Department of Health Seal

TGM for the Implementation of the Hawai'i State Contingency Plan
Section 18.6
SUPPORTING FORMS AND OTHER DOCUMENTS

18.6 SUPPORTING FORMS AND OTHER DOCUMENTS

18.6.1 Soil Boring Log

Accurate boring logs are essential for evaluating and interpreting analytical results. Soil Boring Logs are included in Site Investigation Reports and Remedial Investigation Reports, as well as other reports, where appropriate. See Section 5.5.7 for additional information regarding Soil Boring Logs.

Recommend boring log contents include:

  • Date, time (both starting and ending, if multiple days)
  • Weather and site conditions
  • Name(s) of field or sampling personnel
  • Name of drilling contactor
  • Drilling method
  • Borehole coordinates - latitude and longitude
  • Sketch showing the sampling location (including reference distances)
  • Diameter and total depth of borehole
  • Drilling fluid and angle (if applicable)
  • Blow counts
  • Site name and identification
  • Boring location identification
  • Sample identification number (if applicable)
  • Depth to water and/or bedrock (refusal) when encountered
  • Soil description
  • Sample recovery (and portion submitted for analysis)
  • Type of sample equipment used
  • Field measurements (where appropriate)
  • General comments (e.g., odor, staining, etc.)
  • Planned sample analyses

A sample soil boring log is presented in Section 5, Figure 5-32.

18.6.2 Monitoring Well Installation Log

Throughout the drilling and well installation process, detailed observations are recorded in the Monitoring Well Installation Log. Prepare a well installation log for each monitoring well. See Section 6.2.1.5 for additional information regarding installation logs.

A recommend list of monitoring well installation log contents includes the following:

  • Project name and location
  • Well designation and location relative to contaminant source
  • Date and time of well installation start and completion
  • Environmental consulting company and on-site consultant
  • Drilling company
  • Drilling method
  • Volume of drill fluid and/or pre-development fluid lost into well during installation
  • A graphical depiction of the well
  • Casing material type, diameter, joint type, and screen slot size
  • Filter pack material, calculated and actual volume
  • Annular seal material, calculated and actual volume
  • Annular grout seal material, calculated and actual volume
  • Placement method for filter pack, seal and grout (tremie, pumped, gravity)
  • Borehole diameter
  • Depth to bottom of borehole
  • Depth to bottom of casing
  • Depth to bottom and top of screen interval
  • Depth to bottom and top of solid riser
  • Depth to bottom and top of filter pack
  • Depth to bottom and top of annular bentonite seal
  • Depth to bottom and top of annular grout
  • Depth to bottom of surface seal
  • Depth to the water table
  • Surface seal and well apron design
  • Protective box/casing and cap designs
  • Ground surface elevation
  • Top of casing elevation

A sample Monitoring Well Installation Log is presented in Section 6, Figure 6-7.

18.6.3 Monitoring Well Abandonment Form

A groundwater monitoring well that is no longer needed, sustains damage, or is determined to be improperly installed, must be properly abandoned so the well itself will not become a pathway for contamination. See Section 6.2.5 for additional information regarding well abandonment.

The monitoring well abandonment form (i.e., Abandonment of Monitoring Well Summary Report) must include the following:

  • Location
  • Owner Information
  • Well Construction Information, including installation date, depth to groundwater, casing and screening material, etc.
  • General Abandonment Information, including drilling firm and consulting firm contact information, etc.
  • Well Abandonment Information, including date and reason for abandonment, sealing material, method for placement of sealing material, etc.

A sample Monitoring Well Abandonment Summary Report Form is provided below.

Abandonment of Monitoring Well Summary Report
                          (Monitoring Well ID)
Submit form within 30 days of well abandonment or within 90 days if included in a site closure, monitoring, or investigation report. In addition, submit copies of the original boring log and well construction diagram for the monitoring well, a site map showing the location of the abandoned monitoring well, and the disposal documentation for wastes generated during the abandonment process. Submit all documentation to: Hawai`i Department of Health, Hazard Evaluation and Emergency Response Office, Attention: SDAR, 919 Ala Moana Blvd, Rm. 206, Honolulu Hawai`i 96814.
Location Information Owner Information
Facility Name: Well Owner:
Facility Address: Contact Person:
    Mailing Address:
Latitude:  
Longitude: Phone Number:
Fax Number:
TMK: Land Owner:
Location Description: Contact Person:
  Mailing Address:
   
Monitoring well location map attached: Y / N Phone Number:
Fax Number:
Well Construction Information
Date of Installation: Casing Material:
Casing Diameter:
Drilling Company: Casing Length:
Casing Depth:
Total Depth: Screen Material:
Slot Size:
Depth to Water: Screen Length:
Screen Depth:
Was well set in an aquifer that is current or potential drinking water source? Y / N: Annular Material:
Depth:
Boring log / well construction diagram attached: Y / N Annular Material:
Depth:
General Abandonment Information
Drilling Firm: Consulting Firm:
Contact Person: Contact Person:
Mailing Address: Mailing Address:
   
