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PUBLIC RECORD DATA
'Y TMK # 4-4-3-4-6
Owner: CALVARY CHAPEL KAUAI
Tax Payer: CALVARY CHAPEL KAUAI
Tax Bill: PO BOX 1062, KAPAA, HI 96746 USA
Exemption
Size
Assessed Value
$1,234,500
11.15 ac
Land:
$1,234,500
o sq ft
Total Buildings:
$0
$0
$1,234,500
Total:
$1,234,500
12/11/1981
1017/1991
2/11/2002
2/11/2002
QD
OHAI REUBEN M/JEAN M
AAS-F
LA VERNE D LEWIS/VADA B
*(17.94% INT)*
Buildings: 0
Dwellings: 0
Subdivision: Kapaa Rice & Kula Lots
Project:
Bedrooms/Baths: 0/0
Tenure: Fee Simple
Annual Tax: $25.00
Zoning: A
PITT Code: 500 - Agricultural
Land Use:
Census Tract: 402.02
Lot#: 6
SALES
$63,300 B/P 15520/644
$25,000 DOC 91-136310
o
$40,000 DOC 02-023242
QD
OHAI, JEAN M, TrusteeO
*REUBEN MILLER OHAI REVOCABLE LIVING TRUST
*AGREEMENT DATED MAY 4, 1988, UNDIVIDED 40%
*INTEREST, AND
*JEAN M. MILLER OHAI REVOCABLE LIVING TRUST
*AGREEMENT DATED MAY 4, 1988, UNDIVIDED 60%
*INTEREST
DEED
$400,000 DOC 02-023243
CALVARY CHAPEL KAUAI, A Company or Corporation(Tenants in Severalty)
This information has been supplied by third parties and has not been independently verified by Hawaii Information Service and is, therefore, not
uaranteed.
Copyright ©8/19/2008 by Hawaii Information Service
http://webrel.hawaiiinformation.comlREsearchiHIS/Searchisearch_ PUB.asp?SRC=LNK&STRM=TMK&KEY=443004006000... 8119/2008
.()..,
........
LINDA LINGLE
!
LAURA H. THielEN
GOVERNOR OF HAWAII
CHAIRPERSON
MEREDITH J. CHING
JAMES A. FRAZIER
NEAl S. FUJIWARA
CHIYOME l. FUKINO, M.D.
DONNA FAY K KIYOSAKI, P.E.
LAWRENCE H. MilKE, M.D., J.D.
KEN C. KAWAHARA, P.E.
STATE OF HAWAII
DEPUTY DIRECTOR
DEPARTMENT OF LAND AND NATURAL RESOURCES
COMMISSION ON WATER RESOURCE MANAGeMENT
P.O. BOX 621
HONOLULU, HAWAII 96809
October 3, 2008
/
0419-04 epic
Mr. Bruce Baumgartner
Calvary Chapel Kauai
P.O. Box 1062
Kapaa, HI 96746
Dear Mr. Baumgartner:
Certificate of Pump Installation Completion
Well CCK #1 (Well No. 0419-04) (TMK (4) 4-3-004:006)
We are pleased to inform you that the pump installation work permitted for Well CCK # 1
(Well No. 0419-04) is complete and acceptable, as of September 29,2008. Welcome to the
community of well owners and ground water users in Hawaii!
This certificate of pump installation completion allows you to pump your well on a
regular basis for reasonable and beneficial water use. To protect Hawaii's natural ground water
resources for the benefit of all, the following requirements apply to the use of your well:
1. If the well is not in use it must be properly capped.
2. If the well is to be abandoned then the landowner must cause a licensed contractor to
apply for a well abandonment permit in accordance with §13-168-12(f), HAR prior to
any well sealing or plugging work.
3. In the event that the well operator and/or landowner changes, the Commission shall
be notified prior to the change.
4. In the event the benchmark in the concrete base of the well is altered in any way, an
updated version of the Well Elevation page of the Well Completion Report Part I
shall be submitted to the Commission. If a licensed surveyor had estimated the
original benchmark elevation then a licensed surveyor must establish the new
benchmark elevation. The Well Elevation portion of the Well Completion Report
Part I can be obtained by contacting Commission staff or at
www.hawaii.gov/dlnr/cwrmlforms.htm.
,
Page 2
October 3, 2008
5 . Your approved pump has a capacity of 45 gpm at a head of 250 ft. In the future,
pump replacements of equal or lesser capacity will not require an additional permit
from the Commission, but will require the submission of a Well Completion Report
Part II by the licensed pump installer. If the pump replacement is greater than the
existing pump, you will need to apply for a new pump installation permit.
6. The landowner shall cause the well operator (if a different person) to maintain the
installed meter or other appropriate means for measuring and reporting withdrawals,
and appropriate devices or means for measuring water levels, chloride concentrations,
and water temperature. These data shall be measured monthly and reported to
the Commission on a annual basis, on forms provided by the Chairperson
(attached), in accordance with §13-168-7, HAR. Blank water use report forms can
also be obtained from the Commission's website at www.
hawaii.gov/dlnr/cwrmlresources---'permits.htm
7. The proposed use shall not adversely affect existing or future legal uses of water in
the area, including any surface water or established instream flow standards. The
authorization to drill a well and/or install a pump shall not constitute a determination
of correlative water rights. The landowner and well operator are notified that the
quantity of water taken from the well and/or the pump capacity could be reduced by
the Commission in the future.
8. In the event that your installed pump is less than 70 gallons per minute, and no
elevation survey has been completed, you may be required to do one in the future.
Because groundwater in Hawaii is a public trust, and adverse effects at one well may
affect other water resources, any violation of the above conditions, or any other provision of the
Hawaii Administrative Rules, may be subject to fines of up to $5,OOO/day. The Commission
needs your help and asks that you to do your part in utilizing this shared resource. We prefer to
work with you in meeting the goal of protecting our ground water resources together.
If you have any questions, please contact Denise Mills of the Commission staff at
587-0251 or toll-free from Kauai at 274-3141, extension 70251.
Sincerely,
~~:t!::.E.
Deputy Director
DM:ss
Encl: Water Use Report Forms
c: Kauai Department of Water
High Plains Drilling
I'
I.'
'~
COM~SION ON WATER RESOURCE MANAG~NT
FROM:
~
~--~~~------
INIT.
TO:
CHENG, C.
CHING, F.
CHONG, R.
DANBARA, S.
ENGLAND, D.
FUJII, N.
HARDY, R.
HOAGBIN, S.
ICE, C.
IMATA, R.
KAWAHARA, K.
KIMURA, J.
DATE:
IO/I/ui
--L-
SUSPENSE DATE:
~/
TO:
INIT:
KUNIMURA. I.
LEROUX, E.
MILLS, D.
OHYE, L.
OHYE, M.
OSHIRO, K.
SAKODA, E.
SWANSON, S.
TORRES, A.
UYENO, D.
YODA, K.
YOSHINAGA, M.
(06/08)
FOR:
_ _ Approval
Signature
~ Information
" I =--J
r-" : l
PLEASE:
See Me
Review & Comment
--'- Take Action
Type Draft
Type Final
-'-- File
___ Xerox _
copies
0
t"J
State of Hawaii
For Official Use Only:
COMMISSION ON WATER RESOURCE MANAGEMENT
Department of Land and Natural Resources
WATER METER INSTALLATION REPORT
DB SEP 29 AIO: I 5
Instructions: Please print in ink or type and send completed report (with attachments, if applicable) to the
Commission on Water Resource Management, P.O. Box 621 , Honolulu, Hawaii 96809. The Commission
may not accept incomplete reports. This form shall be submitted within 60 days of the completion of work.
For assistance, please consult the Hawaii Well Construction and Pump Installation Standards or call the
Regulation Branch at 587-0225. For updates to this form or additional information, please visit our website at
http://www.hawaii.gov/dlnr/cwrm/
State Well Number: 0419-04
Method of flow measurement:
D Flowmeter w/totalizer
Manufacturer
~I>' t}t.
, Model no.
CCJr) ~ H5 S~.,. _1;1 ~ (! H~v l' T!._ r:
t\FS',·d (cr r"!/,J; \(;tr;~ENT
/7()
Size - - - - - - -
D Other, explain below and attach schematic
/I.
Photograph as-built attached (required)
Remarks/explanations/comments:
How
Signature
/J?~&
J;,;4/
113'1t?h J ZBb
Date
---L4-+0_3_~+A_IJ,.;;;...J_ _
Water Meter Installation Report (WMIR)Form 212812007
/
c
o
~
,
-
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.n~~;:."
~
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Q
Denise E
MillslDLNRlStateHiUS
To <brueebaumgartner@ealvaryehapel,eom>
ee
10/01/200807:42 AM
MA ... •••••• ..•
bee
Subject RE: meter installation~
Bruce,
Thank you for the information. We need the model number and photos of the meter, and the installation
date. That is all information that you are required to include on the report.
Monthly measurements of water use are required by the State Water Code (Chapter 174C of the Hawaii
Revised Statutes), for all water uses in the state, regardless of use. We use this information to assess
whether an aquifer system is overallocated or not and may use the information to determine whether the
permitted use in any area should be reduced in order to sustain the viability of an aquifer system. We will
include more information on the reporting requirement with the certificate of pump installation completion
when we issue that.
I will watch for your meter installation report. Until we receive this, your well construction and pump
installation work is considered to be incomplete. We have allowed you to use the well water to preserve
your investment in the landscaping materials; however, please be aware that this was an accomodation of
your immediate need in July. My goal right now is to bring your well and current water use into
compliance with state regulations.
Please let me know if you have further questions. Thank you again, Denise
"Bruce Baumgartner" <[email protected]>
"Bruce Baumgartner"
<brucebaumgartner@calvaryc
hapel.com>
09/27/200808:00 AM
Please respond to
<brueebaumgartner@ealvarye
hapel,com>
To <[email protected]>
ee
Subject RE: meter installation
Denise,
Our flowmeter is installed and working fine. We can get about 47 gallons per minute. I've attached the
photos of the meter installed. It also shows the meters serial number. I will complete the printed form and
mail it with the photos via snail mail. The supplier has yet to invoice us for the cost of the meter so I
cannot send a copy of the invoice. The form doesn't mention anything about needing that, just photos.
Let me know if it's important.
Please educate us about the need to do monthly flow measurements. It seems unnecessary if we're
simply using the water for landscape and agriculture, returning it to the ground to fill the aquifers. Also, I
assume there is a form we fill out, so where do we get them and what date of the month do we need to
check the meter?
From: [email protected] [mailto:[email protected]]
Sent: Tuesday, September 23,20089:00 AM
To: [email protected]
Subject: meter installation
Hi Bruce,
I writing to see if your flowmeter has been installed on your well? We haven't received the meter
installation report yet. This work needs to be done to make sure your use of the well is in accordance with
our standards. Also, the meter is needed as means for making and reporting monthly flow measurements
as required by the State Water Code, Chapter 174C and Hawaii Administrative Rules, Section 13-168.
-Denise
Denise E. Mills
HYDROLOGIST
Hawaii Department of Land and Natural Resources
Commission on Water Resource Management
1151 Punchbowl Street, Room 227
Honolulu, Hawaii 96813
Phone: (808) 587-0251
[email protected]
Spam
Not spam DSC00158.JPG
DSC00155.JPG DSC00156.JPG DSC00157.JPG
o
o
"Bruce Baumgartner"
hapel.com>
09/27/200808:00 AM
Please respond to
hapel.com>
History:
To <Denise.E.Mills@hawaiLgov>
cc
bcc
Subject RE: meter installation
~ This message has been replied to.
Denise,
Our flowmeter is installed and working fine. We can get about 47 gallons per minute. I've attached the
photos of the meter installed. It also shows the meters serial number. I will complete the printed form and
mail it with the photos via snail mail. The supplier has yet to invoice us for the cost of the meter so I
cannot send a copy of the invoice. The form doesn't mention anything about needing that, just photos.
Let me know if it's important.
Please educate us about the need to do monthly flow measurements. It seems unnecessary if we're
simply using the water for landscape and agriculture, returning it to the ground to fill the aquifers. Also, I
assume there is a form we fill out, so where do we get them and what date of the month do we need to
check the meter?
Sent: Tuesday, September 23,20089:00 AM
Subject: meter installation
Hi Bruce,
-Denise
Denise E. Mills
HYDROLOGIST
Phone: (808) 587-0251
[email protected]
Spam
Not spam DSC00158.JPG
DSC00155.JPG DSC00156.JPG DSCO0157.JPG
o
Denise E
Mills/DLNRIStateHiUS
09123/2008 09:00 AM
Q
To [email protected]
cc
bcc
Subject meter installation
Hi Bruce,
-Denise
Denise E. Mills
HYDROLOGIST
Phone: (808) 587-0251
[email protected]
MEMO and
WCR
1.
ROUTE:.~LlP
Check for Well No.
pu,j;; Tests Check
0419-04
Diane England
-~4)eal~'Bl08/08
(ver. 07/03/2008)
(survey to regulation memo)
~initial}
Step-Drawdown Test:
followed WCPI Stds
analysis attached
Constant Rate Test:
followed WCPI Stds
analysis attached
o
o
o
o
o
o
o
Potential Well Interference:
Potential Stream Impacts:
Additional Testing or Data Required:
o
o
o
o
LAJc.tl.:L 0
F;~S'"",,1'M.i LL. (y
Pump Test Comments Attached: ~t!
"~
Proposed Pump Capacity is OK.:
2. Well Log Check
3.
0
GeOIOgYCOdefOrwelllnde~Fm Name: /4ft;A.~kS D. England~nitial)
cob~kuofio~~.MttCQ9hye
:..-. C7'(
~
/\'> ,',\,~ t '.);1 (~,l.i"
Yes
I
data complete
Jollowed Special Cond & elevations
well database updated
R. Torres _ _(initial)
(initial)
No
0
0
0
If no. describe deficiency
0
0
0
Longitude
Latitude
NAD27
NADa3
!ft/\
(initial) take action based on above analysis
ATTACHMENTS FOR PUMP INSTALLATION PERMIT (2x):
1COVER LETTER
2COUNTY COMMENTS (OWS/SMA)
300H COMMENTS
40LNR COMMENTS (LO/OCCUDHP)
5WCR ).Accept
PI..
