2022-06-21_PERMIT FILE - M2022031 ‎(2)‎

• Permit No: M2022031
• IBM Index Class Name: Permit File
• Doc Date: 6/21/2022
• Doc Name: Application
• From: Castle Rock Construction Company of Colorado, LLC
• To: DRMS
• Email Name: TC1
• Email Name: MAC
• Email Name: AWA
• Email Name: KME
• Email Name: SMS
• Media Type: D
• Archive: No

�;a WELL CONSTRUCTION_ AND TEST REPORT For Office Use only
e )STATE OF COLORADO, OFRCE OF THE STATE ENGINEER RECEILr I
1. WELL PERMIT NUMBER 24653-,M N
2 OWNER NAME(S) Fort Carson 1 , ��Mailing Address HQ, Fort Carson and 4th Infantry Div ch) WATERRESOl1RGES
City, St Zip ATTN: AFK-ECM-EC, Fort Carson , CO 8_0 1 =
Phone ( 719 ) 526-1730
3. WELL LOCATION AS DRILLED: NW 1/4 NW 1/4, Sec. 19 Twp. 17 S , Range 67 W
DISTANCES FROM SEC. LINES:
1350 ft from North Sec. fine. and 5 ft. from WesSec. line. OR
(Tionn of � v
SUBDIVISION: N/A LOT ABLOCK N/A FILING(UNIT) N/A
STREET ADDRESS AT WELL LOCATION: N/A
4. GROUND SURFACE ELEVATION 6210 ft. DRILLING METHOD Auger
DATE COMPLETED 11 Nov 94 TOTAL DEPTH 24 ft. DEPTH COMPLETED 24 ft.
5. GEOLOGIC LOG: 6. HOLE DIAM. (in.) From (ft) To (ft)
Depth Description of Materiel (Type,Size, Color,Water Location) 6 0 24
0-4.0 Clean red fine to med. gravelly fine
to medium sand
4-4. 5 Red, sandy st y ine gravel to fine
gravelly silt 7. PLAIN CASING
Urange7red Tine sandy slit with fine OD (n) Kind Wall Size From(ft) To(ft)
grave 2 PVC schedule 40 0
briclZ red Slightly Clayey ftfle bdridy
Silt
PERF. CASING: Screen Slot Size: 0.010"
9-tb Uniform fed silt W/veiy little samd. 2 PVC schedule 40 9 24
15-It Fine red silt with Fine gre-vel —
16-24 Fine red clayey silt w sans one an
siltstone layers
Moist at 16 ft 8. FILTER PACK: 9. PACKER PLACEMENT:
Material CSS Type N/A
Size 10-20
Interval.-6. 9-24 Depth N/A
10. GROUTING RECORD:
Material Amount Density Interval Placement
REMARKS: Portl and 70 1 b N/A 2-3.7_
Cement
Typed
Bentonite 65 lb N/A 3. 7-6. 9, 1-2
d DISINFECTION: Type N/A C�ncre0te 80 lb -
mt. sed
12- WELL TEST DATA: Q Check box d Test Data is submitted on Form No. GWS 39 Supplemental Well Test.
TESTING METHOD Electric Meter
Static Level N/f} ft. Date/Tme measured NLA Production Rate N/A gpm,
Pumping level N/A ft. Date/ Time measured N/A , Test length (hrs.)
Remarks dry well
3. 1 have read the statemerris made herein and know the contents thereof, and that they are true to my knowledge. (Pursuant to Section 24-4-104 (13)(
C.R.S.,the making of false statements herein constfilxes perjury in the second degree and is punishable as a class 1 misdemeanor.)
CONTRACTOR USACHPPM, ATTN: MCHB-ME-SG, APG, MD Phone ( 410) 671-5198 Lic. No. N/A
Mailina Address21010-5422
NamelTrtle ((Please ty or rirrt) Sign ure Date
MARY SALAMON,,v ee010 1 sti
/ - zS- 9s