 4/28/2003 91&'0 3/14/2002 3389-02 Diamond Rod & Lorrie Diamond C-23094 BC-23379 BOTH 4/15/2002 5/22/2002 10/1/2002 10/1/2002 10/21/2002 216/2003 3/27/2 3 f' 11/18/2002 3688-05 Love David Love BC-23379 BC-23379 BOTH 11/27/2002 712912004 3/24/2005 5/18/2005 6/312005 12117/2004 312412005 5/18/2005 11/14/2003 3688-06 Raven Dennis Rofkar BC-23379 BC-23379 BOTH 11/17/2003 12/612003 10/18/2005 10/18/2005 712012006 9/20/2006 10/18/2005 10/18/2005 + ":ednesday, March 30, 2011 Page 1 0/10

Transcript of Well Construction Pump Installation

Page 1: Well Construction Pump Installation

Well Background Check Well Construction Pump Installation

Approved Well No. Well Name Applicant Driller Pumplnst. Type Issued Signed WCR1 Accept Issued Signed WCR2 Accept 7

3903-02 Palms of Paradis Juan Orozco BC-23379 BC-23379 BOTH

4859-08 Stephens Paul & Elanor Stephens BC-23379 BC-23379 BOTH )~u._l~

4806-01 Kim 1 Young Soo Kim BC-23379 PUMP A:TY CL~OI\.."l. 4/6/2009

5206-06 Horn Don L. Horn BC-23379 BC-23379 BOTH

7446-05 Well #1 Chad Davis BC-23379 BC-23379 BOTH sc.-J. ~ ~ 4859-09 Ohana First Ohana First LLC BC-23379 BC-23379 BOTH ~~ 5653-01 Walls Black Sand Associates, LLC BC-23379 BC-23379 BOTH ?.,~

3688-27 Marie Robert Paul & Debra Marie De BC-23379 BC-23379 BOTH 1/15/2009 5/912009 7/14/2009 7/14/2009 1/15/2009 5/912009 7/14/2009 7/14/2009

Birdhouse Ted Powell BC-23379 BC-23379 BOTH 7

2385-04 Kohi Gabriele & Kristian Rossoll BC-23379 BC-23379 BOTH

3803-01 Hawaiian Natural Hawaiian Water Holdings Cor BC-23379 BC-23379 BOTH '7 ,

3803-02 Hawaiian Natural Hawaiian Water Holdings Cor BC-23379 BC-23379 BOTH ? .

3803-03 Hawaiian Natural Hawaiian Water Holdings Cor BC-23379 BC-23379 BOTH '/

3803-04 Hawaiian Natural Hawaiian Water Holdings Cor BC-23379 BC-23379 BOTH ? . ,

3803-05 Hawaiian Natural Hawaiian Water Holdings Cor BC-23379 BC-23379 BOTH -;

3803-06 Hawaiian Natural Hawaiian Water Holdings Cor BC-23379 BC-23379 BOTH

Living Waters Ray & Megan O'Neill BC-23379 BC-23379 BOTH 7 .,

Pokemon Chad Saufferer BC-23379 BC-23379 BOTH

Tom Thomas Shraishi BC-23379 BC-23379 BOTH ..,

0533-04 Honuapo Makai Kenneth & Dale Sugai BC-23379 1

BC-23379 BOTH

3588-07 Buddy Richard & Donna Kolar BC-23379 BC-23379 BOTH -2

5407-04 Lucky Strike William & Yucca Clippinger BC-23379 BC-23379 BOTH

3787-11 Wai Puna Michael Ferry BC-23379 BC-23379 BOTH

9/11/2001 3688-04 Watson Robert Watson C-22597 BC-23379 BOTH 9/20/2001 9/29/2001 3/21/2002 5/20/2002 3/312003 4/28/2003 91&'0 3/14/2002 3389-02 Diamond Rod & Lorrie Diamond C-23094 BC-23379 BOTH 4/15/2002 5/22/2002 10/1/2002 10/1/2002 10/21/2002 216/2003 3/27/2 3 f'

11/18/2002 3688-05 Love David Love BC-23379 BC-23379 BOTH 11/27/2002 712912004 3/24/2005 5/18/2005 6/312005 12117/2004 312412005 5/18/2005

11/14/2003 3688-06 Raven Dennis Rofkar BC-23379 BC-23379 BOTH 11/17/2003 12/612003 10/18/2005 10/18/2005 712012006 9/20/2006 10/18/2005 10/18/2005

+ ":ednesday, March 30, 2011 Page 1 0/10

Page 2: Well Construction Pump Installation

Approved Well No. Well Name

4/12/2004 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 3786-01 Gapp

1/3/2005 3687-16 Duley

2/21/2005 3688-10 Wallace

3nJ2005 3587-08 Oliver

3nJ2005 3587-07 Hendershot 2

3/7/2005 3686-05 Gibson

4/29/2005 3686-06 Polu Puka

6/2/2005 3688-12 Harrison

6/2/2005 3688-11 Hyitt

6/2/2005 3586-06 Oh

6/2/2005 3588-02 Jobst

6/2/2005 3787-06 Lucky Me

8/8/2005 3687-18 K&J

8/8/2005 3180-02 Morningstar

10/18/2005 3486-02 Campbell

11/7/2005 3586-07 Family

11/7/2005 3686-07 Ariel

12/1/2005 3686-09 McWell

12/2/2005 3687-20 Tour

12/2/2005 3586-09 Helenihi

Wednesday, March 30, 2011

Applicant Well Construction

Driller Pump Inst. Type Issued Signed WCR1 Accept Pump Installation

Issued Signed WCR2 Accept

Greg Nichols

Isaac J. Fenn

Charles Webb

Oran & Sandra Lien

Ardis Dennis

Richard & Teresta Camp

Michael Bartlett

Connie Bouchard

John Gapp

Robert Duley

William & Marietta Wallace

Patty Oliver

Carolyn Hendershot

Judith Gibson

Rick Carey

Victor Chris Harrison

Carolyn Hendershot

Shelley & Jeffery Hecht

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

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

Gary & Meng-Ju De Vine

Bruce Martin

Eugene McElroy

Charles Tour

James Helenihi

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BOTH 4/19/2004 7/13/2004 7/612005 9/12/2005

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 9/12/2005

BOTH 9/23/2004 10/29/2004 61712005 9/12/2005

BOTH 9/21/2004 11/1/2004 3124/2005 5/18/2005

BOTH 10/26/2004 10/29/2004 3/24/2005 5/18/2005

BOTH

BOTH

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

1/612005 1/15/2005 3/24/2005 5/18/2005

BOTH 11712005 2/1/2005 61712005 9/12/2005

BOTH 2/23/2005 2/26/2005 61712005 9/12/2005

BOTH 31712005 3/9/2005 61712005 9/12/2005

BOTH 3/30/2005 4/412005 61712005 9/12/2005

BOTH 31712005 3/9/2005 7/6/2005 9/12/2005

BOTH 5/312005 9/15/2005

BOTH 6/812005. 6/13/2005 7/612005 9/12/2005

BOTH 6/812005 6/13/2005 3/30/2006 3/30/2006

BOTH 6/812005 6/13/2005 7/612005 9/12/2005

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

BOTH 618/2005 6/13/2005 7/612005 9/12/2005

. BOTH 8/24/2005 9/12/2005 101712005 101712005

BOTH 1/11/2006 1/12/2005 1/27/2006 1/27/2006

BOTH 111712005 11/10/2005 11/21/2005 11/21/2005

111712005 11/8/2005 71612005 9/12/2005

613/2005 2/22/2005 3/24/2005 5/18/2005

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

11n 12005 11/8/2005 61712005 9/12/2005

111712005 11/8/2005 61712005 9/12/2005

6/312005 6/4/2005 3/24/2005 5/18/2005

6/312005 12123/2004 312412005 5/18/2005

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

6/312005 2/25/2005 3/24/2005 5/18/2005

111712005 11/8/2005 61712005 9/12/2005

111712005 11/8/2005 61712005 9/12/2005

111712005 11/8/2005 61712005 9/12/2005

111712005 11/8/2005 61712005 9/12/2005

111712005 11/8/2005 71612005 9/12/2005

5/312005

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

6/812005 6/13/2005 3/30/2006 3/30/2006

6/812005 6/13/2005 7/612005 9/12/2005

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

6/812005 6/13/2005 7/612005 9/12/2005

8/24/2005 9/26/2005 101712005 101712005

1/11/2006 1/12/2005 1/27/2006 1/27/2006

111712005 11/9/2005 11/21/200511/21/2005

BOTH 11/10/2005 11/14/2005 11/21/2005 11/21/2005 11/10/2005 11/14/2005 11/21/200511/21/2005

BOTH 11/10/2005 11/17/2005 11/21/2005 11/21/2005 1111012005 11/17/2005 11/21/200511/21/2005

BOTH 1211/2005 12122/2005 12/14/2005 12/14/2005 12/112005 12/3/2005 12114/2005 12114/2005

BOTH 121212005 12/14/2005 12/30/2005 12/30/2005 12/212005 12114/2005 12130/2005 12130/2005

BOTH 12/212005 12/6/2005 12114/2005 12/14/2005 12/2/2005 12/6/2005 12114/2005 12114/2005

Page 2 oflO

Page 3: Well Construction Pump Installation

Approved Well No. Well Name

12/2/2005 3687-21 Jennings

12/3/2005 3686-11 Zaulocki

12/3/2005 3688-14 Nielsen

12/3/2005 3687-24 P Moore

12/3/2005 3586-11 T Moore

12/3/2005 3787-08 Nailoa

12/3/2005 3687-19 Suncloud

12/3/2005 3687-22 Schneider

12/3/2005 3586-10 B. Bells

12/3/2005 2385-01 Epperson

12/3/2005 3687-25 #57

12/3/2005 3687-26 #58

12/3/2005 3687-23 Takeda

12/3/2005 3686-10 Wishing

Applicant

Scott Jennings

Paul & Tamara Zaulocki

Greg Nielsen

Paul P. Moore

Thomas H. Moore

Roger Pogline

Scott Suncloud

Klaus Schneider

John Acree

Peter Epperson

Tri Coast Development LLC

Tri Coast Development LLC

Basil Takeda

Clifford Schommer

3/30/2006 3688-15 Young Hwa Joun Young Hwa Joung

3/30/2006 3686-14 Bachman Christine Bachman

3/30/2006 3686-13 Wohlschagel Fred Wohlschlagel

3/30/2006 3687-27 King Thomas King

3/30/2006 3586-12 Erickson John Erickson

4/13/2006 3384-01 Mydell Wayland Lum

4/13/2006 3687-33 Joyous Lake James Foster

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

4/13/2006 3585-04 My Dream

4/15/2006 5408-01 Bigpus II

4/15/2006 3589-03 R&B

4/15/2006 3587-09 Makai

5/23/2006 3487-03 #242

8/17/2006 3587-10 Akana

Wednesday, March 30, 2011

Jeff Hecht

Gary Hajek

Roy & Bonnie Terry

Levi McKay

Timothy Housman

Amy Akana

Well Construction Driller Pump Inst. Type Issued Signed WCR1 Accept

Pump Installation Issued Signed WCR2 Accept

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

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 12/2/2005 12/2/2005 12/14/2005 12/14/2005 12/212005 12/2/2005 12/14/2005 1211412005