__ not necessary - only WCP or BOTH.
}
<------ To
}
~
(in~heCk
To be sent to driller/pump installer
Landowner 40 Med-v ',~tdi()yL rq~+
~ tAu~ow~ b/f ttcapr
Staff internal checks W(t..1-- ~ (JJ~-tf!-
5. Roy
(Entered WCR 1IWCCC accept date into database)
6. Sus~
(initial) finalize
7. Ken
(imtial) signature
8. Mitch
(initial) signature (Entered PIP issue date if attached/required)
9. Charleeeni~yan File
C'·( "
........
.
f',! ,: ....".)
.~
.
'.
...
'.
~
.
,
'0
lot
'.1
,
.
1\
LAURA H. THIELEN
LINDA LINGLE
CHAIRPERSON
GOVERNOR OF HAWAII
MEREDITH J. CHING
JAMES A. FRAZIER
NEAL S. FUJIWARA
CHIYOME L. FUKINO, M.D.
DONNA FAY K. KIYOSAKI, P.E.
STATE OF HAWAII
OEPUTY DIRECTOR
P.O. BOX 621
September 4, 2008
0419-04 meter.ltr
Mr. Bruce Baumgartner, Associate Pastor
P.O. Box 1062
Kapaa, HI 96746
Water Meter Requirement & Notice of No Pumping for Well No. 0419-04
We have received the Well Completion Report Part II from your pump installation contractor
for Well CCK #1 (Well No. 0419-04), and found it to be acceptable with the exception ofthe
installation of a water meter. We have acknowledged that the pump installer's responsibilities for
this pump installation are complete, and no further action is required from the installer at this time.
We have sent a letter to your contactor to this effect and you will receive a copy for your record.
The pump installer has indicated that no water meter has been installed for this well.
Therefore, you are responsible for installing a water meter with a totalizer, and for completing the
attached water meter installation report form and submitting it to our office prior to pumping your
well. Upon our receipt of an acceptably complete water meter installation report, we will send you a
certificate of pump installation completion, which will allow you to begin pumping water from
this well on a permanent basis. Use of water from this well (for purposes other than testing) without
a certificate of pump installation completion is a violation and is subject to fines of up to $5,000 per
day.
If you have any questions, please contact Denise Mills of the Commission staff at 587-0251
or toll-free from Kauai at 274-3141 (Kauai), extension 70251.
Sincerely,
. ~t:~v
~
C. KA W
D puty Directo
DM:ss
Encl: Water Meter Installation Report
c: Marcus Fransden, High Plains Drilling
RA, P.E.
/
LINDA LINGLE
LAURA H. THIELEN
GOVERNOR OF HAWAII
CHAIRPERSON
MEREDITH J. CHING
JAMES A. FRAZIER
NEAL S. FUJIWARA
LAWRENCE H. MilKE, M.D, J.D.
STATE OF HAWAII
KEN C. KAWAHARA, PE.
DEPUTY DIRECTOR
P.O. BOX 621
September 4, 2008
0419-04 wcr2.acc
Mr. Marcus Fransden
P.O. Box 756
Rexburg,llD 83440
Dear Mr. Fransden:
Well Completion Report Part II for Well No. 0419-04
We received your Well Completion Report Part II for Well CCK #It(Well No. 0419-04) on
August 5, 2008. We accepted this report as complete on August 27,2008, With the exception of the meter
installation. We understand that the landowner and/or well operator is responsible for installing a water
meter on this well.
You should be aware that when we issued the well construction permit for Well No. 0419-04 in
January 2002, our policy at that time was to issue pump installation permits only after well construction
and testing was completed. After determining that well construction was done in compliance with the
Commission's established well construction standards, we then issued a pump installation permit
specifying the pump capacity approved for installation. Consequently, a pump installation permit was
never issued for this well. However, we changed our policy in 2004 and began issuing well construction
and pump installation permits at the same time for most new wells.
Because you performed work on Well No. 0419-04 nearly 4 years after we changed our permit
issuance policy and the work was completed before the well construction permit expired in January 2008,
we will accept your Well Completion Report Part II in this instance. In the future, however, when
performing well construction or pump installation work under permits issued prior to 2004, you should
contact our staff to verify the status of any permits covering the work or to determine if you need to apply
for and obtain a Commission permit before proceeding with the work to avoid being found in violation of
the State Water Code (§174C, HRS) or Hawaii Administrative Rules §13-7-168.
We will issue a certificate of pump installation completion to the landowner/well operator after
we receive documentation showing that the meter is installed and operational. Please remember that no
pumping for purposes other than well testing in accordance with the Hawaii Well Construction and Pump
Installation Standards is allowed until the certificate of pump installation completion has been issued.
If you have any questions, please contact Denise Mills of the Commission staff at (808) 587-0251
or toll-free from Kauai at 274-3141, extension 70251.
Sincerely,
~~w~
~:Uty Dlfec~tHA
DM:ss
c:
Bruce Baumgartner, Calvary Chapel Kauai
High Plains Drilling, Kauai
·
o
Q
MEMO and ROUTE SLIP (ver. 8/31/2007)
I WCR 1 Check for
Well No.
1. Pump Tests Check Diane
0419-04
10108/07
(survey to regulation memo)
WC/2.-i ~
England2k'~ial)
~ci...
~D~-f~-1
o
Step-Drawdown Test:
followed WCPI Stds
analysis attached
Constant Rate Test:
followed WCPI Stds
analysis attached
proposed pump cap o.k.
Q/ 0<70 gpm no teE
~
o
o
o
o
o
Potential Well Interference: ,",\JII'.~Y\Ov...)""l"\...
Potential Stream Impacts: lA-V'-'<:.~
~
o
o
o
o
v
Additional Testing or Data Required:
0<51 gpm no test required
~o
Pump Test Comments Attached:
2. Well Log Check Geology Code for Well Index:
\
6la.
Fm Name:
;
P
data complete
followed Special Cond & elevations /0 /
well database updated
q/
Ko \Q£A.. \10 IcsD. Englan<tbjwitial)
0
0
0
/r
Longitude
Latitude
NAD27
~ \
-\
,--
\ \.
\
NAD83
I
"
initial) take action based on above analysis (jj ~
~
~,~
~\n,{O\
~ not necessary - only WCP or BOTH.
ATTACHMENTS FOR PUMP INSTALLATION PERMIT (2x):
1COVER LETTER
2COUNTY COMMENTS (OWS/SMA)
300H COMMENTS
.
.
To be sent to driller/pump Installer
40LNR COMMENTS (LO/OCCUOHP)
<------ To Landowner
}
5.
6.
7.
8.
Staff internal checks
~
(inif
heck (Entered WCR 1IWCCC accept date into database)
Sus~ ---I-IIW~- (initial) finalize
Roy
Mitch
Charley/Ryan File
~
I
•
:5 '. '( h4;.-)
}
I) signature (Entered PIP issue date if required)
L '..... " '/'.
"
"/
I
LAURA H. THiElEN
LINDA LINGLE
GOVERNOR OF HAWAII
CHAIRPERSON
DEPUTY DIRECTOR
STATE OF HAWAII
MEREDITH J. CHING
JAMES A. FRAZIER
NEAL S. FUJIWARA
CHIYOME l. FUKINO, M.D.
P.O. BOX 621
August 18, 2008
0419-04 wcrl.acc
Mr. Marcus Fransden
P.O. Box 1227
Rexburg, ID 83440
Dear Mr. Fransden:
Well Completion Report Part I for Well No. 0419-04
We receiv~ your Well Completion Report Part I for the CCK #1 (Well No. 0419-04) on
October 2,2007, and the additional information we requested on August 1,2008. We are
pleased to acknowledge that this report is now complete and acceptable.
This completes your obligation under the well construction permit. A certificate of well
construction completion will be issued to the well operator/landowner and you will receive a
copy. This certificate transfers responsibility of specific aspects of well usage and maintenance
from you to the well operator/landowner.
If you have any questions, please contact Denise Mills of the Commission staff at (808)
587-0251 or toll-free from Kauai at 274-3141, extension 70251.
Sincerely,
DM:ss
c: Bruce Baumgartner, Calvary Chapel Kauai
Shook Lleuellen, High Plains Drilling
c
o
/
LAURA H. THIELEN
LINDA LINGLE
CHAIRPERSON
GOVERNOR OF HAWAII
MEREDITH J. CHING
JAMES A. FRAZIER
NEAL S. FUJIWARA
DONNA FAY K KIYOSAKI, P.E.
STATE OF HAWAII
DEPUTY DIRECTOR
P.O. BOX 621
August 18, 2008
f
0419-04.cwcc
Mr, Bruce Baumgartner, Associate Pastor
P.O. Box 1062
Kapaa, HI 96746
Certificate of Well Construction Completion for Well No. 0419-04 (TMK (4) 4-3-004:006)
We are pleased to inform you that the Well Construction work permitted for the CCK #1 Well (Well No.
0419-04) is complete and acceptable, and to welcome you to the community of well owners and groundwater users
in Hawaii.
To protect Hawaii's natural ground water resources for the benefit of all, the following requirements apply
to the use of your well:
I. Before this well can be pumped on a regular basis, a certificate of pump installation completion must
be obtained.
2. If the well is not in use it must be properly capped.
3. If the well is to be abandoned then the landowner must cause a licensed contractor to apply for a well
abandonment permit in accordance with §13-168-12(f), HAR prior to any well sealing or plugging
work.
4. In the event that the well operator and/or landowner changes, the Commission shall be notified prior to
the change.
5. In the event the benchmark in the concrete base ofthe well is altered in any way, an updated version of
the Well Elevation page of the Well Completion Report Part I shall be submitted to the Commission.
If a licensed surveyor had estimated the original benchmark elevation then a licensed surveyor must
establish the new benchmark elevation. The Well Elevation portion of the Well Completion Report
Part I can be obtained by contacting Commission staff or at www.hawaiLgov/dlnr/cwTmlforms.htm.
Because groundwater in Hawaii is a public trust, and adverse effects at one well may affect other water
resources, any violation of the above conditions, or any other provision ofthe Hawaii Administrative Rules, may
be subject to fines of up to $5,000/day. The CommiSSIOn needs your help and asks that you to do your part in
utilizing this shared resource. We prefer to work with you in meeting the goal of protecting our ground water
resources together.
If you have any questions, please contact Denise Mills ofthe Commission staff at 587-0251 or toll-free
from Kauai at 274-3141, extension 70251.
~
llWCvL-
~~A~'P.E
D~j~'~ctor
Sincerely,
DM:ss
c: Kauai Department of Water
Marcus Fransden, High Plains Drilling
State of Havai
-
WELL COMPLETION REPORT - PART II
AUG 5
____________
p_um~_ln_s_m_I_la_tiO_n
______________________________~8
Instructions: Please print in ink or type and send completed report (with attachments, if applicable) to t
Commission on Water Resource Management, P.O. Box 621, Honolulu, Hawaii 96809. The Commission
may not accept incomplete reports. This form shall be submitted within 60 days of the completion of work.
For assistance, please consult the Hawaii Well Construction and Pump Installation Standards or call the ( f l" ",.,
Regulation Branch at 587-0225. For updates to this form or additional information, please visit our website at! ..
http://www.hawaii.gov/dlnr/cwrm/,j
1. State Well No.:
aLi' ,-o~
ec...1<
Well Name:
I
z:t
2. Address:
t.L-
~
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KA."e:i
'3 - </ : (.
"fi) ,~t,("l )j,
3. Pump Installation Company:
4. Date Pump Installed:
!'"
Island:
Tax Map Key:
J..I. ,..-~ "" ?Li)r-~ A) ~
7 - z..o._·. 08 ,-'
i --
A
'
,
--mt!ithlday/year
..
5. PERMANENT PUMP INFORMATION
'i ~:>",bMAI'>i b...€. G.gJ'~,
Rated Capacity:
gpm
at head of:
~~
Motor Type, H.P., Voltage, rpm: ~ta r!\) i..lfl.a1Jo)
Pump Type, Make, Serial No.:
Z~O
31f>.
ft.
:z.C/ov
"S-oo~
Pump type (check one):
o
o
o
o
Deep Well Turbine
p("Submersible
o
Centrifugal
Rotary-Displacement
Rotary-Gear
,.
6. Method of flow measurement:
Flowmeter wi totalizer
Manufacturer
0
o
o
o
Rotary
Other, explain and attach schematic
. ,..,
~. ·~~;_·i
.j:;,...-
.
~' ,~~j-;.
'
Propeller
ReCiprocating
Impulse
.... r·
.....:;;
I
f;J.. \.
~: (...... -
\
\
Model no.
'10 "5Ft- f"2DV i J:r<b
""....
Size
'-)
~
f)u)A~ ~
..
7. Fill In the as-built section on the other side of this sheet.
8. Attach the rating curve for the insmlled pump.
9. Attach photograph of well clearly showing the benchmark on the concrete pad, the well head, and the
method of flow measurement.
10. Well Owner
CAJ~~ CIbp,.,lI<'ACIM Contact
K-6-eM ~ -PN?~ 1<oAv , ~A-A
Company
Address
Fax
Phone
11. Land Owner
Il,' 9k7'/b
I •
SkM~ ~ Itk.01.A-
Company
Contact
Address
Fax
Phone
12. Remarks
A (,
I
,
"
,
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,
,
{/:~
'
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.
;
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,
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I
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,
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'
.
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,,"
Pump Insmllation Contractor (print)
Signature
rIl h:l&J.6 ~~
n..-<,./.>- '~.
C-57/C-57a/A Lie. No.
Date
,"
/
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--
,
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Denise E
08112/2008 09:37 AM
To <brucebaumgartner@calvarychapel,com>
cc
bcc
Subject RE: Well No. 0419-04 -- incomplete work~
Aloha Bruce,
I've spoken with 'Shook' Lleuellen a couple times since our last communication. I understand he is trying
to help Marcus with the required paperwork for your well to resolve the outstanding issues.
