i ma~~g~ment

FROM: ROY

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.

, \ I ) COMI. .. §SION ON WATER RESOURCE MA~~G~MENT

DATE:

INIT. TO:

KUNIMURA. I. MILLS, D. OHYE, L. OHYE, M. OSHIRO, K. SAKODA,E. SWANSON, S. TORRES, R. UYENO, D. YODA,K. YOSHINAGA, M.

INIT:

SUSPENSE DATE:

FOR:

Approval Signature Information

(11/08)

PLEASE:

See Me Review & Comment Take Action Type Draft

__ Type Final File Xerox _ copies

o Q WELL CONSTRUcnON PERMIT MeUa Raneh WelL Well No. 3486-05

Note: This ptu7ltU shall be prominently displayed at the cOlVtrUCtion site lllllil the work is completed

In accordance with Department of Laud and Natural Resources, Commission on Water Resource M-apnent's Adminisarative Rules, Section 13-168. entitled "Water Use. Wells, and Stream Diversion Works". this doc:umeut pennils the c:onsIrUttion and testing of Malruu Ranch WeD (WeD No. 3486-(5) at TMK 1-5-025:049, Hawaii, subject 10 the Hawaii Wdl CODSIIuctioD &: Pump IDstallation Standards (HWCPIS - February 20(4) which include but are not limited to the foUowing conditions:

2.

3.

4.

s

6

7

8.

9.

10

11

12

I)

14.

IS.

The 0IIapers0a ofdle CommissiClll OIl Water Resoun:e ~ (Commissicll), P.O. Box 621. Honolulu. m 96109, sbIIJ be DOCificd, in WI'1tin(. at Jcast.~ (2J ~ bcbe lIlY WOIt IIIthorizccI by Ibis pend COIIIIIIaICCS IDd IIIIfl'SbIII be allowed to IDIIpeCt ......... IIlIMtics in ICCOIdaiiCe Wi1h § 13-1 68-1 S; Hawaii AdmiDistnIIiw Rules.

This permit sIWI be prominaltly displayed. or III8de IV ...... at die SIte of COIIStnIction work IIIIIi.I wert is COIlIpIeted.

The MR 00I\tIttIIC:Ii0 ~ sbaIl be for ClOIISIIUCtiaIIIDd .... ofdle MIl oaIy. TIle ~ sIIIII coonIii-. willi * ~ IIIIl CUIduct ~ test in .............. wiIb die HWCPIS (die Iatt.,... test .odrIbcd 4*1 lie cIJtaiDed ~ ~ Conniosjcw sid" or It www·--Yl~}.The--- .... tutimitlOdleOllil~dIe .. ftSIII&s.a .... iIr--...-.ic:Ition 10 iasIaD a

---.... No be ~ lIIIIiIa jnIpI!1tioo JICIIIIit is 1ppIOVICd'" ...... by die ~_ NT'wiIIIdrawII afWller =r:-m::& __ C'=:' wiIboIIt a~,.,...." ........... ~ The pam1IiId pel. dcsc:ribed OIl the instaIJlIion ~ redIIce4 in the evcat dut ... fIUIIIP tal does Dot support the aIpICity. ...., CIIpIIdty pump

ID -.a around --L~ ~ of the MIl may DOl c:xcaxI 0IIe..f0ta1h (li4) of die IbcoIeIiaIIbicknas (41 lias iDIIiII-.a) ofdlc IlllllIJUIIIId __ lIDless oIbcrwisC IIItbori:IICcl vy dlc a.apcnoo. The ~ sIIIII iDIlorpcnIID mitipIion --.10 pe¥CDt CCIIIStnIdIoIl debns iom CIIIa'IDIIhc IqIIIbC cnviIuIaDalt. 10 sdIcduIc wort to IMJId periods of hiP r.iD&II.lDd to ~ .., cIeIIed IRIS. soon • pllllibie.

ID am event .... ~ ... remMIs lUCIa • 8Iifids, bunIIs or CGIICaIIrIIions of sIIcIJs or c:bIrCOII II'C aKICIIIIIIIIed """a ~ the permi1Ia: sbaIl stop wert iInd immcdi., COIIUII:t dlc ~ of LIDd ... NatunI ~. S_ HisIaric ~¥Itioo ~ Work recoIIIIllIIiiCe only ala' wriIIal canc:unaKiC by 1be SIIIC Historic PRICI ~ DiYision. l1li)'

The ~ MIl CCIIIStrUction sbIII DOl.tvcndy dc:t ~ or future Icpl_ of_ iD die lla.lndt!diDlq IUIfiiiCe _ or estIbIWIed iDstn:am low ........ This permit or the IIIIbarizIaon 10 c:msauct the WdI shall DOl CXIIIStJCIIIc. cIdcrminttiaa of emdIQw _ ri&bts

The Well ~ ~ PIn I shall be ~ to die 0Iairpas0n WJIhm sixty (60) .,. after c:oa.,IeIiOD af work (pleale com.ct -.If or visit ,"",~IcIIIrI~forcumntfbna}

The pamiUee shill comply wi1b 1111 ippIicIbIe laws, niles, 1IId~; lIOII-COIIIpIiInce l1li)' be pUIIIIds for revOCIbOD _Ibis panut

The MIl CCIIIIInIc:bOD permit 1IIDIicIIioa.-t~ m.d -.If sullmiaallIppIU¥ed by dlc CcmmissioII. iIIcorpcnIed'" Ibis pcnrut by refcn:Dce. This.,.. IS IIso IUbject to the RWa>i5· ffthe HWCPIS Il'C not followed IDII •• --war is wa&tI:d or c:onIIm .......... till oa .. - _'I iawlt AlJy wriances iom the HWCPL! shall be IIppI'O¥Cd by the 0IIiIpen0n prier~ die variaaICe. ...-.- 'J

The wert DI'OIICIIed ia the .u c:cnsIrUdion ~ I!ppIM:aIion .. be COIIIPIcIIed wiIbiD two (2) years ian the .. of permit ~ UDIas odIerwisc ~ Thci ~ may be CIIfaICIed by die 0IairpCri0n upon • sbowiIIc of good CIUIC ... pxWiIiIb ~ A request to C:idend die pamit shall be siIIIIDiaIed to 1bC 0IIirpas0n no liter IbaR the .. tile pc:nDit expins.

ffthe.u is DOt to be used It must be prupedy capped ffthe well is to be llblllIIoned duriDg the CClUIIC of the pIOJCQ dial die pcnniUee ... tppJy for. well _1doamaIt pamit ia ICCOIdaiiCe widlll3-fQ.I2(f) prior to lIlY well_lill, or plugiDg Work.

The ill succeaon. IDII . sbIIII iDdramify. ddad. _ bold the Sta of Hawaii hannIcss from ... ...... Joss. babiIiay. claim, or demIDII for ~ ~ -r-.... arising out ofaay act or 0IIIISSi0n ofdle ..... icct. __ otIkas. ~ ~Idors. _ .... UDder dIis pamit or JeJatin& 10 or willi the .... , cflbis permit

'Ibis pcnnit shall _Iv to the IocaIion shown OIl 1bc IPPIicIlioa oaIy Ifdle MU IS to be reIoc:aIIed, die pamiIIee .... tppJy for a _ wei c:oasInIIlIiODf iDsIaDadon pamit '1l"~ 'IIriIIl Hawaii AdminiiiiaIiw Rules § 13-168-12(t).

Specilll ClOIIdiIioaa in die aa.:bed _1nIISIDiUaI ...... iJJcorpanIed ..... by IefemiiCe

Date of Approval: Marcil 11,1008 N. Cha~ Expiration Dale: Mareh 11.1010 ater?fl~n:e lffi1Jagement

luve reIId die coDdIdo. ad tentJ oftllil ...... it aDd •• dentud 1IIea. IIICapt ad ... tD __ .... ~ u • .ii-. ... :tat • ......,.. eoaditioa of..,. ability tD proceed .ad _CIentaDd .... t I ...... DOt coa .... wart _t1111aaYe ~~ 8libeblnlecffle peraIt tit tile Co........ laadentud .... t tIIiI penait Ia IIOt to be InIIIferred to .. ,. odter eatity. I ........ ~ tIIat~"'" witIt .ay permit eOlldltioa ... ,. be ....... far l"ft'8C8tioD a'" fiaeI of.p to S5,I08 per day ............ die peniIIJt ... of a~ 'n

Driller's Signature: tk1!d /2(1 ~ Printed Name: Derrick Moreira

. L ):I

C-57 License #: _C=..-=l8OO=.;:;.;l::...-__ ~~~ L/ ~ -.. ' ~~ DeIiWl's Well nrillin _.' T"CJ00 g

Firm or Title: _arid= . .z:;..;Puinp=·;;;;;o;;..;Sei2=-_ce~ __

JIIINw.". btJtj ctIJIIG Dftllb JII!IfIIII, ,.",..,.. ttI"~ .. ,.,.." tile .. for 1OIIJ' reaW&

AUIdIment

8PUMPINSTALLATIONPERMrt 0 -Mahg Rueh WelL WeD No. 3486-Cb

Note; WI pmnIt"." k",.""."., tIIpIm4" tk lite liliiii.' am 4r ..",.