BOTH 12/15/2005 113/2006 1/11/2006 1/11/2006 12/15/2005 113/2006 1/11/2006 1/11/2006

BOTH 12115/2005 1/912006 1/27/2006 1/27/2006 12/15/2005 119/2006 1/27/2006 1/27/2006

BOTH 12/16/2005 1212212005 12/30/2005 12/30/2005 1211612005 12/2212005 12/30/2005 1213012005

BOTH 12/15/2005 1/512006 1/11/2006 1/11/2006 12/15/2005 115/2006 1/11/2006 1/11/2006

BOTH 12/15/2005 112412006 2/312006 2/3/2006 12115/2005 112612006 2/312006 2/3/2006

BOTH 12115/2005 12/20/2005 12/30/2005 12/30/2005 12/15/2005 12/20/2005 12/30/2005 1213012005

BOTH 12/15/2005 12/19/2005 12/30/2005 12/30/2005 12/15/2005 12/19/2005 12/30/2005 1213012005

BOTH 12/15/2005 1/512006 1/1112006 1/11/2006 12/15/2005 115/2006 1/11/2006 1/11/2006

BOTH 12/15/2005 111512006 3/30/2006 3/30/2006 12/15/2005 111512006 3/30/2006 3/30/2006

BOTH 12/16/2005 311/2006 3/30/2006 3/30/2006 12/16/2005 311/2006 3/30/2006 3/30/2006

BOTH 12/16/2005 3/312006 3/30/2006 3/30/2006 12/16/2005 313/2006 3/30/2006 3/30/2006

BOTH 12/15/2005 112412006 2/312006 2/3/2006 12115/2005 112412006 2/312006 2/3/2006

BOTH 12115/2005 114/2006 1/11/2006 2/17/2006 12115/2005 2/912006 2/17/2006 211712006

BOTH 4/512006 41712006 4/24/2006 4/24/2006 4/5/2006 41712006 4/24/2006 4/24/2006

BOTH 4/612006 ~r. ~ 4/6/2006

BOTH 4/6/2006 4/12/2006 4/24/2006 4/24/2006 4/6/2006 4/12/2006 4/24/2006 4/24/2006

BOTH 4/612006 ~. ~ 4/612006

BOTH 4/6/2006 411712006 4/24/2006 4/24/2006 4/6/2006 4/17/2006 4/24/2006 4/24/2006

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

BOTH 1211/2006 12/8/2006 12/20/2006 12/20/2006 1211/2006 12/8/2006 12/20/2006 12/20/2006

BOTH 411812006 4/20/2006 5/312006 5/3/2006 411812006 4/20/2006 5/312006 5/3/2006

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

BOTH 4/26/2006 11/27/2006 12/20/2006 12/20/2006 4/26/2006 11/27/2006 12/20/2006 12/20/2006

BOTH 412612006 5/512006 5/30/2006 5/30/2006 412612006 5/512006 5/30/2006 5/30/2006

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

BOTH 6/19/2006 6/20/2006 6/28/2006 6/28/2006 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 8/24/2006 9/21/2006 10/5/2006 10/5/2006

Page30flO

Page 4: Well Construction Pump Installation

Approved Well No. Well Name Applicant Well Construction

Driller Pump Inst. Type Issued Signed WCR1 Accept Pump Installation

Issued Signed WCR2 Accept

8/3/2007 3587-13 Ghiotto

81312007 3587-12 Jazzy Rose

8/10/2007 3586-22 Hale Akala

8/20/2007 3686-18 Trita Ganga

8/20/2007 3281-02 Kai Puka

8/20/2007 3688-18 Musgrave

8/20/2007 3687-50 Mergez

8/25/2007 3586-24 Aunty Jan

9/4/2007 3586-23 Ends

9/12/2007 3486-06 Kaylee

9/12/2007 3686-19 Uli Kai

1017/2007 3687-51 Kan-Sha

1017/2007 3687-52 Ooh

11/9/2007 7552-02 Ninini

11/23/2007 3586-25 Hala Kahiki

11/23/2007 3802-08 PPI

Robert Ghiotto

Robert Derbyshire

Raymond Carl Echt Jr.

John Hanor

Clifford Schommer

Harold Musgrave

Barnaby Vergara

Richard Cottini 1 Holly Cox

Frank Crabtree

Kevin Bernard Rafferty

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

Susan Tolley & Scott Burnha BC-23379 BC-23379

David Miller BC-23379 BC-23379

Kathleen Boyd BC-23379 BC-23379

Brett LaSorelia BC-23379 BC-23379

Charles Eugene Beier

Pur Pacific International

11/23/2007 3586-26 Isle of Lombard Stafford M. Lombard

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

11/23/2007 3687-54 Honu

11/23/2007 3687-53 Kawaiola

12/20/2007 3585-07 B. Bells 2

12/27/2007 1253-02 Milolii 2

12/27/2007 3687-55 Ward Boys

12/27/2007 1253-01 Milolii 1

2/14/2008 3687-58 Oo-Oh

Raymond Doblitk and Katheri BC-23379 BC-23379

Ed Perry

John Acree

Peter Vana

Walt Caravalho

Peter Vana

Paul Gober

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

2/14/2008 3687-57 No Gutter-No Clu Steven Lea BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

2/15/2008 3383-01 Gadler

2/15/2008 5611-01 Honomainoa

2/15/2008 3688-20 Pacific Island

Wednesday, March 30, 2011

Gadler Family Trust

Puu Wahihuena, LLC

Pacific Island Investments, LL BC-23379 BC-23379

BOTH 8/24/2007 10/1/2007 1115/2007 11/5/2007 8/24/2007 10/1/2007 1115/2007 11/5/2007

BOTH 9110/2007 9/27/2007 11/5/2007 11/5/2007 9/10/2007 9/27/2007 11/5/2007 11/5/2007

BOTH 91712007 1/9/2010 8/5/2010 .. 91712007 1/9/2010 8/5/2010

BOTH 10/25/2007 10/30/2007 111712007 111712007 10/25/2007 10/30/2007 111712007 111712007

BOTH

BOTH

91712007 10/16/2007 111712007 12/23/2008

91712007 10/1/2007 11/5/2007 111512007

BOTH 10/25/2007

91712007 10/16/2007 111712007 12/23/2008

91712007 10/1/2007 1115/2007 11/5/2007

10/25/2007

BOTH 10/25/2007 12/12/2007 111012008 3/512008 10125/2007 12/12/2007 111012008 3/512008

BOTH 9/10/2007 5/12/2009 7/27/2009 7/27/2009 9/10/2007 5/12/2009 7/27/2009 7/27/2009

BOTH 11/28/2007 1211312007 1/10/2008 3/5/2008 11128/2007 12/13/2007 1/10/2008 3/5/2008

BOTH 11128/2007 119/2008 7/16/2008 7/16/2008 11/28/2007 119/2008 7/16/2008 7/16/2009

BOTH 10/24/2007 10/27/2007 111712007 111712007

BOTH 10/25/2007 101712007 11/28/2007 11/28/2007

BOTH 11/912007 11/12/2007 11/28/2007 11/28/2007

BOTH 1216/2007 12112/2007 111012008 3/512008

BOTH 1213/2007 12/11/2007 4/10/2008 6/23/2008

BOTH 121612007 12121/2007 111012008 3/512008

BOTH 1216/2007 ~ ~. Le:d--BOTH 12/6/2007 12112/2007 1/10/2008 3/512008

BOTH

BOTH

BOTH

BOTH

BOTH

BOTH

BOTH

BOTH

BOTH

1/9/2008 e:tf. LM'

1/9/2008 4/21/2008 6/212008 6/2/2008

1/3/2008 1/3/2008 1/10/2008 3/5/2008

1/9/2008 4/21/2008 6/212008 6/2/2008

3/4/2008 3/20/2008 4/10/2008 2/18/2009

3/412008 3/13/2008 4/10/2008 4/10/2008

3/4/2008 3/10/2008 4/10/2008 4/10/2008

3/412008 4/4/2008 6/2/2008 6/2/2008

3/4/2008

10/24/2007 10/27/2007 111712007 11n/2007

10125/2007 101712007 11/28/200711/28/2007

11/912007 ?~~: 12/6/2007 12/12/2007 111012008 3/512008

1213/2007 211312008 4/10/2008 6/23/2008

12/6/2007 12/21/2007 111012008 3/512008

1216/2007

1216/2007 12/12/2007 1/10/2008 3/5/2008

1/9/2008

1/9/2008 4/21/2008 61212008 612/2008

1/3/2008 1/3/2008 1/10/2008 3/512008

1/9/2008 4/21/2008 6/212008 6/2/2008

3/4/2008 3/20/2008 4/10/2008 2/18/2009

3/412008 3/13/2008 4/10/2008 4/10/2008

3/4/2008 3/10/2008 4/10/2008 4/10/2008

3/4/2008 4/4/2008 6/2/2008 61212008

314/2008

Page50fl0

Page 5: Well Construction Pump Installation

Approved Well No. Well Name Applicant Well Construction

Driller Pump Inst. Type Issued Signed WCR1 Accept

2/15/2008 3686-20 The White House Charles Hooper

2/15/2008 3586-28 Marilyn John Erickson

2/15/2008 3787-10 Life Christine Bachman

2/15/2008 3487-04 Rapaczville Richard Rapcz

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

3/10/2008 3688-19 Homer's Adasea Mark Heritage and Donna Cha BC-23379 BC-23379

4/11/2008 5206-04 Land Star 1

4/11/2008 5206-05 Land Star 2

4/12/2008 3586-29 Barkley

4/12/2008 3687-60 Charles

4/12/2008 3585-08 All-Ends

4/12/2008 3686-21 Whosoever

4/14/2008 3687-28 Irina

4/16/2008 4959-24 Ungerman

6/5/2008 7346-03 Optimus Prime

6/5/2008 7446-03 Ends End

Land Star Services, Inc. BC-23379 BC-23379

Land Star Services, Inc. BC-23379 BC-23379

Bruce Barkley BC-23379 BC-23379

Charles Raynes & Lucia Moral BC-23379 BC-23379

Richard & Mary Chapman He BC-23379 BC-23379

Craig La Chance

Craig Frady

Jerry Ungerman

Bruce Soli & Larry Krinawek

Barry Riding

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

6/13/2008 3688-24 Pattycake 1 Robert Anderson BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

6/13/2008 3686-22 Feather Rod SmithlDorothy Ruff

6/1312008 5408-02 Ehrenlechner Patrick Ehrenlechner

6/13/2008 3688-21 Vincent Ortiz III Vincent Ortiz III BC-23379 BC-23379

6/13/2008 3688-23 Biskey/Watters Steven Biskeyl Mark Watters BC-23379 BC-23379

6/13/2008 3587-15 Wai 0 Ola E Man Susan Hawkes BC~23379 BC-23379

6/20/2008 6049-09 Mauumae

6/20/2008 3687-62 Goodwill

6/30/2008 7446-04 Ulrych 1

6/30/2008 7446-06 All is Well 2

6/30/2008 7446-02 All is Well 1

6/30/2008 7446-07 Ulrych 2

7/10/2008 3686-23 Stillwell

Wednesday, March 30, 2011

Guy Lashlee c/o Diamond Drill BC-23379 BC-23379

Stephen M. & Jeanne M. Osb BC-23379 BC-23379

Andre & Jyoti Ulrych BC-23379 BC-23379

Barry Ridings

Barry Ridings

Andre & Jyoti Ulrych

Douglas & Mayelin Stillwell

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BOTH

BOTH

BOTH

BOTH

3/4/2008 3/17/2008 4/10/2008 4/10/2008

3/4/2008 5/21/2008 6/212008 11120/2008

314/2008 rt!!!1ti. t.d-

3/4/2008 4/2/2008 4/10/2008 4/10/2008

BOTH 3/19/2008 3/24/2008 4/10/2008 4/10/2008

BOTH 5/23/2008

BOTH 5/23/2008

BOTH 5/23/2008 7/212008 7/16/2008 7/16/2009

BOTH 5/19/2008 1/16/2008 7/16/2008 7/16/2009

BOTH 5/23/2008 6/512008 7/16/2008 7/16/2008

BOTH 4/29/2008 5/19/2008 61212008 11/20/2008

BOTH 411512008 4/16/2008 6/212008 9/29/2008

BOTH 5/23/2008 7/12/2008 7/24/2008 7/24/2008

BOTH 6/24/2008

BOTH 6/24/2008

BOTH 7/10/2008 7/15/2008 7/24/2008 7/24/2008

BOTH 7/10/2008 9/24/2008 12/4/2008 2118/2009

BOTH 7/10/2008 9/16/2008 121412008 2/18/2009

BOTH 7/10/2008 7/21/2008 7/29/2008 7/29/2008

BOTH 7/10/2008

BOTH 7/10/2008

BOTH 7/10/2008 7/31/2008 10/20/2008 10/20/2008

BOTH 7/10/2008 7/28/2008 81712008 81712008

"7 BOTH 10/1/2008 1126/2009 7/14/2009

BOTH 10/1/2008

BOTH 1011/2008

BOTH 10/1/2008 1126/2009 7/14/2009

BOTH 7/25/2008 7/29/2008 81712008 81712008

Pump Installation Issued Signed WCR2 Accept

3/4/2008 3/17/2008 4/10/2008 4/10/2008

3/4/2008 5/21/2008 6/21200811/20/2008

3/4/2008 ~f, (..tt".