We have received the information required to complete the Well Completion Report Part 1 (well
construction). You will receive a certificate of well construction completion within the next week or so.
want to give you a heads up that it contains our standard language, which may alarm you when you read
it, but I want to assure you we are taking your specific situation into consideration as we work with you and
your contractor to complete the required documentation for your well. The contractor is responsible for
meeting our well construction and pump installation requirements, including final reporting upon
completion.
~
( 1
We need to receive a Well Completion Report Part 2 for your well as soon as possbile to comply with our
• \...~\)'-' .i-.~egulations. I am attaching a blank Well Completion Report Part 2 form for your information. This must be
T:"' 1.)..)1 {\l~~'6ubmitted by the contractor who did the work. Please call if you have questions or any further concerns.
~. r}q;~
--Denise
~~'tDenise E. Mills
HYDROLOGIST
Phone: (808) 587-0251
[email protected]
WCR2.pdf
"Bruce Baumgartner" <[email protected]>
"Bruce Baumgartner"
hapel.com>
07/30/200809:23 PM
Please respond to
hapel.com>
To <[email protected]>
cc
Subject RE: Well No. 0419-04 -- incomplete work
Denise,
Thank you so much for helping us in our attempt to resolve this issue on our CCK #1 Well 0419-04. Let
me give you a brief synopsis of our situation:
We had contracted with High Plains Drillings a number of years ago to see us through the completion of
•
digging and pumping water for our 66 aces of agricultural land. We applied for and were granted a well
permit. We then began the process of applying for a Special Use Permit to build church facilities on the
top 12 acre parcel of land, and so we considered various locations for the well site, which lead to delays
and extensions of our well permit. In April of 2005 we were granted the Use Permit, which facilitated the
need for water to begin establishing our landscaping and agricultural crops, as well as on site water for
temporary facilities and construction of permanent facilities. High Plains Drilling finally had the time and
we determined the location to drill about a year ago. It has taken us quite a few months to acquire and
install a well pump and build a protective pump shed, and so we only began pumping water a few weeks
ago. We can pump about ~5-60 gallons of water per minute, and we have three large storage tanks that \ \ -J..vAt~L
we have been filling.
.
6~~ V"'"
W3... . 1l~@;
Calvary Chapel Kauai hired High Plains Drilling to handle every aspect of the permitting and testing
XbI
process, and we were billed by them upon completion of the pump installation. We have been under the ~"-~~
assumption that everything was done according to State requirements. We never received a copy of the
~
attached letter dated November 6, 2007, and so we had no idea anything was wrong, nor did our local well \\' _r; ~
digger who works for High Plains Drilling, "Shook" Lleuellen. I have been in touch with him, and he is
\l""~~'
committed to making sure all the proper paper work is completed and submitted, and he is very apologetic
for the problems he and his partners in Idaho have brought upon us. He can be reached at (808)
828-1194 or (808) 651-9165.
'NJ Y
Here is our newest dilemma. We recently acquired a few thousand dollars worth of landscaping material
(tress, shrubs and flowering plants, as well as vegetable and grass seed) and have just begun to water the
newly planted material.
.'"l
\\.9. '
When we received the letter dated July, 2008, we immediately stopped pumping water. We're quickly
using up the stored water and we are now in danger of loosing a few thousand dollars worth of plant
material, as well as the value of the labor to plant and maintain that material. You can help us to salvage
our investment. We are asking you to allow us to continue pumping from the well to fill our tanks and
water our lawns and newly planted material, as we seek to resolve the concerns you have brought to our
attention. We are willing to abide by a reasonable limit to the amount of water we can pump per week, as
long as it is enough to keep things alive.
Denise, please consider our dilemma of not knowing we were in violation as we began pumping water, as
well as our efforts to complete the permitting process and grant us the pumping allowance.
Thank you for your consideration.
Bruce Baumgartner, Associate Pastor
P.O. Box 1062
Kapaa, HI 96746
(808) 821-2228 office
(808) 652-4831 cell
Sent: Wednesday, July 30,20083:18 PM
Subject: Well No. 0419-04 -- incomplete work
Aloha Bruce,
Charley told me that you called yesterday and today about the expiration notice we sent to High Plains
Drilling last week. We're glad you're following up and that you're willing to help resolve the outstanding
issues related to your well work. Attached to this message is a scanned copy of a notice we sent to High
Plains Drilling in November 2007, explaining the deficiencies in the Well Completion Report Part I.
>-
o
o
A question I have for you is, What are your plans for pump installation? The initial application was for both
well construction and pump installation, but the pump installation permit was never issued.
Your help is greatly appreciated! Please call me to discuss this matter further. I will be happy to provide
what assistance I can to help wrap this up.
--Denise
Denise E. Mills
HYDROLOGIST
Phone: (808) 587-0251
[email protected]
'\
COMMISSION ON WATER RESOURCE MANAGEJENT
FROM:
.ROY
TO:
INIT.
CHENG, C.
CHING, F.
CHONG,R.
DANBARA, S.
ENGLAND, D.
FUJII, N.
HARDY, R.
HOAGBIN, S.
ICE,C.
IMATA, R.
KAWAHARA, K.
KIMURA, J.
AUG -1 2008
DATE:
TO:
SUSPENSE DATE:
INIT:
+
MILLS,D.
_ _ OHYE, L.
OHYE, M.
OSHIRO, K.
SAKODA, E.
SWANSON, S.
TORRES, R.
UYENO, D.
YODA, K.
YOSHINAGA, M.
wU'2.1
03J\J~ '-p(i"
\tV
•
V'-'
II
1
·•..
{tl-U1
.-\ "":'' -::;'-.>
t. (
.V
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FOR:
, ... ,
hbk H~
·f..., ~.
'.
W(I
Ct,</<.
See Me
Review & Comment
Take Action
Type Draft
_ _ Type Final
File
Xerox _
copies
('«1'17
(h.r:
I,
~"
I
11
PLEASE:
_ _ Approval
Signature
Information
KUNIMURA. I.
LEROUX, E.
~ VJ~
(06/08)
1.'/ ;
f."
rk,~ bt~
I
t
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DB AUG I
Frs"':
A7 :
!IS~tf'" (ll,l U.lj~ 1"1\
~c: ~., ~)/ r ~.,~.;~,l~~Et'~·T
Denise Miles
C.W.R.M.
P.O.B. 621
Honolulu, Hi 96809
Concerning CCK #1 (Well # 0419-04), The proposed pump rate is to be
under 50 gpm and we would ask that the constant rate pump test be waived.
Also the depth of the well is due to the fact that is where first water was found in
rock, we were hoping it would less deep, we would ask for a variance from the
theoretical depth be granted .
Thank You
Marcus Frandsen
P.O.B.1227
Kilauea, Hi 96754
7-31-08
Could you please send me a copy of the Pump Permit if the above is satisfactory.
, , ..~
"
59
,. .
o
o
Q
08 JUL 30
Com. On Water Resource Mangmt.
v
Concerning well 1119-02 MBLC Well, has a static water level of
5.23 feet MSL. The well is 80 feet deep and the starts at 24.1 feet msl. I
I thought that it calculates out. The depth is equal to or less than the neighboring
three wells. This was also the depth the first water was found in rock.
Concerning the pump test, I must have somehow assumed that because of the
low gpm pump proposed that it was waived as it had been in the past. I would
request a waiver of the pump test for the MBLC Well ( 1119-02) , CCk # 1 Well
Thank You,
Marcus Frandsen
P.O. Box 1227
Kilaeua, Hi. 96754
1-~,
. og
A 9:
07
o
o
"Bruce Baumgartner"
hapel.com>
07/30/2008 09:23 PM
Please respond to
hapel.com>
~~~
To <Denise.E.Mills@hawaiLgov>
cc
bcc
Subject RE: Well No. 0419-04 -- incomplete work
Denise,
Thank you so much for helping us in our attempt to resolve this issue on our CCK #1 Well 0419-04. Let
me give you a brief synopsis of our situation:
~
,
~Q;
~\~
ViS
.,l'n .'
We had contracted with High Plains Drillings a number of years ago to see us through the completion of
digging and pumping water for our 66 aces of agricultural land. We applied for and were granted a well
permit. We then began the process of applying for a Special Use Permit to build church facilities on the
top 12 acre parcel of land, and so we considered various locations for the well site, which lead to delays
and extensions of our well permit. In April of 2005 we were granted the Use Permit, which facilitated the
need for water to begin establishing our landscaping and agricultural crops, as well as on site water for
temporary facilities and construction of permanent facilities. High Plains Drilling finally had the time and
we determined the location to drill about a year ago. It has taken us quite a few months to acquire and
install a well pump and build a protective pump shed, and so we only began pumping water a few weeks
ago. We can pump about 55-60 gallons of water per minute, and we have three large storage tanks that
we have been filling .
Calvary Chapel Kauai hired High Plains Drilling to handle every aspect of the permitting and testing
process, and we were billed by them upon completion of the pump installation. We have been under the
(\ ,,~. ~ assumption that everything was done according to State requirements. We never received a copy of the
u-r~" ttached letter dated November 6, 2007, and so we had no idea anything was wrong, nor did our local well
digger who works for High Plains Drilling, "Shook" Ueuellen. I have been in touch with him, and he is
committed to making sure all the proper paper work is completed and submitted, and he is very apologetic
, ,.
for the roblems he and his partners in Idaho have brought upon us. He can be reached at (808)
\/\
828-1194. r(808) 65~-916~*
rtLV~
, \ 1\
t a:;
(Shoo ~ lJ\.e...ll ~ '-cUi ~ 1'YV\ NY)', \J
J--'\\t1-lere is our newest dilemma. We recentl~aL!quired a fijw thousand dollars worth of landscaping material
'N~'
(tress, shrubs and flowering plants, as well as vegetable and grass seed) and have just begun to water the
\'IN
...... newly planted material.
~
1
...
,N\i5
0'J--' \
W
(li
.~ i~ When we received the letter dated July, 2008, we immediately stopped pumping water. We're quickly
~""" ~
using up the stored water and we are now in danger of loosing a few thousand dollars worth of plant
plP. / material, as well as the value of the labor to plant and maintain that material. You can help us to salvage
Ai ['
t~ our investment. We are asking you to allow us to continue pumping from the well to fill our tanks and
~(1J'/
~,
.HJ~
j- '" ./
, '" N\iU
\lJ'v
water our lawns and newly planted material, as we seek to resolve the concerns you have brought to our
attention. We are willing to abide by a reasonable limit to the amount of water we can pump per week, as
long as it is enough to keep things alive.
Denise, please consider our dilemma of not knowing we were in violation as we began pumping water, as
well as our efforts to complete the permitting process and grant us the pumping allowance.
:.0) fl!~nk you for your consideration.
Bruce Baumgartner, Associate Pastor
P.O. Box 1062
Kapaa, HI 96746
(808) 821-2228 office/)(?
(808) 652-4831 cell
tClLuvvA:tl>.rV\w
- - . --<J'-"
Sent: Wednesday, July 30, 2008 3: 18 PM
Subject: Well No. 0419-04 -- incomplete work
Aloha Bruce,
--Denise
Denise E. Mills
HYDROLOGIST
Phone: (808) 587-0251
[email protected]
.
....
o
Denise E
07/30/200803:17 PM
o
13 Yl(CG-8autytqJ CuCh'1U
To [email protected] A
cc
Y1 ~T
bcc
Subject Well No. 0419-04 -- incomplete work
tP (I....fi,+tJ.r
(6of) ~ 1.J - 22LX
Ctl! l'gvg') 002-- -+1?3 i
Aloha Bruce,
--Denise
Denise E. Mills
HYDROLOGIST
Phone: (808) 587-0251
[email protected]
-m
0419-04 well pdf
o
o
/
LINDA LINGLE
LAURI\ H. THIELEN
GOVERNOR Of' HAWAII
CHAIRPERSON
DEPUTY DIReCTOR
STATE OF HAWAII
MEREDITH J. CHING
JAMES A. FRAZIER
NEAL S. FUJIWARA
DONNA FAY K KlYOSAKI, P.E.
P.O. BOX 621
November 6, 2007
0419-04.wcrl
Mr, Marcus Frandsen
P,O, Box 756
Rexburg, ID 83440
Dear Mr, Frandsen:
We have received your Well Completion Report Part I for the CCK #] Well (Well No. 0419-04).
However, matters which must be addressed before we can accept your report as complete are as follows:
1. The elevations given in your as-built sectional drawing show that the bottom elevation of the well
exceeds the \4 aquifer thickness limitation, which is not in compliance with Section 2.2 of the Hawaii
Well Construction and Pump Installation Standards (2004), which states:
\.\
'. ~
"Exceptfor salt-water wells, any well constructed in basal aquifersfor the purpose of
nonpotable or potable water withdrawal shall be initially designed and pump tested at a
depth below sea level not exceeding one-fourth ofthe theoretical thickness (41 times the
head) ofthe basal ground-water body, unless authorized by the Chairperson. Upon request
by the permittee and submission of the supporting data and analysis, the Chairperson may
allow deepening and subsequent testing ofsuch wells to a depth below sea level not
exceeding one-half of the theoretical thickness of the basal ground-water body. "
'
Please provide your reason(s) why the depth limitation was exceeded and why prior approval was not
obtained in advance.
"
2. Please provide the data for the constant rate test to support the installation of a pump with a capacity
greater than 50 gpm.
,
'- "
.
\'
,
Until these matters are addressed, we cannot issue the certificate(s) of well construction completion
and/or pump installation completion that transfer(s) responsibility of all aspects of well usage and maintenance to
the well operator/landowner. Please remember that the well may not be pumped for purposes other than well and
aquifer testing until the certificates of I) well construction completion and 2) pump installation completion have
been issued, otherwise such pumpage would constitute a violation of the penn it conditions. Since the penn it is
issued to the contractor, the contractor will be responsible for any non-testing pumpage violations when the
certificates of completion have not been issued (where pumping tests are as defined in the Hawaii Well
Construction and Pump Installation Standards). Please respond to the above item(s) within thirty (30) days of this
letter's date. Failure to do so may result in fines of up to $5,000 per day.
If you have any questions, please contact Lenore Nakama of the Commission staff at (808) 587-02] 8.
