I/o - AASG Geothermal Data Repository

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41
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39
Ahol. Rock
38
KIPAHULU
BLAKE WELL
,~,
.... Wi
ISLAND OF MAUl
O
FROM:
TO:
_~:ZQ?"""""",,,,
______
INITIAL:
_ _ D.LUM
_ _ E. Sakoda
_ _ D. Nakano
_ _ P. Haraguchi
_ _ R. Jinnai
_ _ M.Ohye
_ _ D. Hamada
_ _ K. Oshiro
_ _ M. Tagomori
_ _ G. Matsumoto
_ _ G. Akita
_ _ L. Chang
_ _ S. Kokubun
DATE:
'I;/7.!;9
I J~
FILE IN:
PLEASE:
-.t!J,./e. A{I/
32tJi -05REMARKS:
=~Th::&comment 0.,j
=
_
_
-
Rev. 4/88
O'
SURVEY BRANCH
I/o / J
ision of Water Resource Managem ". . I )fPa-AWf.,f
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Take Action
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!pvestigate & Report II/~' U (II j / eN!-: a~MV..
Draft Reply
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Acknowledge Receipt /1
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Type Final cc: - ./
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Signature
Information
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FAX (808) 874-8021
343 ALU ROAD. WAILUKU, MAUl HAWAII 96793 . PHONE
.
rER &
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March 6, 1990
~_
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state of Hawaii
Department of Land and Natural Resources
Commission on Water Resource Management
P. O. Box 373
Honolulu, Hawaii, 96809
Attn: Mr. Manabo Tagomori
Res
Kipahulu Blake Well
State Well No. 3904-5
Kipahulu, Maui, Hawaii
T.M.K. 1-6-10,03
Gentlemen:
Enclosed are the following for referenced well:
1.
2.
3.
4.
Drillers Report
Water Test Results
As Built Cross Section of Well
Plot Plan Showing Location of Well
If additional information is required contact:
Lou Blazic
P. O. Box 755
Kihei, Hi., 96753
Phone 879-2094
FAX # 874-8021
Sincerely,
David Pico
Well Drilling Contractor
L~\A~': _229
1
By: Lou
, LBccp
Bla~l~
.
1\
DOWAlD Form 71(1)
"
I
.:>litll: ur nitwitll
les
DEP .'TMENT OF LAND & NATURAL RESOU
Dlv1SION OF WATER AND LAND DEVELOPIWt.iH
DRILLER'S
Date of report
A. OWNER
--~,--lP--t--lqllO Person
STATE
REPORT
/
/'
DESCRIPTION
filing report ____ ~_Q ____ ~~__ ~_______________________________________________ _
_~O~__ ~-oo ~f~~ _ ~_LQ-AJ4-U-LVoo-.-j~~-~~ ISLAND _oo,.1\.(L~QJ_oooo_oo
~: g~~Li~~~ ~~~A:~ ::::~~t5At~~1s.~~:~~-Aw·;c?c.~~;:::u:nnupnnn .
D. TYPE OF RIG _______FA:H...._J4.~
____
DRILLING COMPLETED ____ lV~_~RILLER ____ !_~"Jl)__ .-: __ J_~___ _
m~;tl"--yJi r--
r
E. ELEVATION, msl: Top of drilling platform ___ oo._.lZ:Z.,t:::~~;- ft. Bench marund method used to determine .
Height of drilling platform above ground surface L---L.;~- ft. elevation: ~:~_IDA_~L. b_~_A-H __
F. HOLE SIZE: _______ oo ___ ._oo ______ ~.inch dia. to _. __ .l1_$_:~<f!,.,ASelow drilling platform. ~.) 5t.Jl/LJ../li2-(oIf!____________________ .__ .___ .inch dia. to _. ________ .___ .___ ft. below drilling platform.
_. _________________________ .inch dia. to ,r.-------.---.--- ft. below drilling plat~orm.
G. CASING INSTALLED: ____
in. I.D. x --"14-- in. wall solid section to __ 1.54____ ft. below drilling platform.