3/4/2008 4/2/2008 4/10/2008 4/10/2008

3/19/2008 3/24/2008 4/10/2008 4/10/2008

5/23/2008

5/23/2008

5/23/2008 7/212008 7/16/2008 7/16/2009

5/19/2008 1/16/2008 7/16/2008 7/14/2009

5/23/2008 6/512008 7/16/2008 7/16/2009

4/29/2008 5/19/2008 6/212008 11120/2008

411512008 4/16/2008 6/212008 9/29/2008

5/23/2008 7/12/2008 7/24/2008 7/24/2008

6/24/2008

6/24/2008

7/10/2008 7/15/2008 7/24/2008 7/24/2008

7/10/2008 9/24/2008 12/4/2008 2118/2009

7/10/2008 9/16/2008 12/4/2008 2118/2009

7/10/2008 7/21/2008 7/29/2008 7/29/2008

7/10/2008

7/10/2008

7/10/2008 7/31/2008 10/20/2008 10/20/2008

7/10/2008 7/28/2008 81712008 81712008

'7 10/1/2008 1126/2009 7/14/2009

10/1/2008

10/1/2008

10/1/2008 1/26/2009 7/14/2009

7/25/2008 7/29/2008 81712008 81712008

Page 6 of 10

Page 6: Well Construction Pump Installation

Approved Well No. Well Name Applicant Well Construction

Driller Pump Inst. Type Issued Signed WCR1 Accept Pump Installation

Issued Signed WCR2 Accept

8/11/2008 3687-59 Kenny Walt Carvalho

8/22/2008 3587-17 EI Diablo Robert & Susan Tobias

8/22/2008 3686-25 Pelligrino Michael Warnick

8/22/2008 2485-05 Kalapik Nadiya Hrach

8/22/2008 3687-63 Besser Daniel & Sumiko Besser

8/22/2008 2582-01 MO Avery Freed

8/22/2008 3587-16 Daisy Larry & Carolyn Brown

8/22/2008 3687-64 Brokeback One Raymond N. Wilson

8/22/2008 3686-24 Well Spring James & Beth Anada-Stout

8/22/2008 3486-07 Lopaka Wai Puka Bobby L. Gould

8/22/2008 3586-30 Menehune Wishi Joseph & Bonnie Orlikowski

8/22/2008 3686-26 Rob Robert E. Gravel

10/6/2008 3687-65 The Nature Joy Nature Gallina

10/6/2008 3687-66 Googie Ralph Tucker

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

10/6/2008 3686-27 Oasis William Rosaia & Terri Curtis BC-23379 BC-23379

10/6/2008

11/19/2008

3687-67 Mango

3686-12 McGauger

12/18/2008 7447-01 Ahu Pohaku

12/24/2008 3686-29 Emma

12/24/2008 5407-02 Gardens

12/24/2008 4859-06 Pohaku

12/24/2008 3687-68 Paul Moore

12/24/2008 3587-19 Pink Hibiscus

12/24/2008 3687-70 Pele

12/24/2008 3687-69 Sam

12/24/2008 3688-26 Brumen

12/24/2008 4859-05 Lucus

2/18/2009 4959-26 Jahnke

Wednesday, March 30, 2011

Mango Trust BC-23379 BC-23379

Steve Gauger & Priscilla McM BC-23379 BC-23379

Robert Watkins

Paul & Sandra Rambaut

Jose & Maria Garcia

Tom & Stephanie Conner

Paul P. & Lieu Moore

Victor R. Jose

Raymond & Sherrie Taylor

David Gentry

Gary Michaelis

Lucus Living Trust

William & Patricia Jahnke

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 8/14/2008 8/14/2008

BOTH 9/1212008 9/23/2008 12/4/2008 2118/2009 9/12/2008 9/23/2008 12/4/2008 2118/2009

BOTH 9/12/2008 11/17/2008 1214/2008 1214/2008 9/12/2008 11/17/2008 12/412008 12/4/2008

BOTH 911512008 3/9/2009 4/27/2009 4/27/2009 9115/2008 3/912009 4/27/2009 4/27/2009

BOTH 9/12/2008 10/14/2008 12/4/2008 2118/2009 9/12/2008 10/14/2008 12/412008 2118/2009

BOTH 9/15/2008 9/15/2008

BOTH 9/12/2008 9/2212008 12/4/2008 2118/2009 9/12/2008 9/2212008 12/4/2008 2118/2009

BOTH 911212008 9/23/2008 121412008 2/18/2009 9/12/2008 9/23/2008 12/4/2008 2118/2009

BOTH 9/15/2008 9/23/2008 12/4/2008 2118/2009 9/15/2008 9/23/2008 121412008 2/18/2009

BOTH 9/15/2008 10/21/2008 12/412008 2118/2009 9/15/2008 10/21/2008 12/412008 2118/2009

BOTH 9/15/2008 3/21/2009 6/12/2009 6/12/2009 9/15/2008 3/21/2009 6/1212009 6/12/2009

BOTH 9/12/2008 10/13/2008 12/4/2008 2118/2009 9112/2008 10/13/2008 12/4/2008 2118/2009

BOTH 10/21/2008 10/27/2008 12/412008 12/4/2008 10/21/2008 10/27/2008 1214/2008 1214/2008

BOTH 10/21/2008 10/29/2008 1214/2008 2/18/2009 10/21/2008 10/29/2008 12/412008 2118/2009

BOTH 10/21/2008 41712009 6/12/2009 6/12/2009 10/21/2008 41712009 6/12/2009 6/12/2009

BOTH 10/21/2008 11/10/2008 12/412008 12/4/2008 10/21/2008 11/10/2008 12/412008 12/4/2008

BOTH 11/20/2008 11/20/2008 12/412008 2118/2009 11120/2008 11/20/2008 12/412008 2118/2009

""7 *7 BOTH 1/15/2009 2/612009 4/6/2009 1/15/2009 2/612009 4/6/2009

BOTH 1/13/2009 1/14/2009 4/612009 4/6/2009 1/13/2009 1/14/2009 4/612009 4/6/2009

BOTH 1/15/2009 1/15/2009

BOTH 1/15/2009 1/15/2009

BOTH 111512009 3/6/2009 4/27/2009 4/27/2009 1/15/2009 3/612009 4/27/2009 4/27/2009

BOTH 1/15/2009 1/15/2009

BOTH 1/15/2009 1/17/2009 4/612009 4/6/2009 1/15/2009 1/17/2009 4/612009 4/6/2009

BOTH 1/15/2009 1/17/2009 4/612009 4/6/2009 1/15/2009 1/17/2009 4/612009 4/6/2009

BOTH 1/15/2009 3/212009 4/27/2009 4/27/2009 1/15/2009 3/212009 4/27/2009 4/27/2009

BOTH 1/15/2009 5/19/2009 7/14/2009 7/14/2009 1/15/2009 5/19/2009 7/14/2009 7/14/2009

'1 BOTH 2/25/2009 1/16/2010 8/512010

? 212512009 1/16/2010 8/512010

Page 70/10

Page 7: Well Construction Pump Installation

Approved Well No. Well Name Applicant Well Construction

Driller Pump Inst. Type Issued Signed WCR1 Accept

2/18/2009 3586-31 Dylan & Pheonix Stephen & Edna Sorensen BC-23379 BC-23379 BOTH 2/25/2009 3/18/2009 6/12/2009 6/12/2009

2/18/2009 3586-32 lam lam Jeffery Allan & Nancy Fullmer BC-23379 BC-23379

2/18/2009 3081-03 Szomjas

3/27/2009 3687-71 Old Faithful

3/27/2009 7345-06 Vipassana

3/27/2009 3586-33 Puhau

3/27/2009 2986-03 Daigle

3/27/2009 4000-01 Freeman

Joseph Kekedi

Michael Fitzgerald

Vipassana Hawaii

Larry D Rice, et. al.

Rufus Daigle

Raoul Freeman

3/27/2009 3802-10 Island Princess Island Princess Macadamia

3/27/2009 3802-09 Houle 1 Peter Houle

3/31/2009 3586-34 Tinkertot 1 Dennis Beam

3/31/2009 3686-30 Traveler Oasis David & Teresa Cronister

3/31/2009 3488-01 The Shack David Thielen

4/24/2009 7344-01 Starseed

4/24/2009 3486-08 Jose

6/10/2009 4859-07 Casey

7/2/2009 5610-02 Falling Water

10/9/2009 7448-07 Honopueo

Jyoti Ulrych

Andre Ramos

Lyman H. Casey

Scott Watson

Karl Taubman & Cathie Pome

12/2/2009 6430-01 Kawela Partners Kawela Partners LLC

12/14/2009 2385-03 Benko John Benko

12/14/2009 3586-36 La Pali Steven & Rhonda Ingalsbe

1/6/2010 3180-03 Glocamora James LeBlanc

1/26/2010 2583-01 0 Ke Akua Ka W Mark Collins IV

1/26/2010 3687-73 Chanel1

1/26/2010 3687-74 Chanel2

1/26/2010 3687-75 Chanel3

1/26/2010 2684-01 Johnson

1/26/2010 3384-02 Mydell2

Wednesday, March 30, 2011

John Armstrong

John Armstrong

John Armstrong

Gregory D. Johnson

Wayland Lum

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

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 2/25/2009 6/10/2009 7/14/2009 7/14/2009

BOTH 3/212009

BOTH 4/1/2009 10121/2009 815/2010

BOTH 4/1/2009 5/19/2009 7/14/2009 7/14/2009

BOTH 4/112009 4/13/2009 7/14/2009 7/14/2009

BOTH 4/112009

BOTH 4/1/2009 4/1/2009 6/12/2009 6/12/2009

BOTH 4/112009 4/20/2009 7/14/2009 7/14/2009

BOTH 4/112009 4/20/2009 7/14/2009 7/14/2009

BOTH 4/20/2009 5/10/2009 7/14/2009 7/14/2009

BOTH 4/20/2009 5/912009 7/14/2009 7/14/2009

? BOTH 4/20/2009 9/23/2009 8/512010

BOTH 5/22/2009

BOTH 5/812009

BOTH 9/14/2009 10/2/2009 81512010

BOTH 9/14/2009 9/15/2009 8/512010

PUMP

BOTH 1213/2009

BOTH 2/26/2010 3/15/2010 8/512010

BOTH 2/26/2010 2/26/2010 8/512010

BOTH 1/14/2010 1/29/2010 8/512010

BOTH 4/21/2010 4/26/2010 8/512010

BOTH 3/1/2010 3/5/2010 8/5/2010

BOTH 3/1/2010 3/11/2010 8/512010

BOTH 3/1/2010 3/5/2010 8/5/2010

BOTH 7/2/2010 5/10/2010 8/512010

BOTH 4/21/2010

Pump Installation Issued Signed WCR2 Accept

2125/2009 3/18/2009 6/12/2009 6/12/2009

2/25/2009 6/10/2009 7/14/2009 7/14/2009

3/212009

4/1/2009 10/21/2009 8/5/2010

4/1/2009 5/19/2009 7/14/2009 7/14/2009

4/112009 4/13/2009 7/14/2009 7/14/2009

4/112009

4/1/2009 4/1/2009 6/12/2009 6/12/2009

4/112009 4/20/2009 7/14/2009 7/14/2009

4/112009 4/20/2009 7/14/2009 7/14/2009

4/20/2009 5/10/2009 7/14/2009 7/14/2009

4/20/2009 5/912009 7/14/2009 7/14/2009

4/20/2009 9/23/2009 8/5/2010

5/22/2009

5/812009

9/14/2009 10/2/2009 8/5/2010

9/14/2009 9/15/2009 8/5/2010 ?