In KCOrdance with Department of Land and Natmal Resources, Commission on Wata' Resource Management's Adminis1rative Rules, Section 13-161, entitled "Wata' Use, Wells, and S1ream Diversion Works-, Ibis doeument permits the pump installation for MaIcuu Ranch WeD (WeD No. 3416-(5) • TMK 1-s-02S:049, Hawaii, subject to the Hawaii Well Cons1ruction &: Pump Installation Standards (HWCPIS - February 2004) which inc:lude but are not limited to the following conditions:

1. The Oudrperson to the Commission on WIUr Resource Management (Commission), P.O. Box 621, Honolulu, ID 96809, shall be notified, in writin& at 1east two (2) weeks before any work covered by this permit commences and SbIft' Iball be aIJowed to inspect installation activities in ~ with §13-168-1S, Hawaii Administrative Rules.

2. No withdrawal of waaer shall be made other than fur testing until a Certific:ate of Pump Installatina eoq,1etiOll bas been issued by the Commission.

3. This permit shall be prominently displayed. or made available. at the site of COIlSII'IIdiOll work until work is completed.

4. The pump installation permit sbalI be for installation of a Il 8PJ1l rated capacity, or less, pump in the well. This permanent capacity may be reduced in the event that the pump test data does not support the capacity.

S. A water-levcl measuranent acc::ess sha1I be pcrmanentIy installed, in a III8IlDef accepI8ble to the Cbairpencm, to aa:urareIy record water levels.

6. The permittee shall install an approved meter or other appropriate means for measurina and reporting withdrawals and appropriate devic:cs or means for measuring chlorides and tcmpcrIIlUrc at the well head.

7. Well Completion Report Part n shall be submitted to the Cbairpersoo within 60 days after comp1etiOll of work. This form can be obtained by contacting staff or on the internet at www.bawaiLlovJdlnr/c:wrm.

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

9. The pump installation permit application and any related Sblft'submittal approved by the CGmmission In inc:orporIted into this permit by ref"rtllce. This permit is also subject to the HWCPIS. If the HWCPIS are DOt tbUowed IIId IS a comequcoce water is wasted or contaminated, ... OR die property •• y renlt. ADy vmiances from the HWCPIS sbalI be approved by the 0Iairpers0n prior to invoking the variance.

10. The work proposed in tbe pump instaUation 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 Cbairpc:rsoo upon a showing of lood cause and goodfaith perfonnance. A request to extend the permit shall be submitted to the Cbaitpasoo no later than the date the permit cxpira.

11. The permittee. its successors, and usiIDS shall indemnify, defend, and bold the State of Hawaii bannIcss fiom and against any loss. liability, claim, or demllld for property damage. personal injury, or death arising out of any act or omissioo of the applicant, usigns, officers, employees, contractors, and agents under this permit or relating to or c:onnectcd with the granting oftbis permit

12. Special c:onditioos in the attached cover transmittal letter are incorporated herein by referaace.

Date of Approval: Expiration Date:

Marcb 11, %008 Mareb 11.%010

~L .~

-,~~ ~ I laave read the coaditiou a.d ..... of dais perait .ad uadentaad tl... I accept aDd .... _ to ~. caa'" as .")J prereq.llite aDd uaderlyiag coaditioa of ., .bility to proceed aad uaderstaad tlaat I lUll Ret COIa~~rll •• til I .. d tW T7 p.ap fast ....... ave slped, d.ted, .. d retuned dae perant te tile Co •• inio.. I .ad ....... d tIuat ~';t:rait W--.ot to 1";-) tnaafernd to .ay otIaer eatity. I also udentaad tlaat aoa-co.pliaace wida •• y perait coaditiH •• , he:, ads for rewcati_7 •• d flail of ap to 55,000 per day starti .. rro. tile per.it date of approvaL ._- .h .. ~

1nstal1er's Signature: ~~~ C-S7, C-S7a, or A License #: C-l8OOl /J.ie! ¥ -;c.; -~ r ,~} , "

Printed Name: Derrick Moreira Deniclc's WeD DriJtipg and

Firm or Title: Pmnp Service

n..e 1Ip1HllllC11j1116 (11M penIfiI. ,.."",. IHN ", ,., CAIIIJpmtIII, I11III ",. 'lie tIIIIu lor,.",. m:tmII.

AltIIcIuneats

CaliSSION ON WATER RESOURCE MANAGEMENTQ

ROUTE SLIP FOR PERMIT ISSUANCE 11114107

FROM: RYAN DATE: 3/12/08

CHENG, C. KIMURA, J. CHING, F. LEROUX, E. CHONG, R. KUNIMURA, I. DANBARA, S. NAKAMA, L. ENGLAND, D. 4 OHYE, M. FUJII, N. -- --SAKODA, E.

-1-HARDY, R. ~ ==SWANSON, S. -2-HOAGBIN, S. ~ UYENO, D.

ICE, C. --YODA, K.

SUSPENSE DATE:

Approval Signature

-3-lnformation

PLEASE:

See Me -1-Review & Comment

Take Action Type Draft

-2-Type Final -4-File

Xerox copies

IMATA, R. -- --YOSHINAGA, M. -3-KAWAHARA, K.==

WELL NUMBER 3486-05 WELL NAME Makuu Ranch

application type BOT~H 1 WCP COVER lEITER 2 WCP 3 WEll CHECK PRINTOUT

4 PIP COVER lEITER 5 PIP

COMMENTS: 6 SDWB 7 WWB 8 cwe 9 lD

10 HP 11 lUC

~lA/'---

?,G-/\ ~ yvtt.Jfe--\~ ~~ ~...,S~ ~

not in conservation district 12 OCCl not in conservation district _ -; i \~ l (Jib ___ .. _ 13 SMA

NOTES: DRILLER TMK PUMP CAPACITY WELL OWNER LANDOWNER COMMENT DEADLINE

not in sma

Rod Diamond 1-5-025:049

12 Huliauakea Wilson Huliauakea Wilson

3113/07

p,~~ O\.,L/~ ~~

_____ ---:---~--.l-.!...J \ ~J-Q .. ~ p'. 5v>~)~

f' ~ 0 f)"L I&PJ~

LINDA LINGLE GOVERNOR OF HAWAII

Ref: 3486-05.wcp

Mr. Derrick Moreira

o o

STATE OF HAWAII DEPARTMENT OF LAND AND NATURAL RESOURCES

COMMISSION ON WATER RESOURCE MANAGEMENT P.O. BOX 621

HONOLULU, HAWAII 96809

Derrick's Well Drilling and Pump Service P.O. Box 2187 Pahoa, ill 96778

Dear Mr. Moreira:

Well Construction Permit Makuu Ranch Well <Well No. 3486-05)

LAURA H. THIELEN CHAIRPERSON

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

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

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

KEN C. KAWAHARA, P.E. DEPUTY DIRECTOR

April 3, 2008

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

Special Conditions

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

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

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

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

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

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

(1 t4w~L p./ LA H. TmtL~N \" Ch rperson

Enclosures

c: Huliawuakea Wilson (with applicable comments - DOH SDWB, WWB, CWB) USGS HawaiiDWS

o 0 WELL CONSTRUCTION PERMIT

Makuu Ranch Well. Well No. 3486-05 Note: This permit shall be prominently displayed at the construction site until the work is completed

In accordance with Department of Land and Natural Resources, Commission on Water Resource Management's Administrative Rules, Section 13-168, entitled "Water Use, Wells, and Stream Diversion Works", this document permits the construction and testing of Makuu Ranch Well (Well No. 3486-05) at TMK 1-5-025:049, Hawaii, subject to the Hawaii Well Construction & Pump Installation Standards (HWCPIS - February 2004) which include but are not limited to the following conditions:

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11

12.

13.

14.

15.

The ChaiTEerson 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.

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

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

In basal ground water, the depth of the well may not exceed one-fourth (114) of the theoretical thickness (41 times initial head) of the basal ground water unless otherwise authorized by the Chairperson.

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

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

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

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

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

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

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

If the well is not to be used it must be properly capped. If the well is to be abandoned during the course of the project then the permittee must apply for a well abandonment permit in accordance with § 13-168-12(f) prior to any well sealing or plugging work.

