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GWS-31
<br /> 02/2017
<br /> INSTRUCTIONS FOR WELL CONSTRUCTION AND YIELD ESTIMATE REPORT
<br /> This report must be computer generated online,typed or printed in BLACK OR BLUE INK and may be reproduced by photocopy or computer generation.
<br /> Photocopy reproductions must retain margins and print quality. Attach additional sheets if more space is required. Each additional sheet must be identified
<br /> at the top by the welt owner's name,the permit number,form name/number and a sequential page number. Report depths in feet below ground surface.
<br /> If filing online please see the Form Submittal,Payment Options,ft Fee Schedule.You may also save,print and email the completed form to:
<br /> dwrpermiLsonline@state.co.us
<br /> The form must be submitted to the State Engineer's Office within 60 days after completing the well or 7 days after the permit expiration date,
<br /> whichever is earlier. A copy of the form must be provided to the well owner.
<br /> Item Instructions:(numbers correspond with those on the front of this form)
<br /> 1. Complete the well permit and receipt number.
<br /> 2. Provide the identification(owner's well designation)for the well.
<br /> 3. Fill in well owner name.
<br /> 4. Provide the street address where the well is located.
<br /> 5. Provide the GPS location where the welt was drilled(required field).
<br /> Colorado contains two(2)UTM zones. Zone 13 covers most of Colorado. The boundary between Zone 12 and Zone 13 is the 1081"Meridian(longitude).
<br /> West of the 10P Meridian is UTM Zone 12 and east of the 108"'Meridian is UTM Zone 13. The 108w Meridian is approximately 57 miles east of the
<br /> Colorado-Utah state line. On most GPS units,the UTM zone is given as part of the Easting measurement,e.g. 12T0123456. Check the appropriate
<br /> box for the zone.
<br /> 6. Complete the legal description location of the well and county. For wells located in subdivisions,the name,lot,block,and filing,must be provided.
<br /> 7. Report the ground surface elevation in feet above sea level if available. This value may be obtained from a topographic map. Provide the date the
<br /> well was completed and describe the drilling method used to construct the well.
<br /> S. Indicate the aquifer in which the well was completed,the total depth drilled,and the actual completed depth of the well.
<br /> 9. Indicate whether or not the well inspection team was required to be notified prior to construction. If required,provide the date notification was given.
<br /> See https://dwr.colorado.eoviservices/well-construction-inspection for more information on Notifications.
<br /> 10. Check the box indicating the type aquifer in which the well is completed(See Rule 5.2.2 Well Construction Rules►.
<br /> 11. Fully describe the materials encountered in drilling. Do not use formation names unless they are in conjunction with a description of materials. Examples
<br /> of descriptive terms include:
<br /> Type-sandstone,sand,etc.
<br /> Grain size-Boulders,gravel,sand,silt,clay,etc.
<br /> Color-Denote for all materials,most critical in sedimentary rock
<br /> Water Location-Depth where water Is encountered(if it can be determined)
<br /> 12. Provide the diameters of the drilled borehole.
<br /> 13. The outside diameter,type,wall thickness,and interval of plain and perforated casing lengths must be indicated. For perforated casing,the screen
<br /> size must be indicated.
<br /> 14. Indicate the material and size of filter pack(e.g.sand,gravel,etc.)and the interval where placed.
<br /> 15. Indicate the type and setting depth for any packers installed.
<br /> 16. The material,amount,and interval of the grout slurry must be reported. Density may be indicated as pounds per gallon,gallons of water per sack,
<br /> total gallons of water used,or number of sacks used,etc. Specify the grout placement method,i.e.tremie pipe or positive placement. The percentage
<br /> of additives mixed with the grout should be reported under remarks.
<br /> 17. Record the type and the amount of disinfection used,how placed,and the length of time left in the hole.
<br /> 18. Report Well Yield Estimate data as required by Rule 17.1.1. Spaces are provided to report all estimates made during the assessment. The report should
<br /> show that the estimate complied with the provisions of the rules. If available,report clock time when measurements were taken. if an estimate was
<br /> not performed,explain when it will be done. A full Well Yield Test may be performed instead of an estimate;if so,check the appropriate box and
<br /> submit the data on form GWS-39.
<br /> 19. Fill in Company Name,Email,and Address and License Number(or PE/PG)of the Individual who is responsible for the well construction. The licensed
<br /> contractor or authorized individual responsible for the construction of the welt must sign or if filing online,enter his/her name on the report. If filing
<br /> online the State Engineer considers the entering of the licensed contractors name on the form to be a certification of accuracy and truthfulness in
<br /> compliance with Rule 17.4 of the Water Well Construction Rules and Regulations,2 CCR 402.2.
<br /> Rule 17.4 Certification - Work reports must be signed and certified as to accuracy and truthfulness of the information on the report by the welt
<br /> construction or pump installation contractors or authorized individuals responsible for the work performed by them or under their direction or
<br /> supervision,or by the private driller or private pump installer if the work was performed by them. Such reports are deemed to be completed,signed
<br /> and certified udder oath.
<br /> Submit completed report to:State of Colorado,Office of the State Engineer,1313 Sherman St, Room 821,Denver,CO 80203. You may also savc,print,scan
<br /> and email the completed form to dwrpermitsonline(j�state_co.us
<br /> IF YOU HAVE ANY QUESTIONS regarding any item on this form,please call the Division of Water Resources Ground Water Information Desk(303.866-3587),or
<br /> the nearest Division of Water Resources Field Office located in Greeley(970-352-8712),Pueblo(719-542-3368),Alamosa(719-589-6683),Montrose
<br /> (970.249-6622),Glenwood Springs(970-945-5665),Steamboat Springs(970-879.0272),or Durango(970.247-1845),or refer to our web site at dwr.cotorado.rov
<br /> for general information,forms,online filing instructions and access to state rules and statutes.
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