10113/2009

12/312009

2/26/2010 3/15/2010 8/5/2010

2/26/2010 2/26/2010 8/5/2010

1/14/2010 1/29/2010 8/512010

4/21/2010 8/512010

3/1/2010 3/5/2010 8/5/2010

3/1/2010 3/11/2010 8/512010

3/1/2010 3/5/2010 8/5/2010

7/2/2010 5/10/2010 8/512010

4/21/2010

Page 8 of10

Page 8: Well Construction Pump Installation

Approved Well No. Well Name Applicant Well Construction

Driller Pump Inst. Type Issued Signed WCR1 Accept

3/3/2010 3586-09 Helenihi James Helenihi BC-23379

4/26/2010 5914-02 Kuwili Lani Big Island Sustainable Homes BC-23379 BC-23379

4/26/2010 3588-05 Lincoln Lincoln Moses Tyler

5/5/2010 3686-32 Thy Well Be Don La Chance Trust

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

5/5/2010 3687-76 Englund Ronald Alan Englund

5/21/2010 3786-04 Esquibel Joel & Sandy Lawson

5/21/2010 3686-02 Roden Laura Roden

5/25/2010 3689-02 Well ness Robert A. Keilbach BC-23379 BC-23379

5/25/2010 3180-04 Shiva Jah Mango Eugene Andrews BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

5/25/2010 3689-01 Sandy's

5/25/2010 3787-12 Akagi No Mizu

5/25/2010 3586-37 Poo Wai

6/1/2010 5407-03 31-190 HBR

6/1/2010 5106-02 Grosskreutz

6/13/2010 3787-13 Sato

6/13/2010 3687-78 Rickford

Sandra A. Brooks

John Akagi

Paul Whitman

Brett Kayzarl David Koped

Scott & Lynda Grosskreutz

Aikane InterPacific Corp.

Rickford Bradley

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

6/13/2010 3486-10 Rasoalinda & Glo Peter Christopher

BC-23379 BC-23379

BC-23379 BC-23379

6/13/2010 3687-77 Aloha

6/13/2010 3686-33 Wai

6/13/2010 2189-02 Strickler

9/12/2010 3587-20 Baker

9/12/2010 5711-04 Lourds

9/12/2010 2583-03 Isabel

10/24/2010 2485-06 Dallou

10/24/2010 3558-02 Smith

10/24/2010 3686-34 Opihi

1/11/2011 3687-80 HS-2

1/11/2011 3687-81 Hollingsworth

Wednesday, March 30, 2011

Allen Graef

Thomas I. Hauge

Edward K. Strickler III

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

Baker's Enterprises of Hawaii, BC-23379 BC-23379

Stenhouse LLC

Candace Brightman

Molitch 97 Trust

Larry R. Smith

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

Cynthia LatishlMelanie Greger BC-23379 BC-23379

Hawaiian Shellfish, LLC

Dean Edward Hollingsworth

BC-23379 BC-23379

BC-23379 BC-23379

WELL 3/4/2010 8/8/2010

BOTH 1015/2010

BOTH 4127/2010 4/28/2010 8/512010

BOTH 5/11/2010 5/18/2010 8/512010

BOTH 5/11/2010 5/18/2010 8/512010

BOTH 6/23/2010

BOTH 6/23/2010

BOTH 61712010 6/9/2010 8/5/2010

BOTH 61712010

BOTH 61712010 6/10/2010 11/8/2010

BOTH 61712010 6/11/2010 8/512010

BOTH 61712010 6/11/2010 11/8/2010

BOTH 7112/2010

BOTH 7/12/2010 9/13/2010 11/8/2010

BOTH 71112010 7/12/2010 11/8/2010

BOTH 711212010 9/10/2010 11/8/2010

BOTH 71112010

BOTH 7/12/2010 7/18/2010 11/8/2010

BOTH 71112010

BOTH 7/12/2010

BOTH 10/5/2010 1Ont2010 11/10/2010

BOTH 10/512010 10/12/2010 11/812010

BOTH 10/5/2010

BOTH 12128/2010

BOTH 12/20/2010

BOTH 12/20/2010

BOTH 12/15/2010

BOTH 211512011

Pump Installation Issued Signed WCR2 Accept

10/5/2010

4127/2010 4/28/2010 8/512010

5/11/2010 5/18/2010 8/512010

5/11/2010 5/18/2010 8/512010

6/23/2010

6/23/2010

61712010 6/9/2010 8/5/2010

6nt2010

6nt2010 6/10/2010 11/8/2010

6nt2010 6111/2010 8/512010

6nt2010 6/11/2010

7/12/2010

7/12/2010 9/13/2010 11/8/2010

71112010 7/1212010 1118/2010

7112/2010 9/10/2010 11/8/2010

71112010

7/12/2010 7/18/2010 11/8/2010

71112010

7/12/2010

10/5/2010 101712010 11/17/2010

10/5/2010 10/12/2010 11/812010

10/5/2010

12/28/2010

1212012010

12/20/2010

1211512010

2/15/2011

Page 90/10

Page 9: Well Construction Pump Installation

Well Construction Pump Installation Approved Well No. Well Name Applicant Driller Pump Inst. Type Issued Signed WCR1 Accept Issued Signed WCR2 Accept

1/11/2011 3687-79 HS-1 Hawaiian Shellfish, LLC BC-23379 BC-23379 BOTH 2/15/2011 2/15/2011

1/25/2011 3281-03 ManoWai Waa Associates, LLC BC-23379 BC-23379 BOTH 3/9/2011 3/9/2011

1/25/2011 7452-01 Brevoort William Brevoort BC-23379 BC-23379 BOTH ~ ~~ ,~,,!? Ht.; 1/25/2011 3488-02 Nguyen Duong Nguyen BC-23379 BC-23379 BOTH 3/9/2011 3/9/2011 ~

2/6/2011 3686-36 William's Spring William H. Morrison BC-23379 BC-23379 BOTH 3/9/2011 3/9/2011

Wednesday, March 30, 2011 Page 10 of 10 \ .

Page 10: Well Construction Pump Installation

QMMISSION ON WATER RESOURCE MANAGEMQ ROUTE SLIP FOR PERMIT ISSUANCE 3/9/11

FROM: RYAN DATE: 7/6/11

CHONG,R. DANBARA, S.

KIMURA, J. OHYE,L.

FUJII,N. fil -1-HARDY, R.

-3-TAM,B.

-2-HOAGBIN, S. ICE,C.

-4-IMATA, R.

WELL NUMBER 3787-15

application type BOTH 1 WCP COVER LETTER ~I 2WCP V/ 3 WELL CHECK PRINTOUT --v-

proposed well section issu~

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

WELL NAME

or V"

4 PIP COVER LETTER 5 PIP

COMMENTS: 6 SOWS 7 WWS 8 CWB 9 HEER

10 LD 11 HP 12 LUC not in CD 13 OCCL not in CD 14 SMA in SMA 15 BWS (Oahu)

NOTES: DRILLER

x

6.>,1-·

Rod Diamond

SUSPENSE DATE:

Approval -3-Signature --Information

Birdhouse

issues?

Diamond Construction and Water Well Drilling 23379

TMK

phone fax cell

PUMP CAPACITY WELL OWNER LANDOWNER COMMENT DEADLINE 90-DAY DEADLINE

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

o o o o

8/17/11 1/0100

HI 96749

PLEASE:

See Me -1-Review & Comment

Take Action Type Draft

-2-Type Final

File Xerox copies

if checked, send to applicant

Page 11: Well Construction Pump Installation

NEIL ABERCROMBIE GOVERNOR OF HAWAII

Mr. Rod Diamond

o a

STATE OF HAWAII DEPARTMENT OF LAND AND NATURAL RESOURCES

COMMISSION ON WATER RESOURCE MANAGEMENT P.O. BOX 621

HONOLULU, HAWAII 96809

July 25,2011

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

Dear Mr. Diamond:

Pump Installation Permit Birdhouse Well (Well No. 3787-15)

WILLIAM J. AILA, JR. CHAIRPERSON

WILLIAM D. BALFOUR, JR. SUMNER ERDMAN

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

LAWRENCE H. MilKE, MD, J.D.

WILLIAM M. TAM DEPUTY DIRECTOR

Ref: 3787-15.pip

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 14:

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 effluent from well drilling and testing activities. Also, please contact the Noise Radiation and Indoor Air Quality Branch at 586-4700 to check compliance with construction noise permit requirements for this project.

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 copy to the Commission office 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 or toll-free at 974-4000 (Hawaii), 274-3141 (Kauai), 984-2400 (Maui), or 1-800-468-4644 (Lanai & Molokai), extension 70255.

Sincerely,

W-~ ~ WILLIAM J. AILA, JR. 1 tr' Chairperson

Enclosure

c: Ted Powell (with applicable comments - DOH SDWB, WWB, CWB)

Page 12: Well Construction Pump Installation

o PUMP INSTALLATION PERMO Birdhouse Well, Well No. 3787-15

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 Birdhouse Well (Well No. 3787-15) at TMK 1-5-062:108, Hawaii, subject to the Hawaii Well Construction & Pump Installation Standards (HWCPIS - February 2004) which include but are not limited to the following conditions:

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

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

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 20 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 Jppropriate means for measuring and reporting withdrawals and appropriate devices or means for measuring chlorides and temperat~re at the well head.

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

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

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

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

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

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

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.

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

Date of Approval: July 18,2011 July 18, 2013

WILLIAM J. AILA, JR., Chairperson Commission on Water Resource Management Expiration Date:

I have read the conditions and terms of this permit and understand them. I accept and agree to meet these conditions as a prerequisite and underlying condition of my ability to proceed and understand that I shall not commence work until I and the 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 #: BC-23379 Date: _____ _

Diamond Construction and Firm or Title: Water Well Drilling

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

Attachments

Page 13: Well Construction Pump Installation

NEIL ABERCROMBIE 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

July 25, 2011

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

Dear Mr. Diamond:

Well Construction Permit Birdhouse Well (Well No. 3787-15)

WILLIAM J. AlLA, JR. CHAIRPERSON

WILLIAM D. BALFOUR, JR. SUMNER ERDMAN

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

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

WILLIAM M. TAM DEPUTY DIRECTOR

Ref: 3787-15.wcp

Enclosed are two (2) copies of your approved Well Construction Permit for the captioned welles) 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 17:

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. Also, please contact the Noise Radiation and Indoor Air Quality Branch at 586-4700 to check compliance with construction noise permit requirements for this project.

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 copy to the Commission office for our files. For copies of the aquifer pump test worksheet, please call staff or visit www.state.hi.us/dlnr/cwrmlforms.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.

If you have any questions, please call Ryan Imata of the Commission staff at 587-0255 or toll-free at 974-4000 (Hawaii), 274-3141 (Kauai), 984-24 (Maui), or 1-800-468-4644 (Lanai & Molokai), extension 70255.

Sincerely,

Wd'4~ ~ W~LIAM J. AILA, JR. r ~ Chairperson

Enclosures

c: Ted Powell (with applicable comments - DOH SDWB, WWB, CWB)

Page 14: Well Construction Pump Installation

o o WELL CONSTRUCTION PERMIT

Birdhouse Well, Well No. 3787-15 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 Birdhouse Well (Well No. 3787-15) at TMK 1-5-062:108, Hawaii, subject to the Hawaii Well Construction & Pump Installation Standards (HWCPIS - February 2004) which include but are not limited to the following conditions:

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

II.