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

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

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

Date of Approval: March 12, 2008 Expiration Date: March 12,2010

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

Driller's Signature:

Printed Name: Derrick Moreira

C-S7 License #: C-28001 ----"----"--'-'--:....:::..-----

Date:

Derrick's Well Drilling Finn or Title: and Pump Service

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

Attachment

/


Ref: 3486-05.pip

Mr. Derrick Moreira

o o




Derrick's Well Drilling and Pump Service P.O. Box 2187 Keeau, ill 96749

Dear Mr. Moreira:

Pump Installation Permit Makuu Ranch Well <Well No. 3486-05)

LAURA H. THIELEN CHAIRPERSON


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

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

KEN C. KAWAHARA, P.E. OEPUTY DIRECTOR

April 3, 2008

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

Special Conditions

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

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

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

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

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

Finally, this is notice to Rod Diamond that the Pump Installation Permit issued to Diamond Construction and Water Well Drilling for this well is cancelled.

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

SinC()c. a.wA __

~i~~THffi~ Enclosure

c: Huliauakea Wilson (with applicable comments - DOH SDWB, WWB, CWB) USGS HawaiiDWS

l"'l PUMP INSTALLATION PERMI~ "-M:akuu Ranch Well, Well No. 3486-cl!"

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

In accordance with Department of Land and Natural Resources, Commission on Water Resource Management's Administrative Rules, Section 13-168, entitled "Water Use, Wells, and Stream Diversion Works", this document permits the pump installation for Makuu Ranch Well (Well No. 3486-05) at TMK 1-5-025:049, Hawaii, subject to the Hawaii Well Construction & Pump Installation Standards (HWCPIS - February 2004) which include but are not limited to the following conditions:

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

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

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

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

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

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

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

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

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

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

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

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


March 12, 2008 March 12,2010

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

Installer's Signature:

Printed Name: Derrick Moreira

C-57, C-57a, or A License #: C-28001 Date: -------Derrick's Well Drilling and

Firm or Title: Pump Service


Attachments

CO~SION ON WATER RESOURCE MANAGEMENT Q ROUTE SLIP FOR PERMIT ISSUANCE 4117107

FROM: RYAN

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

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

4 ICE, C. IMATA, R. KIMURA, J.

DATE: 4/17/07

~UNIMURA'1. AKAMA, L. !I!,\.-..i.-L

OHYE,M. lL-SAKODA, E.

--SWANSON, S.

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

SUSPENSE DATE:

Approval Signature

-3-lnformation

WELL NUMBER 3486-05 WELL NAME Makuu Ranch

application type BOTH 1 WCP COVER LETTER V 2 WCP ---:;7"" 3 WELL CHECK PRINTOUT ~

4 PIP COVER LETTER 5 PIP

COMMENTS: 6 SDWB 7 WWB 8 CWB 9 LD

10 HP 11 LUC 12 OCCl 13 SMA

NOTES: DRILLER TMK PUMP CAPACITY WELL OWNER LANDOWNER

~ not in conservation district -:6- not in conservation district ~notinsma

Rod Diamond 1-5-025:049

12 Huliauakea Wilson Huliauakea Wilson

PLEASE:


Take Action Type Draft

-2-Type Final 4 File

Xerox copies

FROM: RYAN

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

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

ICE,C. -4-IMATA, R.

KIMURA, J.

COQSSION ON WATER RESOURCE MANAGEMENT 0 ROUTE SLIP FOR PERMIT ISSUANCE 4/17/07

DATE: _________ SUSPENSE DATE:

KUNIMURA, I. NAKAMA,L.

-3-0HYE,M. SAKODA, E. SWANSON, S. UYENO, D. YODA, K. YOSHINAGA, M.

Approval Signature

-3-lnformation

PLEASE:


Take Action --Type Draft -2-Type Final

4 File Xerox copies

WELL NUMBER ~1 t{;& -OS" WELL NAME ~A.a::..cJV ~

0"'WELL CON~)TRUCTION ~P INSTALLATION

1 WCP COVER lETTER 2 WCP 3 WEll CHECK PRINTOUT

4 PIP COVER lETTER 5 PIP

COMMENTS: 6 SDWB 7 WWB 8 CWB 9 HEER

10 lD 11 HP 12 OCCl 13 SMA

NOTES: DRILLER ( TMK PUMP CAPACITY WEll OWNER LANDOWNER


Ref: 3486-05.wcp

Mr. Rod Diamond

o o




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

Dear Mr. Diamond:

Well Construction Permit Makuu Ranch Well (Well No. 3486-05)

PETER T. YOUNG CHAIRPERSON


CHIYOME l. FUKINO, M.D. LAWRENCE H. MilKE, M.D., J.D.

STEPHANIE A. WHALEN

April 25, 2007

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

Special Conditions

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

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

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

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

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

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

Sincerely,

Wf7H 1't

Peter T. Young Chairperson

Enclosures

c: Huliauakea Wilson (with applicable comments - DOH SDWB, WWB, CWB) USGS HawaiiDWS

·"-'-"'''''''~ ____ ''''"''_''''UJl _____ '_._' _a ____ ..... __ _

/

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o 0 WELL CONSTRUCTION PERMIT

Makuu Ranch Well, Well No. 3486-05 Note: This permit shall be prominently displayed at the construction site until the work is completed

In accordance with Department of Land and Natural Resources, Commission on Water Resource Management's Administrative Rules, Section 13-168, entitled "Water Use, Wells, and Stream Diversion Works", this document permits the construction and testing of Makuu Ranch Well (Well No. 3486-05) at TMK 1-5-025:049, Hawaii, subject to the Hawaii Well Construction & Pump Installation Standards (HWCPIS - February 2004) which include but are not limited to the following conditions:

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

The ChaiTJ2erson 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 statfshall be allowed to inspect installation activities in accordance with § 13-168-15, Hawaii Administrative Rules.

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

The well construction permit shall be for construction and testing of the well only. The permittee shall coordinate with the Chairperson and conduct a pumping test in accordance with the HWCPIS (the latest pump test worksheet can be obtained by contacting Commission staff or at www.hawaii.gov/dlnr/cwrm/forms.htm). The permittee shal sullmit to the Chairperson the test results as a basis for sUPJ>Orting an application to install a permanent pump. No permanent pump may be Installed until a pum" installation permit is approved and issued by the Chrurperson. No withdrawal of water shall be made for purposes other than testing without a Certificate of Pump Installation Completion. The permitted pump capacity described on the pump installation permit may be reduced in the event that the pump test does not support the capacity.

In basal ground water, the depth ofthe well may not exceed one-fourth (114) of the theoretical thickness (41 times initial head) of the basal ground water unless otherwise authorized by the Chairperson.

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

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

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

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

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

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

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

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

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

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

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

Date of Approval: March 13, 2007 Expiration Date: March 13, 2009

PETER T. YOUNG, Chairperson Commission on Water Resource Management

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

Driller's Signature:

Printed Name: Rod Diamond

C-S7 License #: C-23379 ---:::c..=:...::...;c..:....-___ _ Date:

Diamond Construction and Firm or Title: Water Well Drilling


Attachment


Ref: 3486-05.pip

Mr. Rod Diamond

o o





Dear Mr. Diamond:

Pump Installation Permit Makuu Ranch Well (Well No. 3486-05)



CHIYOME L. FUKINO, M.D. LAWRENCE H. MilKE, M.D., J.D.

STEPHANIE A. WHALEN

April 25, 2007

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

Special Conditions

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

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

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

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

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

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

Sincerely,

Wf7H ~

Peter T. Young Chairperson

Enclosure

c: Huliauaea Wilson (with applicable comments - DOH SDWB, WWB, CWB) USGS HawaiiDWS

/

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NUMP INSTALLATION PERMIT ~ 'akuu Ranch Well, Well No. 3486-0~

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

In accordance with Department of Land and Natural Resources, Commission on Water Resource Management's Administrative Rules, Section 13-168, entitled "Water Use, Wells, and Stream Diversion Works", this document permits the pump installation for Makuu Ranch Well (Well No. 3486-05) at TMK 1-5-025:049, Hawaii, subject to the Hawaii Well Construction & Pump Installation Standards (HWCPIS - February 2004) which include but are not limited to the following conditions:

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

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

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

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

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

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

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

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

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

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

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

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


March 13, 2007 March 13, 2009

Wf7n "'"

PETER T. YOUNG, Chairperson Commission on Water Resource Management

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

Installer's Signature:

Printed Name: Rod Diamond

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

Diamond Construction and Firm or Title: Water Well Drilling


Attachments

/


TO:

FROM:

SUBJECT:

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11 MAR 5 p2: 5

tf@;HFn'$SI~=iN ON \~(tiT[STATE OF HAWAII RESOI nrr r,'~~r~/Ii~F LAND AND NATURAL RESOURCES , "tt)'MMIS'SlO'N erN WATER RESOURCE MANAGEMENT

P.O. BOX 621 HONOLULU, HAWAII 96809

February 13,2007

Russell Tsuji, Administrator Land Division

W. Roy Hardy, Hydrologic Program Manager 1 Commission on Water Resource Management

Well Construction/Pump Installation Permit Application Makuu Ranch Well (Well No. 3486-05) TMK 1-5-025: 049

PETER T YOUNG CHAIRPERSON


CHIYOME L FUKINO, M.D. LAWRENCE H. MilKE, M.D., J.D.