____________ in. I.D. x ____________ in. wall perfora~d section to __________________ ft. below drilling platform.
___
ok
Type of perforation ~-(,.,~----H-~-taJy-~----~--~.JAA-tPr.-------------------H. ANNULUS: Grouted --- ____ S"O_ ft. to -----5.(.-.--- ft. below drilling platform.
Gravel packed ___ ~____ ft. to ___ .____ .__ 00._. __ ft. below drilling platform.
I. PERMANENT PUMP I~STALLATION:
//
.
, Pump type, make, serial no. -------------------f-.---------------------------------- -----------.-.-.----.-.-0'\..---00--.------ Capacity ____________________ g.p.m.
Motor type, H.P., .voltage, r.p.m. _____________ \M_Q~J~ l_~A__~ ______ ).----------------____________________________________________ .___ _
Depth of pump intake setting ________________ ft. below _______'"'Ib__________ A:-T~ _________________________ which elevation is _______________ .ft.
Depth of bottom of airline ________________ ft. below ____________________________________________________________________ which elevation is _______________ .ft.
____
dri~i~~~~~~r~~
f?_L ____
----J--l-s:-!9- - - - - ·- - - - - -
0
J. INITIAL WATER LEVEL _. __
.ft. below
Date of measurement.
K. INITIAL CHLORIDE: ______~- __ ppm, total depth of well -J1~---- ft. below drilling platform ______ -'- __'5. qp___________ _
amp ing Date
L.
~~~P~-~~--~-~~~~~)l$.lqp:&--~------
6~t~·)oo~~~~_: -_-_\lS-.(qD-~~~~--~-I.;t.i-~n
I
Reference point
___
is ---fZ-I---- ft.
Start water level _____________ ._____ .__~___ ft. below R. P.
Start water level ._oo __ ._oo __ ._. __ ._._. __ ._. _______ Q ____ ft. below R. P.
End water level _______ ._. _____________ t~1 ft. below R. P.
End water level .-.---.------.------.----oo---.llt:::.1--- ft. below R. P.
Depth of well ---------------------------\~·lS--- ft. below R. P.
Depth of well --------oo----------------.-----.----t7-5-.ft. below R. P.
Elapsed
Rate
DrawCITemp.
Elapsed
Rate
DrawCITemp.
c
__
OS_,_Q8~et~~02G.oo(~ ~~~,~:~ ___ ~-- ---1300,P-t-J?O-- to ---- ------- ______~Q ---- ___.._s_ ----z",!5- ----1!;J--
oooo_oo.~~~et~O_u~_~~oooo ____ oo(~~~~_oo ~~~~_~~~:! _ _~:.:.~_~oo
___ .__________ to ---.-----.---- -------------- -------------- -------.------
______
14-.--0-0-- to ----s------- ______ ~o
1_"$._ ----"ZJ$.- ---~-~-t~-I-OO- to ---\11------- -----_~o -----4-~- ----t".-tG- _. __ ~~__
-------.------
to
______________ to
_________ 00 ___
to ___ ~--.---- ___ .____ ._____ __.___________ __________ ._._ _____ .____ .___
______________ to _________ ._____ 00 ______ ._. ______________________ ._____ ._____________ ._
_._._._._._. __ to
________ ._____ to
oooooo .:.. ___ _
------------.---.---.------ -------.------ -------------- -------------- --.----.-.----------------- -.------------ --.----------- -------------- ----------.--___ .__________ ______________ ______________ ______________ _______ ._____ _
_____________________________________________________________________ _
SUBSURFACE FORMATION
M. DRILLER'S LOG:
______O__~_~~~' :.~---- ___ ~D~_~:~~
Water Level
_ _ _ _fp___
_
Water Level
_________ .~~p:~' f_~: __________ ._~_~~~ __~~_~~~~~~_i_~~ __~__~~~_~~~_~___
~~
____ ________ _
::::Pst!~ :ti~: ::::::~-~-~::~ :_. :____________
: : : : : to!~::::::::::::::
:::::::::::::::::::::::::::::::::::::::::::::::::::: ::::::::::::::
.___
__ .. ______ .," __ to ____ ._________ ._________ .___ .____ ._____ .________ ._________________ ______________
.. _.... __ .____ to _______ .____ .. ______________________________________________ .. ____ ._ .. ___
0
______________
______________
______________
___________ .__
______________
______________
to
to
to
to
to
to
