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HomeMy WebLinkAboutPD Background Report (PL-USE-2026-000042)-1- B_Stevens_USE_2026 COUNTY OF HAWAI‘I PLANNING DEPARTMENT BACKGROUND REPORT JESSICA STEVENS USE PERMIT APPLICATION (PL-USE-2026-000042) JESSICA STEVENS is requesting a Use Permit to allow the establishment of an outpatient medical clinic within the first floor of an existing two-story dwelling on a 5.74- acre parcel of land in the Single-Family Residential zoning district. The subject property is located at 28-1167 Old Mamalahoa Highway, about 230 feet north of Pepeʻekeō Street, South Hilo, Hawaiʻi, TMK: (3) 2-8-007:084. APPLICANT’S REQUEST 1. Request: The applicant requests approval of a Use Permit to establish an outpatient medical clinic within an existing single-family residence located in Pepeʻekeō. The proposed clinic is intended to provide outpatient medical evaluation, diagnosis, treatment, and follow-up care specializing in neuromodulation services, including non-invasive Transcranial Magnetic Stimulation (TMS), for individuals with treatment-resistant depression and related conditions. The clinic is proposed to operate by scheduled appointment only, with approximately 8 to 12 patients per day and 2 to 3 on-site personnel. Proposed improvements are limited to minor interior renovations, ADA accessibility upgrades, and minor driveway and parking area improvements, with no expansion of the existing building footprint proposed. The second level of the dwelling would remain a residence. 2. Reason for Request: The request is being made to allow the establishment and operation of a small outpatient medical clinic within an existing structure on the subject property. The Use Permit is required because a medical clinic within the RS-10 zoning district is permitted only upon approval of a Use Permit by the Planning Commission. The request also facilitates the adaptive reuse of the existing structure for professional medical services while maintaining the rural residential character of the surrounding area. -2- 3. Staffing/Employees: The proposed clinic is expected to employ approximately 2 to 3 on-site personnel. 4. Hours of Operation: The proposed clinic would operate by scheduled appointment only, with anticipated hours of operation from 9:00 a.m. to 5:30 p.m., Monday through Friday. 5. Definition of “Medical Clinic”: According to Section 25-1-5 of the Hawaiʻi County Zoning Code, a “medical clinic” means an office building or group of offices for persons engaged in the practice of a medical or dental profession or occupation. A medical clinic does not have beds for overnight care of patients but can involve the treatment of outpatients. 6. Landowners: Jessica Stevens (under a signed purchase agreement with Young Hoe Park & Kyong Sun Shin). 7. Supportive Information: The applicant has submitted the attached in support of the request. (Planning Department Exhibit 1 – Use Permit Application dated February 27, 2026) DESCRIPTION OF STATE AND COUNTY PLANS 8. State Land Use District: Urban. 9. General Plan Land Use Pattern Allocation (LUPAG) Map: Low Density Urban (ldu), which allows for residential, with ancillary community and public uses, and neighborhood and convenience-type commercial uses; overall residential density may be up to 6 units per acre. 10. County Zoning: Single-Family Residential – 10,000 square feet (RS-10). 11. Hamakua Community Development Plan (HCDP): The Hāmākua Community Development Plan was adopted by the Hawaiʻi County Council by Ordinance No. 18-078 on August 22, 2018. 12. Special Management Area (SMA): The project parcel is located approximately 1 mile from the nearest shoreline and approximately 0.9 miles from the mauka edge of the SMA boundary. As such this project does not fall within the SMA and does not require SMA review or approval. 13. Coastal Zone Management: The entire State of Hawai‘i lies within the Coastal Zone Management area. -3- DESCRIPTION OF PROPERTY AND SURROUNDING AREA 14. Subject Property: The subject property consists of approximately 5.737 acres and is developed with an existing two-story residential structure, established driveway access, landscaping, and associated parking areas. The developed area surrounding the structure is generally level, while the remainder of the property consists primarily of open agricultural land. The following building permits have been issued for the property: • Building Permit No. 032330_LTS, finalized on August 17, 2004, for a new 2-story single-family residence. • Building Permit No. BH2013-00866_MGT, finalized on May 13, 2013, for a roof mounted photovoltaic system. 15. Surrounding Zoning/Land Uses: The subject property is situated within an area characterized by a mix of Single-Family Residential-10,000 sq ft (RS-10) and Agricultural 20-acre (A-20a) zoning. Across the highway is an area of Village Commercial-10,000 sq ft (CV-10) and Multiple-Family Residential- 3,500 sq ft (RM- 3.5). Surrounding properties are developed primarily with single-family residential dwellings, accessory residential structures, and agricultural uses, including open pasture and cultivated agricultural lands. The surrounding area maintains a rural, low-density development pattern consisting of dispersed residential development interspersed with agricultural and undeveloped open land. 16. Flood Insurance Rate Map (FIRM): The property is located within Zone “X,” an area determined by FEMA to be an area of minimal flood hazard and is not located within a Special Flood Hazard Area. 17. Flora/Fauna Resources: No formal survey was conducted of the floral and faunal resources of the site. The subject property consists primarily of an existing developed residential area surrounded by open agricultural land. The developed portion of the property contains the existing structure, driveway access, and associated cleared areas. The applicant notes that no significant vegetation removal is proposed and that the project area is already developed. No formal biological, botanical, or wildlife surveys were submitted or referenced by the applicant. The application does not identify any specific floral or faunal species, -4- habitats, or sensitive biological resources on the project site or within the immediate surrounding area. 18. Archaeological/Cultural/Historical Resources: The subject property consists of an existing developed residential site and surrounding agricultural land in Pepeʻekeo, Hawaiʻi. The application states that no known historic or archaeological resources are located within the developed portion of the property and that the proposed work is limited primarily to minor interior renovations and limited surface improvements associated with the existing driveway and parking area. The application further states that no known traditional or customary Native Hawaiian rights are exercised on the developed portion of the property and that no cultural or historic resources were identified within the project area. No archaeological inventory survey or cultural impact assessment was submitted as part of the application materials. The State Historic Preservation Division (SHPD) has completed its review pursuant to Chapter 6E-42, Hawaiʻi Revised Statutes, and determined that “no historic properties will be affected,” per letter dated April 16, 2026. 19. Public Access: No public access to the ocean, shoreline, hiking trails, or mountain areas is identified on or through the subject property. The property is privately owned and accessed via an existing driveway from Old Mamalahoa Highway. The application materials do not identify any established public access easements, trails, or public rights-of-way across the property. PUBLIC UTILITIES AND SERVICES 20. Access/Parking/Traffic: Access to the subject property is via an existing residential driveway from Old Mamalahoa Highway, which is a county roadway under the jurisdiction of the County of Hawaiʻi. The applicant proposes to retain the existing access configuration, with minor grading and asphalt surfacing improvements to define the parking area serving the clinic. No additional driveway access points are proposed. The proposed parking area measures approximately 60 feet by 100 feet and is expected to accommodate approximately 8 to 12 parking spaces, depending on the final layout. The clinic would operate by scheduled appointment only, with patient visits staggered throughout the day to limit on-site -5- occupancy and parking demand. Traffic generation associated with the proposed use is anticipated to be low and comparable to that of a small professional office use, with approximately 8 to 12 patients anticipated per day. The application states that no significant traffic impacts are anticipated due to the limited patient volume and appointment-only operations. 