Phone Number:
Fax Number:
Phone Number:
Fax Number:
Well Abandonment Information
Date of Abandonment: Sealing Material
Depth:
Reason for Abandonment: Volume/Weight/Bags
Mixing Ratio:
Casing/Screen Removed: Y / N Sealing Material:
Depth:
If Yes, was annular material removed? Y / N Volume/Weight/Bags
Mixing Ratio:
If No, was casing cut off below surface? Y / N Method of Sealing Material Placement:
Comments:  
Driller's Signature: Date:
Consultant's Signature: Date:

18.6.4 Voluntary Response Program Application

An application is necessary to determine eligibility to participate in the Voluntary Response Program (VRP). A list of necessary application elements (no specific application form is required) can be found at the HEER Office web page at http://eha-web.doh.hawaii.gov/eha-cma/Leaders/HEER/voluntary-response-program (see How Can I Apply to Participate?). In addition, this website includes a "checklist" that can be downloaded that lists specific application elements that the HEER Office evaluates on new VRP applications.

18.6.5 Environmental Covenant

An environmental covenant is a legal device that restricts activities on sites where contaminated media is left on-site. The Uniform Environmental Covenants Act (UECA), HRS, 508C, was enacted by the Hawai`i State legislature in July 2006. The UECA provides a regulatory mechanism for recording engineering or institutional controls on a property, and requires the creation of a publically accessible web-based registry to identify properties utilizing this mechanism. HDOH, at its discretion, may require UECA covenants. In general, these covenants are required for risk-based closures with extensive or highly persistent contamination. They may also be required where there are foreseeable future use changes that could expose sensitive populations.

Information in a UECA covenant includes the following:

  • Site identification information
  • Grantor and Owner information
  • Site background
  • Intent of environmental covenant
  • Affected property
  • Activity and use restrictions
  • Obligations of the Grantor and all future owners and users of the Property
  • Duration
  • Effective date
  • Representations and warranties
  • Information regarding termination or modification of covenant
  • Enforcement of covenant
  • Rights of access to Property
  • Recording and registry
  • Execution

A sample environmental covenant has been developed by the HEER Office (below), however alternate formats may be acceptable on a case-by-case basis.

SAMPLE
STATE OF HAWAI'I
ENVIRONMENTAL COVENANT


Return by Mail ( ) Pickup ( ) To:

Document contains ___ pages

Tax Map Key: Portions of [

Environmental Covenant # [ ]
[Covenant Name]

SITE                                                                                     

This Environmental Covenant ( Covenant") is made by and between                                    (" Grantor"),                                    ( "Owner"), and the State of Hawai`i Department of Health (" Holder"). Grantor, Owner, and Holder are collectively the " Parties"to this Covenant.

1. Background.

1.1  On July 6, 2006, the Hawai`i Uniform Environmental Covenants Act, Hawai`i Revised Statutes Chapter 508C ("UECA" ) became law in the State of Hawai`i. The legislature found that there is a growing reliance on the risk-based cleanup of contaminated property when removal of contamination to unrestricted levels is infeasible, impracticable, or unnecessary. In such cases, certain land use restrictions, environmental monitoring requirements, and engineering controls known as Activity and Use Restrictions are required to protect the public and the environment from contamination that remains on the Property. The Hawai`i Department of Health, Hazard Evaluation and Emergency Response (HEER) Office uses environmental covenants to ensure compliance with the terms and conditions of risk based cleanup projects under Hawai`i Revised Statutes Chapter 128D.

1.2                                                  . ("Owner") is the owner of real property consisting of: (a) a [       ] acre portion of TMK:                             located at                                    more particularly described in Exhibit A attached hereto and incorporated herein ( the "Property" ).

1.3  Grantor and      (Owner's predecessor-in-interest) entered into that certain [       ] filed in the Office of the Assistant Registrar of the Land Court of the State of Hawai`i as Document No. [       ] and noted on Transfer Certificate of Title Nos., [       ] which affect the Property.

1.4  Pursuant to said Reciprocal Easement Agreement, Grantor undertook an environmental response project on the Property pursuant to Hawai`i Revised Statutes Chapter 128D and the Voluntary Response Program Agreement between Grantor and Holder dated June 2001 (the " Environmental Response Project ").

1.5  The Environmental Response Project is described in the administrative record identified as [FACILITY/SITE NAME, LOCATION, DATE] which record is located at the Office of Hazard Evaluation and Emergency Response, State of Hawai`i Department of Health ("HDOH").

1.6  In consideration of the Environmental Response Project, the Holder has issued a Letter of Completion under Hawai`i Revised Statutes Section 128D-39 dated                            ,[YEAR] ; attached hereto as Exhibit B, ("Letter of Completion") subject however, to the execution and delivery of an environmental covenant made in accordance with and pursuant to UECA.