Sincerely,
W.fln
1't
Deputy Director
LN:ss
o
LINDA LINGLE
LAURA H. THIELEN
GOVERNOR OF HAWAII
CHAIRPERSON
MEREDITH J. CHING
JAMES A. FRAZIER
NEAL S. FUJIWARA
LAWRENCE H. MilKE, M.D., J.O.
KEN C. KAWAHARA, PE.
STATE OF HAWAII
DEPUTY DIRECTOR
P.O. BOX 621
July 16, 2008
0419-04.wcp.exp
Mr. Marcus Frandsen
P.O. Box 756
Rexburg,ID 83440
Dear Mr. Frandsen:
Expiration of Well Construction Permit
Calvary Chapel Well #1 (Well No. 0419-04)
Our records indicate the captioned well construction permit has expired with incomplete
work. An incomplete well completion report was acknowledged by our office on November 6,
2007, without any reply from you. There is no pump installation permit and we have no
information about any pump installation work.
No further work should be done on this well without appropriate permits, and the well
completion certificate cannot be issued to the well owner without first completing the incomplete
items noted in our November 6, 2007 letter. No water shall be used from this well without
proper permitting and certification, subject to fines of up to $5,000 per day.
Please respond to this letter within 30 days of receipt to clarify the status of this well.
If you have any questions, please contact Charley Ice of our staff at (808) 587-0218.
Sincerely,
t?~;i::::::
Deputy Director
CI:ss
c: Calvary Chapel Kauai
/
/
LINDA LINGLE
LAURA H. THIELEN
GOVERNOR OF HAWAII
CHAIRPERSON
KEN C. KAWAHARA. P.E.
DEPUTY DIRECTOR
STATE OF HAWAII
MEREDITH J. CHING
JAMES A. FRAZIER
NEAL S. FUJIWARA
CHIYOME L. FUKINO. M.D.
DONNA FAY K. KIYOSAKI. P.E.
LAWRENCE H. MilKE. M.D .. J.D.
po. BOX 621
HONOLULU. HAWAII 96809
November 6, 2007
0419-04.wcrl
Mr. Marcus Frandsen
P.O. Box 756
Rexburg, ID 83440
Dear Mr. Frandsen:
We have received your Well Completion Report Part I for the CCK #1 Well (Well No. 0419-04).
However, matters which must be addressed before we can accept your report as complete are as follows:
1. The elevations given in your as-built sectional drawing show that the bottom elevation of the well
exceeds the 114 aquifer thickness limitation, which is not in compliance with Section 2.2 of the Hawaii
Well Construction and Pump Installation Standards (2004), which states:
"Exceptfor salt-water wells, any well constructed in basal aquifers for the purpose of
nonpotable or potable water withdrawal shall be initially designed and pump tested at a
depth below sea level not exceeding one-fourth of the theoretical thickness (41 times the
head) of the basal ground-water body, unless authorized by the Chairperson. Upon request
by the permittee and submission of the supporting data and analysis, the Chairperson may
allow deepening and subsequent testing of such wells to a depth below sea level not
exceeding one-half of the theoretical thickness of the basal ground-water body. "
Please provide your reason(s) why the depth limitation was exceeded and why prior approval was not
obtained in advance.
2. Please provide the data for the constant rate test to support the installation of a pump with a capacity
greater than 50 gpm.
Until these matters are addressed, we cannot issue the certificate(s) of well construction completion
and/or pump installation completion that transfer(s) responsibility of all aspects of well usage and maintenance to
the well operator/landowner. Please remember that the well may not be pumped for purposes other than well and
aquifer testing until the certificates of 1) well construction completion and 2) pump installation completion have
been issued, otherwise such pumpage would constitute a violation of the permit conditions. Since the permit is
issued to the contractor, the contractor will be responsible for any non-testing pumpage violations when the
certificates of completion have not been issued (where pumping tests are as defined in the Hawaii Well
Construction and Pump Installation Standards). Please respond to the above item(s) within thirty (30) days of this
letter's date. Failure to do so may result in fines of up to $5,000 per day.
]fyou have any questions, please contact Lenore Nakama of the Commission staff at (808) 587-0218.
Sincerely,
WFrH
1'1.
Deputy Director
LN:ss
o
o
Pump Test Analysis - Comments
Well ID:
Date:
Geologist:
0419-04
10/22/07
Diane England
Step Drawdown Test
1. Proposed pump capacity <70 gpm, no step drawdown test required. \
Constant Rate Pumping Test
1. Proposed pump capacity >50 gpm, constant rate test required. Constant Rate
Test data should be provided to CWRM.
(J)D !f fi nc ..
.J ",")1 '/1,1,.
Well Interference & Stream Impacts
1. Constant Rate Test data required to determine potential for stream and well
impacts.
Other
1. The total well depth (140 ft) exceeds the 'i4-thickness of the aquifer. Maximum
allowable well depth is 64 ft. Request for variance required.
0
State of HaOtii
RECE!VED
WELL COMPLETION REPORT - PART I
Well Construction
01 OCT 2 AIO: 49
Instructions: Please print in ink or type and send completed report (with attachments, if applicable) to the
Commission on Water Resource Management, P.O. Box 621, Honolulu, Hawaii 96809. The Commission may
not accept incomplete reports. This form shall be submitted within 60 days of the completion of work. For
assistance, please consult the Hawaii Well Construction and Pump Installation Standards or call the Regulation
Branch at 587-0225. For updates to this form or additional information, please visit our website at
~ttp:flwww.state.hi.usldlnr/cwrml
1. State Well No.:
0419-04
Well Name:
CCK #1
~~~~--------------------
2.
Address:
3.
Drilling Company:
4.
Drilling method used during contruction:
5.
Date Well Construction (drilled,cased,grouted) completed:
Kapaa Bypass Road
Island:
Kauai
4-3-4:6
Tax Map Key:
i
j.:.~.-., .rr_--.:.i-r..!..i''':';'.",f--\~"'---'-~~·).l..::..::·.~t:4-.!...:1,.::::.,,~.-~,----,<l .....-:::..':.:::.'-~::!..:::::::;,'~'
'r----------------------------•
R
1
y'Rotary'
o
Percussion 0 Other (describe)
t·,
-.0.
1
Fill out attached Driller's Log
month/clay/year
In addition to the driller's log, If a geologic log was prepared, please submit with this form.
.~ Yes
6.
Was the subject well cored?
7.
Initial water-level encountered
Ii
)i No
S~J
ft. below ground
1 - 2.q~ '-' 1
Date and time of measurement:
f
1. ~;.
monthldaylyear time
8.
Step-Drawdown Test completed?
IZl No
0 Yes
Attach Step-Drawdown Test fo"" (12117/97 SDPTD Form)
9.
Constant Rate Aquifer Test completed?
0' No
0 Yes
Attach Constant Rate Aquifer Test fo"" (12117/97 CRPTD Form)
Parameters prior to pump test:
10. Water-level:
i..{N
ft. above msl
8. -I,' ~ ;;, I
month/day/year time
11. Chloride:
ppm
--'t':::...
.. .."...:,I,II_--;-"'~t--:-:- ____
month/daylyear time
Date and time of sampling:
12. Temperature: _______".:...F_,\v_'___
...'i:<, -- II .
0',
month/day/year time
13. Fill in the as-built section on the other side of this sheet.
14. Fill in attached surveyor's report.
15. If a pump is not planned to be installed, please describe (below in the remarks section) how well is secured to
prevent unauthorized access (example: lockable cover, threaded coupling, etc.)
16. The proposed manufacturer's rated pump capacity is
~
i
/
'.>
gpm at a head of
~
,.....0':'
ft.
17. Remarks:
Licensed Driller (print)
Signature
·nlf;{q.lL,J r [WI;;'" t:' b
C-57 Lic. No.
Date
--".J.~2:::::....,.7;...,.;;.....
··; ....
{ _ _ _ _ __
91-21-07
Permittee (print)
Signature
Date
weR1 Fonn 9112101 Page 1 of 4
o
jlD2
13. AS-BUILT \I\W.....L SECTION
(Please a~ach as-built if.different 'Oiagram provided below)
""
_ Hole Diameter:
' 't
tn.
Elevation at top of casing L(.,· -ft, ft., msl*
..--*------.l
(to nearest 0.01 ft.)
__L~_
~+--'
Minimum of 2' Radius & 4" Thick Concrete Pad
____ .___...~_;<._:..
Bench mark
elevation:
-------~----~
i-
-"0»> , .. , '~!f::
.~~,!
<.):':~~.---.
_Ground Elevation: ,1. f,'c,
l..'.'
ft., msl
/
.--~."':.
Please refer to the
.'
::'.1/
J
I ft .• ms'*
(Survey to nearesi
0.01 ft.)
Cement Grout: ! j : ;
ft.
(min. 70% of distance from
ground elevation to top of
water surface or 500 ft.,
whichever is less.)
--."
HAWAII WELL CONSTRUCTION AND
PUMP INSTALLATION STANDARDS
::. f
':~.:.:
to ensure that your as-built is in compliance
with applicable standards.
'. "
::.<1..
,:-'.
-
Solid Casing: (;:: 90% x (Ground Elev.-Water Level Elev»)
Annular space between
hole and casing (min.3"):
-J.-:!-
Wall Thickness:
'0
51
01
Bottom Elevation:
ft.
!-j
Nominal Diameter:
I~J/ .
in.
{ ':2c
Length:
in.
)'''1
- J~;
in.
"/1
ft., msl
~I
Q.I
x
Rock or Gravel Packing:
:..:
>\
,..,.- .If
Total Depth
I i (.
ft.
~
ft.
o
en
Material:
o
o
t,
o
j:r"Perforated
Screen
'z..::.
Crushed Basalt
Length:
Rounded Gravel
Nominal Diameter: __'LI ________ in.
I
.r.
Water Level Elevation:
tl
Open Casing:
N
74
ft. msl*
t
-,-
ft.
Wall Thickness:
0;
Bottom Elevation: - I
21 j 1
in .
ft., msl
-+
Open Hole:
Length: _ _ _ _ _ _ _ _ _ _ _ _ _ ft.
Diameter: _ _ _ _ _ _ _ _ _ _ _ _ _ in.
-,
L. _________.______ _
*msl
Bottom Elevalion: _ _ _ _ _ _ _ _ _ ft., msl
= mean sea level
~\
Solid Casing Material:
Carbon Steel: compliant with (check one or more): 0 ANSIIAWNA C200
And compliant with (check one or more):
Stainless Steel: (check one):
0 ASTM A242
0 API Spec. 5L
0 Type E
0 ASTM A409 (production wells)
ABS Plastic conforming to ASTM F480 and ASTM 01527: (check one)
0 ASTM A 139
0 Grade B
0 Other
0 ASTM A312 (monitor wells)
jfSchedule 40
PVC Plastic conforming to ASTM F480 and (ASTM 01785 or ASTM 02241): (check one):
Thennoset Plastic: (check one)
0 ASTM A53
0 Type S
0 Schedule 80
.Il'Schedule 40
0 Schedule 80 0 Schedule 120
o 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 10 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 ASTM A242
0 API Spec. 5L
0 Type E
0 ASTM A409 (production wells)
ABS Plastic conforming to ASTM F480 and ASTM 01527: (check one)
0 ASTM A 139
0 Grade B
0 Other
0 ASTM A312 (monitor wells)
0 Schedule 40
Thennoset Plastic: (check one)
0 ASTM A53
0 Type S
0 Schedule 80
)~'Schedule 40
0 Schedule 80 0 Schedule 120
o 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
weR1 Form
9112101 Page 2 of 4
/
, ...t
·TO
r
"t.,
DRILLER'S LOG
VVELL NUMBER: D 1
Depths (ft.)
! q - c "1
Rock Description, Water Level,etc.
') f:,; '-..,
- - to -i - ----~-----,
-Lto
,•
'"',.
.
Dates
"
.
i 'J,- ~
--:.--
'-,
Rock Description, Water Level, etc.
Dates
_ _ to _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
_ _ to _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
0:"';
.~ 1.... '
Depths (ft.)
'J-';'
. ~.$
~/
\;, ~_ '0
" 7'v hi .. ,'_
i f Gte,_
- '..,_ _
_
, _,,_,_~_,J'o_ _ _ _ _ _ _ _ _ _'_'--0.,;.'
"'1
"';
.-' ...- ..::-;
(..i:
_ _ to _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
__ w_____________ ____
_ _ to _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
_ _ to _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
_ _ to _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
_ _ t o _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
_ _ to _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
__to _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
_ _ to _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
_ _ t o _ _ _ _ _ _- - - - - - - - ____
_ _ 10 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
__to _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
_ _ to _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
_ _ t o _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
_ _ to _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
__to _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
_ _ to _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
__to _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
_ _ to _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
__to _ _ _ _ _ _ _ _ _ _
_ _ 10 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
_ _ t o _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
_ _ to _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
_ _ t o _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
_ _ 10 _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
__to _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
_ _ to _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
__to _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
_ _ to _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
__to _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
~
______
Remarks:
WCR1 Form 9112101 P8ge 3 of 4
o
Well Elevation 0
r-r
'-
Benchmark Elevation
1)$ -0 q
-~
k
....
i
I
1
Attach photos of completed well and concrete pad showing benchmark location.
I certify that the elevation shown above:
1) Was done in accordance with acceptable surveying practices
2) Is accurate to the nearest 0.01 ft.
3) Is referenced to mean sea h.:vel
/
'\
i
/ ,
I
../ f;1
""- !
Surveyor
License No.
Date
"
I
0
o
!
J
~
I
!,,
!
;
~
~
f
i
II
I
I
o
N 2~
04·31&
'W IScf I q
. 54-4
I EXA.MPLE
I'
:.r(.~"~l'<"', ""~
Lat: 19"36'45"
_"c..
Long: 154°57' 18"
U
1zc
~
"::..,.-~'
"
,t
SKETCH OF WELl. LOCATION
(Referenced to permanent landmark, i.e. building, road, fence, etc.)
