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WELL CONSTRUCTION AND YIELD ESTIMATE REPORT Fut Office Usq,Or;ly <br /> Form <br /> 31 N . State of Colorado, Office of the State Engineer <br /> GWS- 1313 Sherman St., Room 821, Denver, CO 80203 303.866.3581 <br /> 02/2017 www.water.state.co.us and dwroermitskinlineo)state.CO.us 1 .' <br /> 1.Well Permit Number: 30-230 Receipt Number: 36 <br /> 2.Owner's Well Designation:LTC-GW-6 <br /> 3.Well 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): Zone 12 [•]Zone 13 Easnng:509911.0 Northing:4278558 <br /> 6,Legal Well Location: NE 1/4, SE 1/4, Sec., 16 ,Twp. 16 N or S Range 67 LLJE or W 6 P.M. <br /> County: El Paso <br /> Subdivision: Lot . Block , Filing (Urntl <br /> 7.Ground Surface Elevation:6,793 feet Date Completed: 071 1 7/2017 _ Drilling Method: Air Hammer -- <br /> 8.Completed Aquifer Name: Granite/Fountain Format Total Depth: 52.5 feet Depth Completed: 49 feet <br /> 9, Advance Notification: Was Notification Regxred Prior to Construction? Yes No, Date Notification Given: _Q/16!2017 <br /> 10. Aquifer Type: []Type I (One Confining Layer) ype I (Multiple Confining Layers) ❑Laramie-Fox Hills <br /> (Check one) []Type II (Not overlain by Type Im QType II (Overtain by Type III) ❑Type It lailuvialrcoltuvial) <br /> 11. Geologic Log: 12. Hole Diameter(in.) From (ft) To(ft) <br /> Depth Type Grain Size Color Water Loc. 6 5/8 0 19 <br /> 0 Gravel 2-3 cm Pink 8 4 13/16 19 52.5 <br /> 3 Sandy Gravel 2.3 mm Red Brown 8 <br /> 12 Sitty Gravel 1-2 cm Dusky Red 8 13, Plain Casing <br /> 23 Sand Stone 2.3 cm Dusky Red 8 OD(in) Kind Walt Size lint From(ft) To tft) <br /> 31 Clay fine Red 8 See Attached Sheet <br /> 32 Granite NA Red 8 <br /> Perforated Casing Screen Slot Size (in): 3/8 <br /> OD (in) Kind Walt Size(ins From tft) To(ft) <br /> See Attached Sheet <br /> 14. Filter Pack: 15. Packer Placement: <br /> Material Sand Type NA <br /> Size 12.20 <br /> Irterval See Attached Depth NA <br /> 16.Grouting Record <br /> Material Amount Density interval Method <br /> Remarks: Grout 32 Gat See Attached 0-19 Ft <br /> 17. Disinfection: Type NA Amt. Used NA <br /> 18.Well Yield Estimate Data: Check box if Test Data is submitted on Form Number GWS-39, Well Yield Test Report <br /> Well Yield Estimate Method. Perist_alti_c_ Pump and Baiter <br /> Static Level: See Attached Sheet` 'Es:iinated Yield igpm) $eeAttached <br /> Date,'Time measured: Sept. 21, 2017, 2:15 PM Estimate Length.(hts) See Attache <br /> Remarks:See Attached Sheet for well completion information. <br /> 19. 1 have read the statements made herein and know the contents thereof,and they are t'cie to my knoMedge lh,s document is signed for name entered if <br /> filing online)and certified in accordance with Rile 17 4 of the Water well.'onct-iictinn RAM,7 CC R 402 2 The filing of a document that contains faise <br /> statements is a�notahon of section 37 91 108(1)le},C R C.,and is puinsndble by fines uf.:o�1,00C and or ievocetion or the cnrtracunp license If fi.mg mt ne <br /> the State Engineer conside•s the entry of the licensad contiactor's racie to be co nphan-e w of RuiF 17 4 <br /> Company Name: Email. Phone w:area aide. License Number: <br /> Authentic Drilling 'Aarccb•Authenticdritting.cutn (72C)465-1450 i510 <br /> Mailing Address:201 Perry Park Ave. k105 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 />