2023-01-10_PERMIT FILE - M2023001 ‎(12)‎

• Permit No: M2023001
• IBM Index Class Name: Permit File
• Doc Date: 1/10/2023
• Doc Name Note: Exhibit G - Water Information
• Doc Name: Application
• From: J-2 Contracting Company
• To: DRMS
• Email Name: PSH
• Email Name: JLE
• 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 dwr.colorado.gov and [e-mail]
1.Well Permit Number:63811 -MH Receipt Number:
2.Owner's Well Designation:MW-1
3.Well Owner Name:Sunset Industrial, LLC.
4.Well Location Street Address:n/a
S.As Built GPS Well Location(required): Zone 12 Zone 13 Easting:529731.0 Northing:4475202.0
6. Legal Well Location: NE 1/4, SW 1/4, Sec., 3 Twp.5 N or S[, Range 65 ME or W , 6 P.M.
County: Weld
Subdivision: n/a Lot , Block , Fiting(Unit)
7.Ground Surface Elevation:4653 feet Date Completed: 09/08/2022 Drilling Method: holtowstem auger
8.Completed Aquifer Name: n/a Total Depth: 114 feet Depth Completed: 114 feet
9.Advance Notification: Was Notification Required Prior to Construction? Yes No, Date Notification Given: 08/30/2022
10.Aquifer Type: Type I(One Confining Layer) ype I(Multiple Confining Layers) ❑Laramie-Fox Hills
(Check one) ❑Type 11(Not overlain by Type III) ❑Type II(Overlain by Type III) ElType III(alluvial/colluvial)
11. Geologic Log: 12. Hole Diameter(in.) From(ft) To(ft)
Depth Type Grain Size Color Water Loc. 7.5 0 114
0-4 Sand,silty fine brown
4-8 Sand,gravelly fine-med "
8.12 Clay,sandy fine 13. Plain Casing
12-33 Sand,gravelly coarse OD(in) Kind Wall Size(in) From(ft) To(ft)
33-44 Clay,sandy fine 40' 2.375 PVC .154 0 44
44-72 Sand,gravelly coarse "
72-76 Gravel,sandy coarse "
76-112 Sand,gravellycoarse "
112-115 Cla stone fine gray Perforated Casing Screen Slot Size(in): .010
OD(in) Kind Wall Size(in) From(ft) To(ft)
2.375 PVC .154 44 114
14.Filter Pack: 15. Packer Placement:
Material Native/Silica Sand Type Bentonite Chips
Size 10/20 0-20'
Interval 20-114' Depth
16.Grouting Record
Material Amount Density Interval Method
Remarks: n/a
17. Disinfection: Type n/a Amt.Used
18.Well Yield Estimate Data: heck box if Test Data is submitted on Form Number GWS-39,Well Yield Test Report
Welt Yield Estimate Method:
Static level: 41Y Estimated Yield(gpm)
Date/Time measured: 9/9/22 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:
Cesare, Inc. [e-mail] [phone]
fling Address:7108 S.Alton Way, Bldg B,Centennial,CO 80112
Sign(or enter name if filing online) Print Name and Title Date:
Jay B. Edwards Jay B. Edwards-Engineering Field Coordinator 09/13/2022