12.

13.

14.

15.

16.

17.

The Chai1l!erson of the Commission on Water Resource Management (Commission), P.O. Box 621, Honolulu, HI 96809, shall be notified, in writing, at least two (2) weeks before any work authorized by this permit commences and staff shall be allowed to inspect installation activities in accordance with §13-168-15, Hawaii Administrative Rules (HAR).

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

The well construction permit shall be for construction and testing of the well only. The permittee shall coordinate with the Chairperson 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/cwrmlresources-permits.btm). The permittee shall submit to the Chairperson the test results as a basis for supporting an application to install a permanent pump. No permanent pump may be installed until a pump installation permit is approved and issued by the Chairperson. No WIthdrawal of water shall be made for purposes 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 Chairperson. If it can be shown that the well does not tap basal ground water then this condition may be waived after consultation with and acceptance by Commission staff. However, in no instance can the well tie drilled deeper than one-half (112) of the theoretical thickness without Commission approval.

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

In the event that 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 Histonc Preservation Division.

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

The 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.bawaii.gov/dlnr/cwrmlresources -permits.htm for current form).

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

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

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

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

The work proposed in the well construction permit application shall be completed within two (2) years from the date of permit approval, unless otherwise specified. The permit may be extended by the Chairperson upon a showing of good cause and good-faith performance. A request to extend the permit shall be submitted to the Chairperson no later than the date the permit 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 permittee must apply for a well abandonment permit in accordance with § 3-168-12(f), HAR, 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.

This permit shall apply to the location shown on the application only. If the well is to be relocated, the permittee shall apply for a new well constru installation permit m accordance with §13-168-12(f), HAR.

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

. W~ ~ Date of Approval: July 18,2011 Expiration Date: July 18, 2013

/__ WILLIAM J. AILA, JR., 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:

Printed Name: Rod Diamond

C-S7 License #: BC-23379 Date:

Diamond Construction Firm or Title: and Water Well Drilling

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

Attachment

Page 15: Well Construction Pump Installation

o o Well Check Program 4/1/04 - Revised for update to Well Standards (February 2004)

Data Input

Well Number 3787-15 Well Name Birdhouse Ground Elevation 50 Cement Grout 40 Grouting Method other Hole Diameter 8.5 Total Depth 57 Water Level 2 Depth to water 48 Public Water Supply Well? no Solid Casing Material pvc plastic plastic Solid Casing Specification Schedule 40 Solid Casing Length 50 Solid Casing Diameter 4.5 Solid Casing Wall Thickness Open Casing Length 7

Results

Well Depth Theoretical Thickness of Aquifer 82 1/4 Aquifer Thickness 20.5 Depth of Well below Sea Level -7 okay Section 2.2

Well Casing Minimum Wall Thickness

Material pvc plastic Minimum Thickness per standards no requirement Wall Thickness Provided o no standard Section 2.4(b)

Minimum Length of Solid Casing 90% of ground to top of aquifer 43.2 Length of solid casing Provided 50 okay Section 2.4(c)

Casing Material Schedule 40 in compliance Section 2.4(d) (for pvc only - check for 200' limit) okay Section 2.4(d)

Annular Space Depth of Grouting

Calculated Depth of Grouting 33.6 Depth of Grouting provided 40 okay Section 2.6(c)

Minimum Annular Space required 2 Thickness of Annular Space 2 okay Section 2.6(d)

Page 16: Well Construction Pump Installation

o o

NElL AllERCROMBE _00_

WILLIAM J. AlA, JR. -WII.UMiI D. BALFOUR, JR.

STATE OF HAWAII DEPARTMENT OF LAND AND NAnJRAL RESOURCES

COMMISSION ON WATER RESOURCE MANAGEMENT PO 1OX121

HONOLULU. HAWAII 8Il8Ol

June 16, 20 II

SUMNER ERDMAN LORETTA J. FUDDY, AC.B.W., AlP.H.

NEAL S. FWIWARA DONNA FAY K.IGYOBAIO. p.e.

lAWRENCE H. IoIICE. ItO .. J.D.

WILLIAM M. TAM -..--

TO: Honorable Loretta J. Fuddy, A.C.S.W .• M.P.H., Director Department of Health Attention: Acting Chief. Wastewater Branch

Joanna L. Seto, Chief. Safe Drinking Water Branch Alec Wong, Chief. Clean Water Branch Dr. Keith Kawaoka, Office of H~valuation and Emergency Response

FROM: William J. Aila, Jr., Chairperson / ,1/IHt'· I ~ Commission on Water Resource ~einent I

SUBJECT: Well ConstructionlPump Installation Permit Application Birdhouse Well (Well No. 3787-1S) TMK 1-S~2:I08 Well address: 1 S-1 034 Kilika Road

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 for any conflicts or inconsistencies with the programs, plans, and objectives specific to your department. Please I'!S~Dd by retu~ lh" c",r :\eDli f~'" by J"'~l18. 20U. Ifwe do not receive comments or a requestor additlona review time y is ate, we WI I assume that you have no comments.

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

RI:ss Attachment(s )

RESPONSE: II

I)

II

I J

I J

~

TIIiI wen qullilia •• _ which WIll _ •• ___ orpatable _to. public _.,.... (clellBed .. MrVina 25 cw min J*lllie II ..... 60 daYI per,. cw'" I 5 or min seMCII-.cti_) ad .ut NCCiw ou-ofHahll approvallllill: to its _to comply wililifawaii AdministnIIive Ruin (HAR), Title II. OapCcr 20. RuIea hillin, to Potable W ... S,-. ,11.2(1.29

11IiI well daM DOl plify. I IOU_ .mn.1 IN.IbIic -I}'II-(_ !eM tbaa 25 peopic; ~ min ,..... at ..... 60 days per,. or 15 ........ ..-ions) II1II ifille well_ is ..... fofclrinlana. t .. pri ..... _ ...... tal for~ II1II chemical...- booroIe inItI_a.ch ..... and .outiMly-.iIDr" __ quality ......... ~.lflldln plulned ... Iiaat .. iI_ i_ to _die public _ Iyst_ doliaillOB then Dtroctcir of HaIdI appcoWlI iI required IIIiII: 10 _pl-.boo

If the well is used to nppIy both potable all411Dft11C1bb1c ......... in ....... Iyst_. the _ ..... I .. i_. ____ II1II ..... Oow ~ioas by ~"'1Iy..,.... patabl.1nd ftaa.potabIa ~ ... by.a air .... or.a appnmd '-kfIow ....-... d by ele.1y ..... 6l1li111_· potable lpi",1 witb warm ....... to ,...,.t ~ CDMIIIIIPIiDn of 11D111'QbIbIe _ IIacItfJow .... Wlllian devices Mould be rourinaly iupected andlelled.

It daM IlOl .". dial this well will be used Ibr _lUIIpIive putpCIIa and illlDl sabjec:t to Salt Drilllall, W_ Replatlotu,

For tbe oppIicM~. iIIlmutian,.. _ orponiblo _ewIIcr _iludion '111,,1, ... locaIed _die pr1IpIIIId .......... (Intannalion 1II1Ched)

An NPD£S penIIIt is requiNCI

Otbcr ........ DOH nllelheplllioN, mbmMioa. or _malClllions .. _W

.. the ............ IocatIOII or .. well ...... buI illlia within the..-.I deIcribccI_ tIIH applicahon. _ diwlion COIIJoden the _II to 11111 be appIlCIble. and we do Il0l __ to NYiew 1M _1--..

( J No _lIIobjections

Contact Person: Atta ~ /l41~tJ?:A... Signed: 7/ ...::.;< ::.::::::>

Phone: :S~ - "'$1, Date: 7/epl

Page 17: Well Construction Pump Installation

o

CWRM Application Source: Birdhouse Well (State Well No. 3787-15)

Safe Drinking Water Branch Engineering Section

See attached private water wells information sheet.

Underground Injection Control (UIC)

In general, a shallow well, or a well that recharges quickly from local rainfall, should not be used as a drinking water source because such a well increases the risk of having unsatisfactory groundwater quality that when consumed may compromise health. Factors that directly 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 its acceptable and intended use, especially if for human consumption. Water quality should not be presumed acceptable and unchanging. Land-based activities around the well and within the well's recharge area may, over time, have an unacceptable effect on the well's water quality. Well construction materials and related equipment could also affect water quality.

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

Page 18: Well Construction Pump Installation

- o o

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

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

u.s. ENVIRONMENTAL PROTECTION AGENCY (EPA) RECOMMENDATIONS

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

OTHER CONTAMINANTS

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

LABORATORIES

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

RESULTS

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

"- -------"----------------------

Page 19: Well Construction Pump Installation

NEIL ABERCROMBIE GOVERNOR OF HAWAII

July 1,2011

o o

STATE OF HAWAII DEPARTMENT OF LAND AND NATURAL RESOURCES

STATE HISTORIC PRESERVATION DIVISION 60 I KAMOKILA BOULEVARD, ROOM 555

KAPOLEI, HAW All 96707

MEMORANDUM

TO:

FROM:

SUBJECT:

William M. Tam, P.E., Deputy Director State Commission on Water Resource Management P.O. Box 621, Honolulu, Hawai'i 96809 c/o Ryan Imata (Ryan.R.Imata@hawaiLgov)

Theresa K. Donham, Lead Archaeologist, Hawai'i Island Section

Chapter 6E-42 Historic Preservation Review -

WILLIAM J. AILA, JR CHAIRPERSON

BOARD OF LAND AND NA ruRAL RESOURCES COMMISSION ON WATER RESOURCE MANAGEMENT

GUY H. KAULUKUKill FIRST DEPUTY

WILLIAM M. TAM DEPUTY DIRECTOR· WATER

AQUATIC RESOURCES BOATING AND OCEAN RECREA liON

BUREAU OF CONVEYANCES COMMISSION ON WATER RESOURCE MANAGEMENT

CONSERVATION AND COASTAL LANDS CONSERVATION AND RESOURCES ENFORCEMENT

ENGINEERING FORESTRY AND WILDLIFE HISTORIC PRESERVATION

KAHOOLA WE ISLAND RESERVE COMMISSION LAND

STATE PARKS

Log No. 2011. 1804 Doc No. 1107TD03

Well ConstructionlPump Installation Permit Application, Birdhouse Well (3787-15) Kea'au Ahupua'a, Puna District, Island of Hawai'i TMK: (3) 1-5-062:108

RESPONSE:

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

[X] We concur that no historic properties will be affected by the work described under this pennit.

[ ] We request additional infonnation in order to detennine whether historic properties will be affected. Please submit the following infonnation:

Contact Theresa K. Donham at (808) 933-7653 or [email protected] if you have any questions.

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

Signed:

tfJi----I

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

Page 20: Well Construction Pump Installation

NEIL ABERCROMBIE GOVERNOR OF HAWAII

o o

STATE OF HAWAII DEPARTMENT OF LAND AND NATURAL RESOURCES

COMMISSION ON WATER RESOURCE MANAGEMENT P.O. BOX 621

HONOLULU, HAWAII 96809

June 16,2011

TO: Russell Tsuji, Administrator Land Division ~ /J

FROM: JI. William M. Tam, Deputy Director 0#,f-­{ ,,/ Commission on Water Resource Management

SUBJECT. Well ConstructionlPump Installation Permit Application Birdhouse Well (Well No. 3787-15) TMK 1-5-062:108

(n

WILLIAM J. AILA, JR. CHAIRPERSON

WILLIAM D. BALFOUR, JR. SUMNER ERDMAN

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

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

WILLIAM M. TAM DEPUTY DIRECTOR

1)

W o w

" ...... --­......... .."... ~,,,,-)

~r"" '. •• ..J .,:-,,-~::;

"::::Jrr ,

--:-.c:: .,,-- rr. ~!2o (:)

:z

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 with regard to the programs, plans, and objectives specific to your division. Please respond by returning this cover memo form by July 18,2011. Ifwe do not receive comments or a request for additional review time by this date, we will assume you have no comments.