21. Water: The Department of Water Supply (DWS) notes that there is an existing 5/8-inch meter serving the subject parcel off the existing 6-inch waterline on Old Mamalahoa Highway, which is limited to an average daily usage of 400 gallons and as such suitable for only one (1) single-family residence. However, DWS states that water can be made available from the existing 6-inch waterline fronting the subject parcel, in accordance with the DWS water availability conditions and requirements such as providing estimated maximum daily water usage, and the installation of a reduced pressure type backflow assembly. Additionally, DWS states that their water system standards require that a minimum flow of 2,000 GPM be available at the site for fire protection use. Since the existing 6-inch water line fronting the subject parcel is inadequate to provide the required fire flow, the applicant will be required to contact the Fire Department to determine any other fire protection requirements or alternatives. 22. Wastewater: There is no public sewer available in the immediate area. The applicant notes that the existing dwelling is currently serviced by one (1) permitted cesspool. Planning staff notes that the State Dept. of Health stated (via email) that “if there is a change of use of the existing dwelling to a medical center then the existing cesspool shall be required to be upgraded”. The applicant shall submit plans for treatment facilities to the Department of Health and to the Department of Environmental Management (DEM) director for review as required by Section 21- 11. 23. Solid Waste: The DEM notes that solid waste shall be properly disposed of at DOH-permitted solid waste management facilities. The applicant states that commercial solid waste service will be arranged through a licensed waste collection provider upon commencement of clinic operations. -6- 24. Essential Utilities and Services: Electrical and telephone services are available to the subject property. The nearest fire protection services to the subject property are provided by Fire Station 1A – Hawaiʻi Fire Department, located in Pepeʻekeo approximately 1 mile from the project site, while Police services are provided by the Hawaiʻi Police Department, with the nearest police facilities located in Hilo and Laupāhoehoe. The nearest staffed police station appears to be Hawaiʻi Police Department in Hilo, located approximately 8 to 9 miles south of the property. AGENCY COMMENTS 25. Department of Environmental Management (DEM): (Planning Department Exhibit 2 – April 23, 2026, Memo). 26. Department of Water Supply (DWS): (Planning Department Exhibit 3 – April 23, 2026, Letter). 27. County Police Dept.: (Planning Department Exhibit 4 – March 27, 2026, Memo). 28. Dept. of Public Works – Building Div.: (Planning Department Exhibit 5 – April 21, 2026, Memo). 29. State Dept. of Health (DOH): (Planning Department Exhibit 6 – March 27, 2026, Memo). 30. State Department of Health-Wastewater Branch: (Planning Department Exhibit 7 – March 20, 2026, Email). 31. State Historic Preservation Division (SHPD): (Planning Department Exhibit 8 – April 16, 2026, Letter). AGENCIES – NO COMMENTS/NO CONCERNS 32. DLNR – Land Division; State Office of Planning and Sustainable Development. AGENCIES – NO RESPONSE 33. Department of Public Works- Engineering Division, Fire Department, DLNR – DOFAW. PUBLIC COMMENTS 34. Pepeʻekeo Community Development Corporation (PCDC): (Planning Department Exhibit 9 – March 23, 2026, Letter). -7- APPLICANT RESPONSES TO COMMENTS 35. Applicant Community Notification and Outreach timeline: (Planning Department Exhibit 10 – (undated Letter). 36. Applicant Response to DWS/DEM: (Planning Department Exhibit 11 – Apri 30, 2026, Letter). 37. Applicant Response to Fire/DWS: (Planning Department Exhibit 12 – May 4, 2026, Letter). 38. Applicant’s Agent Response to DWS: (Planning Department Exhibit 13 – May 2, 2026, Letter). 39. Applicant’s Agent Response to DEM: (Planning Department Exhibit 14 – May 4, 2026, Letter). Big Island Neuro Health Foundation Hilo, Hawaiʻi | | 702-354-2704 Big Island Neuro Health Foundation Hilo, Hawaiʻi | | 702-354-2704 BINHF Project Narrative Use Permit Application – TMK: 3-2-8-007-084 Proposed Outpatient Medical Clinic Big Island Neuro Health Foundation Project Overview The proposed project involves the use of an existing, lawfully established residential structure for a small outpatient medical clinic specializing in neuromodulation services, including non-invasive Transcranial Magnetic Stimulation (TMS). The clinic will provide evaluation, treatment, and follow-up care for individuals with treatment- resistant depression and related conditions. The clinic will operate as an outpatient medical facility only, and no overnight care or residential services will be provided. Patients will be scheduled individually throughout the day, resulting in a low daily patient volume and limited on-site occupancy at any given time. The facility will operate in a manner similar to a small professional medical office. Site Plan and Access A conceptual site plan has been provided showing the location of the existing structure, driveway access, ingress/egress, and the proposed parking area. The property currently has an existing residential driveway providing access from Old Mamalahoa Highway. Minor grading and asphalt surfacing are proposed to improve the existing driveway and define the parking area serving the clinic. No additional driveway access points are proposed. Parking and Traffic The proposed parking area is approximately 60 feet by 100 feet, which can accommodate multiple vehicles and is expected to provide approximately 8–12 parking spaces depending on final layout. The clinic will operate with scheduled patient appointments throughout the day, resulting in limited patient volume at any given time. Due to the outpatient nature of the Big Island Neuro Health Foundation Hilo, Hawaiʻi | | 702-354-2704 services and staggered appointment scheduling, parking demand and traffic generation are expected to be low and comparable to a small professional office use. Existing Structure and Floor Plan A conceptual floor plan has been provided showing the intended room uses within the existing structure. The proposed clinic layout includes: • Reception / administrative area • Waiting room • Consultation room for provider evaluations • Two treatment rooms for TMS services • ADA-accessible restroom The floor plan is conceptual and illustrates the intended use of interior spaces. Residential Use (Second Floor Dwelling) The second floor of the existing structure will remain as a residential dwelling with no proposed changes. The residential space may be utilized for provider housing associated with the clinic. The residential use is accessory and incidental to the primary outpatient medical clinic use located on the first floor. No patient care, clinical services, or public access will occur within the residential portion of the structure. Proposed Improvements Improvements to the structure are limited primarily to minor interior renovations necessary to accommodate outpatient medical use. These improvements include: • Minor interior wall adjustments • Installation of a reception window • Conversion of an existing bathroom to an ADA-accessible restroom • Interior finish improvements • Minor site work associated with driveway surfacing and parking area definition Big Island Neuro Health Foundation Hilo, Hawaiʻi | | 702-354-2704 No expansion of the building footprint is proposed. Utilities (Water and Wastewater) The property is served by an existing potable water source and cesspool currently serving the residence. The proposed clinic is expected to have water demand comparable to a small professional office with limited daily occupancy. The existing cesspool is anticipated to accommodate the proposed use. Coordination with the appropriate agencies will occur if additional review or confirmation is required. Big Island Neuro Health Foundation Hilo, Hawaiʻi | | 702-354-2704 Solid Waste Commercial solid waste service will be arranged through a licensed waste collection provider once clinic operations commence. Signage Only minimal signage is anticipated, likely limited to a small identification sign for the clinic near the entrance. Any signage will comply with applicable County of Hawaiʻi signage regulations. Change of Use The existing structure was originally permitted as a residence. The applicant understands that a Change of Use Permit through the Department of Public Works will be required as part of the conversion to clinic use and will coordinate with the appropriate department as necessary. This process typically involves building permit review, ADA accessibility confirmation, and life-safety review as required prior to occupancy. Big Island Neuro Health Foundation Hilo, Hawaiʻi | | 702-354-2704 Project Timeline The anticipated project timeline is as follows: • Permit review and approvals: 2026 • Interior renovations and site improvements: approximately 3–6 months following approvals • Clinic operations anticipated to begin following completion of renovations and inspections Community