STEPHANIE A WHALEN

-: ... ~.:.: . _" i'"""'r1

"~o

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

We would appreciate your comments on the captioned application with regard to the programs, plans, and objectives specific to your division. Please respond by returning this cover memo form by March 13,2007. Ifwe do not receive comments or a request for additional review time by this date, we will assume you have no comments.

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

RI:ss Attachment(s)

RESPONSE:

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

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

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

[ ] Other relevant Land Division ruleslregulations, information, or recommendations are attached.

[ ] No objections

DQC Other comments: Original source of private title was issued prior to Statehood.

Contact Person: ____ G_ar~yL-Ma_r_t_l_· n _______ _ Phone: 587-0421

AL mL~' Signed: __ -+-~ ___ ~ __ ~ ____ ----,-,,-\ _____ _ Date: --------2007

+ OHi-07 ~

02:17pm"" Fr.DOH/Sah Drir~,i.ni Water Branch T-956 P.009/011 F-375 9095964351 - I '-JV ".....".,.

rr;:- t" f ~~!t'D ......... ' .. ~ t: Jw.

S:~~~ ,~~r~: .. :~.;,~, t.~jr~-IW~~ Llf'ItIAllN0lE GOv=NOR'O~ I1AWfdI

-( ....... _ .... Jt" .... ~ ••.• .! .;.-}.J ;:" ..

FEB 1 6 2007

TO~

FROM:

CH MEREDITH J. CiotlNG JAMES A FRAZIER

. -rn IIIEAL S. FUJIWARA

....., ,.... - CHJYOME L FUKIMO. M.D. LAVwREI'\CE H. MIlKE. M.D .• J.D.

STI:PliA.NIJ; A. WHAlEN

STATE OF HAWAII $ .-...... .... ---DEPARTMENT OF lAND AND NATtJRAL ~ESOURCES COMMISSION ON WATER RESOURCE MANAGEMENT

po. aOX621 I-lONOLULU. HAWAII 96SOS

February 13,2007

Honorable Chiyome L. Fukino, M.D., Director Department ofHealtl.l Attention; Director's Office

Harold Vee, Was1ewater Branch Stuart Yamada, Safe Drinking Water Branch Alec Wong, Clean Water Branch

Peter T. Young, Chairperson 11 Conunissjon on Water Resource Management

SUBJECT: Well COllstruction/Pump Installation Permit Application Makuu Ranch Well (Well No. 3486-05)

Tran smitted for your review and comment is a copy of the captioned Well ConS\ructionlPump Installation permit application.

We would appreciate your comments on the captioned application for any conflicts or inconsistencies with the programs, plans, and objectives specific to your department. Please respond by retllrni" this cover memo form b March 13 2007. lfwe do not receive comments or a request for ad itional review time by this date. we will assume t at you have no comments.

Please find the attached maps to locate the proposed well. Tfyou have any questions about this pennit application, request additional information, or request additional review time, please contact Ryan Imata oflhe Commission staffat 587~025S.

RI:ss A nachment( s)

RESPONSE: [ 1

[ 1

L J

[ 1

I I

rvi [ 1

I J

This well qualifios;o., ~ _IT •• wbich will !IC,y~"". SOllrce ofpomb\c "a'O<t",o" plIbli< wat~ 'Y"cm (dodin.d ilS sc<Vinc 2j (>T m~'peopl" at I ..... 60 days pel' y«lr (IT hils 15 or morc sety;"" 'OIln;e(ions) 8l\d mu.d m:om.: Director ofHcahb apDTUv.1ll!!:!2!:to its use la comply with }lawaii AUministntivc R"ll:$ (HAR). Titlc 1J, Chap,., 20. Rules RclaliJIg It> I'"~bl,, Water Sy"cms, §11·10-29.

rll;S Yi~U dQel; not qualify as a ~OIUCl! ~nl! a public Wll1!t sy~l.m (serves less than 2S poopl. OT more people a! lo!lL~t 60 dnys Jll:r:rear Ot 15 ~.c eCfUloclions) Rnd if the well "" .. I .... l.' IlRd for drinkillS, II", priv;lle ownc:r should tt..~1 f<'lT b"<;\eliological and dlemi~<lll1rO&ellCC bcfOte: ;n_iijtin,: such USC .nd rotltincly mooilo .. U.e w"t.". quality thercallotJ'. ~Iowe.,.,.. iffuturc pl8J\I\I!:d """ Sum t~is sour." incre .. "," 10 meet tbc public """ ... 'Y'lem definition tben DircclOI of Ht!3illt appro\lill is required l!!i!!!; to implcmeumtioll.

Jf:lle w@1I i. lJ~ed to sup}lIy both pOlabl. 'mel JK)D-potabk pulpj)~e. in iI 5ingle system. DIe u..et .],,,11 "Iiminalc crou~onTHO;tions and bacldlow coull.oIi"". by p(t)lsil'llily scpat.llin~ pD~bl. mrl non-porable sysl ...... , by ~n air [!lI\l or an app"' .... d boIPdlow pro\<edtO!T, ""d by c'~ly labclinS ~II nen· poa.ablt 'pisot:l wirh waminl! si~ ... ", pn" ... '" irlAdvcnCllt C()lI~u"'pliDn Qfnon-potablc waitt. BoK:klloYi prcventioo dev",," :<iloldd be romincly illSJl<'cl.<;I and ICSlea.

It does not appear UI:l1 Ihi. wt!ll will be used fOT cDn. .... mpri~ l1UrpOSCi f11d i, nor >ubj",,! to Safe DrillkiJl~ w ...... R~JlllliQn5.

for Ih~ ~l1pJi<ant's illfO(1Ila1;on," 1'O\I,..e ofpossiblt w",,,.w.,lor contamination I liS II i. not lo;ntcd ~arthc pro"",,,,,,d well si~ (infOl'II,;sli~m i1tta~hed).

All NPDES petillil i~ n:qIJired.

Other ~Icllam DOH ruJesl ... !!, .. ~tions. inform3l.i~n, or =OIIlmendBtiollS arc aua.:hetl.

In the ~eDl tlla: die lOcal ion of the well chaslS" but 15 still within the pa.·cel d.$"'~d On Ibis applicatio'I, <)\11 divisioD considc,~ I],., commcmts to Slill be applialblr!. and ..... do ll~t nlled to feview the n ...... IOCBtio.L

No cammenw'obje;:tiO.lS

Contact Person: Phone: ---------------------------------- ------------Signed: ______ ....../-"7·"'i~~--------

(/ FEB 2 8 2fJJ1 Date:

MAR-01-2007 02:24PM FAX: 8085864351 ID:DLNR CWRM PAGE:008 R=96%

".-. ~

03-01-07 t" ,

02: 17pm.... F r!ll\;..DOH/Sa hi Dr ip~.i,nll Wa til r Branch ,,,,4'

8085864351 T-956 P.009/011

8-3486-05 Hawaii

The Department of Health, Safe Drinking Water Branch has the following additional comments for the Well Construction I Pump Installation Permit Application for the MalalU Ranch Well (Well No. 8-3486-05 Hawaii):

Underground Injection Control (DIe) Comments:

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

2. Well water quality should be initially and periodically tested for its acceptable and intended use, especially if it is to be used for human consumption. Water quality should not be presumed acceptable and Wlchanging. Land-based activities around the well and within the well's recharge area may, over time, have an unacceptable affect on the well's water quality. Well construction materials and related equipment could also mect water quality.

F-375

MAR-01-2007 02:24PM FAX: 8085864351 ID:DLNR CWRM PAGE:009 R=96%

F rom-DEPT OF HEAL,r,>it,ENVI RONMENTAL MNGMT

')<0' 8085864352 T-907 P.002/002 F-112

LINDA LINGLE 4QviR~OA' OF nA\'\IAM Pm~~NG~

TO:

FROM;

, SUBJECT:

STATE OF HAWAII OEPARTMi:NT OF LANO AND NATURAL ~ESOURCES

COMMISSION ON WATER RESOURCe MANAGEMENT po. ElOX621

HONO~ULU, HAWAII 961j(l~

February 13,2007

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

Harold Yee, Wastewarer Branch Stuart Yamada, Safe Drinking Water Branch Alec Wong, Clean Water Branch

Peter T. Y oung~ Chairperson ~ Commission (In Water Resource Management

Well Construction/Pump Installation Permit Application Makuu Ranch Well (Well No, 3486-0.21

II1ERf;DITH J. CHINCl JAMES A. F'RAZIIOR r , NeAL S. F~JIWAAA LA

CHJYOM~ L. FUKINO. loA D. LAWRI!NCe H. MilKE. MD .• J O.

STEPHAN!!: .... WHAI.EN

FEB 1 ;-~ 2aO~ r

! Transmitted for your review and comment is a copy of the captioned Well Constructic)n/Pump I lnstallation penni! application.