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

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

[ ] A water lease/permit has been obtained by the applicant through lease no. _________ --\c,..,.....-

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

[ ] No objections

fx] Other comments: Original source of private title was issued prior to

Contact Person: ___ --'G.;u.q~r~yjt----lMaua.r ........... t .... j.un--------- Phone: 587-0421

Date: __ 6_13_0_I_ll __ _

CN o

<:~..: z: ~.J •. -.

Page 21: Well Construction Pump Installation

~: t' 1 ,-OJ .

c o

STATE OF HAWAII DEPARTMENT OF LAND AND NATURAL RESOURCES

COMMISSION ON WATER RESOURCE MANAGEMENT P.o. BOX 621

HONOLULU, HAWAII 96809

June 16,201]

Ms. Bobby Jean Leithead Todd Planning Director Planning Department County of Hawaii 101 Aupuni Street, Suite 3 tWo, HI 96720

Dear Ms. Todd:

Special Management Area Use Penn it Requirements for Well Construction/Pump Installation PermIt Application

Birdhouse Well (Well No. 3787-15)

WILLIAM J AI LA, JR C,,",AIRn:ftSON

WILLIAM D. BALFOUR. JR. SUMNER ERDMAN

LORETTAJ. FUDDY, ACS.W.. M.P.H NEAL S. FUJIWARA

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

WILLIAMM TAM DEPUTY DIRECTOR

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

We would appreciate your comments on the captioned application with regard to the SMA permitting requirements specific to your division. Please respond by returning this cover memo fopn by JIlT 18. ~Oll" Ifwe do not receive comments or a request for additional review time by this date, we will aSstlttl'e you

ave no comments.

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

RI:ss

RESPONSE:

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

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

[ 1 No objections

Page 22: Well Construction Pump Installation

101 Pauahi Street, Suite 3 Hile, Hawaii 96720-4224 (808) 961-8288 (808) 961-8742

To:

c

Ryan Imata

Fax: (808) 587-0219

Phone:

From:

Pages:

Date:

Re: Well Construction Permit cc:

o Urgent x For Review o Please Comment

Ryan,

....... -' County of Hawaii

Planning Dept

Bethany Morrison

2

6/28/11

o Please Reply o Please Recycle

Hope all is well with you. Please find the following SMA requirements for wall constructionl pump installation permits:

Birdhouse Well (Well No. 3787-15)

Let me know if you have any questions.

Thank you,

Bethany J. Morrison Planner County of Hawaii Planning Department 101 Pauahi Street, Suite 3 Hilo, Hawaii 96720-4224 Phone (808) 961-8138 Fax (808)961-8742

-------,,--- ---- ---

Page 23: Well Construction Pump Installation

o o

NELMERCItOMIE -"'- WLLIIW J. AU.A. JR. -WLLIAM D. IIAU'OUR, JR.

STATE OF HAWAII DEPARlMENT OF LAND AND NATURAL RESOURCES

CO_ISSlON ON WATER RESOURCE MANAGEMENT PoaoxCl1

HONOLULU. HAWAII ...

June 16,2011

SUMNER ERDMAN LORETTA J. FUDO'I', A.C.S.W., M.P.H.

NEAL 8. FWIINMA DOIIINA FAV K ICIYOIWCI, P.E. LAWRENCE H. MIlKE, 11.0 .. J.D.

WIWMIM.TAM -...-

TO: Honorable Loretta J. Fuddy, A.C.S.W., M.P.H., Director ~ent of Health Attention: Acting Chief, Wastewater Branch

Joanna L. Seta, Chief, Safe Drinking Water Branch Alec Wong, Chief, Clean Water Branch Dr. Keith Kawaoka, Office of~valuation and Emergency Response

FROM: William J. Aila, Jr., Chairperson / ~/~~. 1;- Commission on Water Resource ~ge-ment I

SUBJECT: Well Construction/Pump Installation Pennit Application Birdhouse Well (Well No. 3787-15) TMK 1-5-062:108 Well address: 15-1034 Kilika Road (3)

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

Please find the attached maps to locate the proposed well. If you have any questions about this permit application, ~st addition81 infonnation, Dr request additional review time, please contact Ryan Imata of the CommiSSion staffat 587-0255.

RI:ss Attachment(s)

RESPONSE: I ]

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ThiI .... 1 quPfioa ........ wIIioII",;n _ •• _of ......... _10 .JIIII!Iio_~ (ddiaccI_ ..,,;q25 ... _ .............. 150 ... ,.. ...... 15 ............... ____ ) ..... ___ oa-Oflfllldl IPJIIVVIII Ilia'" ill _10 COIIIpIJ witII Ka\wUi Adnriaillrlliwe RUllI (HAlt), Tid. II, ChIpIor 20. RuIeI Ita ..... 10 I'IIIIIIIe W ... S,-.. '11-20-29.

l1Iia .... 1 ....... 4J1181ify •• _ ~ .-a.u~_IJII_ ( ___ 25 ..... 01'_ peapIe II ..... Q) clays,.,... ... IS.mae -'i_I ... iftlle .... l_ ....... rar~tlleprivlle_ ....... _ .... ~ ....... I bIfGN illiIiaIiq-.ll_ andJOUliMlyIllla.i ....... _~tIIeruII.r. JIOwMr. if ............ _ a-Ihis_ ~ 10 ..... J: ...... 'iic_.,.. clefiniliaa tMa ~ oflWlll appRI .... II ncj1IindmiulO i~.

1(* .... is ......... l\iliiii)< balta P*ble ad IIDI,I1ICIIJIbIr-JIOICI ia ...... ~.1IIe .... tIaoIJ eli_ ..... 0lIl ••• _c'-lIIIIlMokII_ 00IIIIIICCi0aa by~_1y .................. IIIII.-.paIa .... .,-..1o}' _1Iir lip'" _~wd ~..-.. _db, ~ IabeIiJ'I all_ potaIIIe ..... WitII-a.a .... 10...- iIIIoI--.t ....... 1 ... cif .......... _. BIIckfIow,..-- dDYica ..... d lie RIUIiaaIy iIIIpecad

-~ II"' • ....,.. dial this .... 1 ... 1 .. UIId Ibr-..ciw JIUIIIOIIIad is ... bjeGtIO s.r. Drilltin. WfIIIr R ...........

Forthe Il'Pllcat'I illl'ormltioa.. _ ofpoui1llc ___ ...... iuIion~ II is utlOClled _ the prapoMd \WII_ (iDfcIraaIioa attacIIod)

An NPDES permit ia nquiIad

OtIIerme-DOHrul .............. iabmfto .... ___ ~........ lO 10; I .... _ tllalthelooltion ofdle well ch.,a but ililill wItIIin the ...... 1 ...... Ded ... db .............. our cIi~1ioa CCIIIIicIIn the I08IIIIeIIIIIO llill be IIPPIiClble. II1II WI do 1ICIt"'1O ..... 1IIe lOW 10CItiDft.

')c( No~ Contact Person: . Jerry Nu~ogawa~ Eng. in Hiiol __ t~~~0401 -------}l~ ./\- .. '.J-_ _ • Signed: __ ."K_,/fI~_--.=; 'I---.;V~ ,....;...lA~~~ ____ _ Date: ro~ '1" -:>-0 II

Page 24: Well Construction Pump Installation

D'~f~~ ~,~(tl~lo,J.'",~o ~~JII't".J5:. \f\.. ,e ChOZ.~""",\U!- SICl.. ~ l 91i I . ~TAI t:. 01- Ht'vyAIl (PU;Jw) tJ'lr.\~ fO)~' ~ANITATION BRANCH

DEPARTMENT OF'HEALTH ~ ENVI'RONMENTAL PROTECTION AND HEALTH SERVICES DIVISION

CESSPOOL SURVEY M~r~'Sf

Property Owner r,;:.,;t~. =;:=C£~~~::!!'SsO!!=.:::.=::::::::::- AddreS8_--fltc~·· .. L_~rJ,.tI~CI.....IK.~·'.otiIJ. .. "L.I:).;--_ Tax Map Key eLm S" - Go '2.. - I 0 2---' Lot No .. ________ ~~-----Island /In.,,,)Q: .. j Clty _______ ---; ___ Distrlct B"M BUilder or Contractor __ ~rJ(~·_-'o&M~!idoII:iw:J:4J .... -L ... +~_lntended For _--.J&~J~CIJ,' ~:..M~;..!£io:ILd:.. .... ,!40--4"PLp "'" ...... \liIId~<fp'qN..L...1 Primary ? Secondary _________ O'her -~ __ _"'a.._----_-_ Distance From ~ " Bulldiny.g ___ --JII..-'O __ r __ Boundary --....:"7:.........f.f ___ Stream. Well. Body of Water, Etc __ ~ ____ _

Diameter (Clear) Ft. P Depth-Ft /<2$ , Capacity (Gal I __ -='2-~ ..... 'b(=i-__ No. Ft Down to Water Table _________ Ground Slope P9 -lui. #'

Sod Profile (Starting from Surface) ( I f:1! J I ( I 0.'1 (/. .4 ~~ t. GULf "';4 ,,,,,A "4

Type of Wall or Curb "",:cf,e. ';'AcR# Reinforced Concrete Cover"_-=:.",, ______ _

Distance from Finished Ground to Top of Cover (Ft.).,(,.. __________________ _

Date Certificate Issued == Date Approved ' +J/~ 19~U~ ____ -HX~.~~~~~L------f- , t1Sanrtanan

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Page 25: Well Construction Pump Installation

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Page 26: Well Construction Pump Installation

.. o o NEIL ABERCROMBIE

GOVER"'"' OF HAWAII WILLIAM J. AILA, JR

ClWfItr£ft&ON

WILLIAM D. BALFOUR. JR SUMNER ERDMAN

LORETTA J. FUDDY. AC.S.W .• M.P.H. NEAl S. FUJIWARA

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

TO:

STATE OF HAWAII DEPARTMENT OF LAND AND NATURAL RESOURCES

COMMISSION ON WATER RESOURCE MANAGEMENT po. BOX 621

HONOLULU. HAWAII 96809

June 16,2011

Honorable Loretta J. Fuddy, A.C.S.W., M.P.H., Director Department of Health Attention: Acting Chief, Wastewater Branch

Joanna L. Seto, Chief, Safe Drinking Water Branch Alec Wong, Chief, Clean Water Branch

WILLIAM M. TAM ~TYDI"ECTO"

Dr. Keith Kawaoka, Office ofHa~valuation and Emergency Response

FROM: William J. Aila, Jr., Chairperson / ~/~t' / ;- Commission on Water Resource ~ement I

SUBJECT: Well ConstructionlPump Installation Permit Application Birdhouse Well (Well No. 3787-15) TMK 1-5-062:108 Well address: 15-1034 Kilika Road (3)

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 for any conflicts or inconsistencies with the programs, plans, and objectives specific to your department. Please respond by retumin~ this cover memo form by July 18.2011. Ifwe do not receive comments or a request for additiona review time by this date, we will assume that you have no comments.

Please find the attached maps to locate the proposed well. If you have any questions about this permit application, request additional information, or request additional review time, please contact Urn i~.-,.;£ Imata of the CommiSSIon staff at 587-0255. ::!) _c.