Considerations Pepe’ekeo Community Development Committee EOB Meeting for project presentation is scheduled for 3/23/26 @ 0900am. The clinic is expected to operate with limited daily patient volume and minimal traffic, consistent with a small professional office use. Project Valuation The estimated valuation of the proposed project, including property acquisition, improvements, and equipment, is approximately $6,000,000. Attachments • Fee-Simple Landowner Authorization • USE Permit Application • Conceptual Site Plan • Property Pictures • Flood Hazard Map of property • Clinic Floor Plan – 1st floor • Clinic Floor Plan – 2nd floor (no changes) • Sample – Notification of USE Permit Application to neighboring properties • Map of properties within 500ft of property to be notified • List of property owners to be receive “Letter of Notification of USE Permit Application” Big Island Neuro Health Foundation Hilo, Hawaiʻi | | 702-354-2704 USE Permit Narrative TMK: 3-2-8-007-084 Address: 28-1167 Old Mamalahoa Highway, Pepeʻekeo, Hawaiʻi Request: Establishment of a Medical Clinic (Outpatient Use) within an Existing Structure Background Information (Items A–K) A. Detailed Description of the Proposed Use The applicant requests approval of a Use Permit to establish a Medical Clinic (outpatient use) within an existing, lawfully established structure located at 28-1167 Old Mamalahoa Highway, Pepeʻekeo, Hawaiʻi (TMK 3-2-8-007-084). The clinic will provide outpatient medical evaluation, diagnosis, treatment, and follow-up care under physician oversight. No inpatient services, overnight accommodations, or emergency room functions are proposed. The clinic will operate by scheduled appointment only, with anticipated hours of operation from approximately 9:00 a.m. to 5:30 p.m., Monday through Friday. The clinic is expected to serve an average of approximately 8–12 patients per 8-hour business day. Patient visits will be staggered to prevent congestion and maintain a low-intensity operational profile. Initial staffing is anticipated to include approximately 2–3 on-site personnel. No expansion of the existing building footprint is proposed. Big Island Neuro Health Foundation Hilo, Hawaiʻi | | 702-354-2704 Improvements will be limited to interior renovations necessary to accommodate examination rooms, consultation space, administrative areas, and accessibility compliance. B. Description of the Subject Property The subject property consists of approximately 5.737 acres located in Pepeʻekeo, Hawaiʻi. The parcel contains an existing developed structure, established access, and associated parking areas. The developed area surrounding the structure is generally level. The remainder of the property consists primarily of open agricultural land. The proposed Medical Clinic will utilize only the existing structure and immediate developed area; the remainder of the property will remain unchanged. C. State and County Plans Affecting the Subject Request State Land Use District: The property is located within the State Land Use Agricultural District pursuant to Chapter 205, Hawaiʻi Revised Statutes. County General Plan Designation: The property is designated Agricultural under the Hawaiʻi County General Plan. County Zoning: The property is zoned RS-10 (Single-Family Residential – 10,000 sq. ft. minimum building site area). A Medical Clinic is permitted within the district subject to approval of a Use Permit. Property Tax Classification: The property is classified as Agricultural for real property tax purposes. Tax classification does not alter zoning Big Island Neuro Health Foundation Hilo, Hawaiʻi | | 702-354-2704 designation. Special Management Area: The property is not located within the Special Management Area. Community Development Plan: The property is located within the East Hawaiʻi region. The proposed clinic supports access to local community services while maintaining rural character. D. Surrounding Zoning and Land Uses Surrounding properties are primarily zoned RS-10 and Agricultural and consist of rural residential dwellings and agricultural uses. The surrounding area is characterized by low-density residential development and open agricultural land. E. Flood Insurance Rate Map (FIRM) The property is located within FEMA Flood Zone X (Area of Minimal Flood Hazard) and is not within a Special Flood Hazard Area. F. Archaeological and Historic Resources No known historic or archaeological resources are located within the developed portion of the property. The proposed project does not involve significant ground disturbance beyond limited surface preparation for driveway improvements, if required. G. Valued Cultural Resources No known traditional or customary Native Hawaiian rights are exercised on the developed portion of the property. The proposed use will not impair access to cultural or historic resources. Big Island Neuro Health Foundation Hilo, Hawaiʻi | | 702-354-2704 H. Floral and Faunal Resources The project involves use of an existing developed structure. No significant vegetation removal or habitat alteration is proposed. No adverse impacts to floral or faunal resources are anticipated. I. Access Access is provided via Old Mamalahoa Highway utilizing an existing access corridor. The roadway is paved and in functional condition. No new access points are proposed. J. Traffic Impacts Traffic generation is expected to be minimal due to appointment-only scheduling and limited patient volume (approximately 8–12 patients per day). Traffic levels are comparable to other small professional office uses. No significant traffic impacts are anticipated. K. Availability of Utilities The property is served by existing utilities, including electricity, telephone service, water, and solid waste service. Sewage disposal is provided through an existing approved system. The proposed use will not require expansion of public infrastructure. Required Use Permit Findings (Items 4A–C) 4A. Consistency with Zoning Code and General Plan The proposed Medical Clinic is consistent with the intent and purpose of the RS-10 zoning district when approved through a Use Permit. The clinic will operate at a small rural scale within an existing structure and will not alter the residential character of the district. Big Island Neuro Health Foundation Hilo, Hawaiʻi | | 702-354-2704 The project supports General Plan objectives promoting locally accessible services while preserving rural and agricultural character. 4B. No Material Detriment to Public Welfare or Community Character The clinic will operate during standard business hours, by appointment only, with limited daily patient volume and minimal staffing. No emergency services, outdoor operations, amplified sound, or high- intensity activity is proposed. The use will not be materially detrimental to the public welfare nor cause substantial adverse impact to the community’s character or surrounding properties. 4C. No Unreasonable Burden on Public Infrastructure The project utilizes existing developed infrastructure and utilities. Traffic generation is minimal and comparable to other small professional office uses. The proposed use will not unreasonably burden roads, drainage systems, water supply, public safety services, schools, or other public infrastructure. Conclusion The proposed Medical Clinic represents a small-scale outpatient medical use within an existing developed structure. The project maintains compatibility with surrounding rural and agricultural properties, minimizes operational intensity through appointment-only Big Island Neuro Health Foundation Hilo, Hawaiʻi | | 702-354-2704 scheduling, and utilizes existing infrastructure. For the reasons stated herein, approval of the requested Use Permit is respectfully requested. Big Island Neuro Health Foundation Hilo, Hawaiʻi | | 702-354-2704 Big Island Neuro Health Foundation Hilo, Hawaiʻi | | 702-354-2704 CLINIC SITE Big Island Neuro Health Foundation Hilo, Hawaiʻi | | 702-354-2704 Conceptual Site Plan TMK: 3-2-8-007-084 Proposed Outpatient Medical Clinic Existing residential driveway access will remain. Minor grading and asphalt surfacing are proposed to define the parking area serving the clinic. No additional driveway access points are proposed. Patient visits are scheduled by appointment only, resulting in low traffic volume and no anticipated parking overflow. Big Island Neuro Health Foundation Hilo, Hawaiʻi | | 702-354-2704 Big Island Neuro Health Foundation Hilo, Hawaiʻi | | 702-354-2704 Big Island Neuro Health Foundation Hilo, Hawaiʻi | | 702-354-2704 Clinic Floor Plan – 1st Floor TMK: 3-2-8-007-084 Proposed Outpatient Medical Clinic • Proposed ADA Accessible Restroom (Sink & Toilet) • Conceptual floor plan showing intended room uses for the proposed outpatient clinic. • Interior layout may be adjusted slightly during renovation. Big Island Neuro Health Foundation Hilo, Hawaiʻi | | 702-354-2704 2nd Story Floorplan TMK: 3-2-8-007-084 Proposed Outpatient Medical Clinic Residential Use (Second