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WELL CONSTRUCTION AND YIELD ESTIMATE REPORT For Office Use Only <br /> Form No. State of Colorado, Office of the State Engineer <br /> GWS-31 1313 Sherman St., Room 821, Denver, CO 80203 303.866.3581 <br /> 02/2017 www.water.state.co.us and dwrpermitsonline@state.co.us <br /> 1. Well Permit Number: MH-059597 Receipt Number: <br /> 2. Owner's Well Designation:RMCC-MW-6(Nix-RMCC-Mon 6) <br /> 3.Well Owner Name:Ready Mixed Concrete Company <br /> 4.Well Location Street Address:8133 County Road 28, Platteville, CO 80651 <br /> 5. As Built GPS Well Location (required): Zone 12 0 Zone 13 Easting: 508159.0 Northing: 4449047 <br /> 6. Legal Well Location: SW 1/4, SW 1/4, Sec., 28 Twp.3 �N or S Q, Range 67 E or W Q, 6 P.M. <br /> County: Weld <br /> Subdivision: Lot , Block , Filing (Unit) <br /> 7. Ground Surface Elevation:4801 feet Date Completed: 06/11/2019 Drilling Method: Hollow Stem Auger <br /> 8. Completed Aquifer Name : Alluvial Total Depth: 52 feet Depth Completed: 52 feet <br /> 9. Advance Notification: Was Notification Required Prior to Construction? . Yes []No, Date Notification Given: 05/10/2019 <br /> 10. Aquifer Type: Type I (One Confining Layer) Type I (Multiple Confining Layers) []Laramie-Fox Hills <br /> (Check one) []Type II (Not overlain by Type III) ❑Type II (Overlain by Type III) Type III (alluvial/colluvial) <br /> 11. Geologic Log: 12. Hole Diameter(in.) From(ft) To (ft) <br /> Depth Type Grain Size Color Water Loc. 8 0 52 <br /> 0-2 Overburden sand clayey sand Brown <br /> 2-51 sand, some gravt tan 17.8' 13. Plain Casing <br /> OD (in) Kind Wall Size(in) From (ft) To (ft) <br /> 51-52 claystone grey 2 PVC Sch 40 42 2.5 ag <br /> Perforated Casing Screen Slot Size (in): 0.010 <br /> OD (in) Kind Walt Size(in) From (ft) To (ft) <br /> 2 PVC Sch 40 52 42 <br /> 14. Filter Pack: 15. Packer Placement: <br /> Material Native Type NA <br /> Size <br /> Interval 52-5 Depth <br /> 16. Grouting Record <br /> Material Amount Density Interval Method <br /> Remarks: Bentonite 75 lbs 5-1 place ft hydrate <br /> water measured below ground on 6-13-19 <br /> cement 1 sack 1-0 place a trowel <br /> 17. Disinfection: Type NA Amt. Used NA <br /> 18.Well Yield Estimate Data: FICheck box if Test Data is submitted on Form Number GWS-39, Well Yield Test Report <br /> Wet[Yield Estimate Method: NA <br /> Static Level: 10 Estimated Yield (gpm) NA <br /> Date/Time measured: time of drilling Estimate Length (hrs) NA <br /> Remarks: <br /> 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 <br /> 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 <br /> 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 <br /> the State Engineer considers the entry of the licensed contractor's name to be compliance with Rule 17.4. <br /> Company Name: Email: Phone w/area code: License Number: <br /> Civil Resources, LLC gary@civilresources.com (720)684-7221 NA <br /> Mailing Address:P. 0. Box 680 Frederick, CO 80530 <br /> Sign (or enter name if filing online) Print Name and Title Date: <br /> Gary Linden Gary Linden Sr Engineering Geologist 06/12/2019 <br />