RI:ss Attachment(s )

<- ("::::i~ c ':.'~, ... :.'J :z N

RESPONSE: -0

This well qualifies as a source which will SCJVe as a solU'Ceofpotable water to a public water system (defined .. serving 2S or more peopleatleast~ days per year or has IS or more service connections) and .. ust receive Director of Heahh approvallllill: to its use to comply with Hawaii Adminitfeve

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Rules (HAR). Tide II, Chapter 20, Rules Relating to Potable Water Systems. § 11-20-29. ••

This well does not qualify as a source .erving a publiC water system (serves less than 2S people or more people atle .. t 60 days per year or I 5 servi~ connectional and if the well water is used for drinking, the private owner should test for bacteriological and chemical presence before initiating sueli use and routinely monitor the water quality thereafter. However. if future planned use &om this source increases to meet the public water system definition then Director of Health approval is required m:in 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 baekflow preventer, and by clearly labeling all non­potable spigots with warning signs to prevent inadvertent consumption of non-potable waler. 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 Regulationa.

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

An NPDES permit is required

, ~ ,p' •. "' ft. ,"~,~ i~' i

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Other relevant DOH rulesfregulations. inronnation, or recommendations ~ attached. l Q 1 0 ; In the evem 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.

k [ )

No comments/objections

Jerry Nuriogawa:, Eng. in Hiiol .: : ,

_1~~~0401 Contact Person: . --------Date: ftJ~ tJ -;)..() /I -------~----------------

Signed: __ .1:l.o~~_·~~~~'~ __ · __

Page 27: Well Construction Pump Installation

D~U'f\.\fC>ooV""'<tc..s ~.1SltlA:\.e-._1.\(!J<,-o ~~Jvk',JS. \f\- . C ('-Oz.S"w. •• lf.t- s tel.&. ~ t 9/» I , ~TAI t:. 01- HAVYAII ( p7l; k.c;) I~\~ f."}~~1 ~ANITATION BRANCH

DEPARTMENT OF"HEALTH ~ ENVIRONMENTAL PROTECTION AND HEALTH SERVICES DIVISION

hf-rp-S; Property Owner -rl;.,;~ .. :::::::=C£~==~~.~~:t====::::::- Address _----!tf(~auod....,.".-~CJ.",;:-..l....(.L!IG .... '6.0g 4-.. -'-,).;----Tax Map Key L/---=:. S - (. 2... - I 0 5?~ Lot No.-----___ ---:o;--____ _

CESSPOOL SURVEY

11_ ,. ID Island I'\J"O (I'l) ,A.) Clty ________ ~--Distnct {7/,d6.4

BUilder or Contractor __ ....::.~~-_-.J0L9~..:.!:!AA~/'"'4~·£_4-.."'-- Intended For ---'&...-.. .... «""'!""";"O~ .... £""""':. ...... ...,::'fioo--JA4""p .... &5oo" ...... \(t-...,;7Q"""""--J Primary ,/ Secondary _________ O,ther ___ ..... G....L--_____ _

Distance From ~ Building 10

I' Boundary --,"7--t-f ___ Stream, Welf, Body of Water, Etc ..

Diameter (Clear) Ft. ~ Depth-Ft 1"..1;; I Capacity (Gal ) __ -='2-~2..:...7-f=#-__

No_ Ft Down to Water Table __________ Ground Slope 99 4,,1 .(

5011 Profile (Starting from Surface) (' #:M J 1/ I Oa(J '£. ,4.<'-: t. 4J/<L,",JI.c/,;t..A "£0

Type of Wall or Curb -~k~&:l~-.t£..-<,.fe=-......... ~I'7.Ib .... · ~cL ....... :....-__ Reinforced Concrete cover_~v' _______ _

Distance from Finished Ground to Top of Cover (Ft.) .,1'--__________________ _ Date Certificate Issued = Date Approved ' -1.1, 'k. 19 --IItlg';'~---H-~.3...' ~~~,."t~4-___ _

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Page 28: Well Construction Pump Installation

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Page 29: Well Construction Pump Installation

C~'SS'ON ON WATER RESOURCE MANAGEMENT 0 ROUTE SLIP FOR NEW APPLICATIONS

FROM: RYAN

FUJII, N.

-1-HARDY, R.

-2-HOAGBIN, S. ICE,C.

4 IMATA, R.

DATE: 30-Mar-11

KUNIMURA, I. -3-TAM,W.

NAKAMA, L.

V=UYENO,D. YODA,K. -­

~YOSHINAGA, M.-

SUSPENSE DATE:

1 Approval -3-Signature

Information

WELL NUMBER 31 B 1- \5" .E:( WELL CONSTRUCTION

WELL NAME Birdhouse

J21 PUMP INSTALLATION

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

t/

6-Apr-11

PLEASE:

See Me -1-Review & Comment

Take Action Type Draft acknow letter

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

Xerox copies

WUP Number na

DWUPA o WUP Transfer

2 PERMIT PROCESS TABLE

3 CWRMMAPS =z::: making 1-mile radius and penciling in on hanging maps 4 APPL. FORM (11 COPIES)

5 USGS MAPS (11 COPIES) 6 TAX MAPS (11 COPIES) 7 PARCEL OWNER VERIF.

8 CONTRACTOR VERIF. 9 ALL INFO FILLED IN

10 BACKGROUND CHECK 11 $25 FEE DEPOSIT SLIP 12 DHP/CDUP/SMA pre·screen

13 EA 343 5(a) triggers?

FOLDER:

~ 0/

--L. MLS PRINTOUT =Z::= DCCA LICENSE SCREEN PRINTOUT

/ -;r ~ 1'0 WiiI1 ~MA I \1..()~ \n GP ---L (SMA map printout http://gis.hicentral.comlwebsite/parcelzoninglviewer.htm.,or INGRID'S SMA/CD MAP)

(LUC map printout http://luc.state.hLuslluc_maps.htm., or INGRID'S SMA/CD MAP)

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

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

INCOMPLETE ACTION DATES:

DATE ACTION

Page 30: Well Construction Pump Installation

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Page 31: Well Construction Pump Installation

NEIL ABERCROMBIE GOVERNOR OF HAWAII

Mr. Rod Diamond

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STATE OF HAWAII DEPARTMENT OF LAND AND NATURAL RESOURCES

COMMISSION ON WATER RESOURCE MANAGEMENT P.O. BOX 621

HONOLULU, HAWAII 96809

June 16,2011

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

Dear Mr. Diamond:

WILLIAM J. AI LA, JR CHAIRPERSON

WILLIAM D. BALFOUR, JR SUMNER ERDMAN

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

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

WILLIAM M. TAM DEPUTY DIRECTOR

3787-15.ack.doc

Well Construction/Pump Installation Permit Application for Well No. 3787-15

On May 19,2011, the Commission received your completed Well Construction/Pump Installation permit application and filing fee for the Birdhouse Well (Well No. 3787-15). Your application will be processed within ninety (90) days from this date.

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

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

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

If you have any questions about your permit application, please contact 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.

Rl:ss Attachment

c: Ted Powell

WILLIAM M. TAM Deputy Director

Page 32: Well Construction Pump Installation

o o NEIL ABERCROMBIE

GOVERNOR OF HAWAII WILLIAM J. AILA, JR.

CHAIRPERSON

TO:

STATE OF HAWAII DEPARTMENT OF LAND AND NATURAL RESOURCES

COMMISSION ON WATER RESOURCE MANAGEMENT P.O. BOX 621

HONOLULU, HAWAII 96809

June 16,2011

Honorable Loretta J. Fuddy, A.C.S.W., M.P.H., Director Department of Health Attention: Acting Chief, Wastewater Branch

Joanna L. Seto, Chief, Safe Drinking Water Branch Alec Wong, Chief, Clean Water Branch

WILLIAM D. BALFOUR, JR. SUMNER ERDMAN

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

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

WILLIAM M. TAM DEPUTY DIRECTOR

Dr. Keith Kawaoka, Office ofHaz~valuation and Emergency Response

FROM: William J. AiIa, Jr., Chairperson / /#tC"' /;"- Commission on Water Resource M'anagement

I SUBJECT: Well Construction/Pump Installation Permit Application

Birdhouse Well (Well No. 3787-15) TMK 1-5-062:108 Well address: 15-1034 Kilika Road

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 for any conflicts or inconsistencies with the programs, plans, and objectives specific to your department. Please respond by returning this cover memo form by July 18,2011. 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 staff at 587-0255.

RI:ss Attachment(s)

RESPONSE:

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[ 1

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[ 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 II, Chapter 20, Rules Relating to potable Water Systems, §11-20-29.

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

If the well is used to supply both potable and non-potable purposes in a single system, the user shall eliminate cross-connections and backflow connections by physically separating potable and non-potable systems by an air 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 [ lis [ I 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: _________ _

Page 33: Well Construction Pump Installation

NEIL ABERCROMBIE GOVERNOR OF HAWAII

c o

STATE OF HAWAII DEPARTMENT OF LAND AND NATURAL RESOURCES

COMMISSION ON WATER RESOURCE MANAGEMENT P.O. BOX 621

HONOLULU, HAWAII 96809

June 16,2011

TO: Russell Tsuji, Administrator Land Division -' £!

FROM: /J William M. Tam, Deputy DirectorCt./#~ 1"./ Commission on Water Resource Management

SUBJECT{ Well ConstructionlPump Installation Permit Application Birdhouse Well (Well No. 3787-15) TMK 1-5-062:108

WILLIAM J. AILA, JR. CHAIRPERSON

WILLIAM D. BALFOUR, JR. SUMNER ERDMAN

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

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

WILLIAM M. TAM DEPUTY DIRECTOR

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 July 18,2011. Ifwe do not receive comments or a request for additional review time by this date, we will assume you have no comments.

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

Page 34: Well Construction Pump Installation

NEIL ABERCROMBIE GOVERNOR OF HAWAII

TO:

FROM:

SUBJECT:

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STATE OF HAWAII DEPARTMENT OF LAND AND NATURAL RESOURCES

COMMISSION ON WATER RESOURCE MANAGEMENT P.O. BOX 621

HONOLULU, HAWAII 96809

June 16,2011

Dr. Puaalaokalani Aiu, Administrator Historic Preservation Attn: Theresa Donham .. /':1 William M. Tam, Deputy Director w/tf'r Commission on Water Resource Management

Well Construction/Pump Installation Permit Application Birdhouse Well (Well No. 3787-15) TMK: 1-5-062:108

WILLIAM J. AI LA, JR CHAIRPERSON

WILLIAM D. BALFOUR, JR. SUMNER ERDMAN

LORETTA J. FUDDY, A.C.S.w., MPH NEAL S. FUJIWARA

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

WILLIAM M. TAM DEPUTY DIRECTOR

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 July 18,2011. Ifwe do not receive comments or a request for additional review time by this date, we will assume you have no comments.

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

Page 35: Well Construction Pump Installation

NEIL ABERCROMBIE GOVERNOR OF HAWAII

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STATE OF HAWAII DEPARTMENT OF LAND AND NATURAL RESOURCES

COMMISSION ON WATER RESOURCE MANAGEMENT P.O. BOX 621

HONOLULU, HAWAII 96809

June 16,2011

Ms. Bobby Jean Leithead Todd Planning Director Planning Department County of Hawaii 101 Aupuni Street, Suite 3 Hilo, HI 96720

Dear Ms. Todd:

Special Management Area Use Permit Requirements for Well Construction/Pump Installation Permit Application

Birdhouse Well (Well No. 3787-15)

WILLIAM J. AILA, JR. CHAIRPERSON

WILLIAM D. BALFOUR, JR. SUMNER ERDMAN

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

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

WILLIAM M. TAM OEPUTY DIRECTOR

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 SMA permitting requirements specific to your division. Please respond by returniug this cover memo form by July 18, 2011. Ifwe do not receive comments or a request for additional review time by this date, we will assume you have no comments.

