2020-06-25_REVISION - C1981035 (34)

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Form WELL CONSTRUCTION AND YIELD ESTIMATE REPORT Z_13For Office Use Only State of Colorado Office of the State Engineer GWS-31 >VTl"t5 RkFl~;IC 1313 Sherman St. Room 821 Denver, CO 80203 303.866.3581 fl � ,* 02/2017 www.water.state.co.us and dwrpermitsonline@state.co.us �� •Z� 1. Well Permit Number: 303358 Receipt Number: 9703921H �' 4 �5C, 18 2. Owner's Well Designation:MW-3-C r.FR k?,g•� 3. Well Owner Name:GCC Energy, LLC C_NGfNE CRS 4. Well Location Street Address:NA OLb Eh' 5. As Built GPS Well Location (required): OZone 12 0 Zone 13 Easting: 752337.0 Northing:4124417 6. Legal Well Location: NE 1/4, SE 114, Sec., 3 Twp.34 N or S©, Range 12 E or W NM P.M. County: La Plata Subdivision: NA Lot NA Block NA Filing (Unit) NA 7. Ground Surface Elevation:7418.5 feet Date Completed: 03/08/7017 Drilling Method: Rotary Air Hammer 8. Completed Aquifer Name : Unspecified Total Depth: 350.42 feet Depth Completed: 344.85 feet 9. Advance Notification: Was Notification Required Prior to Construction? Yes ONo, Date Notification Given: 10. Aquifer Type: ❑Type I (One Confining Layer) [■Type I (Multiple Confining Layers) ®Laramie-Fox Hills (Check one) []Type II (Not overlain by Type III) ❑Type II (Overlain by Type III) ❑Type III (alluvial/calluvial) 11. Geologic Log: 12. Hole Diameter (in.) From (ft) To (ft) Depth Type Grain Size Color Water Loc. 12.0 0.00 41.00 0-30 weath'd sandstn sand gryish orang NA 6.9 41.00 350,42 30-315 siltstone/sandstn silt/sand It to dk gray NA 349.5-350.40 sandstone sand brown-gray NA 13. Plain Casing 350.4.350.42 coal coal black NA OD (in) Kind Wall Size (in) From (ft) To (ft) 8.625 STEEL 0.188 -3.50 41.00 2.375 PVC 0.218 -3.00 44.50 Perforated Casing Screen Slot Size (in): 0.020 OD (in) Kind Wall Size (in) From (ft) To (ft) 2.375 PVC 0.218 44.50 344.85 14. Filter Pack: 15. Packer Placement: Material Silica Sand Type NA Size 10-20 Interval 41.50-345.80 Depth NA 16. Grouting Record Material Amount Density Interval Method Remarks:Monitoring well. Dry drilling method.Drilling services by DAK Drilling.TX 3'X 0.5'cement 318"bentonite chips 2 sacks NA 345.80-350.42 poured pad installed around locking wellhead.Annular seal is hydrated 318"bentonite chips. SS 13.5 sacks NA 0.00-41.5 poured centralizers installed every 40'on screen&casing. Hole dry at time of TD. Free water 3/8"bentonite chip s entered borehole overnight. 17. Disinfection: Type NA Amt. Used NA 18. Well Yield Estimate Data: MCheck box if Test Data is submitted on Form Number GWS-39, Well Yield Test Report Well Yield Estimate Method: bailer Static Level: 304.21 ftbgs Estimated Yield (gpm) 0.5 Date/Time measured: 3/27/17 14:00 Estimate Length (hrs) 1.5 Remarks:monitoring well development by bailer surging ft production 19, 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$1,000 and/or revocation of the contracting license. If filing online the State Engineer considers the entry of the licensed contractor's name to be compliance with Rule 17.4. Company Name: Email: Phone w/area code: License Number: Resource Hydrogeologic Services, Inc. info@resourcehydrogeologic.com (970) 764-4920 7NA Mailing Address:101 W 11th St#103 Durango, CO 81301 Sign (or enter name if filing online) Print Name and Title Date: Landon Beck Landon Beck - Principal Hydrogeologist 08/17/2017