2. Intent . The parties executing this Covenant intend it to be an "environmental covenant" created and executed pursuant to UECA. The State of Hawai`i Department of Health is deemed to be a "holder" in accordance with the UECA. The property shall be burdened by the Activity and Use Restrictions described in paragraph 4 to the benefit of the Holder, and, in accordance with the Covenant, and use of this Property shall be subject to the Environmental Response Project or this Covenant. This Agreement is to be governed by and construed in accordance with Hawai`i law, and courts sitting in the State of Hawai`i, including the United States District Court for the District of Hawai`i to the extent it has jurisdiction.

3. Affected Property . This Covenant applies to the Property.

4. Activity and Use Restrictions. The Grantor and Owner shall comply with the following Activity and Use Restriction:

4.1. [List applicable activity and use restrictions here]

5. Obligations of the Grantor and all future owners and users of the Property . The Grantor and Owner for themselves and on behalf of their heirs, successors, assigns and all persons acquiring or owning any right, title, or interest in the Property and their respective heirs, successors, assigns, lessees, licensees, executors, administrators, devisees and any users of the Property, now agree to comply with the Activity and Use Restrictions and incorporate either in full or by reference the restrictions of this Covenant in any deed, lease, license or other instruments granting a right to use the Property and any mortgage.

6. Duration. This Covenant shall be perpetual unless amended, terminated or modified pursuant to and in compliance with UECA.

7. Effective Date . This Covenant shall be effective at such time as all of Grantor, Owner, and the Holder have executed this Covenant.

8. Representations and Warranties. Each person signing this Covenant warrants that, to the best of his or her knowledge, he or she is the appropriate individual to represent his or her own interest or the interest of the entity on whose behalf the person is signing this Covenant in matters related to this Covenant. Each person signing also warrants that he or she possesses the proper authority to enter into this Covenant in the capacity stated in the applicable signature block. Additionally, the Grantor and Owner warrant that to their knowledge, there are no recorded or unrecorded interests in the Property that have not been disclosed.

9. Termination or Modification of this Covenant. This Covenant may be amended or modified or terminated only by a recorded document signed by the Grantor, Owner, and Holder and only in accordance with applicable provisions of UECA.

10. Enforcement. This Covenant is subject to the enforcement provisions of UECA.

11. Rights of Access to the Property. The Holder shall have the right to enter the Property at reasonable times without prior notice for the purpose of determining compliance with the terms of this Covenant. Nothing in this Covenant shall impair any other authority the Holder may otherwise have to enter and inspect the Property. No confidential information secured by an official, agent, or employee of the Holder within the scope and course of his or her inspection shall be disclosed by them except as it relates directly to Property contamination and then, only in connection with their official duties and employment.

12. Recording and Registry. This Covenant and any modification, amendment or termination instrument shall be recorded with the State of Hawai`i Bureau of Conveyances or Office of the Assistant Registrar of the Land Court of the State of Hawai`i or both as applicable. The Grantor shall provide a copy of the final recorded Covenant, any amendments, any termination documentation, and documentation of any other matters related to this Covenant to the Holder. The validity of this Covenant is not affected by failure to provide a copy of the Covenant. This Covenant is, however, subject to the laws of the State of Hawai`i governing recording and priority of interests in real property. A copy of this Covenant and any modification, amendment or termination instrument shall be available at the Holder's Registry of Environmental Covenants.

19. Execution. This Covenant may be executed in any number of counterparts, each of which shall be deemed an original, but all of which together shall constitute one and the same instrument.

The Parties hereby execute this covenant as of this                 day of                  ,[YEAR] .

By                                                                            

Name:                                                                      

Title:                                                                         

 Grantor

State of Hawai`i Department of Health

By                                                                            

Name:                                                                      

Title:                                                                         

 Holder

By                                                                            

Name:                                                                      

Title:                                                                         

By                                                                            

Name:                                                                      

Title:                                                                         

 Owner

NOTARY SEAL FOLLOWS

EXHIBIT A

Insert Detailed Legal Description of Property where Covenant applies

18.6.6 Removal or Remedial Action Fact Sheets

To support public participation, a Fact Sheet may be necessary to summarize site information, the response action process, and the proposed response action. A Fact Sheet also presents information regarding the opportunity to review the record and submit public comment on the proposed response action within a specified comment period (at least 30 days). See Section 2.4.6 for additional information regarding public participation. The following outline is suggested for a Removal or Remedial Action Fact Sheet. Sample Fact Sheets are also available on the HEER Office Web page.

Example Outline for a Removal or Remedial Action Fact Sheet

1.0

Introduction

2.0

Site and Vicinity Description

3.0

Site Characterization

4.0

Environmental Hazards

5.0

Removal or Remedial Action Development

6.0

Proposed Removal or Remedial Action

7.0

Next Steps (timetable)

8.0

Community Involvement

9.0

Information Repository

10.0

Agency Contact