We would appreciate your comments On the captioli<:!d application for any conflicts or : inconsistencies with the programs, plans, and objectives specific to your department. Please respond by 'returnin this cover memo form b ' March 13 2007, If "lie do not receive comments or a request for . additlOrk'11 review time y t liS date, we WI assume that you have no comments.

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

: lmata ofthe Commission staffa! 587-0255.

: RI:ss Anachmerlt(s)

: RESPONSE:

: II

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if 1

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1'11,8 willi QL~~hr.f;\; iI~ iI rourcc which will ~.,.\'t;O ~~" ;;omce of {J~lablt ""t.r li' t, public w~l~r t<Y;I~\I'I (defiMd as ;~ ..... i,,~ l5 or mQr~ l"'opl" 3t I •• " 60 d~y', rer Y •• ~ orh •• 1501' mc ... ~~f';'. conn<!cl!Ons) .,,4 m"$~ J<;"'~"" Dit"c[o~ <:If 1'1",11111 nppro~all!.d1!! 10 it, lISe 10 ccmply wilh l'I'IW;li' Adll\illiS\l'illiv~ Rules (HARt TI[k II, Ch~lplf;\r 20. Rules RdilJllg to J)otable Wmer Sj;Te,,,~, ~11-~O-29.

ih.;; w~B dots not qilalify as iI ~Qm:'\l<: M:rvmg a pu~ljc WilrOf sy.t<:m (serves Ics~ Ih~n ~~ peoplc Of 1I10te peQPIl: VT .leas! 60 days P~( Y~ill or J 5 scrvic,; \1Qrmcctl~Jj&}fl.nd Jf'lL~Q well w~lro::r 1!i}I1i-cd for dJ'Jllkul~ ihe pny~l~e o\\"n~f !illiouid ,,,:s.t tor b~C(etluk')I:,!~f!~I.;m.o ob~mlca] pt~S(!r1(,~ lll~f(,l~ 1l"lltlatlJ1[7 ~~C:h ~:it,; ana routinely R\,)ltlIOr Iho Willer qllDmy thertaftol'. HQw~"cr.lf 111lUre Pla{II1<,(! u:;e from TI,lS so~r.:~ m~r.:n5':i [0 meer tll~ 1=",,,110 wale, Sygl(,,~ illhmlion th":1 Dirocrllr (>f l'l~illtll approval is requited I,rinr to impJem.nrariM. .

If I~ well is used [0 sLlpply bOlh POlilblc Dnd PCln-pc.t.ble 11"'j)QS~, In D ~ir,glc ~y~lel1l, Ihe lI~~r sh,.!1 cl"nin~l~ "ro5,-collllCCriol)s ana b~"ktlow ~0r.n(CtiOn5 by i>h!~jNlly ~cpilri1[ing potabl: ~o1d I\OIl·pOl~~le syst.:ms by ~'l air Y;ln or an llPI'rCt,"d IlackO(lW prevcnrtr. 411d 1'.]1 <:1«Irl)' Jabelil1j; all "(>11-pOTable spigot. Wilh w..-ning ~i[(lIS to prevco[ lIlacl wrlcn: conallnprion of nQlI"poniblc water. :flack !low prevention dc.ic~~ $h(luld b. rOlllil1<Jy i1L>p.Q~d and tcsled.

II docs nOI aJlPl!aL'lh~[ Illi~ ~II will b~ used fOf (Oo1Sl";'ptl"'" purpo~eo fl,lil is 1)<)1 ,ubjccl ro S&iC D,i'll<ing Willer Rc{:ulalians

for III<: i\pplicsrn'g inform~Tiol\, " 10I1r,.: ofpossiblc W$;,r~wal¢r (\)ntmi1lOaliOll Iii. II i. not loca:cci near Ih~ proposed well ~'t~ (ipform.ltio1l8~ach.a)

An Nl'DES p~nnit ,~ n:quircd.

Oll10:r rcl<:~am 0011 tllla~II-e<!fllllllions. intoDna!icl1, ar r~ .. ommo:nd!ltiolls ale ani\ol;~".

In lile evenl rllar thB 16C~liQI1 (1flh~ w~1I changes bur is M!lI within lhe patcel de.crib«l Oll rhjs apl'ii~"tion. our divisioll o.:,"sid.:n; tn.: COrnmOll!,; 10 Sl;/! be appllcab!<l, ~~l<J '1'0: do not need to roview Ih" n~w Ia:mioll.

FEB-c'D-20m 10: 21RM FRX:8085864352 I D : DLHF' GJR~1 PAGE: 002 R=9T-;

,.... . reb-2f·200~.lO:~am From-DEPT OF HEAL}H"ENVIRONMENTAL MNGMT 3085864352

'" T-907 P.D01/OOZ F-112

~ . ' " -he' Depal1ment of Health, Clean Watert3ranch has the 'following comments:

I. Fo~ Well-Drilling Activities

~y dischqtge to State waters of treated process wastewater effluent associated with well driUing activities 'is -egulated QY Hawaii Administrative Rules, Title 11, Chapter 55, Appendix I. effective-Septe~ber22, 1997. rreateci.process wastewater effluent covered by this general permit includes weR drifting slunies. Illbricating luids wastewaters. and well purge wastewaters. This general-permit does net cover well pump testing. The applicable iNotice of Intent Forms and filing fee shaU be submitted at least thirty (30) days· before the start of ~ischarge to the-Department of Health. Clean Water Branch at 919 Ala Moana Boulevard, Room 301, ~onolulu. Hawaii 96814--4920 or P.O. Box 3378, Honolulu. Hawaii 96801-3378. Inquiries may be directed to the Clean Water Branch at (BOB) 586-4309 or by fax at (808) 586-4352.

2. For Well Pump Testing

The discharger shaa take all measures necessary to prevent the discharge of pollutants from entering State . waters. S ... d1 measures shall includei if necessary. containment of the initial discharge until the_ dJsch;arge: is essentl~lIy free of pollutants. If the discharge is entering a stream or river bed. best man~gement . -pradices &?hall be implemented to prevent the discharge from disturbing the clarity of the receivin~1 water. If the discha'rge is entering a stOf\'11 drain, the dis~harger must obtain written permission from t11e owner of that stonn: drain prior to discharge. Furthermore, best management practices shall be implemented to pr~vent the discharge from collecting sediments and ether pollutants prior to entering the ston"!l drain.

I'

JSlcr

...

. .

'-

'.

FE8-20-2007 10:21HM FHX:8085864352 I D : DU1R G.JRf'1 PHGE:001 R=97%

c o FEB





STEPHANIE A. WHALEN

TO:

FROM:




February 13, 2007

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

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

Peter T. Young, Chairperson 11 Commission on Water Resource Management

ct:)l :;;0 C\' ~ "., ~ 'f)

~ r'-.... ~5 -, "'~

....-"""0; (7) OJ ..... ,on --1 /~ ~ .p~

~.o:: ':~ ",

~'.-;Y .. - .- ." '>. .J.. ... -

C') .~ C4 r:1 ...... .."" ..:;.~ .-il m r-rf ...... -- ?» -j ..c..

SUBJECT: Well Construction/Pump Installation Permit Application Makuu Ranch Well (Well No. 3486-05)

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

We would appreciate your comments on the captioned application for any conflicts or inconsistencies with the programs, plans, and objectives specific to your department. Please respond by returning this cover memo form by March 13,2007. Ifwe do not receive comments or a request for additional review time by this date, we will assume that you have no comments.

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

RI:ss Attachment( s)

RESPONSE:

[ I

[ I

[ I

[ I

[ I

[ I

[ I

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

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

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

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

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

An NPDES pennit is required.

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

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

~ No comments/objections NO ~vz;(J , Contact Perso~: 'gerr1NU!t,0{J &t vvr;r I n Signed: .-.::C'foh~_---=~ __ ~~ ________ _

Phone:

Date:

q?;?;. oL/o I 01~zo~ol

:lJ tf.1I :") ;-!11 ....-< , '1 0

o o

Results

Well Depth Theoretical Thickness of Aquifer 41 1/4 Aquifer Thickness 10.25 Q!iPtf{i)t.WJ11I bf1/ovvSea Level '" ,i·OY ,...'. '~ okay·· /,. ·,'·:'/·1 Se¢tlOIl/2:2: .

Well Casing Minimum Wall Thickness

Material pvc plastic Minimum Thickness per standards no requirement /

WalHhickness prpvided ... ' :' .. 0,i31,2p to~all Section2.4(b) Minimum Length of Solid Casina

90% of groun~ to top of aquifer 107.1 Length: Qt.$olidcas;ng Provide,d '.: . ,:v: .1"20 ok~y" , Section 2.4(c)

C8sffjgM~teriaf Schedule 40· in ~Qmpllance Section 2.4(d) .. ((orltv.C.Qhly-check for 20Q' limit) '. okay Section 2.4(d) Annular Space

Depth of Grouting Calculated Depth of Grouting 83.3 Depth QtGrouting provid.ed. 85 okay Section 2.6(c)

Minimum Annular Space required 2 . Thickness of Annular Space , ... ~ .. , : ... .. ~ okay Sectipn·2.6(d)

COMMQON ON WATER RESOURCE MANAGEMENT Q ROUTE SLIP FOR NEW APPLICATIONS

FROM: RYAN

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

1 HARDY,R. ~ HIGA, D.

_2_ HOAGBIN, S. ICE,C.