Provide Latitude and Longitude of well referenced to NAD83 to nearest second
weR1 Form 1117106 Page 4 of 5
,. . ,
0
Cafvary Cfiapef Xauai
~
,
'ProcCaiminn J-fispraises in tlie isCandS
March 1, 2006
Dean Nakano
Acting Deputy Director
P.O. Box 621
Honolulu, HI 96809
C"-:l
Dean,
Mahalo for granting us an extension on our well construction permit. It was a great blessing to
receive your letter. We will be sure to contact Lenore Nakama should we have any questions.
Associate
r
Project Coordinator
Page 1
Phone: (808) 821·2228
•
Fax: (808) 822-7796
•
P.O. Box 1062 Kapaa, HI 96746
•
Email: [email protected]
/
LINDA LINGLE
PETER T. YOUNG
GOVERNOR OF HAWAII
CHAIRPERSON
MEREDITH J. CHING
JAMES A. FRAZIER
NEAL S. FUJIWARA
CHIYOME L. FUKINO. M.D.
LAWRENCE H MilKE. M.D .. J.D.
STEPHANIE A. WHALEN
STATE OF HAWAII
DEAN A. NAKANO
ACTING DEPUTY DIRECTOR
P.O. BOX 621
February 24, 2006
Ref: 0419-04.ext
Associate Pastor, Land Project Manager
P.O. Box 1062
Kapaa, HI 96746
This is in response to your February 8, 2006 letter, requesting an extension of the Well
Construction Permit for CCK #1 Well (Well No. 0419-04), which expired on January 23, 2006.
According to your letter, there have been unplanned delays in securing a well drilling contractor
to perform the work.
Your request has been approved. The new expiration date for the Well Construction
Permit is January 23, 2008. /
We have received a copy of the permit executed by Mr. Marcus Frandsen of High Plains
Drilling. If you decide to hire another contractor, please do not forget to have the new contractor
sign another copy of the permit, and return it to us, prior to the start of any work.
If you have any questions, please contact Lenore Nakama at 587-0218.
Sincerely,
Wf7H
1'1DEAN A. NAKANO
Acting Deputy Director
LYN:ss
C
0
CaEvary Chape{ Xauai
ProcCaimine :J{is praises in tfie isCantfs
February 8, 2006
Ernest Y. W. Lau, Deputy Director
P.O. Box 621
Honolulu, HI 96809
RE: CCK#I, Well No. 0419-04
Dear Mr. Lau:
We would like to request an extension to our Well Construction Permit referenced above. There
have been unplanned delays in securing a well digging contractor to perform the work.
Sin¢ely,
C 1,V: Y CHAPEL KAUAI
cc: Robert Hallman, Pastor
Page 1
Phone: (808) 821-2228 •
Fax: (808) 822-7796
•
•
Email: [email protected]
LINDA LINGLE
PET£R T. YOUNG
GOVERNOR OF HAWAII
CHAIRPERSON
MEREDITH J. CHING
CLAYTON W. OELA CRUZ
JAMES A. FRAZIER
STEPHANIE A. WHALEN
ERNEST YW. LAU
STATE OF HAWAII
DEPUTY DIRE-CrQR
P.O. BOX 621
February 20, 2004
Ref:0419-04.let
P.O. Box 1062
Kapaa, HI 96746
This is in response to your letter dated February 10,2004, requesting an extension of time
to complete the work authorized under the Well Construction Permit for Well No. 0419-04. We
understand that construction was delayed due to changes in the type and extent of development
first envisioned, well placement concerns (regarding the presence of cesspools), and changes in
personnel at the church.
Your request is hereby approved. The new expiration date for the well construction
permit is January 23,2006/ Please be aware that the Hawaii Well Construction and Pump
Installation Standards have been updated, and you should comply with these new standards. A
copy can be found at our website at www.state.hi.us/dlnr/cwrm/rules/wellstnd.pdf.
If you have any questions, please contact Lenore Nakama at 587-0218 or toll-free at
274-3141, extension 70218.
Sincerely,
ERNEST Y.W. LAU
Deputy Director
LN:ss
o
o
MEMORANDUM FOR THE RECORD
FROM:Lenore Nakama
SUBJECT:
Request for Extension of Well Construction Permit (or Well No. 0419-04
2/17/04 Called Bruce Baumgartner to ask for a brief explanation for the need for an
extension (per Standard Condition 10 which requires a showing of good cause and
good-faith performance).
Bruce explained that there were several reasons for the delay. They were at first
working on developing 2 lots on 56 acres, so there were a lot of placement questions
and issues. They have since decided to concentrate only of the upper lot, so they have
changed the type of development first envisioned. They have also been working on well
siting to avoid being near existing cesspools. Lastly, there have been changes in the
personnal at the church. John Young, our contact for the permits, has had extensive
back surgery and has been away. He is not expected to return for another month at
least.
Bruce said they would like a 2-year extension of time.
o
o
CCP'~·iS..r~~\,i:~I~l r'(:~' ~Jr.!\~~~~
February 10, 2004
RF
,'JLI",,'
""",,·,[1,
Water Resource Management
Commission Chairperson
P.O. Box 621
Honolulu, ill 96809
RE: CCK #1, Well No. 0419-04
Dear Commission Chairperson:
We would like to request an extension to our Well Construction Permit referenced above.
cc. Robert Hallman, Pastor
Phone: (808) 821-2228
E-Mail: [email protected]
c
r
March 13, 2002
Water Resource Management
Commission Chairperson
P.O. Box 621
Honolulu, Hi 96809
Dear Commission Chairperson:
Our intent is to start this work within 2 weeks. /
~:~;?It~~
~Z-M. Galv;P'
Secretary
Phone: (808) 821-2228
E-Mail: [email protected]
OWEll CONSTRUCTION PERMIT(J
CCK#1, Well No. 0419-04
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 construction and testing of C(3,K
#1 (Well No. 0419-04) at Kapaa Bypass Road, Kauai, TMK 4-3-4:6, subject to the Hawaii Well Construction & Pump Installation
Standards (1/23/97) which include but are not limited to the following conditions:
1.
The Chairperson of the Commission on Water Resource Management (Commission), P.O. Box 621, Honolulu, HI 96809, shall be notified, in
writing, at least two (2) weeks before any work authorized by this permit commences and staff shall be allowed to inspect installation activities in
accordance with §13-168-15, Hawaii Administrative Rules.
2.
The well construction permit shall be for construction and testing of the well only. A minimum 1114-inch diameter monitor tube shall be
permanently installed, in a manner acceptable to the Chairperson, to accurately record water levels. The permittee, well operator, and/or well
owner shal coordinate with the Chairperson and conduct a pumping test in accordance with the Standards (a pump testing worksheet is
attached). The permittee, well operator, and/or well owner shall submit to the Chairperson the test results as a basis for supporting an
application to install a permanent pump and withdraw water for use. No permanent pump may be installed until a pump installation permit is
approved and issued by the Chairperson.
3.
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.
4.
The permittee, well operator, and/or well owner shall incorporate mitigation measures to prevent construction debris from entering the aquatic
environment, to schedule work to avoid periods of high rainfall, and to revegetate any cleared areas as soon as possible.
5.
In the event that subsurface cultural remains such as artifacts, burials or concentrations of shells or charcoal are encountered during
construction, the permittee, well operator, and/or weil owner shall stop work and contact the Department's Historic Preservation immediately.
6.
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 determinalion of correlative water
rights.
7.
The following shall be submitted to the Chairperson within sixty (60) days after completion of work:
a.
Well completion report, (attached· Part I, Well Construction Report).
b.
Elevation (referenced to mean sea level, msl) survey by a Hawaii-licensed surveyor.
c.
As-built sectional drawing of the well.
d.
Plot plan and map showing the exact location of the well.
e.
Complete pumping test records, induding time, pumping rate, drawdown, chloride content, and other data.
8.
The per:mitteE!.LlNell op~rator, and/or well owner shall comply with all applicable laws, rules, and ordinances: non-compliance may be grounds for
revocation of U1;S permit.
9.
The well construction permit application is incorporated into this permit by reference and is subject to the Hawaii Well Construction & Pump
Installation Standards (January 23, 1997; HWCPIS). If the HWCPIS are not followed and as a consequence water is wasted or contaminated, a
lien on the property may result.
10.
The permit may be revoked by the Commission if work is not started within six (6) months after the date of approval or if work is suspended or
abandoned for six (6) months, unless otherwise specified. The work proposed in the well construction permit application shall be completed
within two (2) years from the date of permit approval, unless otherwise specified. The permit may be extended by the Chairperson upon a
showing of good cause and good-faith performance. A request to extend the permit shall be submitted to the Chairperson no later than three (3)
months prior to the date the permit expires. If the commencement date is not met, the Commission may revoke the permit after giving the
permittee, well operator, and/or well owner notice of the proposed action and an opportunity to be heard.
11.
If the well is not to be used it must be properly capped. If the well is to be abandoned then the permittee, well operator, and/or well owner must
apply for a well abandonment permit in accordance with §13-168-12(f) prior to any well sealing or plugging work.
12.
The permittee, its successors, and assigns shall indemnify, defend, and hold the State of Hawaii harmless from and against any loss, liability,
claim, or demand for property damage, p'ersonal 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.
13.
Spea,' oo"",tion, " Ihe ,"ohed oo~, ..,,,,,"10' ~..""' ""'""""ted he","
Date of Approval:
Expiration Date:
January 23, 2002
January 23, 2004
by
cefe",,~
g
~
GILBERT S. COLOMA-AGARAN, Chairperson
I have read the conditions and terms of this permit and understand them, I accept and agree to meet these conditions as a prerequisite and
underlying condition of my ability to proceed and understand that I shall not commence work until I and the driller have signed, dated, and
returned the permit to the Commission, I also understand that non-compliance with any permit condition may be grounds for revocation and
fines of up to $1000 per day starting from the pe it ate of approval.
Permittee's
Signature:_~+-+---..,~~_ _ _ _ _ _ __
Printed Name:
Driller's Signature:
7J1/J~]A~
Printed Name:
)rjo., '('t;l{S rt'4bPSEh..
J1'3) O::t
Firm or Title: --={,--=Q.:;...:..,}V,--a--,-r--;~t--=C-,-,h"",",Gi"-pe,"""""I~K~a(;J:..L.q
. . . j_
.
Date: )
C-57License#:~~tJ Date: 3'-127-aa...
Firm or Title: ~ eA~ ~.&1JiiJ
Please sign both copies of this permit, return one to the Chairperson, and retain the other for your records.
Attachment
c:
USGS
Department of Health! Safe Drinking Water, Wastewater, and Clean Water Branches
Kauai Department of Water Supply
BENJAMIN J. CAYETANO
GILBERT S. COLOMA·AGARAN
GOVERNOR OF HAWAII
CHAIRPERSON
BRUCE S. ANDERSON
MEREDITH J. CHING
CLAYTON W. DELA CRUZ
BRIAN C. NISHIDA
HERBERT M. RICHARDS, JR.
LlNNEL T. NISHIOKA
STATE OF HAWAII
DEPUTY DIRECTOR
P.O. BOX 621
January 3D, 2002
0419-04 CCK #1.wCP
Mr. John Young
P.O. Box 1062
Kapaa, HI 96746
Dear Mr. Young:
Well Construction Permit
CCK #1 (Well No. 0419·04)
Enclosed are two (2) copies of your approved Well Construction Permit for the captioned we
that authorize well construction activities but excludes installation work for your permanent pump, As
part of the Chairperson's approval, the following special conditions were added and are part of your
permit under Permit Condition 13:
Special Conditions
1,
Attached for your information is a copy of the Department of Health's (DOH) review comments. Please note
DOH's requirements related to discharge of effluent from well drilling and testing activities.
2.
To prevent contamination, the annular space of the well must be sealed with grout from the ground surface to a
minimum depth of 500 feet or 70% of the vertical distance between the ground surface and the top of the aquifer
selected for exploration, long-term monitoring, or development, whichever depth is less.
This permit does not authorize work for your permanent pump installation. Approval and
issuance of your pump installation permit is contingent upon completed application and information
provided to and accepted by Commission staff as required in the Well Construction & Pump Installation
Standards (1/23/97) and any special conditions performed under this permit. However, a permanent
pump may be installed prior to the permanent pump installation permit issuance in accordance with the
Commission's April 15, 1998 Declaratory Ruling No. DEC-ADM98-G5, which states that:
"Permanent pump installation for capacities between 0-70 gpm and where the proposed
use is for private individual needs in non-ground-water management areas may be
allowed prior to the final pump installation permit issuance. When required as a
condition of the well construction permit, subsequent pumping tests shall validate the
acceptability of the permanent pump. The permanent pump installed prior to final pump
installation permit issuance is subject to removal if the testing shows that a smaller pump
is required to reduce the potential of affecting neighboring wells and localized upconing
at the applicant's well. "
Mr. John Young
Page 2
January 30, 2002
If you qualify and wish to take advantage of this ruling, please include a written request to install
the permanent pump prior to final pump installation permit issuance when you return to us your signed
well construction permit.
Please sign and have the contractor sign both permit originals and return one for our files. Also,
copies of the aquifer pump test worksheet and the well completion report form are enclosed for your
use.
IMPORTANT - Drilling work shall not commence until a fully signed permit is returned to
the Commission. Please provide all the information in this packet to your well drilling
contractor (a C-57 license is required). The permittee, well operator, and/or well owner are
responsible for all conditions of the permit. This includes ensuring that the well construction
contractor, or other party who constructs the well(s), submits a completed Part I of the Well
Completion Report form (enclosed) within sixty (60) days after the well construction work is
completed. Be advised that you may be subject to fines of up to $1000 per day for any
violations of your permit conditions starting from the permit approval date.
If you have any questions, please call Lenore Nakama of the Commission staff at 587-0218 or
toll-free at 274-3141, extension 70218.
~BJ.a1r
GILBERT S. COLOMA-AGARAN
Chairperson
Enclosures
~ WELL CONSTRUCTION PERMO
CCK#1, Well No. 0419-04
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 construction and testing of CCK
#1 (Well No. 0419-04) at Kapaa Bypass Road, Kauai, TMK 4-3-4:6, subject to the Hawaii We" Construction & Pump Insta"ation
Standards (1/23/97) which include but are not limited to the following conditions:
1.