__ • • __
______________ ____________________________________________________ ______________
_________________________________________________________________ _
________________________________ .________________________________ _
____________________________________ .____________________________ _
_________________________________________________________________ _
________________________________________ ._____________ ._. ___ .____ _
0 " . ___ • • _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ . " . ___________________ •
_
___ 0. ____ •
___
_______ .______
_______ .______
_________ ._. __
________ ._____
_. ____ ._. _____
__. __ ._____ .__
___ •
___ • • _ _ _ _ _ _ _ _ _ _ _ _ _ _ 0
__ . 0 __
to __ .. _____ .____ .. ___ ._____________ .________ .____________________________________ _
to
to
to
to
to
to
_____ ._. ____ ._______ ._. ____ ._. ________ .__________ .________________ -____________ _
_______________ .____ ._ .. ___ .______ .______ .___________ .___________ _
____ ._. ________ .. ____ .__________ .__ .___ .. ______ .. _. __________ .___ _
______ .___ ._. __________ ._______________________________________________________ _
______________ ~ ______ ._________________ ._______________________________________ _
____ ._. _____________________ .___ .__________ .___________________________________ _
N. REMARKS: __________________________________________________________________________ .________________________________________________________________________________________________________________ ._
FOR DRILLER'S USE
Job Name __ ._________ .___________ .____ _
Job No. ___________________________________ _
INSTRUCTIONS: Send three(3) copies to: Manager-Chief Engineer, Division
of Water and Land Development, P. O. Box 373, Honolulu, Hawaii 96809.
REFERENCES: Chapter 178, entitled "Artesian Wells, Generally," HRS, as
amended by Act 123 SLH 1970. Honolulu Board of Water Supply, "Rules and
Regulations Providing for the Protection, Development and Conservation of
Water Resources." Sec't 8-105(j). "Powers, Duties and Functions of the Board,"
Charter of the City and County of Honolulu, 1959.
FOR OFFICIAL USE
.
'U)D ?;'I'
14-"_
Latitude
_____________
._. ___ .____ .________
.
I~lo°
04' '?1'
Longitude
________ ._______________
.____ _
." '1
Well No. _______________________________
0 4 - Of:)_
K tPet:ULV - UAKtE
\AJE~~~!~ _ ~ __ :_:l_~: . ~
__ ___ _ -6~--O::; -.~t:;1':'L-~:KlO~~-'ZEt;Q4dif5:_:'- ~o§l!l:~-';;iU~~H. 1.. ---' - -~'.:' ~ ~---~.:~::~~~-:-·~-·:~~r-P~.A."1i";o~D~-:=t"f't~~O·I---·----·------
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T:!""-1----~~.J:.:.JII'II ~__
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_____
\0
~CALc::"
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SC;;c..110 t--S
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FI.
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DEPARTMENT OF" WATER SUPPLY
COUNTY Of" MAUl
P. O. BOX 1109
WAILUKU. MAUl. HAWAII 96793
January 17, 1990
TO
: Mr. Lou Blazic
FROM
Cari Cerizo, Chemist
~
SUBJECT: Norm Blake - Kipahulu Well
Attached are results of the water samples that were submitted on
1-12-90. Please note that the recommended storage time is 7
days.Therefore the validity of the results decreases as the
storage time increases.
Sample:
Norm Blake - Kipahulu Well
Date of collection
Time
Date Received
Results
[mg/L]
# 1
12-29-89
8:00a
1-12-90
25
# 2
12-29-89
10:00a
1-12-90
25
# 3
12-29-89
2:00p
1-12-90
25
# 4
12-29-89
4:00p
1-12-90
25
Maximum contaminant level for chlorides
1
= 250 rng/L
•
o
HECEtVED
t£/Jaflla ~/cCJ eeddpCJCJ( t£/J1g91J19 .
343 ALU ROAD· WAILUKU, MAUl HAWAII 96793· PHONE 244.9835
June 15,1989
.