Floor Dwelling) The second floor of the existing structure will remain as a residential dwelling with no proposed changes. The residential space may be utilized for provider housing associated with the clinic. The residential use is accessory and incidental to the primary outpatient medical clinic use located on the first floor. No patient care, clinical services, or public access will occur within the residential portion of the structure. Legend: 2nd Floor dwelling is existing with no proposed changes. County of Hawai‘i DEPARTMENT OF ENVIRONMENTAL MANAGEMENT 345 Kekūanāoʻa Street, Suite 41 · Hilo, Hawai‘i 96720 · cohdem@hawaiicounty.gov Ph: (808) 961-8083 · Fax: (808) 961-8086 Hawai‘i County is an Equal Opportunity Provider and Employer Daniel Girvan, P.E. Director Craig Kawaguchi Deputy Director C. Kimo Alameda, Ph.D.Mayor William V. Brilhante Jr. Managing Director MEMORANDUM Date : April 23, 2026 To : Jeffrey Darrow, Director Planning Department From : Daniel Girvan, Director Department of Environmental Management Subject : PL-USE-2026-000042 ______________________________________________________________________________ The Wastewater Division has reviewed the subject application and offers the following comments and/or recommendations: ☐No Comments ☐The proposed subdivision is accessible to a sewer. The applicant is required to connect all existing and proposed structures to the public sewer in accordance with Section 21-6 and Division 2 of theHawaii County Code. ☐The proposed subdivision is within 300-linear feet of an existing sewer system. The applicant shall install sewer lines as required by Section 23-85 of the Hawaii County Code. Sewer lines shallcomply with Chapter 21, Division 2☐Extensions of the public sewer system: The applicant shall submit a letter application to the director detailing where and why the sewerextension is being requested, and a payment mechanism:☐The applicant constructs and pays full cost for the extension and may receive for 10 years after completion one-half of all sewer charges collected by the County from other properties thatconnect to the extension, provided the reimbursement does not exceed the cost incurred by theapplicant.☐County constructs the extension (the County has yet to create a program to allow this):☐The applicant pays the full cost for the extension and may receive for 10 years after completion one-half of all sewer charges collected by the County from other properties thatconnect to the extension, provided the reimbursement does not exceed the cost incurred bythe applicant.☐The applicant pays one-half the cost and the County pays the other half of the extensioncost. The applicant shall submit sewer engineering plans and sewer study to the WastewaterDivision for review. Jeffrey Darrow, Planning Director April 23, 2026 Page 2 ☐ The applicant shall submit a study documenting proposed additional sewer flows so the director can evaluate the capacity of the existing system to handle them. Contact Wastewater Division staff for Sewer Study requirements. ☐ The proposed subdivision may be subject to existing or future federal, state, or county regulation under Title 40 CFR 403. Contact the Wastewater Division Pretreatment Group for information regarding pretreatment standards and requirements. ☒ The proposed project is about 200 feet from nearest Hawaiʻi County Sewer. The applicant shall comply with Department of Health requirements, and all other applicable federal, state, and county regulations. The applicant shall submit plans for treatment facilities to the Department of Health and to the Department of Environmental Management director for review as required by Section 21-11. For sewers in private roadways: ☐ Sewers will be dedicated to the County in accordance with Section 21-19. Contact the Wastewater Division for sewer and easement details and requirements. Applicant shall hold the County harmless for any damage to roadway corridors during or caused by the construction. Contact Wastewater Division for Permit to Perform Work on the Public Sewer System. ☐ Sewers will be private and will not be dedicated to the County. The applicant shall comply with all Department of Public Works requirements. Contact the Wastewater Division for Permit to Perform Work on the Public Sewer System. ☐ Other: WRS:Initials o WATERa - 191 99' DEPARTMENT OF WATER SUPPLY • COUNTY OF HAWAI`I N;wAi eP 345 KEKUANAO'A STREET, SUITE 20 • HILO, HAWAII 96720 TELEPHONE (808)961-8050 • FAX(808) 961-8657 April 23, 2026 COH PLANNING DEPTAPR232026PH3:18 TO: Mr. Jeffrey Darrow, Director PEG, I HAND DELIVEREDEDPlanningDepartment FROM: Keith K. Okamoto, Manager-Chief Engineer SUBJECT: Use Permit Amendment Application (PL-USE-2026-000042) Applicant: Jessica Stevens Request: To Establish an Outpatient Medical Clinic Within the First Floor of an Existing 2-Story Residential Structure Tax Map Key 2-8-007:084 We have reviewed the subject application and have the following comments and conditions. Please be informed that there is an existing 5/8-inch meter(Account No. 490-28000) serving the subject parcel off the existing 6-inch waterline on Old Mamalahoa Highway, which is limited to an average daily usage of 400 gallons and suitable for only one (1) single-family dwelling. Water can be made available from the existing 6-inch waterline within Old Mamalahoa Highway fronting the subject parcel, in accordance with the Department's existing water availability conditions, which are subject to change without notice. The Department has no objection to the proposed application subject to the applicant understanding and accepting the following conditions: 1. The Department requests that the applicant submit estimated maximum daily water usage calculations for review and approval. The water usage calculations shall be prepared by a professional engineer licensed in the State of Hawai`i and should include the estimated peak flow in gallons per minute (GPM) and the total estimated maximum daily water usage in gallons per day, including all irrigation/landscaping use. Upon receipt of the water usage calculations above, the Department will make a determination as to the water commitment deposit amount and prevailing facilities charge (subject to change) to be paid, if necessary. 2. The proposed use will require the installation of a reduced pressure type backflow prevention assembly within five (5) feet of the existing meter on private property. If a larger or additional meter is required, a backflow prevention assembly will also be required for that meter. The Water, Our Ulvtost Precious Resource . . . Wai A Kane . . . The Department of Water Supply is an Equal Opportunity provider and employer. Mr. Jeffrey Darrow, Director Page 2 April 23, 2026 3. installation ofthe backflow prevention assembly(s)must be inspected and approved by the Department before water service can be granted. 4. The Department's Water System Standards require that a minimum flow of 2,000 GPM be available at the site for fire protection use. Please be informed that the existing 6-inch waterline within Old Mamalahoa Highway is inadequate to provide the required fire flow and the nearest fire hydrant is more than the required 150 feet. The applicant should contact the Fire Department to determine any other fire protection requirements or alternatives. Subject to other agencies' requirements to construct improvements within the road right-of-way fronting the property affected by the proposed development,the applicant shall be responsible for the relocation and adjustment of the Department's affected water system facilities, should they be necessary. Should there be any questions,please contact Ms. Robyn Matsumoto of our Water Resources and Planning Branch at(808) 961-8070, extension 255. Sincerely yours. 6./1 I/W46 Keith K. Okamoto, P.E. Manager-Chief Engineer RM:dfg copy— Ms. Jessica Stevens C. Kimo Alameda, Ph.D. o°• \,.+: Reed K. Mahuna rtlayor J Ib L. '. I Police Chief William V. Brilhante Jr. f'r" Sherry D. BirdtlanagingDirector Deputy Police('hie( County of Hawai' POLICE DEPARTMENT 349 Kapi'olani Street • Hilo,Hawaii 96720-3998 808)935-3311 • Fax(808)961-2389 COH PLANNING DEPT March 27, 2026 MAR 30 2026 41 r:28 REC'D HAND DELIVERED TO JEFFREY W. DARR• , PLANNING DIRECTOR FROM H A. . Q. !' 