The Chairperson of the Commission on Water Resource Management (Commission), P.O. Box 621, Honolulu, HI 96809, shall be notified, in
writing, at least two (2) weeks before any work authorized by this permit commences and staff shall be allowed to inspect installation activities in
accordance with § 13-168-15, Hawaii Administrative Rules.
2.
The well construction permit shall be for construction and testing of the well only. A minimum 11/4-inch diameter monitor tube shall be
permanently installed, in a manner acceptable to the Chairperson, to accurately record water levels. The permittee, well operator, and/or well
owner shall coordinate with the Chairperson and conduct a pumping test in accordance with the Standards (a pump testing worksheet is
attached). The permittee, well operator, and/or well owner shall submit to the Chairperson the test results as a basis for supporting an
application to install a permanent pump and withdraw water for use. No permanent pump may be installed until a pump installation permit is
approved and issued by the Chairperson.
3.
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.
4.
The permittee, well operator, and/or well owner shall incorporate mitigation measures to prevent construction debris from entering the aquatic
environment, to schedule work to avoid periods of high rainfall, and to revegetate any cleared areas as soon as possible.
5.
In the event that subsurface cultural remains such as artifacts, burials or concentrations of shells or charcoal are encountered during
construction, the permittee, well operator, and/or well owner shall stop work and contact the Department's Historic Preservation immediately.
6.
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 construcf the well shall not constitute a determinalion of correlative water
rights.
7.
The following shall be submitted to the Chairperson within sixty (60) days after completion of work:
a.
Well completion report, (attached - Part I, Well Construction Report).
b.
Elevation (referenced to mean sea level, msl) survey by a Hawaii-licensed surveyor.
c.
As-built sectional drawing of the well.
d.
Plot plan and map showing the exact location of the well.
e.
Complete pumping test records, including time, pumping rate, drawdown, chloride content, and other data.
8.
The perynitteEl.Lwell op~rator, and/or well owner shall comply with all applicable laws, rules, and ordinances; non-compliance may be grounds for
.
revocation of mlS permit.
9.
The well construction permit application is incorporated into this permit by reference and is subject to the Hawaii Well Construction & Pump
Installation Standards (January 23, 1997; HWCPIS). If the HWCPIS are not followed and as a consequence water is wasted or contaminated, a
lien on the property may result.
10.
The permit may be revoked by the Commission if work is not started within six (6) months after the date of app'roval or if work is suspended or
abandoned for six (6) months, unless otherwise specified. The work 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 three (3)
months prior to the date the permit expires. If the commencement date is not met, the Commission may revoke the permit after giving the
permittee, well operator, and/or well owner notice of the proposed action and an opportunity to be heard.
11.
If the well is not to be used it must be properly capped. If the well is to be abandoned then the permittee, well operator, and/or well owner must
apply for a well abandonment permit in accordance with §13-168-12(f) prior to any well sealing or plugging work.
12.
The permittee, its successors, and assigns shall indemnify, defend, and hold the State of Hawaii harmless from and against any loss, liability,
claim, or demand for property damage, p'ersonal 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.
13.
Spedal
oond'ti~. '" thea_ed _,""~lttallette,a~ '"00_"" he""" -~~ ~
by
Date of Approval:
Expiration Date:
January 23, 2002
January 23, 2004
tv
GILBERT S. COLOMA-AGARAN, Chairperson
I have read the conditions and terms of this permit and understand them. I accept and agree to meet these conditions as a prerequisite and
underlying condition of my ability to proceed and understand that I shall not commence work until I and the driller have signed, dated, and
returned the permit to the Commission. I also understand that non-compliance with any permit condition may be grounds for revocation and
fines of up to $1000 per day starting from the permit date of approval.
Date: _ _ _ _ _ __
Permittee's Signature: _ _ _ _ _ _ _ _ _ _ _ _ __
Firm or Title: _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Printed Name:
Driller's Signature:
_ _ _ _ _ _ _ _ _ _ _ _ _ _ C-S7 License # : _ _ _ _ _ Date: _ _ _ _ _ __
Firm or Title: _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Printed Name:
Please sign both copies of this permi~ return one to the Chairperson, and retain the other for your records.
Attachment
c:
USGs
Department of Health! Safe Drinking Water, Wastewater, and Clean Water Branches
Kauai Department of Water Supply
JI
42
c:
12
a
I
53
lotJ
JO
t,)
c
53
!Hi
~
I
27
wE>-l-~O.
36
O,..\\q·O~
5~
,
22
I
/
\
'.4io.~
/
120
//
o
o
Search Results
o
o
Page 1 of 1
Copyright 12/11/2001 by Hawaii Information Service
PUBLIC RECORD DATA
Taxkey Subdiv/Condo
4-4-3-4-6Kapaa Rice & Kula
lots
Property
TnrAddress
A
Owner/Lessee
BedsBaths
OHAI,REUBEN M TR fETAL
lEWIS, LA VERNE D/VADA
B
Land
area
11.15 ac
Living
area
This information has been supplied by third parties and has not been independently verified by Hawaii
Information Service and is, therefore not uaranteed.
http://webre2.hawaiiinfonnation.com/REsearchiAsp/Punctions/Property/SearchTMK.asp?ACl 12111/01
o
Well No.
Well Name
Applicant
o
data
0419-04
Date of Review
Reviewer
CCK#1
............ r
ifljifljJ/i/"
RRI
SECTION 1: WELL LOCATION INFORMATION
Island
Aquifer System
Aquifer Sector
KAUAI
LIHUE
ANAHOLA
Proposed Use
Proposed Withdrawal
System Sustainable Yield
SECTION 2: WELL SECTION DATA
(enter data in grey cells only)
Elevation at top of casing
ft., m.s.1.
ft., m.s.1.
ft.
ft.
Ground Elevation
Cement Grout
Rock Packing
Hole Diameter
Total Depth
#VALUEI
12000
36
Solid Casing
Material
Designation
Length
Diameter
Wall Thickness
in.
ft.
Casing
Estimated Head
Calculated Aquifer Thickness
_________ ft., m.s.1.
Material
Designation
Length
Diameter
Wall Thickness
Openings
Open Hole
1025 ft.
County Water Supply (YIN ?)
Length
Diameter
SECTION 3: CHECKLIST
Depth of Well below Sea Level
Well Casing
Minimum Wall Thickness
Material
County or Non-County
Minimum Thickness per standards
Length of solid casing Provided
Casing Material
Annular Space
Depth of Grouting
Calculated Depth of Grouting
Depth of Grouting provided
Thickness of Annular Space
in.
in.
sq.in.ll.f.
ft.
in.
(values to check are shaded)
Well Depth
Theoretical Thickness of Aquifer
1/4 Aquifer Thickness
Wall Thickness Provided
Minimum Length of Solid Casing
90% of ground to top of aquifer
ft.
1025 ft.
256.3 ft.
72 ft.
PVC
non-county
0.237 in.
0.250 in.
2.7 ft.
80 ft.
Sch40
2.1 ft.
Oft.
----4-in.
(refer to HWCPIS Section 2.2)
okay
(disregard if the well is not basal)
okay
(refer to HWCPIS Section 2.4 c)
(disregard this if this is a non-county well)
okay
(refer to HWCPIS Section 2.4 d)
okay
(refer to HWCPIS Section 2.4 e)
If the cell above reads #N/A, reference HWCPIS)
not enough
(refer to HWCPIS Section 2.6 c)
okay
(refer to HWCPIS Section 2.6 d)
Page 1
Jan-Z3-0Z 10:30am
From-HI DEPT OF< HEALTH
808-586-4370
~
T-736
P<OZ/05
F-5ZZ
eENJAfoIlN J. CAYETANO
GOA.MNCAOF ....,..
~s.ANDeRSON
MalEOmt J. CHING
ClAYTON W. DELA CRUZ
BRIAN C. NISHIDA
kERIIaIT ~. RICHARDS. JR.
LINIEL T. NIIitftOKA
IIINIY~QO
STATE OF HAWAII
DEPARTMENT OF LANO AND NATURAL RESOURCE'S
COMMISSION ON WAT;':~;!?URCE MANAGEMENT
RECEIVED
SAFE DRINKING WATER BRANCH
HONOLIlLU. HAWAII 9B1\09
January 7, 2002
TO:
Honorable Bruce S. Anderson. Director
Department of Health
Attention:
Dennis Tulang, Wastewater Branch
William Wong. Safe Drinking Water Branch
Dr. Keith Kawaoka, Ha:zardous Evaluation and Emergency Response
Alec wong, Clean Water Branch
.
FROM:
Gilbert S. Colorna-Agaran, Chairperson
SUBJECT:
Well Construction/Pump Installation Permit Application
CCK #1 (Well No. 0419-04)
~O --1
J.
U~V
Transmitted for your review and comment is a copy of the captioned well application;
Please find the attached maps to locate the proposed well. If you have any questions about this permit
applic;ation, r~uest additional information, or request additional review time, please contact Lenore Nakama of
the Commission staff at 581-0218.
LN:ss
Attachment(s)
RESPONSE:
TtIi& wall qualiflec; 11& a &Outea wNch will seNIl 85 e 60uree of polSbIe walSr to ~ publIC wSl4Ir &y&lam (CleflnllCllI6 ~rving 25 or mora peoPle 1I11Oast 110
day& par year or hali 15 or mOte Sf;rvic;e connection6) 11l1li mUlit receive DirEctOr Or HeaRn appravalJll12t to 11:1
to QDI11PIy with Hawaii
AQminililr~1ive RIJI~ (HAR), TIlle' 1. Chapter 20, RLlles Relating to POIBbie Water S~terna, !i11-20:S:-
'*'
[I
[I
eo
Tm _11110815 nOC ALlIllify 11& II &ource serving a public: wltor Iy:nem (/lerve~ 1066 lhan 25 people or rJ1(Ire people at teast
daY.' per yellr or 15 IieIVica
coonection&) anclif tna waD WSlSr is used lor artnklnQ, tile ptIv\lle owner ,hould 18&1 for b3C1eriolOgical arid Chamal ptIIIIenco before initillting r;udJ
ullC llno roulinety monllor Ihe water 'lualilylnerealler. Howe\IOr. If t"tu,", ~n ... eo u&e frOm U'liS SOI.I~ increases 10 Mdelllle p.IbtIc: water 8)11Jtelll
Clefinitiofl than DlftICIor of tiallllh approvdl is Mquitecl QdQJ: Ie Imp!emetltallon.
II VIe well III u~ to supply both p'olIIPllilllnd non-potBbIe PUrp0&8:5 in a Single Sy5Iem. the
shall eliminate ~ and bllCldlow
CDOneaiOn'EP
ieally lICpatadng pOUIble lind non-poliIbIe &y&IBI'n& I>yan ilit gap or lin BpprovecItl8CkfIcw prllV8mar. and by dully labeling all
wiIh wamtne slOne to pre\relll jnadvartenl coflliumplion or non·poUIDlS wBter. Backnow prevention devlaas Should be I'OUUneIy
U&Bf
non1lOlatlie II
inspcaecs a
II
[1
[1
tanId.
II d~& pOl appear tIUIllt!iS wtlY WIll be UlICCS for c:onllumplive pulPOifiN> lind i& not subjtICI to SIIIIiI Drinking VIIalel' Regulatiom;.
For the ajlPliGant'& itlformallcm, a OOl.lr(:fil of possible waSlBWBlEr contamination llls [1 if;
attached)<
.
nOlloeated
near uw propo&ad well site (inlOnnation
An NPDES pwmit is required.
IX!
Other I1Ilavant DOH Rlle&lragulations. Intormalloll, or reallIlmundllllonllllrll "rtildUld.
[ ]
No commentslOlljocticm;
Contact Person:
Stuart Yamada
Signed: _ _ _~
.....~",,
_ _ _ _ _ _ _ _ _ _ _~~_
Phone; 586-4258
Date: _-=O~1/~2::..::::3:.L./~02~_ _
Jan-Z3-0Z 10:30am
.-.
From-HI DEPT OF HEALTH
808-586-4370
T-736
P.03/05
2-0419-04 Kauai
The Department of Health, Safe Drinking Water Branch has the following additional
comments for the Well ConstructionlPump Installation Permit Application fOT the CCK
Well No.1 (Well No. 2-0419-04 Kauai):
Please be advised that the Department of Health has experienced drinking water and
groundwater contamination by submersible pumps containing mercury. Specifically, the
failure of the seals ofthe pumps allowed mercury to leak out into the well shaft resulting
in contamination of the well and the water served by the well. .Please review your pump
specifications to be sure that the submersible pump(s) you are proposing to use do not
contain materials which could result in either groundwater contamination or drinking
water contamination.
1115/02
F-5ZZ
o
BENJAMIN
o
J. CAYETANO
GOVERNOR OF HAWAII
CHAIRPERSON
BRUCE S. ANDERSON
MEREDITH J. CHING
BRIAN C. NISHIDA
HERBERT M. RICHARDS. JR.
LlNNEL T. NISHIOKA
DEPUTY DtRECTOR
STATE OF HAWAII
P.O. BOX 621
January 7, 2002
TO:
Honorable Bruce S. Anderson, Director
Attention:
William Wong, Safe Drinking Water Branch
Dr. Keith Kawaoka, Hazardous Evaluation and Emergency Response
Alec Wong, Clean Water BranC~h
•
FROM:
Gilbert S. Coloma-Agaran, Chairperson
SUBJECT:
.
1.
.
.
CCK #1 (Well No. 0419-04)
Transmitted for your review and comment is a copy of the captioned well application.
We would appreciate your comments on the captioned application for any conflicts or inconsistencies with
the programs, plans, and objectives specific to your department. Please respond by returning this cover
memo form by January 23. 2002. If we do not receive comments or a request for additional review time by this
date, we will assume that you have no comments.
application, request additional information, or request additional review time, please contact Lenore Nakama of
LN:ss
Attachment(s)
RESPONSE:
[I
This well qualifies as a source which will serve as a source of potable water to a public water system (defined as serving 25 or more peop'le at least 60
days per year or has 15 or more service connections) and must receive Director of Health approval prior to its use to comply with Hawaii
Administrative Rules (HAR). Title 11. Chapter 20. Rules Relating to Potable Water Systems. §11-20-29.