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

Sincerely,

u/~~~ 12... WILLIAM J. AILA. JR {~ Chairperson

RI:ss

RESPONSE:

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

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

[ ] No objections

[ ] Other comments:

Contact Person: ___________________ _ Phone: --------

Signed: _____________________ _ Date: _______ _

Page 36: Well Construction Pump Installation

Search Results o o Page 1 of 1

Search criteria: TMK Taxkey 3-1-5-62-108

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

r • 3-1-5-62-108 Hawaiian F 15- POWELL, TED 3 2 21,780 sqft 1,152 3/4/2011 DEED $144,( Paradise Park 1034

KILIKA RD

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

Copyright ©6/13/2011 by Hawaii Information Service

http://web09.hawaiiinfonnation.comlREsearchIHIS/Searchisearch _PUB.asp?NOCACHE=... 6113/2011

Page 37: Well Construction Pump Installation

Professional and Vocational Liosing (PVL) - powered by eHawaii.goo 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/MAINT. REQUIREMENT DUE

ENTITY: INDIVIDUAL BUSINESS CODE: SOLE OWNER

ORIG L1C DATE: 10/12/2001 EXPIRE DATE: 09/30/2012

CLASS PREFIX: BC SPECIAL PRIVILEGE:

RESTRICTION: EDUCATION CODE:

CONDITIONS AND LIMITATIONS:

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.

http://pvl.ehawaii.gov/pvlsearchlapp?_a=d&_f=n&lictp=CT&licno=23379&off=&nm=RO ... 6113/2011

Page 38: Well Construction Pump Installation

DQRTMENT OF LAND AND NATURAL RESOUQS DOCUMENT NO.: UAC OR ATTACHED WORKSHEET DATE' March 29 2011 ,

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

S 11 326 C 1026 0752 (1 ) $25.00 Diamond Drilling

" " " " " " (2) $25.00 Kauai Water Well

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

TOTAL $ 50.00

REMARKS: LINE (1) Birdhouse Well LINE (2) TMK: 5-1-005:040-001 LINE (3 LINE (4) LINE (5) LINE (6) LINE (7) LINE (8) LINE (9) LINE (10)

Page 39: Well Construction Pump Installation

,..,.., \

STATE OF HAWAP DEPARTMENT OF LAND AND NATURAL RESOURCES COMMISSION ON WATER RESOURCE MANAGEMENT

o APPLICATION FOR A WELL CONSTRUCTION I PUMP INSTALLATION PERrtlIAILED

RIGINAl 24 NA.t II Instructions: Please print in ink or type and send completed application with attachments to the Commission on water Resource Management, P.O. Box 621, Honolulu, Hawaii 96809. Application must be accompanied by10 copies and a non­refundable 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 587~225. For further information and updates to this application form, visit http://www.hawaii.gov/dlnr/cwrm.

same Well Mailing Address

same

Ted Powell

1700 Roscoe 8t. La Porte, TX 77571

For Official Use Only:

r (~:'.<: t, ~; \~. " , . '."".,;'

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:i\'/,TER .. ,:::J!EN~

2011 MAR 29 AM II: 40

same

13. Method of flow measurement X Flow meter

1-7::-::--~-~=-:--:---:-:-,,----:---t 0 Open Pipe Proposed Amount of Withdrawal, gpd (gallons per 0 Weir

350 DOm~ o Other

number (a surveyor is required for all Well 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:

21. Conservation District Use Well is in Conservation District X Well is not in Conservation District o Required, COUP # date approved

X Not Required (attach documentation from OCCl) ----o I have not checked with OCCl about whether or not a COUP is required. I understand that checking with the County prior to making this application will expedite my review. I further understand that issues raised by this agency may delay or result in denial of the permit issuance, or revocation of the permit after it is issued.

I have not checked if weH is in or out of Conservation District I understand that checking if the wen is in a Conservation District may expedite my review. I further understand that issues raised may delay or result in

C-57/C-57aJA License No,

17 MAR 11 Date

Rodney K Diamond Print

HCR #3 Box 14073 Keaau HI 96749

966-4129 diamond,drilling.pump@gmail,oom

E-mail

out if application is for Pump Installation)

BC23379 C-57/C-57aJA License No,

17 MAR 11 Date Rodney K Diamond

966-4129 E-mail

WCPI App. Form 5120/09

Page 40: Well Construction Pump Installation

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Page 41: Well Construction Pump Installation

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

Hole Diameter: 8.5 inches.

Elevation at top of casing ~ ft., msl* I

~~_t ___ ...... _~ Minimum of 2' Radius & 4" Thick Concrete Pad (to contain benchmark surveyed to nearest 0.01 ft.)

~.:;::./ ::/.: .. __________ . ____ ._ • ..:.....1>'... .' '''-.

Cement Grout: ~ft. (min. 70% of distance from ground elevation to top of

/I/~,\ : .. ::.

I •••••

i' i(~

f" ~.

! ~U: I I:.t;::

Ground Elevation: 50_ft, msl*

~~ I I

I I I

Please refer to the HAWAII WELL CONSTRUCTION AND PUMP INSTALLATION STANDARDS

to ensure that your as-built is in compliance with applicable standards.

-t v:· I <.~:~

',:t>'

water surface or 500 ft., whichever is less.)

Grouting method:

~_ _ Solid Casing: (= 90% x (Ground Elev.-Water Level Elev»

Total Length: ____ -""'--_____ _ 50 ft. ';',:-I ',':',

I >.:,::, I . ·f ~.-'.

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

o Positive : Displacement I

x Other

4.5 in.

540 in.

Nominal Diameter: ___ ..:L'-'~ ____ ---'

Wall Thickness: ___ ..=-!-=--____ '

_2_ in. 4- -0-BottomElevation: ___ --::.><-___ _ ft., msl*

i I

Rock or Gravel Packing: Ii Total Depth -1L ft. I

~feet. , Material:

i I

Open Casing: • Perforated o Screen

Total Length: 7 ft.

/" Nominal Diameter: 4.5 in. /"

i X Crushed Basalt -·1 i

~

Wall Thickness: S40 in.

I o Rounded Gravel

I Bottom Elevation: -7 ft., msl* .t __ note: Neither bentonite nor mud should be used in

saturated zone during drilling Estimated Water Level Elevation:

Open Hole: _2_ft.msl*

Length: __ ~N~~,-,-_______ ft . . ______ L__ _ _____ L Diameter: ____________ ,in.

Bottom Elevation: ft., msl*

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

For non-salt water Basal Wells - bottom elevation of well should not be deeper than 1/4 of aquifer thickness or, Bottom Elevation of Well Limit = (Water Elevation - 41 x Water Level Elevation 1 4) Example: Estimated + 2 ft. Water Level Elev.>>> Bottom Elevation of Well Limit = (2 - 41 x (2) 14) = -18.5 ft.

Solid Casing Material: Carbon Steel: compliant with (check one or more): 0 ANSIIAWNA C200 0 API Spec. 5L 0 ASTM A53 0 ASTM A 139

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) 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 Thennoset 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 AWNA 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 ANSIIAWNA C200 0 API Spec. 5L 0 ASTM A53 0 ASTM A 139

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): o ASTM A409 (production wells) o 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 Thennoset 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 AWNA C950 o PTFE Fluorocarbon Tubing conforming to ASTM 03296 o FEP Fluorocarbon Tubing conforming to ASTM 03296

Page 42: Well Construction Pump Installation

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Page 43: Well Construction Pump Installation

.+ STATE OF HAWAP 0 DEPARTMENT OF LAND AND NATURAL RESOURCES COMMISSION ON WATER RESOURCE MANAGEMENT

APPLICATION FOR A WELL CONSTRUCTION I PUMP INSTALLATION PERMIT

Instructions: Please print in ink or type and send completed application with attachments to the Commission on Water Resource Management, P.O. Box 621, Honolulu, Hawaii 96809. Application must be accompanied by10 copies and a non­refundable filing fee of $25.00 payable to the Dept. of Land and Natural Resources. The Commission may not accept incomplete applications. For assistance, call the Regulation Branch at 587-0225. For further information and updates to this application form, visit http://www.hawaii.gov/dlnr/cwrm.

same

Landowner's

1700 Roscoe St. La Porte, TX 77571

same

20

20n HAR 29 AM II: 40

same

12. Proposed Amount of Withdrawal, gpd (gallons per

350

and license number (8 surveyor is required for all Well Construction Permits and may be required for some

Deferred

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

X 16 Domestic Number of units to be served:

24. (Must be filled out if application is for Well Construction)

Rodney K Diamond BC23379 Licen business name C-57/C-57aJA License No.

~kt2-Jl Rodney K Diamond ~r MAR 11 Print

HCR #3 Box 14073 Keaau HI 96749

966-4129 Fax

[email protected] E-mail 966-4129

C-57/C-57aJA License No.

17 MAR 11 Date

E-mail

WCPI App. Form 512010t

Page 44: Well Construction Pump Installation

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Page 45: Well Construction Pump Installation

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

Hole Diameter: 8.5 inches.

Grouting method; o Positive

Displacement

x Other i

Total Depth

~feet. !

!

i !

J

Elevation at top of casing ~ ft., msl* _ Minimum of 2' Radius & 4" Thick Concrete Pad (to contain benchmark surveyed to nearest 0.01 ft.)

Cement Grout: 40 ft. (min. 70% of distance from ground elevation to top of water surface or 500 ft., whichever is less.)

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

_2_ in.

Rock or Gravel Packing:

-1L ft.

Material:

x Crushed BasaH

o Rounded Gravel

Estimated Water Level Elevation:

_2_ft.msl*

~ t-J-----. " Ground Elevation: 50_ft, msl*

_';:«'qE1lj. n?>'~ -~J;--~ :"-1\: :";.::.[

! ,,'. ,'.

I I·~.:;·. ~)'I I Please refer to the

HA WAIl WELL CONSTRUCTION AND PUMP INSTALLATION STANDARDS

i t~~·:~ :::'~. i I to ensure that your as-built is in compliance with applicable standards. , I·"'" ,.,', I ! .:.:.:. :':':'1 I

-{ 'I) ;:,1 ~ ... ... Solid C"'''' (= 90% x (G,.om! .,...·wate, ...... "lev))

{( //:I! Total Length: ____ --"5~0 ______ ft.

i ;'/:i Nominal Diameter: ___ ""4C'-'.5"'-_____ in.

t' / ~.< >:~II '. •. '. f·

4

1

,-,,- '11,/Q~~ ~ Bottom Elevation:, ___ -"'-O<:..-_____ ft., msl*

Wall Thickness: ___ -"S'-'4""0 ____ i,n.

t-

~D~ ~i! i I~ Q~I l' ~ ~!

Open Casing: • Perforated 0 Screen

:.\ ~lt/ ·1 -- 'f' Wall Thickness: __ -,5",-,4=0 ____ .in.

I 4 Bottom Elevation: -7 ft., msl* L - - note: Neither bentonite nor mud should be used in

saturated zone during drilling

--

Total Length: ____ -'7c...-______ ft.

Nominal Diameter: __ ...;4::!::.~5~ _____ in.

Length: __ ..:..N=~-=-_______ ft.

t----- Open Hole:

I I

Diameter: ____________ ,in.

Bottom Elevation: ft., msl*

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

For non-salt water Basal Wells - bottom elevation of well should not be deeper than 1/4 of aquifer thickness or, Bottom Elevation of Well Limit = (Water Elevation - 41 x Water Level Elevation 1 4) Example: Estimated + 2 ft. Water Level Elev.»> Bottom Elevation of Well Limit = (2 - 41 x (2) 14) = -18.5 ft.

Solid Casing Material: Carbon Steel: compliant with (check one or more): 0 ANSI/AWNA C200 0 API Spec. 5L 0 ASTM A53 0 ASTM A 139

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

Open Casing Material:

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 AWNA C950 o PTFE Fluorocarbon Tubing conforming to ASTM 03296

- 0 FEP Fluorocarbon Tubing conforming to ASTM 03296

Carbon Steel: compliant with (check one or more): 0 ANSI/AWNA C200 0 API Spec. 5L 0 ASTM A53 0 ASTM A 139 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) 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 AWNA C950 o PTFE Fluorocarbon Tubing conforming to ASTM 03296 o FEP Fluorocarbon Tubing conforming to ASTM 03296

Page 46: Well Construction Pump Installation

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