0, ASSISTANT POLICE CHIEF, AREA I PERATIONS BUREAU SUBJECT: USE PERMIT APPLICATION (PL-USE-2026-000042) APPLICANT: JESSICA STEVENS REQUEST: TO ESTABLISH AN OUTPATIENT MEDICAL CLINIC WITHIN THE FIRST FLOOR OF AN EXISTING 2-STORY RESIDENTIAL STRUCTURE TAX MAP KEY: (3) 2-8-007:084, PEPE' EKEO, SOUTH HILO, HAWAI'I Staff, upon reviewing the provided documents, does not anticipate any significant impact to traffic and/or public safety concerns. Thank you for allowing us the opportunity to comment. If you have any questions, please contact our South Hilo District Commander, Captain Aaron Carvalho, at (808) 961-2316 or via email at aaron.carvalho@hawaiipolice.gov. AC:ws/26HQ0235 Hawai'i County is an Equal Opportunity Provider and Employer' Hawai’i County is an Equal Opportunity Provider and Employer BD-10 BUILDING DIVISION – DPW COUNTY OF HAWAI'I – 101 Pauahi Street, Suite 7 – Hilo, Hawai‘i 96720 Hilo Office (808) 961-8331 · Fax (808) 961-8410 Kona Office (808) 323-4720 · Fax (808) 327-3509 April 21, 2026 TO: Alex Roy - County of Hawaii – Planning Dept. County Of Hawaii Planning Department 101 Pauahi St. Ste. #3 Hilo, HI. 96720 SUBJECT: Use Permit Application (PL-USE-2026-000042) Applicant: Jessica Stevens Request: To Establish an Outpatient Medical Clinic Within the First Floor of an Existing 2-Story Residential Structure Tax Map Key: (3) 2-8-007:084; Pepeʻekeō, South Hilo, Hawaiʻi This is to inform you that our records on file, relative to the status of the subject discloses that: No Building permit was issued for work done on the premises. No building permit was issued for the change of occupancy. At the time of completion, the subject complied with all Building Code regulations that were in effect. Variance from any building regulation (Building, Electrical, Plumbing, or Sign) was/was not granted. The following violations(s) still outstanding: Building Electrical Plumbing Sign Others: Owner shall acquire and complete the necessary Non-Residential Building Permit(s) to convert/alter the existing 2-story single-family dwelling unit to a mixed-use commercial structure as required per Hawaii County Code – Chapter 5 Construction Administration Code, Section 5-3-1. -https://www.hawaiicounty.gov/our-county/legislative/office-of-the-county- clerk/county-code -https://www.hawaiicounty.gov/home/showpublisheddocument/14/6387436 34861870000 Applicant shall note that if the 2nd story is intended for use as “provider housing associated with the clinic”, this shall be considered a change of use from the Hawai’i County is an Equal Opportunity Provider and Employer BD-10 permitted single-family dwelling unit use and shall be addressed in the required Non-Residential Building Permit. Should you have any questions regarding matters contained herein, please feel free to contact Joel Fitzgerald at phone no. (808) 961-8488. JOSH GREEN, M.D. KENNETH S. FINK, M.D, MGA, MPH GOVERNOR OF HAWAII DIRECTOR OF HEALTH KE KIA’AINA O KA MOKU’AINA O HAWAI’I KA LUNA HO’OKELE STATE OF HAWAII DEPARTMENT OF HEALTH P.O. BOX 916 HILO, HAWAII 96721-0916 MEMORANDUM DATE: March 27, 2026 TO: Mr. Jeffrey W. Darrow Planning Director, County of Hawaii FROM: Eric Honda District Environmental Health Program Chief SUBJECT: Use Permit Application (PL-USE-2026-000042) Applicant: Jessica Stevens Request: To Establish an Outpatient Medical Clinic Within the First Floor of an Existing 2-Story Residential Structure TMK: 2-8-007:084; Pepeʻekeō, South Hilo, Hawaiʻi In most cases, the District Health Office will no longer provide individual comments to agencies or project owners to expedite the land use review and process. Agencies, project owners, and their agents should apply Department of Health “Standard Comments” regarding land use to their standard project comments in their submittal. Standard comments can be found on the Land Use Planning Review section of the Department of Health website: https://health.hawaii.gov/epo/landuse/. Contact information for each Branch/Office is available on that website. Note: Agencies and project owners are responsible for adhering to all applicable standard comments and obtaining proper and necessary permits before the commencement of any work. General summary comments have been included for your convenience. However, these comments are not all-inclusive and do not substitute for review of and compliance with all applicable standard comments for the various DOH individual programs. Clean Air Branch 1. All project activities shall comply with the Hawaii Administrative Rules (HAR), Chapters 11-59 and 11-60.1. Jeffrey W. Darrow March 27, 2026 Page 2 of 4 2. Control of Fugitive Dust: You must reasonably control the generation of all airborne, visible fugitive dust and comply with the fugitive dust provisions of HAR §11-60.1-33. Note that activities that occur near existing residences, businesses, public areas, and major thoroughfares exacerbate potential dust concerns. It is recommended that a dust control management plan be developed which identifies and mitigates all activities that may generate airborne and visible fugitive dust and that buffer zones be established wherever possible. 3. Standard comments for the Clean Air Branch are at: https://health.hawaii.gov/epo/landuse/ Clean Water Branch 1. All project activities shall comply with the HAR, Chapters 11-53, 11-54, and 11-55. 1. The following Clean Water Branch website contains information for agencies and/or project owners who are seeking comments regarding environmental compliance for their projects with HAR, Chapters 11-53, 11-54, and 11-55: https://health.hawaii.gov/cwb/clean-water-branch-home- page/cwb- standard-comments/. Hazard Evaluation & Emergency Response Office 1. A Phase I Environmental Site Assessment (ESA) and Phase II Site Investigation should be conducted for projects wherever current or former activities on site may have resulted in releases of hazardous substances, including oil or chemicals. Areas of concern include current and former industrial areas, harbors, airports, and formerly and currently zoned agricultural lands used for growing sugar, pineapple or other agricultural products. 2. Standard comments for the Hazard Evaluation & Emergency Response Office are at: https://health.hawaii.gov/epo/landuse/. Indoor and Radiological Health Branch 1. Project activities shall comply with HAR Chapters 11-39, 11-45, 11-46, 11-501, 11-502, 11-503, and 11-504. 2. Noise may be generated during demolition and/or construction. The applicable maximum permissible sound levels, as stated in Title 11, HAR, Chapter 11-46, “Community Noise Control,” shall not be exceeded unless a noise permit is obtained from the Department of Health. 3. Construction/Demolition Involving Asbestos: If the proposed project includes renovation/demolition activities that may involve asbestos, the applicant should contact the Asbestos and Lead Section of the Branch at https://health.hawaii.gov/irhb/asbestos/. Safe Drinking Water Branch Jeffrey W. Darrow March 27, 2026 Page 3 of 4 1. Agencies and/or project owners are responsible for ensuring environmental compliance for their projects in the areas of 1) Public Water Systems; 2) Underground Injection Control; and 3) Groundwater and Source Water Protection in accordance with HAR Chapters 11-19, 11-20, 11-21, 11-23, 11-23A, and 11- 25. They may be responsible for fulfilling additional requirements related to the Safe Drinking Water program: https://health.hawaii.gov/sdwb/. 2. Standard comments for the Safe Drinking Water Branch can be found at: https://health.hawaii.gov/epo/landuse/. Solid & Hazardous Waste Branch 1. Hazardous Waste Program - The state regulations for hazardous waste and used oil are in HAR Chapters 11-260.1 to 11-279.1. These rules apply to the identification, handling, transportation, storage, and disposal of regulated hazardous waste and used oil. 2. Solid Waste Programs - The laws and regulations are contained in HRS Chapters 339D, 342G, 342H, and 342I, and HAR Chapters 11-58.1 and 11-282. Generators and handlers of solid waste shall ensure proper recycling or disposal at DOH-permitted solid waste management facilities. If possible, waste prevention, reuse, and recycling are preferred options over disposal. The Office of Solid Waste Management also oversees the electronic device recycling and recovery law, the glass advanced disposal fee program, and the deposit beverage container program. 3. Underground Storage Tank Program – The state regulations for underground storage tanks are in HAR Chapter 11-280.1. These rules apply to the design, operation, closure, and release response requirements for underground storage tank systems, including unknown underground tanks identified during construction. 4. Standard comments for the Solid & Hazardous Waste Branch can be found at: https://health.hawaii.gov/epo/landuse/. Wastewater Branch For comments, please email the Wastewater Branch at doh.wwb@doh.hawaii.gov. Sanitation / Local DOH Comments: 1. According to HAR §11-26-35, No person, firm, or corporation shall demolish or clear any structure without first ascertaining the presence or absence of rodents that may endanger public health by dispersal from such premises. Should any such inspection reveal the presence of rodents, the rodents shall be eradicated before demolishing or clearing the structure. A demolition permit is required prior to demolition. Jeffrey W. Darrow March 27, 2026 Page 4 of 4 Other 1. CDC - Healthy Places - Healthy Community Design Checklist Toolkit recommends that state and county planning departments, developers, planners, engineers, and other interested parties apply these principles when planning or reviewing new developments or redevelopment projects. 