[I
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.
[I
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
non-potable spigots with warning signs to prevent inadvertent consumption of non-potable water. Backflow prevention devices should be routinely
inspected and tested.
.-~
[I
It does not appear that this well will be used for consumptive purposes and is not subject to Safe Drinking Water Regulations.
[I
For the applicant's information, a source of possible wastewater contamination [11s [1 is not located near the proposed well site (mfd:rmation'l
a t t a c h e d ) . ,
_
[I
[I
An NPDES permit is required.
....
Other relevant DOH rules/regulations, information, or recommendations are attached.
commentsiObjectio~s '. ND f:£ c() ~~'. Orrft IR .
Contact Person: 10 VI N
~lIYaVtC
J>(
No
'f't(j /
Sign~ 7fJ ~<~
Phone:
Date:
r
c._
::;:::0
680iz--tjO
/- 17-IJ-OOL
-n
~an-16-2002
From-DEPT OF HEALTH ENVIRONMENTAL MNGMT
02:38pm
8085864352
T-728
P.Oo2/oo2
F-228
/:;::IU
_. -
-
BENJAMIN J. CAYETAJIIO
GILBERT
-
a. COlOMl\-ABIIRAN
r:-.~D~~=N
ClA't'TONW_DB.ACAU2
J:'".. I )~ ," I i : ['6
BRIAN C_ NISHIDA
•
HERIIEItT M. RlCHAADS. JR
:
; .j
.-..n_
UNNa T. NISHIOICA
STATE OF HAWAII
DePARTMENT OF LAND AND NATUAAl- FlESOURCES
P.O. IIOX 621
HONOLUW, HAWAII 9II8OQ
RECEIVED
SAFE DRINKING WATER BRANCH
January 7, 2002
JA!
'''-!
.; "lnM
;\: .L,. ~
Attention:
Alec Wong, Clean Water Branch
TO:
cIAifJ
;rr(
•
j . .,. \.
FROM:
SUBJECT:
Well Construction/Pump lnstallation Permit Application
CCK #1 (Well No. 0419-04)
..-
the programs, plans. and objeCtives specific to your department. Please respond by returning this cover
memo form by January 23. 200~. If we do not receive comments or a request for additional review time by this
date, we wUi assume that you have no comments.
the Commission staff at 587-0218,
LN:ss
Attachment(s)
RESPONSE:
( )
( )
This well qulllilia& as a SOurce wlliCh will seMI 118 a source of potable Wilier to II public Wlllar syslem (dafined i1& serving 25 or mom peopla 111.6160
da~ per >'e.IIr or lias 15 or more S8N1ce COlInealona) and must r~e DlrllClOr of Health appl'DI/al prim'to it& u&a1D oomply with Ka~i
AdmInlSlI'alive Rules (teAR). Tille 11. Chapter 20. RUles Relating to POllible WIlIer Syolemu, !j11-Zl;S:l1\IS well doel nOlllUalify as • soulee seMlla II public: W1I1eI' system (serves less Ullin ZS peopJe or mora pll(lple at Ie~t 60 dllY'l per Y.IIar or Hi SIII'I1c:e
aJnneaiOllCl) lno If tI1B wal water is usee! fOr drinking, the pnval6 owner :ohould losl for Dac:lerlologlcal arid cllemk;al prelillflC8 before Inllinn!' suCh
Bnd routinely mOllitOt the WIlIer Qulllitv IhBreaflsr. HllWlMlr, if future P\lInned USB from !hili IiDUICII inaeilSes to moat the pubic wafsr sy&1Bl1l
definition then Olnlc:tor of HlIlJlth ilpprDViinli ""'Iuired prior ID impiemenUlIiQn.
1,158
II
( )
[I
[ )
)(
[I
If tna well Is uS«ICI to 6Upply both pOtable and non-j)Otabie PUtpOS8S In a Single syStem, lhe user sllaD ellmlll8'l8 crOBa-connectlonS and backllOw
poIIIble and non-poIiIbIa syr;tsrm; I>Y lin air gap or an iIDPI'OVC<l backllOw prc:wnIIIr, and by Clcarty lilbaling all
non·pOll'*' & wId'I wamlng signa 10 prevent inadvertenl conlilolmpdon of non.polJlbla wiotar. Backflow prlMlfllion daviCllIi &I\ould be routinely
Insp8ded
18&!Bd.
cannaclion~1ly
pn lcaly l8~rillInIl
It dOllS nOllppeerWillhi1i wall WIll be U$ed rot consumptive putpOses and 1$ not subject to Safe Orlnkitlg Willii' ~gUIaIlonI.
For IhB applicant's infCrmallon, a lOurce of PQIIelble WII~1ar contllmlnlltlOll []I& [ ] Iii nollDClllBd nBar the prapo&Bd wall &ita (informalion
allac:hICI,.
.
All NPOES permit i6 requil'ld.
OItlar relevant OOH ruleelrQgula!ion&. information. or moom01t'lndaliOn& am attached.
NO eomm8n1111Q~ecIion&
Contact Person: _..,.A~L,,---=ec-=-----.JIW,------,l)__~=--ioo-_ _~_
sig"ed;---'o:,Q~·~",:#-l~~~""-lV~~~+,_ _ _ _ __
---
...
__ .-_...
Phone:
S'?6-lk3 Q j
Date:
tt th (O2-·~JAl?()
~.
.- !an-16-2002 02:38pm
From-DEPT OF HE.ALTH ENVIRONt.£NTAL MNGMT
8085864352
T-728
P.001/002
F-228
The Department of Health, Clean Water Branch has the fol/owing comments:
1.
For Well-Drilling Activities
Any discharge to State waters of treated process wastewater effluent associated with well drilling activities is
regulated by Hawaii Administrative Rules, Title 11. Chapter 55, Appendix I, effective September 22, 1997.
Treated process wastewater effluent covered by this general permit includes well drilling slurries, lubricating
fluids wastewaters, and well purge wastewaters. This general· permit does not cover well pump testing. The
applicable Notice of Intent Forms and filing fee shall be submitted at least thirty (30) days before the start of
discharge to the Department of Health, Clean Water Branch at 919 Ala Moana Bou/evard, Room 301,
Honolulu, Hawaii 96814-4920 or P.O. Box 3378, Honolulu, Hawaii 96801-3378. Inquiries may be directed to
the Clean Water Branch at (808) 586-4309 or by fax at (808) 586-4352.
2.
For Well Pump Testing
The discharger shall take all measures necessary to prevent the discharge of pollutants from entering State
waters. Such measures shall include, if necessary. containment of the initial diSCharge until the discharge
is essentially free of pollutants. If the discharge is entering a stream or river bed, best management
practices shall be implemented to prevent the discharge from disturbing the clarity of the receiving water. If
the discharge is entering a storm drain, the discharger must obtain written permission from the owner of
that storm drain prior to discharge. Furthermore, best management practices shall be implemented to
prevent the discharge from collecting sediments and other pollutants prior to entering the 5tOfT!! drain.
JS/cr
-----_. -
'--
--.--.-----~
o
GOVERNOR OF HAWAII
CHAIRPERSON
BRUCE S. ANDERSON
MEREDITH J. CHING
BRIAN C. NISHIDA
HERBERT M. RICHAROS. JR.
LlNNEL T. NISHIOKA
DEPUTY DIRECTOR
STATE OF HAWAII
P.O. BOX 621
January 7, 2002
Harry Yada, Acting Administrator
Land Division
TO:
i,..-A) j
/")
lnf/
Linnel T. Nishioka, Deputy Director
~V' u {~~
FROM:
SUBJECT:
CCK #1 (Well No. 0419-04)
Transmitted for your review and comment is a copy of the captioned well application which
includes a request for a pump installation permit.
We would appreciate your comments on the captioned application with regard to the programs,
plans, and objectives specific to your division. Please respond by returning this cover memo form
by January 23, 2002. If we do not receive comments or a request for additional review time by this
date, we will assume you have no comments.
Please find the attached maps to locate the proposed well. If you have any questiOns about this
permit application, request additional information, or request additional review time, pleas~ contact
Lenore Nakama of the Commission staff at 587-0218.
:
)
LN:ss
Attachment(s )
RESPONSE:
[1
A water lease/permit is required of this applicant and an application for such will be requested' by our~ision.
Lxlx
A water lease/permit is not required of this applicant.
[1
A water lease/permit has been obtained by the applicant through lease no. _ _ _ _ _ _ _ _ __
[1
This well project [ 1requires [ ] does not require a COUP. If a COUP is required it [
not been approved and [ 1is [ ] is not currently active.
[ ]
Other relevant Land Division rules/regulations, information, or recommendations are
[ ]
No objections
coon
1has
2:
atta~~.~,?
?; ::.:; ~:
,-.-:::: .
[~x
Other comments:
Contact Person:
Orl' gl' na1 source of prlva
. t e t 1. t1 e lS
. Gr
in 1910.
Gary Martin
Phone:
~
$;
Z
r
?: ::u
S
f'T1
ari/~~",5 2 3 7c:::,i S S ~
tl~:~'~~ U ~~
58 7 - 0 4 iJ-;:o ~)
0"
-(,....l~~~
C/')
Signed:_~c.....L_,-+_~
_ _ _ _ _·_ _ _ _ _ __
[ 1 has
9_2_00_2_
Date: _JA_N__
W•
en
c:::-
-
0
Z
0
e
-
/
GOVERNOR Of HAWAII
CHAIRPERSON
BRUCE S. ANDERSON
MEREDITH J. CHING
BRIAN C. NISHIDA
LlNNEL T. NISHIOKA
STATE OF HAWAII
DEPUTY DIRECTOR
P.O. BOX 621
January 7, 2002
0419·04,rev
Mr. John Young
P,O. Box 1062
Kapaa, HI 96746
Dear Mr. Young:
Well Construction/Pump Installation Permit Application for Well No. 0419-04
We acknowledge receipt, on December 21, 2001, of your completed Well
Construction/Pump Installation permit application and filing fee for the CCK #1 (Well No. 041904). You can expect your application to be processed within ninety (90) days from this date.
For your information, the process of constructing a well is normally regulated and
permitted in two (2) steps. First, a well construction permit is issued for drilling and testing
purposes only. Based upon information provided by you through a Well Completion Report Part
1 (Well Construction), a pump installation permit (upon completed application) may then be
issued to authorize pump work. If a pump is installed then a Well Completion Report Part 2
(Pump Installation) is required.
If you have any questions about your permit application, please contact Lenore Nakama
of the Commission staff at 587-0218 or toll-free at 274-3141, extension 70218.
~J&
L1NNE.L T. NISHIOKA
Deputy Director
LN:ss
c: Jean Ohai
GOVERNOR OF HAWAII
CHAIRPERSON
BRUCE S. ANDERSON
MEREDITH J. CHING
BRIAN C. NISHIDA
LlNNEL T. NISHIOKA
OEPIJT'V DIRECTOR
STATE OF HAWAII
P.O. BOX 621
January 7, 2002
TO:
Attention:
~. ....
Alec Wong, Clean Water Bran~Ch.
FROM:
SUBJECT:
.
1.
.
.
.
CCK #1 (Well No. 0419-04)
the programs, plans, and objectives specific to your department. Please respond by returning this cover
memo form by January 23, 2002. If we do not receive comments or a request for additional review time by this
date, we will assume that you have no comments.
LN:ss
Attachment( s)
RESPONSE:
[1
This well qualifies as a source which will serve as a source of potable water to a public water system (defined as serving 25 or more peop'le at least 60
days per year or has 15 or more service connections) and must receive Director of Health approval ~ior to its use to comply with Hawaii
Administrative Rules {HARJ, Title 11, Chapter 20, Rules Relating to Potable Water Systems, §11-20- 9.
[1
This well does not qualify as a source serving a public water system (serves less than 25 people or more people at least 60 days per year or 15 service
connections) and if the well water is used for drinking, the private owner should test for bacteriOlogical and chemical presence before initiating such
use and routinely monitor the water quality thereafter. However, if future planned use from this source increases to meet the public water system
definition then Director of Health approval is required mIm to implementation.
[1
If the well is used to supply both potable and non-potable purposes in a single system, the user shall eliminate cross-connections and backflow
connections by physically separating potable and non-potable systems by an air gap or an approved backflow preventer. and by clearly labeling all
non-potable spigots with warning signs to prevent inadvertent consumption of non-potable water. Backflow prevention devices should be routinely
inspected and tested.
[1
It does not appear thai this well will be used for consumptive purposes and is not subject to Safe Drinking Water Regulations.
[ J
For the applicant's information, a source of possible wastewater contamination [lis [l is not located near the proposed well site (information
attached).
[J
An NPDES permit is required.
[J
Other relevant DOH rules/regulations, information, or recommendations are attached.
[1
No comments/objections
Contact Person: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Phone:
Signed: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Date: _ _ _ _ _ _ __
GOVERNOR OF HAWAII
CHAIRPERSON
BRUCE S. ANDERSON
MEREDITH J. CHING
BRIAN C. NISHIDA
LlNNEL T. NISHIOKA
DEPUTY DIRECTOR
STATE OF HAWAII
P.O. BOX 621
January 7, 2002
TO:
Harry Yada, Acting Administrator
Land Division
FROM:
Linnel T. Nishioka, Deputy Director
SUBJECT:
CCK #1 (Well No. 0419-04)
Transmitted for your review and comment is a copy of the captioned well application which
includes a request for a pump installation permit.
We would appreciate your comments on the captioned application with regard to the programs,
plans, and objectives specific to your division. Please respond by returning this cover memo form
by January 23. 2002. If we do not receive comments or a request for additional review time by this
date, we will assume you have no comments.
Please find the attached maps to locate the proposed well. If you have any questions about this
permit application, request additional information, or request additional review time, please contact
Lenore Nakama of the Commission staff at 587-0218.
LN:ss
Attachment( s)
RESPONSE:
[1
A water lease/permit is required of this applicant and an application for such will be requested by our division.
[1
A water lease/permit is not required of this applicant.
[1
A water lease/permit has been obtained by the applicant through lease no. _ _ _ _ _ _ _ _ __
[1
This well project [ ] requires [ 1does not require a COUP. If a COUP is required it [
not been approved and [ 1is [ 1is not currently active.
