2020-08-09_PERMIT FILE - M2020041

• Permit No: M2020041
• IBM Index Class Name: Permit File
• Doc Date: 8/9/2020
• Doc Name: Application
• From: Kilgore Companies
• To: DRMS
• Email Name: ECS
• Email Name: MAC
• Media Type: D
• Archive: No

WELL CONSTRUCTION AND YIELD ESTIMATE REPORT For Office Use Only
Form State of Colorado, Office of the State Engineer
GWS-31 1313 Sherman St., Room 821, Denver, CO 80203 303.866.3581
02/2017 www.water,state.co.us and dwmermitsontine0Astate.co.us
1. Well Permit Number: Receipt Number: 59658-MH
2. Owner's Well Designation:GW-1
3. Well Owner Name:Kilgore Companies (7057 West 2100 South, Salt Lake City, Utah)
4. Well Location Street Address:35405 State HWY 9 Silverthorne, CO 80498
5. oomo=rGPS Well Location (required): ❑Zone 12 OZone 13 Easting: 4401254.0 Northing: 4403457.69
6. Legal Well Location: 1/4, 1/4, Sec., 20 Twp.3.0 =N or S[D, Range 78.0 =E or W�, Sixth P.M.
County: Summit County
Subdivision: Lot , Block , Filing (Unit)
7. Ground Surface Elevation:8266 feet Date Completed: 06/14/2019 Drilling Method: ODEX
8. Completed Aquifer Name : Total Depth: 20 feet Depth Completed: 20 feet
9. Advance Notification: Was Notification Required Prior to Construction? . Yes []No, 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 11 (Overlain by Type III) ❑Type III (alluvial/colluvial)
11. Geologic Log: 12. Hole Diameter(in.) From (ft) To (ft)
Depth Type Grain Size Color Water Loc. 5" 0 20
04 Topsoil 0.002-0.1 mm Brown No
4-6' Gravelly Sand 0.05-75mm Brown No
6-8' Sand 0.05-2mm Tan No 13. Plain Casing
8-10' Gravel 2-75mm Grey Yes OD (in) Kind Watt Size (in) From (ft) To (ft)
10-14' Gravelly Sand 0.05-75mm Light brown Yes 2 Sch40PVC .154 0 5.0
14-20' Pebbles 75-125mm Grey Yes
Perforated Casing Screen Slot Size (in):
OD (in) Kind Walt Size (in) From (ft) To (ft)
2 Sch40PVC 0.10 5.0 20.0
14. Filter Pack: 15. Packer Placement:
Material Silica sand Type
Size 10-20
Interval 4-20' Depth
16. Grouting Record
Material Amount Density Interval Method
Remarks:Cemented to surface with lockable steel stickup Bentonite 100% 14 Pour
cover.
17. Disinfection: Type NA Amt. Used NA
18. Well Yield Estimate Data: Check box if Test Data is submitted on Form Number GWS-39, Well Yield Test Report
Well Yield Estimate Method:
Static Level: 10 feet Estimated Yield (gpm)
Date/Time measured: 6.12.19 Estimate Length (hrs)
Remarks:
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 Welt 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:
HRL Compliance Solutions [e-mail] [phone] UT 5212206-2250
Mailing Address:2385 F 1/2 Road, Grand Junction, CO 81505
Sign (or enter name if filing online) Print Name and Title Date:
Mark Mumby Mark Mumby, P.G. 06/21/2019