--IMATA,R. --

KUNIMURA, 1.-

DATE: 6-Dec-06

~AKAMA'L.

NAKANO,D. ~ OHYE, M. SAKODA, E.

--SWANSON, S. ----UYENO, D. --

YODA, K. YOSHINAGA, M.-

SUSPENSE DATE:

Approval -1-Signature -3-lnformation

WELL NUMBER )~9 b - cr; D WELL CONSTRUCTION

WELL NAME Makuu Ranch

D PUMP INSTALLATION

ATTACHMENTS FOR APPLICATION PROCESSING - Both applicant & staff generated 1 TRANS. LETTER ~ 2 PERMIT PROCESS TABLE ---:-;;r 3 CWRMMAP

4 APPL. FORM (11 COPIES)

5 USGS MAPS (11 COPIES)

6 TAX MAPS (11 COPIES)

7 PARCEL OWNER VERIF.

~ ---;:r-

-;:/ ~ MLS PRINTOUT -r DCCA LICENSE SCREEN PRINTOUT

13-Dec-06

PLEASE:


Take Action Type Draft acknow letter

-2-Type Final w/elec.signat., label file folder -4-File

Xerox copies

I2f' BOTH

8 CONTRACTOR VERIF.

9 ALL INFO FILLED IN

10 BACKGROUND CHECK

11 $25 FEE DEPOSIT SLIP

12 DHP/CDUP/SMA pre·screen

~~ 'Itt!J

FOLDER:

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

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

INCOMPLETE ACTION DATES:

DATE ACTION

.----.~~-.~----------------


Mr. Rod Diamond




February 13,2007


Dear Mr. Diamond:

o PETER T. YOUNG

CHAIRPERSON



STEPHANIE A. WHALEN

3486-0S.ack

Well ConstructionlPump Installation Permit Application for Well No. 3486-05

We acknowledge receipt, on January 19,2007, of your completed Well ConstructionlPump Installation permit application and filing fee for the Makuu Ranch Well (Well No. 3486-05). You can expect your application to be processed within ninety (90) days from this date.

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

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

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

RI:ss Attachment

c: Hulilauakea Wilson

Sincerely,

w:rH W.ROYHARDY Hydrologic Program Manager

o LINDA LINGLE

GOVERNOR OF HAWAII PETER T. YOUNG

CHAIRPERSON

TO:

FROM:




February 13, 2007

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

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

Peter T. Young, Chairperson 11 Commission on Water Resource Management



STEPHANIE A. WHALEN

SUBJECT: Well Construction/Pump Installation Permit Application Makuu Ranch Well (Well No. 3486-05)


We would appreciate your comments on the captioned application for any conflicts or inconsistencies with the programs, plans, and objectives specific to your department. Please respond by returning this cover memo form by March 13.2007. Ifwe do not receive comments or a request for additional review time by this date, we will assume that you have no comments.

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

RI:ss Attachment( s)

RESPONSE: [ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

[ ]

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

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

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

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

For the applicant's information, a source of possible wastewater conlamination (]is (] is not located near the proposed wen site (information attached).

An NPDES permit is required.

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

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

No comments/objections

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

Signed: ________________ _ Date:

o LINDA LINGLE

GOVERNOR OF HAWAII PETER T. YOUNG

CHAIRPERSON



TO:

FROM:

SUBJECT:




February 13,2007

Russell Tsuji, Administrator Land Division


Well ConstructionlPump Installation Permit Application Makuu Ranch Well (Well No. 3486-05) TMK 1-5-025: 049

STEPHANIE A. WHALEN



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

RI:ss Attachment(s)

RESPONSE:

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

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

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

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

[ ] No objections

[ ] Other comments:

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

Signed: __________________ _ Date: _______ _


TO:

FROM:

SUBJECT:

o o




February 13,2007

Melanie Chinen, Administrator Historic Preservation


Well Construction/Pump Installation Permit Application Makuu Ranch Well (Well No. 3486-05) TMK 1-5-025: 049



CHIYOME l. FUKINO, M.D. LAWRENCE H. MilKE, M.D., J.D.

STEPHANIE A. WHALEN



Please find the attached maps to locate the proposed well. If you have any questions about this permit application or request additional review time, please contact Ryan Imata of the Commission staff at 587-0255. If you require additional information regarding specific information that can be provided by the applicant, please contact the applicant directly at the contact information provided on the application form.

RI:ss Attachment(s)

RESPONSE:

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

[ ] We concur that the work described under this permit will not disturb historic sites.

[ ] We do not concur that the work described under this permit will not disturb historic sites. We require the following for our concurrence:

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

Signed: __________ ~ ______________________________ _ Date: ________ _

Professional and Vocational Licensing (PVL) - powered by eHawaii.gov

C 0 Page 1 of 1

GENERAL LICENSEE

LIC ID: CT-23379 Active/Inactive: ACTIVE

NAME: RODNEY K DIAMOND

TRADE NAME:

STATUS: CURRENT, VALID & IN GOOD STANDING

ENTITY: INDIVIDUAL BUSINESS CODE: SOLE OWNER

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

CLASS PREFIX: BC SPECIAL PRIVILEGE:

RESTRICTION: EDUCATION CODE:

BUSINESS ADDR: HCR #3 BOX 14073 KEAAU HI 96749

MAILING ADDR:

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

587-3295.

~OtA 9,~~ 4f'(7S

I~ ~ov~~ uvt &-L~h~ U\.f,. VVp~

~e-Ye ~ c;- It. 'fY' ~ _- ti£NlS~~

?~ "1- \ - .,... '2. ~ ~lI ~ \ J\ #)/(Jl . ,

http://pvl.ehawaii.gov/pvlsearch/app?_a=d&_f=n&lictp=CT&licno=23379&off=&nm=RO... 2/7/2007

Well Background Check

Approved Well No. Well Name Applicant

Kodhi Kenneth Davis

Barvaria 1 Jeffrey J. Spaur

Makuu Ranch Huliauakea Wilson

Dick & Jane Lynn R. Young

0037-01 Honolua Stoops David Stoops

Greene Family Tr Rob Ledson

08/2002 3688-05 Love

11/14/2003 3688-06 Raven

4/12/2004 3500-02 Nichols

4/14/2004 3687-10 Fenn

6/4/2004 3688-07 Webb

6/14/2004 3688-08 Lien

8/27/2004 3586-04 Dennis

8/31/2004 3687-13 Camp

10/21/2004 3787-05 Bartlett

12/23/2004 3686-04 Connie

1/3/2005 3687-16 Duley

03/2005

113/2005

3388-01

3786-01

Hendershot

Gapp

2/21/2005 3688-10 Wallace

3nt2005 3686-05 Gibson

3nt2005 3587-08 Oliver

3nt2005 3587-07 Hendershot 2

4/29/2005 3686-06 Polu Puka

6/2/2005 3588-02 Jobst

6/2/2005 3786-02 Peters

David Love

Dennis Rofkar

Greg Nichols

Isaac J. Fenn

Charles Webb

Oran & Sandra Lien

Ardis Dennis

Richard & Teresta Camp

Michael Bartlett

Connie Bouchard

Robert Duley

Carolyn Hendershot

John Gapp

William & Marietta Wallace

Judith Gibson

Patty Oliver

Carolyn Hendershot

Rick Carey

Russel & Joan Jobst

Martin W. Peters

Well Construction Driller Pump Inst. Type Issued Signed WCR1 Accept

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BOTH

BOTH

BOTH

BOTH

BOTH

BOTH

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

BOTH 11/17/2003 12/612003 1011 812005 10/18/2005

BOTH 4/19/2004 7/1312004 7/6/2005 9/1212005

BOTH 4123/2004 9/1312004 3/24/2005 5/18/2005

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

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

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

BOTH 9/21/2004 11/1/2004 3124/2005 5/1812005

BOTH 10/2612004 10/29/2004 3/24/2005 5/18/2005

BOTH

BOTH

BOTH

BOTH

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

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

1/612005

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

BOTH 212312005 2126/2005 61712005 9/1212005

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

BOTH 31712005 3/9/2005 61712005 9/1212005

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

BOTH 5/312005 9/15/2005

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

BOTH 6/812005 6/13/2005

6/2/2005 3787-06 Lucky Me Regina M. Lutz and Kayrene L BC-23379 BC-23379 BOTH 6/8/2005 6/13/2005 7/612005 9/1212005

