2020-12-21_PERMIT FILE - C1981010 ‎(17)‎

• Permit No: C1981010
• IBM Index Class Name: Permit File
• Doc Date: 12/21/2020
• Doc Name: Design & Construction for GW Monitoring Wells
• Section_Exhibit Name: APPENDIX V PART C
• 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 [e-mail]
1.Well Permit Number: 319190 Receipt Number: 10006469
2. Owner's Well Designation:CY-3
3. Well Owner Name:Trapper Mining Inc.
4. Well Location Street Address:6.5 miles SW Craig CO
5. As Built GPS Well Location (required): ©Zone 12 E]Zone 13 Easting:278118.7 Northing:4480857.6
6. Legal Well Location: SW 1/4, NW 1/4, Sec., 28 Twp.6 0 Nor S®, Range 91 E or W LE, 6th P.M.
County: Moffat
Subdivision: , Lot , Block , Filing (Unit)
7. Ground Surface Elevation:6286.329 feet Date Completed: 07/14/2020 Drilling Method: Air Rotary
8. Completed Aquifer Name: Total Depth: 430 feet Depth Completed: 425 feet
9. Advance Notification: Was Notification Required Prior to Construction? F1 Yes No, Date Notification Given: 07/09/2020
10. Aquifer Type: ®Type I (One Confining Layer) []Type I (Multiple Confining Layers) ®Laramie-Fox Hills
(Check one) ®Type II (Not overlain by Type 111) aype 11 (Overlain by Type Ill) OType III (alluvial/colluvial)
11. Geologic Log: 12. Hole Diameter(in.) From (ft) To (ft)
Depth Type Grain Size Color Water Loc. 9 7/8" 0 39
0-34 clay Et gravel fine brown b" 39 430
34-70 ss/ms fine .........grey 60
70-80 ss/st fine drk grey 13. Plain Casing
80-82 coal course blk OD (in) Kind Wall Size (in) From (ft) To (ft)
82-178 ss fine grey 6 5/8" Steel 0.188 +4 39
178-208 ss/ms fine grey 4" PVC SCH40 +4 380
208-214 coal course blk 4" PVC SCH40 420 425
214-218 carb shale med drk bm
218-280 ss fine rey Perforated Casing Screen Slot Size (in): .030
280-300 ss/ms fine It/gry OD(in) Kind Wall Size(in) From (ft) To (ft)
300-415 ss fine it/gry 4" PVC SCH40 380 420
415-430 ss/ms fine drk/gry
14. Filter Pack: 15. Packer Placement:
Material Silica Sand Type
Size 6/9
Interval 376-430 Depth
16. Grouting Record
Material Amount Density Interval Method
Remarks: Portland 10 sks 6 gal/sk 0-39 Trimmie
Bentonite hole plug 32 sks 3/8" 0-376 Trimmie
17. Disinfection: Type Calcium Hypochlorite-73%chlorine Amt. Used 8 ounces
18. Well Yield Estimate Data: OCheck box if Test Data is submitted on Form Number GWS-39,Well Yield Test Report
Well Yield Estimate Method:
Static Level: Estimated Yield (gpm)
Date/Time measured: 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 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:
Trapper Mining Inc. [e-mail] [phone]
Mailing Address:PO Sox 187, Craig CO 81626
Sign (or enter name if filing online) Print Name and Title Date:
Graham Roberts Graham Roberts, Environmental Engineer 09/23/2020