89 J UN ,~ AIO. 0 I
O'V. Of WATER &
LAND Ui"vLLOPMENT
State of Hawaii
Dept. of Land and
Natural Resources
Commission on Water
Resource Management
P. O. Box 621
Honolulu, HI
96809
Re:
Kipahulu - Blake Well
State Well No. 3904-05
Kipahulu, Maui, Hawaii
Gentlemen:
Please be advised that work will commence on referenced
project on June 21, 1989.
Address all correspondence to:
Lou Blazic, General Engineering Contractor
P. O. Box 755
Kihei, Maui, HI 96753
Sincerely,
DAVID PICO - Well Drilling Contr.
LiL"&;;By LoU Blazic, R.M.E.
LB: 1 j
cc:
Norman R. Blake, Jr.
o
o
JOHN WAIHEE
WIUIAM W. PATY
GOVERNOR OF HAWAI r
CHAIRPERSON
STATE OF HAWAII
DEPARTMENT OF LAND AND NATURAL RESOURCES
JOHN C. LEWIN. M.D.
MICHAEL J. CHUN. Ph.D.
ROBERT S. NAKATA
RICHARD H. COX. P.E.
GUY K. FUJIMURA
COMMISSION ON WATER RESOURCE MANAGEMENT
MANABU TAGOMORI. P.E.
P. O. BOX 621
DEPUTY
HONOLULU. HAWAII 96809
\111 ~;:O{
WELL CONSTRUCTION PERMIT
(]\
for
'
Kipahulu-Blake Well
State Well No. 3904-05
Kipahulu, Maui
TO:
Nonn Blake
In accordance with the Department of Land and Natural Resources
Administrative Rules, Section 13-168, entitled "Water Use, Wells, and Stream
Diversion Works", your application to construct and test State Well No. 3904-05 for
.pon-potable domestic use within Tax Map Key: 1-6-10:03 is approved subject to the
following conditions:
1.
The Division of Water and Land Development (DOWALD), GeologyHydrology Section, shall be notified at 548-7619, before any work
covered by this pennit commences.
2.
The permit shall be for construction and testing only. No pennanent pump
may be installed and no water used from the well without the necessary pump
installation permit from the Commission.
3.
The grouted annulus shall be from 0-50 ft. instead of 0-20 ft. as proposed in
the application.
4.
The following shall be submitted to OOWALD, P.O. Box 373,
. Honolulu, Hawaii 96809 within 30 days after completion of the well:
a.
Well Completion Report.
b.
Ground elevation (referenced to mean sea level) detennined by
survey by a Hawaii-licensed surveyor.
o
o
WELL CONSTRUCTION PERMIT
Page 2
State Well No. 3904-05
c.
As-built sectional drawing of the well.
d.
Plot plan and map showing the exact location of the well.
e.
Complete pumping test record; including time, pumping rate,
drawdown, chloride content, and water quality data
5.
The applicant shall comply with all applicable laws, rules, and
ordinances.
6.
This permit may be revoked if work is not started within six months
of date of issuance or if work is suspended or abandoned for six .
months. The work shall be com ted within two years of the date of
issuance.
Date of Issuance
cc:
USGS
Department of Health,
Drinking Water Program
Ground Water Protection Program
Maui Department of Water Supply
Lou Blazic
-------~~-------------------
o
o
1710
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••
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,./
JOHN WAIHEE
GOVERNOR OF HAWAII
39 APR ~
p
.lO
JOHN C. LEWIN, M.D.
.q
4: ..
DIRECTOR OF HEALTH
8: S6'
STATE OF HAWAII
\'lATER &
LAHD Oc\; tU)pl--\E.Nl
riP!. OF
DEPARTMENT OF HEAL.TH
P. O. BOX 3378
HONOLULU, HAWAII 96801
March 21, 1989
The Honorable William W. Paty, Chairperson
Commission on Water Resource Management
Department of Land and Natural Resources
State of Hawaii
P.O. Box 621
Honolulu, Hawaii 96809
Dear Mr. Paty:
SUBJECT:
WELL CONSTRUCTION PERMIT APPLICATION
KIPAHULU - BLAKE WELL
STATE WELL NO. 3904-05
KIPAHULU, MAUl
Thank you for the opportunity to review the subject document.
reviewed the application and have the following comments to offer:
We have
1.