2. If new information is found or changes are made to your submittal, DOH reserves the right to implement appropriate environmental health restrictions as required. Should there be any questions on this matter, please contact the Department of Health, Hawaii District Health Office, at (808) 933-0917. 1 Roy, Alex From:Roy, Alex Sent:Friday, March 20, 2026 9:20 AM To:; Subject:FW: Request for Information - Planning Commission Application Attachments:26628-328007084-OldMamalahoaHwy-Cspl-Dated-2004-08-01.pdf Jessica, I received a response from DOH (see below) that the cesspool will need to be converted to a new IWS to covert the home to a medical clinic. I understand that this introduces additional costs, so I recommend looking into what that would require to see if the project is still feasible. You will want to reach out to IWS companies on island and see what they charge for the upgraded IWS, as well as the closure of the cesspool. LMK if you have any questions, Aloha, Alex J. Roy, MSc County of Hawaii Planning Department – Hilo Office SMA Section – Planner VI From: Tomomitsu, Mark S <mark.tomomitsu@doh.hawaii.gov> Sent: Friday, March 20, 2026 8:28 AM To: Roy, Alex <Alex.Roy@hawaiicounty.gov> Cc: Enos, Kaylin <kaylin.enos@doh.hawaii.gov> Subject: FW: Request for Information - Planning Commission Application Hello Alex, We have a cesspool record that the existing 2-bedroom building located at TMK 328007084 is being served by a cesspool. If there is a change in use of the existing dwelling to a medical center then, the existing cesspool shall be required to be upgraded. Depending on the ww quality and quantity associate with the change in use of the building a wastewater treatment works may be required for the cesspool upgrade. Thank you, Mark Mark Tomomitsu Environmental Engineer | EMD/Wastewater Branch Hawai’I State Department of Health | Ka ‘Oihana Olakino 2827 Waimano Home Road, Pearl City, HI 96782 Office: (808) 586-4294 2 CONFIDENTIALITY NOTICE: This mail message (and attachements) is for the intended recipient(s). It may contain confidential and/or privileged information. It might also be protected from disclosure under the Hawai’i Uniform Information Practice Act (UIPA) or other laws and regulations. Review, use, disclosure, or distribution by unintended recipients is prohibited. If you are not the intended recipient, please contact the sender immediately in a separate e-mail and destroy the original message and any copies. From: Enos, Kaylin <kaylin.enos@doh.hawaii.gov> Sent: Tuesday, March 17, 2026 11:38 AM To: Tomomitsu, Mark S <mark.tomomitsu@doh.hawaii.gov>; Roy, Alex <Alex.Roy@hawaiicounty.gov> Subject: RE: Request for Information - Planning Commission Application Hi Mark, Could you please assist Alex with his IWS conversion inquiry? Alex, the 2 bedroom dwelling is connected to an approved to use cesspool. Thank you, Kaylin Enos Office Assistant | Environmental Management Division | Hilo Wastewater Branch Hawai’i State Department of Health | Ka ‘Oihana Olakino 1582 Kamehameha Avenue | Hilo, HI 96720 Office: (808) 933-0401 HILO TMK Zones are (3) 1, 2, 3, 4, 9-4 to 9-9, email request to kaylin.enos@doh.hawaii.gov KONA TMK Zones are (3) 5, 6, 7, 8, 9-1 to 9-3, email request to wwbkona@gmail.com CONFIDENTIALITY NOTICE: This mail message (and attachments) is for the sole use of the intended recipient(s). It may contain confidential and/or privileged information. It might also be protected from disclosure under the Hawaii Uniform Information Practice Act (UIPA) or other laws and regulations. Review, use, disclosure, or distribution by unintended recipients is prohibited. If you are not the intended recipient, please contact the sender immediately in a separate e- mail and destroy the original message and any copies. Please Note: Our jurisdiction does not extend to properties serviced by sewer. To see if you are serviced by sewer, check your water bill for a sewer charge or check if you receive a sewer bill. Any complaints or questions related to wastewater issues on these properties should be directed to the relevant county department or private sewer system provider. STATE OF HAWAl'I I KA MOKU'AINA 'O HAWAl'I DEPARTMENT OF LAND AND NATURAL RESOURCES KA 'OIHANA KUMUWAIWAI 'AINA STATE HISTORIC PRESERVATION DNISION KAKUHIHEW A BL VD BUILDING 601 KAMOKILA, STE 555 KAPOLEL HAWAII 96707 JOSH GREEN, M.D. GOVERNOR I KE KIA'AINA SYLVIA LUKE LIEUTENANT GOVERNOR I KA HOPE KIA'AINA DAWN N.S. CHANG CHAIRPERSON BOARD OF LAND AND NATURAL RESOURCES COMMISSION ON WATER RESOURCE MANAGEMENT RYAN K.P. KANAKA'OLE FIRST DEPUTY CIARA W.K KAHAHANE DEPUTY DIRECTOR -WATER AQUATIC RESOURCES BOATING AND OCEAN RECREATION BUREAU OF CONVEYANCES COMMISSION ON WATER RESOURCE MANAGEMENT CONSERVATION AND COASTAL LANDS CONSERVATION AND RESOURCES ENFORCEMENT ENGINEERING FORESTRY AND WILDLIFE HISTORIC PRESERVATION KAHOOLAWE ISLAND RESERVE COMMISSION LAND STATE PARKS IN REPLY REFER TO: Project No. 2026PR00267 Doc. No. 2604SN09 Archaeology SUBJECT: Hawaii Revised Statutes (HRS) §GE-42 Historic Preservation Review - County of Hawai'i Special Use Permit Application (PL-USE-2026-000042) Stevens Medical Clinic Project Pepe'eke'o Ahupua'a, South Hilo District, Island of Hawai'i TMK: (3) 2-8-007:084 April 16, 2026 Jeff Darrow, Director County of Hawaii Department of Public Works 101 Pauahi Street, Suite 3 Hilo, HI 96720 Email: planning@hawaiicounty.gov Dear Jeff Darrow: This letter provides the State Historic Preservation Division's (SHPD's) review of the subject County of Hawaii (COH) special use permit application received by our office on March 17, 2026. The submittal included a COH permit application (PL-USE-2026-000042), construction plans, and an aerial photo of the project area. The proposed project area comprises a 1.00-acre portion of the 5. 73-acre parcel. The applicant is requesting a COH special use permit to establish a Medical Clinic within an existing structure located on the subject parcel. The project will also consist of minor grading to the existing driveway access and additional grading or a parking area (60 ft. x 100 ft.). The submittal indicates that ground disturbance will be minimal. A review of SHPD records indicates no archaeological in ventory survey has been conducted in the project area, and no historic properties have been previously identified within the parcel. Historic aerial imagery shows prior ground-disturbing activity from past agricultural use, making it unlikely that any surface historic properties remain intact within the parcel. Based on the information provided, SHPD's project effect determination is "No historic properties affected" pursuant to HAR §13-284-7(a)(1) for the current project. Additionally , pursuant to HAR §13-284- ?(e), when SHPD comments that the proposed project shall not affect significant historic properties, the HRS Chapter 6E historic preservation review process ends. The permit issuance process may continue. Attach to permit: If historic properties such as lava tube openings, concentrations of artifacts, structural remains or human skeletal remains are found during construction activities please cease work in the immediate vicinity of the find, protect the find from additional disturbance, and contact the State Historic Preservation Division at (808) 933-7653. Please contact Sean Naleimaile, Hawai'i Island Archaeologist IV, at Sean.P.Naleimaile@hawaii.gov, for any questions or concerns regarding this letter. Jeff Darrow April 16, 2026 Page 2 Aloha, Jessica Puff, PhD Administrator, State Historic Preservation Division Deputy State Historic Preservation Officer cc: Alex Roy, alex.roy@hawaiicounty.gov Jessica Stevens, Notification & Outreach Timeline Project: Big Island Neuro Health Foundation – Proposed Outpatient Medical Clinic Location: 28-1167 Old Mamalahoa Highway, Pepeʻekeo, Hawaiʻi Application: PL-USE-2026-000042 Applicant: Big Island Neuro Health Foundation (Jessica Stevens, President & CEO) Community Organization: Pepeʻekeo Community Development Corporation (PCDC) February 2026 – Initial Outreach (Pre-Application / Courtesy) • February 3, 2026 From: BINHF → To: PCDC Initial outreach requesting an opportunity to present the proposed project. • February 6, 2026 From: BINHF → To: PCDC Project details, including scope, purpose, and community need, were provided along with an offer to present and provide additional materials. Attachment included with email: o Exhibit A: BINHF Project Presentation (overview of proposed clinic, services, and community need) • February 10, 2026 From: PCDC → To: BINHF PCDC advised that presentation could be scheduled for a future meeting and requested a preliminary meeting with the board. March 2026 – Continued Engagement & Information Sharing (Courtesy) • March 16–17, 2026 From: BINHF ↔ To: PCDC Ongoing coordination to schedule a meeting with the board; Applicant confirmed availability and provided materials in advance for review. Attachment included with email: o Exhibit B: Same documented shared