We,rtnesday, February 07, 2007

Pump Installation Issued Signed WCR2 Accept

6/312005 1211712004 3124/2005 5/18/2005

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

111712005 11/8/2005 71612005 9/1212005

6/3/2005 2122/2005 3/24/2005 5/18/2005

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

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

111712005 11/8/2005 61712005 9/1212005

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

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

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

111712005 11/8/2005 61712005 9/1212005

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

111712005 11/8/2005 61712005 9/1212005

111712005 11/8/2005 71612005 9/1212005

111712005 11/8/2005 61712005 9/1212005

111712005 11/8/2005 61712005 9/1212005

5/3/2005

6/8/2005 6/13/2005 10/18/2005 10/18/2005

6/812005 6/13/2005

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

Page 1 of4

Approved Well No. Well Name

6/2/2005 3586-06 Oh

6/2/2005 3688-12 Harrison

6/2/2005 3688-11 Hyitt

8/8/2005 3687-18 K&J

8/8/2005 3180-02 Morningstar

10/18/2005 3486-02 Campbell

11nt2005 3586-07 Family

11/7/2005 3686-07 Ariel

01/2005 3686-09 McWell

12/2/2005 3687-20 Tour

12/2/2005 3586-09 Helenihi

12/2/2005 3687-21 Jennings

12/3/2005 3686-11 Zaulocki

12/3/2005 3687-19 Suncloud

12/3/2005 3687-22 Schneider

12/3/2005 3688-14 Nielsen

12/3/2005 3586-10 B. Bells

12/3/2005 3686-12 Terry

12/3/2005 3687-26 #58

03/2005 3687-23 Takeda

12/3/2005 2485-03 Hosteler

12/3/2005 3686-10 Wishing

12/3/2005 3586-11 T Moore

12/3/2005 3787-08 Nailoa

12/3/2005 3687-25 #57

12/3/2005 2385-01 Epperson

12/3/2005 3687-24 P Moore

3/30/2006 3586-12 Erickson

UVednesday, fCebrua~

Applicant

Shelley & Jeffery Hecht

Victor Chris Harrison

Carolyn Hendershot

Kenneth Spence

Steve Shaffer


BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BOTH

BOTH

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

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

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

BOTH 812412005 9/12/2005 101712005 101712005

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


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

618/2005 6/13/2005 7/61'2005 9/1212005

6/8/2005 6/1312005 3130/2006 3130/2006

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

1/11/2006 111212005 1/27/2006 112712006

Christopher & Marta Campbell BC-23379 BC-23379 BOTH 11n/2005 11110/2005 11/21/2005 11/21/2005 111712005 11/9/2005 11/21/200511/21/2005

Gary & Meng-Ju De Vine

Bruce Martin

Eugene McElroy

Charles Tour

James Helenihi

Scott Jennings

Paul & Tamara Zaulocki

Scott Suncloud

Klaus Schneider

Greg Nielsen

John Acree

Roy & Bonnie Terry

Tri Coast Development LLC

Basil Takeda

Winna Marie Hosteler

Clifford Schommer

Thomas H. Moore

Roger Pogline

Tri Coast Development LLC

Peter Epperson

Paul P. Moore

John Erickson

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BOTH 11/10/2005 11/14/2005 11/2112005 11/21/2005 1111012005 11/14/2005 111211200511/21/2005

BOTH 11/10/2005 11/17/2005 11/21/2005 11/2112005 11/10/2005 11/17/2005 11/21/200511/21/2005

BOTH 1211/2005 1212212005 12/14/2005 1211412005 1211/2005 1213/2005 12114/2005 12/14/2005

BOTH 12/212005 12114/2005 12130/2005 12130/2005 12/212005 12/14/2005 1213012005 12130/2005

BOTH 12/212005 12/6/2005 12/14/2005 12/14/2005 121212005 1216/2005 12114/2005 1211412005

BOTH 121212005 121212005 12114/2005 12/14/2005 121212005 121212005 12/14/2005 1211412005

BOTH 1211512005 1/312006 111112006 1/1112006 12115/2005 1/312006 1/1112006 1/11/2006

BOTH 12/15/2005 12/20/2005 1213012005 12130/2005 12/15/2005 1212012005 1213012005 12130/2005

BOTH 1211512005 12119/2005 12130/2005 12130/2005 12115/2005 12119/2005 12130/2005 12/30/2005

BOTH 12/15/2005 1/912006 1127/2006 1/27/2006 12115/2005 1/912006 1/27/2006 1/27/2006

BOTH 1211512005 1/512006 1/11/2006 1/1112006 1211512005 1/5/2006 1/1112006 1/11/2006

BOTH 12115/2005 12115/2005

BOTH 12116/2005 3/312006 3/30/2006 3/30/2006 12/1612005 31312006 3/30/2006 3/30/2006

BOTH 12/15/2005 1124/2006 2/3/2006 21312006 12115/2005 1/24/2006 2/312006 21312006

BOTH 12115/2005 12/15/2005

BOTH 12115/2005 114/2006 1/1112006 2117/2006 12115/2005 219/2006 2117/2006 2/17/2006

BOTH 12/15/2005 115/2006 1111/2006 1/11/2006 12/15/2005 115/2006 1/11/2006 1/1112006

BOTH 1211512005 112412006 21312006 213/2006 12115/2005 1/26/2006 2/312006 2/312006

BOTH 12/16/2005 3/1/2006 3130/2006 3/30/2006 1211612005 3/1/2006 3130/2006 3/30/2006

BOTH 12115/2005 1/15/2006 3/30/2006 3/3012006 12115/2005 1/15/2006 3/30/2006 3/30/2006

BOTH 12116/2005 12122/2005 12130/2005 12/30/2005 1211612005 12122/2005 12/30/2005 1213012005

BOTH 4/612006 4/17/2006 4/24/2006 4/2412006 4/612006 4/17/2006 4/24/2006 4/24/2006

Page 2

Approved Well No. Well Name Applicant

3/30/2006 3686-14 Bachman Christine Bachman

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

3/30/2006 3686-13 Wohlschagel Fred Wohlschlagel

3/30/2006 3687-27 King Thomas King

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

4/13/2006 3585-04 My Dream Jeff Hecht

4/13/2006 3384-01 Mydell Wayland Lum

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

05/2006 3589-03 R&B

4/15/2006 3587-09 Makai

4/15/2006 5408-01 Bigpus II

5/15/2006 3687-34 PPLC

5/23/2006 3487-03 #242

8/17/2006 6116-01 D&D

8/17/2006 3686-16 Summer

8/17/2006 3687-38 Charlie

8/17/2006 3587-10 Akana

8/17/2006 3585-05 Malat

8/17/2006 3586-14 Piilani

07/2006 3686-15 Lamberson 1

8/31/2006 2385-02 Kakela Akai

8/31/2006 3586-13 Deeter

8/31/2006 3586-15 Merlin Mac

8/31/2006 5106-01 Bugado

8/31/2006 3486-04 Lagadon

8/31/2006 3687-37 Kipukawai

9/8/2006 3787-09 All's

9/8/2006 3687-39 Kalanikoa

Wednesday, February 07, 2007

Roy & Bonnie Terry

Levi McKay

Gary Hajek

Christian Pearson

Timothy Housman

Dean Schmitz

Douglas M. Keown

Thomas Mullen

Amy Akana

Chris Malat

Arruda Properties

John Lamberson

John & Sherry Williams

Paul Allen Deeter

Gerard & Gail Madie

Justin Bugado

Jason T. Lagadon

Marq Simms

Don & Sylvia Hashimoto

Glenn Severance


BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BC-23379 BC-23379

BOTH 4/6/2006

BOTH 4/5/2006 4f712006 4/24/2006 4/24/2006

BOTH 4/612006 4/12/2006 4/24/2006 4/24/2006

BOTH 4/612006

BOTH 121112006 1218/2006 12120/2006

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

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

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

BOTH 4/26/2006 5/512006 5/30/2006 5/3012006

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

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

BOTH 6/19/2006

BOTH 6/19/2006 6/2012006 6/28/2006 6/28/2006

BOTH 8/24/2006 12/1/2006 12/20/2006

BOTH 911112006 9/27/2006 10/5/2006 10/5/2006

BOTH 8124/2006 9/27/2006 10/5/2006 10/512006

BOTH 8124/2006 9/21/2006 10/5/2006 10/5/2006

BOTH 812412006

BOTH 8/24/2006 10/10/2006 11/6/2006

BOTH 8124/2006

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

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

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

BOTH 10/5/2006

BOTH 1015/2006 10/1212006 11/6/2006

BOTH 10/5/2006 10/1012006 11/612006

BOTH 10/6/2006

BOTH 1016/2006 10/2012006 11/612006


4/6/2006

41512006 41712006 4/24/2006 412412006

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

4/612006

1211/2006 1218/2006 12120/2006

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

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

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

4/26/2006 5/512006 5130/2006 5/30/2006

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

4126/2006 11127/2006 1212012006

6/1912006

6/1912006 612012006 6128/2006 6128/2006

8/24/2006 121112006 12120/2006

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

8124/2006 9/27/2006 10/5/2006 10/5/2006

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

8/2412006

8/24/2006 10/10/2006 11/6/2006

8124/2006

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

10/5/2006 10/16/2006 11/6/2006

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

10/5/2006

10/5/2006 10/1212006 111612006

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

1016/2006

10/6/2006 10/20/2006 11/6/2006

Page 3 0/4

{!;~-_t ~A~ ~Ol-.