The permit indicates that the well will be for domestic use. If
the well is to serve 25 or more individuals at least 60 days per
year or will have a minimum of 15 service connections, the
applicant will be required to comply with the Department's
Administrative Rules, Title 11, Chapter 20, "Potable Water
Systems."
2.
Section 11-20-29 of Chapter 20 requires that a new source of
potable water serving public water systems be approved by the
Director of Health prior to its use. Such an approval is based
primarily upon the submission of a satisfactory engineering report
which addresses the requirements set in Section 11-20-29.
If you should have any questions, please contact the Drinking Water
Program at 548-2235.
Very truly yours,
~
~P~
JOHN C. LEWIN, M.D.
Director of Health
MAR
~ 1989
REF:W/L-KO
Honorable John C. Lewin, M. D.
Director of Health
Department of Health
State of Hawaii
1250 Punchbowl Street
Honolulu, Hllwaii 96813
Attn:
Mr. Thomas Arizumi, Drinking Water Program
Well Construction Permit Applications
In accordance with the Department of Land and Natural Resources
Administrative Rules, Section 13-168-12(c), we are sending you a copy
of the follovring permit applications:
North l{ohala Exploratory and Observation Wells, State Well Nos.
7345-03, 7345-01M • 02M, 7347-03, 7347-01M 81 02M, 7445-01M, 7448-06,
7448-01M to OSM. 7449-01M, 7549-01M.
Kipahulu-Blake Well. State Well No. 3904-05.
Please submit your comments to us f orally or in writing, within
three weeks from the date of this letter.
If you have any questions, please contact Dan Lum at 548-7643.
MT:ES:ko
Enc.
l\i1a.rch 1, 1989 .
Mr. Norm Blake
Dear Mr. Blake:
This is to acknowledge receipt of your application for a well
construction permit and $25.00 filing fee for a wpll at Kipe.hulu, Maui.
My staff is reviewing the application and will call you should there
be any questions.
Sincerely,
t MANABU TAGOMORI
Deputy Director
ES:ko
cc:
!\lr. I.ou Blaz:!c
i
February 28, 1989
Honorable Vince Bagoyo t Director
Department of Water Supply
County of Maui
200 S. High Street
Wailuku. Maui, Hawaii 96793
Dear Mr. Bagoyo:
Well Construction Permit Applications
We are sending you a copy of the following permit applications for
your review and comments:
Kipahulu-Blake Well, State Well No. 3904-05.
Please submit ~l'otlr comments to us, orally or in writing. within
three weeks from the date of this letter.
If you have any questions, please contact Dan J... um at 548-7643.
Sil1cerely.
;//
/~
... /~L:~/:;Z~
l\iIANABU TAGOMORI
Deputy Director
ES:ko
Ene.
Rev. 12/88
DBION OF WATER RESOURCE ~EMENT
uf
FROM:
TO:
INITIAL:
_ _ M. TAGOMORI
D. Lum
=~.
G. Matsumoto
_~
. Akita
L~_1. Chang
Y. Shiroma
7'
_ _ E. Sakoda
_ _ D. Nakano
_ _ W. Rozeboom
_ _ P. Haraguchi
_ _ S. Samuels
_ _ R. Chung
_ _ T.Kam
_ _ A. Monden
_ _ H. Young
_ _ R. Suzuki
_ _ N. Kaneshiro
_ _ T.Nakama
DATE:
~'}ILE IN: _ _ _ _ _ _ __
PLEASE:
~~ction By_ _
Route to Your Branch
Review & Comment
__ Draft Reply__
__ Acknowledge Receipt
__ Xerox _ _copies
File
Mail
For Information
_
_ _ S. Kokubun
_ _ _ D. Hamada
_ _ _ 1. Nanbu
_ _ _ F. Ching
REMARKS:
o
",
o
i~cC£IVED
'i/Javla 1'IctJ eeddptJtJl'i/J1g611f6f EB22
A B:
343 ALU ROAD" WAILUKU, MAUl HAWAII 96793· PHONE 2 4 4 . 9 8 3 5 ·
February 21, 1989
I.
