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WELL CONSTRUCTION AND YIELD ESTIMATE REPORT For_9ffice Uw Only <br /> Form No. State of Colorado, Office of the State Ergmeer <br /> GWS-31 1313 Sherman St., Room 821, Denver, CO 80203 303,866.3581 <br /> 021'2017 Jv'ww.Naier.sta Le.cu.us and dwrperinit5orline-state.cj.us <br /> 1.Well Permit Number:46847-MHt - 0 7 Receipt Number: <br /> 2.Owner's Well Designation:LTC-GW-4 <br /> 3.Wel(Owner Name:Transit Mix Concrete Co. <br /> 4.Well Location Street Address:2485 Hitch Rack Ranch Road, Colorado Springs, CO 80926 <br /> 5.As Built GPS Well Location(required): ❑Lone 12 M Zone 13 Easting:509217.0 Northing:4278795 <br /> 6.Legal Well Location: SW 114, NE 1/4, SeC,, 16 Twp. 16 N or S M Ra'ige_67 E or W 6 P.M. <br /> County: El Paso <br /> Subdivision: _ Lot-_ Block Filing (Unit) <br /> 7.Ground Surface Elevation:6.995 feet Date Completed: 07/21/2017 Drilling Method: Air Hammer _ <br /> 8.Completed Aquifer Name: Granite Total Depth: 203 feet Depth Completed: 199.5 feet <br /> 9.Advance Notification: Was Notification Required Prior to Construction? . Yes No, Date Notification Given: /1 t2-Q11.__. <br /> 10. Aquifer Type: Type I (One Corfining Layer) (]Type I iMultipte Corfming Layersi []Laramie•Fox Hills <br /> (Check one) QType 11 (Not overlain by Type ii!) OType 1� (Overlain by Type 111) QType III (al,uvlallcotluvlalt <br /> 11. Geologic Log: 12. Hole Diameter(in.) From ift) To(ft) <br /> Depth Type Grain Size Color Water Loc. 6 5/8 0 9 <br /> 0 Withered Granite Sandy Gravel Dark Brown 5 4 13/16 9 203 <br /> 4 Granite NA Red Bi own 5 <br /> 41 Hornblend NA Dark 5 13. Plain Casing <br /> 42 Granite NA Red 5 OD(in) Kind Watt Size(in) From ift) Tc,(it) <br /> 58 Biotite/Olivine NA Black 5 See Attached Sheet <br /> 60 Granite NA Red 5 <br /> 64 Biotite/00vire NA Black 5 <br /> 65 Granite NA Light Red 5 <br /> Perforated Casing Screen Slot Size (in): 3,8 <br /> OD(inI Kind Wall Size fin) From(ftl To ifti <br /> See Attached Sheet <br /> 14. Filter Pack: 15. Packer Placement: <br /> Material Sand Type NA <br /> Size 12-20 NA <br /> interval See Attached Depth <br /> 16, Grouting Record <br /> Material Amount Density Interval Method <br /> Remarks: Grout 16 Gal See Attaches 0.9 Ft <br /> 17. Disinfection: Type NA Amt. Used NA <br /> 18. Well Yield Estimate Data: Check bnx if Test Data is submitted on Form Number GWS-39, Well Yield Test Report <br /> Well Yield Estimate Method: Peristaltic Pump <br /> Static Level: See Attached Sheet _ Fstlmated Yield (gpmi SeeAttached <br /> Date/Time measured: 21, 2017. 12:35 PM ESU rate Length ihr ; 3 <br /> Remarks:See Attached Sheet for well com tetion information. <br /> 19. 1 have read the statements made herein and know the coitents thereof,and t`)ey are b ue to m�knowledge This document is signed for name entered 4 <br /> thing online)and ce,tified,n accordance with Rule i7 4 of the WaW w'eit --onstruction Rures,2 CCR 402 2 The filing cf a document tka:contains false <br /> statements is a violation of section 37 91 '08(111e! C R S,and is purrs`)abte by fine<up to 51 000 and or resccation of the convact ne License Ii filing orr,ne <br /> the State Engineer considers t'ie entry of the licensed conua.tar's game tc,t,,-(o,npllan-e witt'Rile 1.7, 4 <br /> Company Name: En,aii Phone w/area code: License Number <br /> Authentic Drilling Mai LCn Authentic drilling ,um 1720)465-1450 1510 <br /> Mailing Address:201 Perry Park Ave. r105 Larkspur, CO 80118 <br /> Sign(or enter name if filing online) Print Name and Title Date: <br /> Marc Haes Marc Haes, Operations Manager 10/12/2017 <br />