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

11/20/2006 3586-16 Monica II Joseph O'Sullivan BC-23379 BC-23379 BOTH 12114/2006 12120/2006 12114/2006 12/20/2006

11/20/2006 3586-17 Turtle Mical Simon BC-23379 BC-23379 BOTH 1218/2006 1218/2006

11120/2006 6953-03 Paoo-Gray Joel Gray BC-23379 BC-23379 BOTH 1218/2006 1218/2006

11120/2006 2780-01 Mary's Well Michael Chroman BC-23379 BC-23379 BOTH 1218/2006 1218/2006

12126/2006 3586-18 R&R Roy & Rosemary Hollowell BC-23379 BC-23379 BOTH 211/2007 211/2007

12126/2006 3588-03 Chong-Tim Dana Chong-Tim BC-23379 BC-23379 BOTH 211/2007 211/2007

12126/2006 3687-42 Sophinos Valerie Maria Robertson BC-23379 BC-23379 BOTH 211/2007 211/2007

12/26/2006 3687-40 Hawkins George Hawkins BC-23379 BC-23379 BOTH 2/1/2007 21112007

06/2006 3687-41 Kipuka Dane D. Silva BC-23379 BC-23379 BOTH 2/1/2007 21112007

9

Wejrtne.sd~y, February 07, 2007 Page 4

Search Results o o Page 1 of 1

Copyright ©2/7/2007 by Hawaii Information Service

Assessed Values reflect tax year 2006.

Search criteria: TMK Taxkey 3-1-5-25-49

• PUBLIC RECORD DATA Taxkey Subdiv /Condo Tnr Address Owner ILessee Bds Bths Land area Liv area Last Sale Instr Pric r. 3-1-5-25-49 Hawaiian F 15- WILSON, 1.00 ac 0 12/11/2003 DEED $8,00

Paradise Park 2032 HULILAU K K 11th Ave

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

http://webre2.hawaiiinformation.comlREsearchIHIS/Searchi search_PUB. asp?N OCA CHE=... 21712007

-----------------------.. -....•....•..

DOCUMENT NO . ARTMENT OF LAND AND NATURAL RESOIQ-S

UAC OR ATTACHED WORKSHEET . DATE· December 5 2006 .. , SRC/ COST

F YR APP D OBJ CTR PROJECT PH ACT AMOUNT NAME/DESCRIPTION (WANG INPUT)

S 07 326 C 1026 0752 (1 ) $25.00 TNV\(RE Enin.geering

" " " " " " (2) $25.00 Lori Diamond

" " " " " .. (3) $25.00 Lori Diamond .. .. .. .. .. " (4) $25.00 Lori Diamond .. .. .. " .. .. (5) $25.00 Jeffr~~ Spaur

(6) . ,

(7)

(8) .' ,

(9) ~

(10)

TOTAL $125.00 .. ~ 0;

REMARKS: LINE (1) Brydeswood No. 1 LINE (2) Stoops Well LINE (3 Dick & Jane Well LINE (4) Makuu Ranch LINE (5) Barvaria One LINE (6) LINE (7) . ;

LINE (8) LINE (9) LINE (10)

.... "

STATE OF HAWAJO 0 DEPARTMENT OF LAND AND NATURAL RESOURCES COMMISSION ON WATER RESOURCE MANAGEMENT

APPLICATION FOR A WELL CONSTRUCTION I PUMP INSTALLATION PERMIT

Instructions: Please pIlnt In Ink or type and ~ completed IIJIfIIICaIIOn willi aoactw.18I11S to the COIIIlIIlsslol. on Water Resource Management, P.O. Box 621, Honolulu, Hawai 96809. Application must be ............ _ bflO copies and a n0n

refundable filing fee of $25.00 payable to the Dept. of Land and Natural Resoun:es. The CoI ••• 1ission mar not acc:ept incomplete appli<;ations. For assisIance, call the Regulation 8rancIi at 587-0225. For iIIfhef" inumafiun and updaIes ID fhis application form, visit http:l'-.hawaii.govIdtnrIc:wrm.

Hulilauakea Wilson Huli (Same)

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

X 16 Domestic Number of units to be served:

Rodney K Diamond

r-F-or-Qffi--C-Ia-I-u-se-o-n-IY-:-----,V /

JB DEC 4 A 9: 2 5

Same

Rodney K Diamond 1/2 Print Dale 10 0/06

~ ~neyKDiamond ~7IC-STaI" License No.

Dale 1 0/20/06

HCR #3 Box 14073 Keaau HI 96749 HCR #3 Box 14073 Keaau HI 96749

966-4129 966-4129 E-mail E-mail

WCPI App. Form 10/05104

r "

o

o

3fJNYH::J Ol l::Jiuens

4YW XYI """WIt. JLYU' IWnIIt tftW NOU'lllY4

• l1li'0

'/,./.U "l-'J.ft,- • .""" , ... ",~ ._ .. ,1" ....... ~_ " ,..w ... _,0"".;.1 /IV :1IJ.fJN

)\10 ·01:1£

.. , (11-' -,

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

Hole Diameter: 12 inches.

Elevation at top of casing 121

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

t Solid casing: (= 90% x (Ground Elev.-Water level Elev»

Total length: ____ -"12..,,0'--_____ ft,.

Nominal Diameter: __ ~6"-____ ,in.

WaD Thickness: ___ 54=O,---,-__ i,n.

Grouting method:

Annular space between hole and casing (1.S" for positive displacement, 3" for other methods):

Bottom Elevation:. ______ -O-:.-___ ft., msl*

+ o Positive Displacement

xOther _3_in. Open Casing: • Perforated C Screen

Rock or Gravel Packing: Total length: ____ :><..S ______ ft.

Total Depth

~ feet.

~ ft. Nominal Diameter: __ ->6<--_____ i,n.

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

x Crushed Basalt Bottom Elevation:. ___ -"'-s'-___ ft., msl*

o Rounded Gravel

--l note: Neither bentonite nor mud should be used in

saturated zone during drilling

Estimated Water level Elevation: ~-- Open Hole:

Est.4" ft. rnsl* I

I length: __ ......,N!.!..~_'_ ______ ft.

* Diameter: ___________ ,in.

* 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 CornpletionlWeII Abandonment reports and referenced to a benchmark which has been established by a surveyor licensed by the State.

Bottom Elevation:

For non-salt water Basal Wells - bottom elevation otwell shoutd not be deeper than 1/4 of aquifer thickness or, Bottom Elevation of Well Umit = ~ater Elevation - ) Example: Estimated + 2 ft. Water level Elev. Bottom Elevation of Well Umit = ( 2 - ) = -18.5 ft.

Solid Casing Material:

ft., msl*

Carbon Steel: compliant with (check one or more): 0 ANSIIAWWA C200 0 API Spec. 5L 0 ASTM A53 0 ASTM A 139 And compliant with (check one or more): 0 ASTM A2.42 (or A6oo) 0 Type E 0 Type S 0 Grade B 0 Other

Stainless Steel: (check one): o ASTM M09 (production wells) o ASTM A312 (monitor wells) ABS Plastic conforming to ASTM F480 and ASTM 01527: (check one) 0 Schedule 40 0 Schedule 80 PVC Plastic conforming to ASTM F480 and (ASTM 01785 or ASTM 02241): (check one): • Schedule 40 0 Schedule 80 0 Schedule 120 Thermoset Plastic: (check one) 0 Filament Wound Resin Pipe conforming to ASTM D2996

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

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

And compliant with (check one or more): 0 ASTM A2.42 (or A606) 0 Type E 0 Type S 0 Grade B 0 Other Stainless Steel: (check one): 0 ASTM M09 (production wells) 0 ASTM A312 (monitor wells) ABS Plastic conforming to ASTM F480 and ASTM 01527: (check one) 0 Schedule 40 0 Schedule 80 PVC Plastic conforming to ASTM F480 and (ASTM 01785 or ASTM 02241): (check one): • Schedule 40 0 Schedule 80 0 Schedule 120 Thermoset Plastic: (check one) 0 Filament Wound Resin Pipe conforming to ASTM 02996

o Centrifugally cast Resin Pipe conforming to ASTM 02997 o Reinforced Plastic Mortar Pressure Pipe conforming to ASTM 03517 o Glass Fiber Reinforced Resin Pressure Pipe conforming to AWWA C950 o PTFE Fluorocarbon Tubing conforming to ASTM D3296 o FEP Fluorocarbon Tubing conforming to ASTM D3296

wePI App. Form 10l05I04

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