3
OIV, OF WATER &
LAND DEVtlOPMENT
Division of Water and
Land Development
State of Hawaii
P.O. Box 373
Honolulu, HI 96809
Re:
New Water Well Lot A, Calley Su·bdivision
Kukuiula, Kipahulu, Hana,
Maui, Hawaii T.M.K. 1-6-10:03
Gentlemen:
Enclosed are a new well application, location map, and $25.00 application fee on subject project.
Please address all correspondence to:
Lou Blazic, General Engineering Contractor
P.O. Box 755
Kihei, HI 96753
Your attention to this matter is greatly appreciated.
Sincerely,
DAVID PICO - WELL DRILLING CONTR.
License No. ABC 2291
~~
By Lou Blazic, R.M.E.
LB: 1 j
Encls.
State 01 HawaiI
DEPOMENT OF LAND AND NATURAOESOURCES
APPLICATION FOR (check one)
,KlWELL DRILLING PERMIT
L(WELL MODIFICATION PERMIT
Instructions: Send completed application and attachments to Department of Land and Natural
Resources, P.O. Box 373, Honolulu, Hawaii 96809.
Refel ence: Regulation 9, Dept. of Land & Natural Resources.
4
Is the well located in a Designated Ground Water Control Area?
_Yes
If "yes". application must be accompanied by a Water Use and/or Water Supply Permit and a
non-refundable filing fee of $100 payable to the Department of Land 6 Natural Resources.
0
ever, if application is for minor modification of well, filing fee may be waived. If "no" , no
filing fee is required. Filing fee is waived for federal, state, and county governmex:t agencies
1.
1-
WELL LOCATION:
Island M r1 L1,'
Tax Map Key
~-It>:03 Attach a plot plan
showing well location referenced to established property boundaries.
rJo"=DIA§e .
Telephone 3,{;l-b21-7o;q
Zip Code' 080/
2.
WATER USER
Address
3.
PROPOSED DRILLIN G COMPANY:
4.
PROPOSED WORK: MDrill new well
ODeepen
ORedrill
DAIter
DSeal
o Abandon Blnstall new pump OReplace pump OModify pump
...cD""""'-'8I....:v~1·-I,dr----i-P.J./~C--=O~____________
Fill in the diagram and briefly describe the proposed work (use back of form if necessary):
PROPOSED SECTION OF WELL
Elevali~ at top 0/ casing ~
/:2•
It .. msl.
Ground Elev.
1.:21,
It.. msl-
Cement
Grout
..JQ.tt. ------:~#_
Hole
Dia.
/
~
In.-----t--<~
I
Total
t..//
DepthULft. ---~
V
I I
Rock
Packlng~rt.----~I
I
I
I
(jJ.yc5
y
6
I
-Approximate elev. at filing. Final elev. (msl)
by a surveyor'licensed by the StDte must be
submitteu at start of construction.
OMunicipal
ZE'Domestic
Casing: 4'7 Perlorated D.ScTem
Material
~ ~O
Lellgth.:z I
r
Diameter
II
Wall thickness~ '~
,
Openings \
sq.ln./L ..
Open Hole:
A'"l.Length _ _ _-c:::;;r
_ _ _ __
Uiameter _ _ _ _ _ __
OMilitary
ODisposal
CJ Agriculture Dlndustrial
QOther (specify) _ _ _ _ _ _ _ _ __
5.
PROPOSED USE:
6.
PROPOSED AMOUNT OF WITHDRAWAL: Check most appropriate box and fill in amount.
94'Daily O(}O
gallons
OMonthly
gallons
OYearly
gallon:
/0 - 20
7.
t!
gallons per minu1
Signature:
For Official Use:
~, Signature:
3201- OS-
Landowner of Well Site
State Well No.
Date:
DLNR Permit No.
61 pf ~ 88
I
--------------------..,--------o£"o(jS/7LLJ
2/2V~1
DLNR Application No.