on 2/6/26 - BINHF Project Presentation (overview of proposed clinic, services, and community need) • March 23, 2026 (Morning) From: BINHF & PCDC (In-Person/Virtual Meeting) Meeting held with PCDC representatives to introduce and discuss the project. • March 23, 2026 (Follow-Up Email) From: BINHF → To: PCDC Applicant confirmed that notification materials would be shared and reiterated availability to respond to community questions. • March 23, 2026 (Evening) From: PCDC → To: BINHF PCDC acknowledged the meeting and confirmed that the Applicant would be invited to participate in the May community meeting. Attachment included with email: o Exhibit C: PCDC Email Confirming May Community Meeting Invitation March 30, 2026 – Courtesy Notification Materials Shared • March 30, 2026 From: BINHF → To: PCDC At the request of PCDC, the Applicant provided a courtesy update confirming that formal notification mailings would be sent in accordance with Planning requirements and that the required notice sign had been posted on-site. The materials were shared to ensure PCDC had access to the same information being provided to surrounding property owners. • Attachments included with email: o Exhibit D: Use Permit Notification Letter (copy of official notice mailed to surrounding property owners) o Exhibit E: BINHF Community Brochure (project overview and community-facing information) • March 30, 2026 (Response) From: PCDC → To: BINHF Acknowledgement of receipt of notification materials and brochure. March–April 2026 – Formal Planning Compliance (Required) • March 28, 2026 Posting of on-site notice sign visible from the roadway • March 31, 2026 Mailing of notification letters to property owners and lessees within required 300-foot radius (per Hawaiʻi County Planning requirements) • Submission of: o Affidavit of Mailing uploaded to EPIC: March 31, 2026 o Affidavit of Posting uploaded to EPIC: March 31, 2026 • All actions completed in accordance with Planning Department requirements April 2026 – Transparency & Public Record • April 2026 From: BINHF → To: EPIC / Public Record Compiled and uploaded complete email correspondence (February 6 – April 1, 2026) to EPIC to ensure transparency and public access • Maintained availability for community questions and participation in meetings Summary All required notification actions were completed in accordance with Hawaiʻi County Planning Department requirements. In addition, the Applicant conducted voluntary outreach beginning in early February 2026, including direct communication with PCDC, provision of project materials, and ongoing availability to support community understanding and engagement. Attachments were provided contemporaneously with email communications to ensure PCDC had access to the same materials shared with neighboring property owners. The March 30, 2026, communication providing the notification letter and brochure was a courtesy action and not a requirement of the Planning process. Exhibits referenced herein are attached and incorporated by reference. This exhibit reflects both compliance with all required notification procedures and additional good-faith efforts to ensure transparency and community awareness. Presenter: Jessica Stevens, MSN, RN Founder & President Big Island Neuro Health Foundation Big Island Neuro Health Foundation Hilo, Hawaiʻi | | 702-354-2704 Big Island Neuro Health Foundation Proposed Rural Healthcare Project – Pepeʻekeo Official Mission Statement The mission of Big Island Neuro Health Foundation is to expand access to evidence- based neuromodulation services, including Transcranial Magnetic Stimulation (TMS), for adults with treatment-resistant mental health conditions in rural and underserved communities on Hawaiʻi Island. Priority Population Statement Priority emphasis, as resources allow, is placed on Veterans, active-duty service members, and other underserved adult populations living in rural mental health shortage areas, consistent with applicable federal and state non-discrimination requirements. Project Overview Big Island Neuro Health Foundation proposes the establishment of an outpatient Transcranial Magnetic Stimulation (TMS) clinic in Pepeʻekeo to expand access to evidence-based treatment for adults with treatment-resistant depression and related conditions. What Is TMS? Transcranial Magnetic Stimulation (TMS) is an FDA-cleared, non-invasive outpatient therapy that uses magnetic pulses to stimulate areas of the brain involved in mood regulation. • No medication • No surgery • No sedation • Provided in a standard clinical setting Presenter: Jessica Stevens, MSN, RN Founder & President Big Island Neuro Health Foundation Big Island Neuro Health Foundation Hilo, Hawaiʻi | | 702-354-2704 Community Need & Access Gap • Hawaiʻi County experiences higher suicide rates than the statewide average, particularly in rural communities. • Access to specialty mental health treatment on Hawaiʻi Island is limited. • Currently, the only comparable TMS service on Hawaiʻi Island is offered by Kīpuka o ke Ola Native Hawaiian Rural Health Clinic in Waimea, an important resource that primarily serves the North Hawaiʻi region. • Due to the island’s large geographic size, this single location is not sufficient to meet the needs of residents across East Hawaiʻi. Many individuals must travel long distances, creating barriers to timely and consistent care. This project is intended to reduce travel burdens and bring advanced treatment options closer to rural East Hawaiʻi communities. Project Approach • Acquisition and adaptive reuse of an existing property • No new land development proposed • Use subject to County Planning Department approval for outpatient medical services Alignment with State, County & Federal Priorities • Supports State of Hawaiʻi and Hawaiʻi County initiatives focused on: o Suicide prevention o Behavioral health improvement o Rural healthcare access • Eligible under the USDA Community Facilities Grant/Direct Loan Program, which supports essential healthcare facilities serving rural populations Community Focus • Services for adult residents of East Hawaiʻi • Emphasis on underserved populations • Priority on community access and continuity of care Big Island Neuro Health Foundation Hilo, Hawaiʻi | | 702-354-2704 Big Island Neuro Health Foundation Proposed Rural Healthcare Project – Pepeʻekeo Official Mission Statement The mission of Big Island Neuro Health Foundation is to expand access to evidence- based neuromodulation services, including Transcranial Magnetic Stimulation (TMS), for adults with treatment-resistant mental health conditions in rural and underserved communities on Hawaiʻi Island. Priority Population Statement Priority emphasis, as resources allow, is placed on Veterans, active-duty service members, and other underserved adult and adolescent populations living in rural mental health shortage areas, consistent with applicable federal and state non- discrimination requirements. Project Overview Big Island Neuro Health Foundation proposes the establishment of an outpatient Transcranial Magnetic Stimulation (TMS) clinic in Pepeʻekeo to expand access to advanced neuromodulation treatment options for adults and adolescents (15 yrs and older) with treatment-resistant depression, obsessive compulsive disorder, and related conditions. What Is TMS? Transcranial Magnetic Stimulation (TMS) is an FDA-cleared, non-invasive outpatient therapy that uses magnetic pulses to stimulate areas of the brain involved in mood regulation. • No medication • No surgery • No sedation • Provided in a standard clinical setting Big Island Neuro Health Foundation Hilo, Hawaiʻi | | 702-354-2704 Community Need & Access Gap • Hawaiʻi County experiences higher suicide rates than the statewide average, particularly in rural communities. • Access to specialty neuro health treatment on Hawaiʻi Island is limited. • Currently, the only comparable Transcranial Magnetic Stimulation (TMS) service on Hawaiʻi Island is offered by Kīpuka o ke Ola Native Hawaiian Rural Health Clinic in Waimea, an important resource that primarily serves the North Hawaiʻi region. • Due to the island’s large geographic size, this single location is not sufficient to meet the needs of residents across East Hawaiʻi. Many individuals must travel long distances, creating barriers to timely and consistent care. This project is intended to reduce travel burdens and bring advanced neuromodulation treatment options closer to rural East Hawaiʻi communities. Data from the Hawaiʻi State Department of Health indicate that suicide mortality rates in Hawaiʻi County exceed the statewide average, highlighting the importance of expanding access to effective treatment options in rural communities. Advanced neuromodulation therapies such as Transcranial Magnetic Stimulation provide an additional treatment option for individuals who have not responded to traditional therapies. Proposed Clinic Location The proposed clinic would be located at 28-1167 Old Mamalahoa