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
GW5-31 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:6oa%-MH319189 Receipt Number: 10006468
2. Owner's Well Designation:CY-2
3.Well Owner Name:Trapper Mining Inc.
4. Well Location Street Address:6.5 miles SW Craign CO
5. As Built GPS Well Location (required): 0 Zone 12 E]Zone 13 Easting:278121.4 Northing:4480855.082
6. Legal Well Location: SW 1/4, NW 114, Sec., 28 Twp.6 M N or 5 Q, Range 91 E or W Q, 6th P.M.
County- Moffat
Subdivision: Lot , Block , Filing (Unit)
7. Ground Surface Elevation:6285.79 feet Date Completed: 07121/2020 Drilling Method: Air Rota
8. Completed Aquifer Name : Total Depth: 285 feet Depth Completed: 2$5 feet
9. Advance Notification: Was Notification Required Prior to Construction? . Yes 0 No, Date Notification Given: 07/09/2020
10.Aquifer Type: []Type I (One Confining Layer) OType I (Multiple Confining Layers) ®Laramie-Fox Hills
(Check one) OType II (Not overlain by Type III) .Type II (Overlain by Type III) 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 6" 39 285
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 +4 240
208-214 coal course blk 4" PVC SCH40 280 285
214-218 carb shale med drk brn
218-280 ss fine grey Perforated Casing Screen Slot Size (in): .020
280-285 ss/ms fine It/gry OD(in) Kind Wall Size(in) From (ft) To (ft)
4" PVC SCH40 240 280
14. Filter Pack: 15. Packer Placement:
Material Silica Sand Type
Size 6/9
Interval 232-285 Depth
16, Grouting Record
Material Amount Density Interval Method
Remarks: Portland 10 sks 6 gal/sk 0-39 Trimmie
Bentoniteholeplut 26 sks 3/8" 0-232 Trimmie
17. Disinfection: Type Calcium Hypochlorite-73%chlorine Amt. Used 8 ounces
18.Well Yield Estimate Data: Check box if Test Data is submitted on Form Number GW5-39, WeR Yield Test Report
Welt 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 Box 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