~#EC.Ic:.
@
,
I ;
,
DEPARTWT OF LAND AND NATURAL REIURCES
APPLICATION FOR (check one)
J&tWELL DRILLING PERMIT
DWELL MODIFICATION PERMIT
Send completed application and attachments to Department of Land and Natural
Resources. P. O. Box 3i3, Honolulu, Hawaii 96809.
Refel ence: Regulation 9, Dept. of Land & Natural Resources.
Instructions:
4
Is the well located in a Designated Ground Water Control Area?
_Yes
If "yes". application must be accompanied by a Water Use andlor Water Supply Permit and a
non-refundable filing fee of $100 payable to the Department of Land 6 Natural Resources.
ever, if application is for minor modification of well, filing fee may be waived. If "no". no
,.ffi)"W'-\
filing fee is required. Filing fee is
1.
wai~ed
for federal, state, and county governmex:t agencies
1-
WELL LOCATION:
Island f},) Ay I
Tax Map Key
~-IO:03 Attach a plot plan
showing well location referenced to established property boundaries.
NO«M ZlA[,.e
\
Telephone 31.1-~;2/-·70);f
Zip Code...;:,,;;...o-:..'3~f!)~/ _ __
.
2.
WATER USER
Address
3.
PROPOSED DRILLIN G COMPANY:
·1.
PROPOSED WORK: ~Drill new well
.crneepen ORedrill
CJAIter
OSeal
Abandon
Binstall new pump
OReplace pump
OModify pump
_.....I:])"'-&ool8Io..:v~1•....d,.;--_P.,.......,....;c.___O~____________
o
Fill in the diagram and briefly describe the proposed work (use back of form if necessary):
PROPOSED SECTION OF WELL
Elevali~ at top of casing ~
12•
It. • msl.
Ground Elev.
II .. msl·
p
Cement
Groul ~It.----:'-*
Solid CaSing:~~
Matenal
~ _U(
Lenglh
0)1
Diameter
In
Wall thickness ..J;, I,
1:1
7' /,.
Hole /
Dia._fO_ln. ----~~
I
I
Tolal U/
DeplhLLLft. ---~
V
Casing:
I
I
)L"~<JO
y
6
I
• Approximate elev. Ilt filillg. Final elev. (lIIsl1
by a surveyor licensed by the SlDle must be
submittel.l at start of conslructlon.
$7Perforale.d DScn:r:n
Malerial
~t/C
Lellglh
_ I
Diameter
Wall thickness
Openings
I I
I
Rock
Packing:e::fl. - -_ _~I
OMunicipal
lE'Domestic
!.l!
_
.?y "
II
'In
i~
sq.itJ./L.f
O~en
lIole:
F1.Length _ _ _-c:;"
_ _ _ _ _ 11
Uiameler
OMilitary
ODisposal
Ir
5.
PROPOSED USE:
6.
PROPOSED AMOUNT OF WITHDRAWAL: Check most appropriate box and fill in amount.
~Daily OdD
gallons
OMonthly
gallons
DYearly
gallom
/0 -
7.
\I
OAgriculture OIndu5trial
GOther (specify) _ _ _ _ _ _ _ _ __
gallons per minut
2{:)
Signature:
For Official Use:
~ Signature:
.39
Landowner of Well Site
State Well No.
Date:
DLNR Permit No.
Sf! pf ~ 88
I
I
at - 0 ~)
------------------
DLNR Application No.
C#ECJ<::' IJE/?()SI7'£/J
--;--:-----
e .1/27/(11
~V
.. ..: JV
41
40
39
Ahole Rock
38
KIPAHULU
BLAKE WELL
HANA
.. .
~
ISLAND OF MAUl
o
o
HAllA
PROJECT AREA
~
NORTH
=====:==-_....."
.'_oC::=i.~~~';
SCALE IN MILE
ISLAND OF MAUl
o
o
WAILUKU
HANA
ULUPALAKUA
PROJECT AREA
~
NORTH
..
2
0
4
SCALE IN MILE
I
12
ISLAND OF MAUl