Highway in Pepeʻekeo, Hawaiʻi County. The project involves the adaptive reuse of an existing residential structure for outpatient medical services. No major exterior structural changes are proposed. Key characteristics of the site include: • Existing structure already constructed • On-site parking available on the property • Patient visits scheduled by appointment • Normal daytime operating hours Big Island Neuro Health Foundation Hilo, Hawaiʻi | | 702-354-2704 The clinic will operate as a small appointment-based outpatient medical practice. This approach allows the project to expand access to specialty medical treatment while maintaining compatibility with the surrounding residential area. Alignment with State, County & Federal Priorities • Supports State of Hawaiʻi and Hawaiʻi County initiatives focused on: o Suicide prevention o Neuro health and mental health Improvement o Rural healthcare access • Eligible under the USDA Community Facilities Grant/Direct Loan Program, which supports essential healthcare facilities serving rural populations Community Focus • Services for adult residents of East Hawaiʻi • Emphasis on underserved populations • Priority on community access and continuity of care (Data Source: Hawaii State Department of Health, Vital statistics – Last Update 2/7/2025) Big Island Neuro Health Foundation Hilo, Hawaiʻi | | 702-354-2704 Big Island Neuro Health Foundation Hilo, Hawaiʻi | | 702-354-2704 CLINIC SITE: 28-1167 Old Mamalahoa Hwy Pepe`ekeo PCDC <pcdc96783@gmail.com> Mon, Mar 23, 2026 at 10:59 PM To: Jessica Stevens <> Aloha e Jessica, This morning meeting was a good introduction to understanding more of your project. We appreciate you being available for questions that may arise by the community. WE look forward to seeing you at the May's Community meeting. Aloha, Wanda Making the Difference Together Aloha, Wanda Secretary PCDC [Quoted text hidden] USE PERMIT APPLICATION NOTICE Date: 3/30/2026 To: Property Owner Name(s) and mailing address, You are receiving this notice because you are an owner or lessee of record within 300 feet of a property for which a Use Permit application has been submitted to the County of Hawaiʻi Planning Department. 1. Applicant Jessica Stevens - Big Island Neuro Health Foundation 2. Location of Property (Location Map / Site Plan is enclosed) Tax Map Key (TMK): (3) 2-8-007:084 Address: 28-1167 Old Mamalahoa Hwy Pepeʻekeo, South Hilo, Hawaiʻi 3. Nature of the Application The applicant is requesting approval to establish an outpatient medical clinic within the first floor of an existing residential structure. The proposed use includes outpatient medical clinic which provides non-invasive neuromodulation services (Transcranial Magnetic Stimulation) on an appointment-only basis. 4. Filing Date The application was accepted by the Planning Department on March 18, 2026. 5. Right to Request a Contested Case Hearing You have the right to submit a written request for a contested case procedure. If you wish to intervene as a party, you must file a written request using the form titled “Petition for Standing in a Contested Case Hearing” no later than seven (7) calendar days prior to the Planning Commission’s first scheduled public hearing on this application. The petition must comply with Planning Commission Rule 4-6(a) relating to prehearing procedures and must be notarized. A filing fee of $200 is required and must be submitted online via the County of Hawaiʻi Electronic Processing and Information Center (EPIC): https://hawaiicountyhi-energovpub.tylerhost.net/Apps/SelfService#/home 6. Opportunity to Provide Testimony If you choose not to request a contested case hearing, you may still express your support or opposition to the application by submitting written testimony or providing oral testimony at the Planning Commission public hearing to be scheduled. 7. Additional Information The application is available for public review at the County of Hawaiʻi Planning Department. For questions or additional information, please contact: Hawaiʻi County Planning Department 101 Pauahi Street, Suite 3 Hilo, Hawaiʻi 96720 Phone: (808) 961-8288 Enclosures: Location Map “The establishment of a nonprofit, outpatient, non- invasive TMS clinic represents an important and much-needed addition to the continuum of care available locally.” - NAMI Big Island • Mahalo Thank you for taking the time to review this information and for your interest in the proposed project. Contact Us Jessica Stevens, MSN, RN Big Island Neuro Health Foundation Email: If you have any questions or would like to discuss the project, please feel free to reach out directly. Proposed Outpatient Medical Clinic Proposed Location: 28-1167 Old Mamalahoa Highway Pepeʻekeo, Hawaiʻi Expanding access to FDA approved outpatient neuro health treatment for East Hawaiʻi This document is provided for informational purposes only and is not part of the official notice of application. What Is Being Proposed? A small, outpatient medical clinic providing non-invasive Transcranial Magnetic Stimulation (TMS), an FDA- cleared, evidence-based treatment, under physician supervision. • Appointment-based only • Approximately 8–12 patients per day • Daytime business hours COMMUNITY IMPACT No expansion of the existing structure Minimal daily traffic Designed to remain low impact Big Island Neuro Health Foundation Mission To expand access to evidenced-based neuromodulation services, including transcranial magnetic stimulation (TMS), for adults and adolescents with treatment-resistant depression and obsessive compulsive disorder in rural and underserved communities on Hawai’i Island. What This Project Is NOT? Not an inpatient or residential facility Not a crisis or emergency center No walk-in services Not a high-traffic operation This is a quiet, scheduled medical service similar to a specialty doctor’s office. COMMUNITY COMMITMENT Transparency throughout the process Available to answer questions Respect for neighbors and surrounding community EPIC Response Document Application No.: PL-USE-2026-000042 Response to DWS and DEM comments dated April 23, 2026 Project: Big Island Neuro Health Clinic TMK: 2-8-007:084 Location: Pepeʻekeo, South Hilo, Hawaiʻi Date: 4/30/2026 Response to Department of Water Supply (DWS) and Department of Environmental Management (DEM) The Applicant acknowledges the comments provided by the Department of Water Supply (DWS) and the Department of Environmental Management (DEM) regarding water usage, fire flow requirements, and wastewater considerations for the proposed project. A licensed Professional Engineer has been engaged to evaluate the project’s estimated maximum daily water usage, peak flow (GPM), meter capacity requirements, and fire protection considerations in coordination with applicable agency standards. A stamped report with supporting calculations and recommendations will be submitted upon completion for agency review. With respect to wastewater, the Applicant acknowledges that the project is not currently connected to the County sewer system and will comply with all applicable Department of Health requirements. Plans for wastewater treatment facilities will be developed and submitted to the Department of Health and the Department of Environmental Management for review and approval as required. The Applicant will continue to coordinate with DWS, DEM, and other applicable agencies to ensure full compliance with all infrastructure and regulatory requirements. EPIC Response Document Application No.: PL-USE-2026-000042 Response to DWS for Fire Flow and Fire Protection Coordination April 23, 2026 Project: Big Island Neuro Health Clinic TMK: 2-8-007:084 Location: 28-1167 Old Mamalahoa Hwy Pepeʻekeo, South Hilo, Hawaiʻi Date: 5/4/2026 Response to Department of Water Supply (DWS) Fire Flow and Fire Protection Coordination The Applicant acknowledges the Department of Water Supply (DWS) comment regarding the limitation of the existing waterline to meet the standard 2,000 gallons per minute (GPM) fire flow requirement. In response, the Applicant has initiated coordination with the Hawaiʻi Fire Department, Fire Prevention Bureau, to confirm applicable fire protection requirements and evaluate acceptable alternative approaches based on the scale and nature of the proposed outpatient clinic. Potential alternatives under consideration include, but are not limited to, on-site water storage, use of a dry hydrant or drafting connection, enhanced emergency access provisions, and/or evaluation of fire sprinkler or fire service upgrades, as determined necessary by the Fire Department. Final fire protection measures will be established in coordination with the Fire Department and incorporated into the project design during the building permit phase to ensure full compliance with all applicable fire and life safety requirements. The Applicant will continue to coordinate with DWS, DEM, and all applicable agencies to ensure compliance with infrastructure and regulatory requirements.