[1
[1
Other relevant Land Division rules/regulations, information, or recommendations are attached.
[ ]
Other comments:
No objections
Contact Person: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Phone: _ _ _ _ _ __
Signed: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Date: _ _ _ _ _ _ __
1has
[ ] has
Dee 21
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4-1191 Kuhio Hwy, Kapaa, Kauai Hawaii 96746
Ph. 808-8225504 I Fax 808-822-2148
email: [email protected]
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BUSINESS SUPPORT
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Dec 21 01 03:06p
OCNJAMIN J. CIIVt:TANO
('JLDOn s. COlOIo4A-AOA~N
OC'Jlh.:ttNUKa'tWltM
ratuAM·":4I"
IlRUC,: S.IIHUUlSON
ROII(RT G. CIRlll.IJ
URIAN ~ ~ISlIIIN\
DAVIDA. NODRICA
HI:HIlI:RT "'. RICHII'tDIl. JH.
LlNNt:L T. NISHIOKA
n...ourvr.rt;hlfll
STATE OF HAWAII
DEPARTMENT OF LAND AND NATunAL RESOURCES
P.O IJOX621
HONOI ULU. HAWAII 96609
December 14. 2001
0419-Q4.11c;k
Mr. John Young
P_O. Box 1062
Kapaa, HI 96746
Dear Mr_ Young:
Well Construction/Pump Installation Permit Application for Well No_ 0419-04
We have received your Well Construction/Pump Installation permit application and filing
fee for the CCK #1 (Well No_ 0419-04).
Through a December 12, 2001 telephone conversation with my staff, we have amended
your application to indicate that the proposed well will be constructed at TMK 4-3-4:6 and that
the well will serve 25 or more people at least 60 days per year.
The only outstanding matter is your ability to sign the application as the landowner at the
proposed well site. We understand that you plan to acquire the land within the next week or so.
Until then, we are not able to accept your Signature as the landowner_ Please have the current
landowner sign the application or send us the documentation that shows that Calvary Chapel
Kauai is the landowner. This will allow us to accept your application as complete and you can
then expect your application to be processed within ninety (90) days_
If you have any questions about your permit appli<A;ltion, please contact Lenore Nakama
of the Commission staff at 587-0218 or toll-free at 274-3141. extension 70218.
~incereJY,
~
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. 'l~0D -1
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LlNNEL T NISHIOKA
Deputy Director
LN:ss
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GOVERNOR Of HAWAII
CHAIRPERSON
BRUCE S. ANDERSON
ROBERT G. GIRALD
BRIAN C. NISHIDA
DAVID A. NOBRIGA
LlNNEL T. NISHIOKA
DEPUTY DIRECTOR
STATE OF HAWAII
P.O. BOX 621
December 14, 2001
0419-04.ack
Mr. John Young
P.O. Box 1062
Kapaa, HI 96746
Dear Mr. Young:
Well Construction/Pump Installation Permit Application for Well No. 0419-04
We have received your Well Construction/Pump Installation permit application and filing
fee for the CCK #1 r,yvell No. 0419-04).
Through a December 12, 2001 telephone conversation with my staff, we have amended
your application to indicate that the proposed well will be constructed at TMK 4-3-4:6 and that
the well will serve 25 or more people at least 60 days per year.
The only outstanding matter is your ability to sign the application as the landowner at the
proposed well site. We understand that you plan to acquire the land within the next week or so.
Until then, we are not able to accept your signature as the landowner. Please have the current
landowner sign the application or send us the documentation that shows that Calvary Chapel
Kauai is the landowner. This will allow us to accept your application as complete and you can
then expect your application to be processed within ninety (90) days.
If you have any questions about your permit application, please contact Lenore Nakama
of the Commission staff at 587-0218 or toll-free at 274-3141, extension 70218.
Y
Sin. cereI .,.
~().
dtGJ04--.
LlNNEL T. NISHIOKA
Deputy Director
LN:ss
LV\C OR ATTACHED v.oRKSHEET
DATE: 12/13/01
OOCU" HIT t-O •
SRC/ COST
F YR /lPP D OBJ CTR PROJECl PH ACT
AVOUfT
NAME/DESCRIPTION (W,AJ\K; I t-lPVT)
John & Kathleen Young
' (1) ')5.':'0
S 02 326 C 1026 0752
-------------------
-- --- - ---- ---- ------ -- --(2)
- -- --- - ---- ---- ------ -- --- -- --- - ---- ---- ------ -- --- 0)
(4)
- -- --- - ---- ---- ------ -- --TOTAL
R~KS:
LINE (1)
LINE (2)
LINE
0)
LINE (4)
Well No. 0419-04
----------------------------------------T"--------------~~!OO
Well Background Check
Well Construction
Approved Well No. Well Name
CCK1
Applicant
Driller
Type
Issued Signed WCR1 Accept
Pump Installation
Issued Signed WCR2 Accept
BOTH
o
o
Tuesday, November 27,2001
Pagelofl
State of Haaii
COMMISSIO
"WATER RESOURCE MANAGEONT
Depanment of Land and Natural Resources
APPLICATION FOR PERMIT
Kwell Construction
i);Pump Installation
and/or
Instructions: Please print in ink or type and send completed application with attachments to the Commission
on Water Resource Management, P.O. Box 621, Honolulu, Hawaii 96809. Application must be accompanied by
3 copies and a" non-refundable filing fee of $25.00 payable to the Dept. of Land and Natural Resources. The
Commission may not accept incomplete applications. For assistance, call the Regulation Branch at 587-0225.
For further Information and updates to this application form, visit http://www.state.hi.usldlnr/cwrm.
,
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APPLICANT INFORMATION: (Fill out all three, if applicable, and place a check next to the primary contact)
CAt.VA~Y CllltPfL Je1U6l Contact Person: JOHN ~V"'G
Mailing Address:
P.O. I3()X 1062 I kAPAA J HI. 967%
Fax:
E-mail: C C kA VA J(92" "aHA. NG-.'T
,
1. (a) 0 WELL OWNER:
I
Q\! 1"" ':, ",', T
(b) 0 lANDOWNER:
(i;zfWAA){CHAfEL J44tM1
Mailing Address:
Fax:
(c)
0 CONTRACTOR:
e~.
/lex 1()62
J
i<.,vdow I1.J
__
967i'6
Y'.AfAA . HI
E-m'ail:
':1'
Phone: -i1tLl.6~/ ~ 2a..t:!2w23L-11Li_ _
80S JiAUItlAN
Contact Person:
CCkAVA' (o/fH.oHA« NeT
Contact Person: _ _ _ _ _ __
Phone: _ _ _ _ _ _ __
E-mail: _ _ _ _ _ _ _ __
Lic #: _ _~_ _.,.__-,..,.._
(circle one: C-57, C-57a l or A)
Mailing Address:
Fax:
WELL & PUMP INFORMATION: (Please fill in the diagram on the back of this form.)
2. WELL NAME:
C c.tt We LL - /
_--LI<I~J4-u..!....=:..!...~!..J;~_______
Island:
- '3 - 'I- : Y ~b
¥
S'l$10 b CJ<fS Tax Map Key:
~"AA ISWAS.5 JC\oA-O -~,oM HI "7¥6
Address lUSt> "lid
Zone
Sec
Plat
~
Attach the relevant portion of (a) a 7.5-Minute Series USGS to~ogr8phic map (scale 1:24,000) and include the name of the quad map, and (b) a
property tax map, showing well location referenced to established property boundaries.
~onstruct New Well
3. PROPOSED WORK:
.«
Install New Pump·
o
Modify Pump·
0 Modify Existing Well.
(check all that apply)
o Abandon/Seal·
•
_ _ _ _ _ _ _ _ (if unknown, please call Commission at 587-0225)
·State Well No.:
4. CONSTRUCTION:
o
¥Drilled
o
Dug
Shaft
o
Tunnel
Is this well part of a battery of wells? DYes ONo {Please describe~/ !
5. PROPOSED PUMP INFORMATION:
Rated Pump Capacity: __--S~-c;;;o
"
,
'," gallons per minute
Pump Type (Check one):
o
o Rotary
o Rotary-Displacement
o Rotary-G~ar
Deep Well Turbine
~submersible
6.
o Centrifugal
PROPOSED USE: o
(check a/l that apply)
o
o
o
..-'
Propeller
Reciprocating
Impulse
0 Industrial
Municipal (including hotels, stores, etc.)
pcDomestic (individual, noncommercial water s y s t e m ) . I
:-Does this well serve 25 or more people at least 60 days per year or have 15 or more service connections? )eves 0 No
o
o
0 No. of Acres:
Irrigation (crop)
o Other (explain):
_.L./=2:';'J.xO,-"O,,-O~_ _ _ _ _ gallons per day
Military
7. (a) PROPOSED AMOUNT OF WITHDRAWAL:
o
(b) METHOD OF FLOW MEASUREMENT:
Flowmeter
[!J"'"Open-pipe
0 Weir
0 Orifice
o
Other(explain)
OTHER IMPORTANT INFORMATION:
8. LEGAL REQUIREMENTS:
o
0 COUP
SMAP
o
~one
DEA
EIS
o
Other (explain)
9. REMARKS, EXPLANATIONS:
(if more space is needed, please attach additional sheet)
I understand that approval of this application attaches the following standard conditions: 1) the proposed work is to be completed within two (2) years of
the approval date; 2) the contractor shall submit to the Commission a well completion/abandonment report within 60 days after the completion date of
the permitted work; 3) monthly water use data shall be submitted to the Commission; 4) such approval shall not constitute a determination of correlative
water rights and shall not guarantee the pump capacity or future use up to the permitted pump capacity.
•,.ItVA'
Well Owner ~C:t..l...:!~u.u'-l-..JI;i~.L...llr.M 'fI' Landowner (;
::L.J..EJII;.L.LJ~7=~0h7't---
(print legibly)
(print legibly)
Signature
Signature
Signature
Date
Date
Date
For official use only
Latitude
_ _ _ _ _ _ Aquifer System No.
Longitude
State Well No.
~ A.:V"""'!/1i'·')'~(A..
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WCPIPA Form 10/25/00
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10. PROPOSED WELL SECTION (Please attach schematic if different from diagram provided below)
12-
Hole Diameter:
Elevation at top of casing ~ ft., msl-
in.
Minimum of 2' Radius & 4" Thick Concrete Pad (to contain benchmark
surveyed to nearest 0.01 ft.)
Ground Elevation: -;z8 ft., mslPlease refer to the
HAWAII WELL CONSTRUCTION AND
. PUMP INSTALLATION STANDARDS
ft.
Cement Grout:
(min. 70% of distance from
ground elevation to top of
water surface or 500. ft.,
whlCheveris less.)
to ensure that your as-built is in compliance
with applicable standards.
.jf---j
Solid Casing: ( 90% x
Annular space between
hole and casing (min.3"):
IA'-
(Grou~d Elev.-Water Level Elev»
80
Total Length:
Nominal Diameter: .
in.
ft.
~/~
Wall Thickness:
k
Bottom Elevation:
-
or
in.
in.
50
ft., msl*
Rock or Gravel Packing:
Total Depth
_ _ _ ft.
/(90 ft.
Open Casing:
Perforated
Screen
Total Length: _ _--=2=o=-,oo:;:-_____ft.
Material:
Crushed Basalt
Rounded Gravel
14-
Nominal Diameter: ----'7;t7-------in.
Wall Thickness: _ _ _....:AI::..:z._ _ _ _ _ _ in.
'70'
Bottom Elevation:
Elevation:
note; Neither bentonite nor mud should be used in
:2 S- ft. msl-
-
'... ft., msl-
Estimated Water Level
saturated zone during drilling
Open Hole:
Length: _ _ _ _ _ _ _ _ _ _ _ _ _ft.
Diameter: _ _ _ _ _ _ _ _ _ _ _ _ _in.
ft., msl-
Bottom Elevation:
- 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 CompletionlWeli 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 Le;el Elevation )
Example: Estimated + 211. Water Level Elev. -.Bottom Elevation of WeI! Limit = (2 _ 41
~ (2, = -18.5 ft.
Solid Casing Material:
Carbon Steel: compliant with (check one or more): ANSIIAWWA C200
API Spec. 5L
ASTMA139
ASTMA53
And compliant with (check 'one or more):
ASTM A242
Type E
Type S
Grade B
Other
ASTM M09 (production wells) .
ASTM A312 (monitor wells)
'ASS Plastic conforming to ASTM F480 and ASTM 01527: (check one)
Schedule 40
PVC Plastic conforming toASTM F480 and (ASTM 01785 or ASTM 02241): (check one):
Thermoset Plastic: (check one)
Schedule 80
XSchedule 40'
Schedule 80
Schedule 120
Filament Wound Resin Pipe conforming to ASTM 02996
Centrifugally Cast Resin Pipe conforming to ASTM 02997
Reinforced Plastic Mortar Pressure Pipe conforming to ASTM 03517
Glass Fiber Reinforced Resin Pressure Pipe conforming to AWWA C950
PTFE Fluorocarbon Tubing conforming to ASTM 03296
FEP Fluorocarbon Tubing conforming to ASTM 03296
Open Casing Material:
Carbon Steel: compliant with (check one or more):
ANSIIAWWA C200
ASTM A242
API Spec. 5L
Type E
ASTM A409 (production wells)
ASS Plastic conforming to ASTM F480 and ASTM 01527: (check one)
ASTMA139
Grade B
,Other
ASTM A312 (monitor wells)
.)C'Schedule 40
Thermoset Plastic: (check one)
ASTM A53
Type S
Schedule 80
Schedule 40
Schedule 80
Filament Wound ReSin Pipe conforming to ASTM 02996
Centrifugally Cast Resin Pipe conforming to ASTM 02997
Reinforced Plastic Mortar Pressure Pipe conforming to ASTM 03517
Glass Fiber Reinforced Resin Pressure Pipe conforming to AWWA C950
PTFE Fluorocarbon Tubing conforming to ASTM 03296
FEP Fluorocarbon Tubing conforming to ASTM 03296
Schedule 120
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Transcription

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