2014-05-20_REVISION - M1998013

• Permit No: M1998013
• IBM Index Class Name: REVISION
• Doc Date: 5/20/2014
• Doc Name: DRMS Adequacy review comments via email May 19, 2014 AM02
• From: Civil Resources, LLC
• To: DRMS, Bestway Concrete
• Type & Sequence: AM2
• Email Name: ECS
• Media Type: D
• Archive: No

FORM NO.
GWS -31
4/2012
WELL CONSTRUCTION AND TEST REPORT
STATE OF COLORADO, OFFICE OF THE STATE ENGINEER
1313 Sherman St., Ste 821, Denver, CO 80203
Main 303 866 -3581 Fax [phone] www.water.state.co.us
For Office Use Only
1. WELL PERMIT NUMBER:
2. WELL OWNER INFORMATION
NAME OF WELL OWNER: Bestway Concrete & Aggregate
MAILING ADDRESS: 301 Centennial Drive
CITY: Milliken STATE: CO ZIP CODE: 80543
TELEPHONE NUMBER w /area code: 970 587 7277
3. WELL LOCATION AS DRILLED: NE 1/4, NW 1/4, Sec., 1 Twp? x N or S, I I Range 68 © E or W [K]
DISTANCES FROM SEC. LINES: 200 ft. from fX N or I S section line and 2647 ft. from 0 E or x❑ W section line.
SUBDIVISION: , LOT , BLOCK . FILING (UNIT)
Optional GPS Location: GPS Unit must use the following settings: Format must be UTM, Units Owner's Well Designation:
must be meters, Datum must be NAD83, Unit must be set to true N, I Zone 12 or F] Zone 13 Easting:
STREET ADDRESS AT WELL LOCATION: Northing:
4. GROUND SURFACE ELEVATION NA feet DRILLING METHOD
DATE COMPLETED 04/16/2014 TOTAL DEPTH 44 feet DEPTH COMPLETED feet
5. GEOLOGIC
Depth
LOG:
Type
Grain Size
Color
Water Loc.
6. HOLE DIAM (in.) From (ft) To (ft)
4" 0 17
0 -7
top soil
fine
brown
7 -9
fine grained sand
fine
brown
9 -17
coarse gravel
coarse
brown
12'
7. PLAIN CASING:
OD (in) Kind Wall Size (in) From (ft) To (ft)
2" sch 40 _154 0 7
PERFORATED CASING: Screen Slot Size (in): 10 slot
2" sch 40 .154 7 17
17 -18
bedrock
fine
brown
8. FILTER PACK:
Material sand
Size 10 -20
Interval 5 -17
9. PACKER PLACEMENT:
Type
Depth
10. GROUTING RECORD
Material Amount Density Interval Placement
bent 2 baps 1000cf 0 -5 hand
Remarks:
11. DISINFECTION: Type Amt. Used
12. WELL TEST DATA: ❑ Check box if Test Data is submitted on Form Number GWS 39 Supplemental Well Test.
TESTING METHOD
Static Level ft. Date/Time measured: Production Rate gpm.
Pumping Level ft. Date/Time measured Test Length (hrs)
Remarks:
13. 1 have read the statements made herein and know the contents thereof, and they are true to my knowledge. This document is signed (or
name entered if filing online) and certified in accordance with Rule 17.4 of the Water Well Construction Rules, 2 CCR 402 -2. The filing of a
document that contains false statements is a violation of section 37- 91- 108(1)(e), C.R.S., and is punishable by fines up to $5000 and /or revocation
of the contracting license. If filing online the State Engineer considers entering of licensed contractor name to be compliance with Rule 17.4
Company Name:
Drillinq Enqineers
Phone w /area code:
License Number:
N/A
Mailing Address:
Sign (or enter name if filing online)
Print Name and Title
Date