2023-05-08_HYDROLOGY - M2001046

• Permit No: M2001046
• IBM Index Class Name: Hydrology
• Doc Date: 5/8/2023
• Doc Name: Water Monitoring - Groundwater
• From: Brannan Sand and Gravel CO
• To: DRMS
• Email Name: ECS
• Email Name: MAC
• Media Type: D
• Archive: No

WELL CONSTRUCTION AND YIELD ESTIMATE REPORT For Office Use Only
Form No. State of Colorado, Office of the State Engineer
GWS-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:MH-64704 Receipt Number:
2. Owner's Well Designation:NIX-RMCC-MON 9
3. Well Owner Name:Ready Mixed Concrete Company
4.Well Location Street Address:8500-8764 SH-66 Platteville, CO 80651
5. As Built GPS Well Location (required): Zone 12 E]Zone 13 Easting:508949.1 Northing:4450379.11
6. Legal Well Location: NW 1/4, NE 1/4, Sec., 28 Twp.3 N or 5 M, Range 67 E or WE], 6 P.M.
County: WELD
Subdivision: Parcel: 120928100011 Lot , Block , Filing (Unit) 28
7. Ground Surface Elevation:4798 feet Date Completed: 04/13/2023 Drilling Method: 8"O.D. Hollow stem Auger
8. Completed Aquifer Name : alluvial Total Depth: 50 feet Depth Completed: 50 feet
9. Advance Notification: Was Notification Required Prior to Construction? Yes []No, Date Notification Given: 04/10/2023
10. Aquifer Type: Type I (One Confining Layer) []Type I (Multiple Confining Layers) []Laramie-Fox Hills
(Check one) OType II (Not overlain by Type III) ❑Type II (Overlain by Type III) Type III (alluvial/cotluvial)
11. Geologic Log: 12. Hole Diameter(in.) From (ft) To (ft)
Depth Type Grain Size Color Water Loc. 8 0 50
0 Overburden Brown
5 Sand Brown
10 Sand 8 Gravel Brown -10 13. Plain Casing
15 Gravel 8:Cobble Brown OD (in) Kind Wall Size(in) From (ft) To (ft)
20 Gravel 8 Cobble Grey/ Brown 2 PVC SCH.40 0 30
25 Gravel li Cobble Grey/Brown
30 Sand £t Gravel Brown
35 Sand li Gravel Brown
40 Sand 8 Gravel Brown Perforated Casing Screen Slot Size(in):20 Slot_
45 Sand,Gravel,cobbl Brown OD (in) Kind Wall Size(in) From (ft) To (ft)
50 Sand £t Sandstone Brown 2 PVC SCH.40 30 50
14. Filter Pack: 15. Packer Placement:
Material Silica Sand Type N/A
Size 10/20 N/A
Interval 5-50 Depth
16. Grouting Record
Material Amount Density Interval Method
Remarks:Bedrock at approx. 49ft. bentonite chips 100lbs 1-5 Poured&Hydrated
Concrete 40lbs 0-1 Placed&Formed
17. Disinfection: Type N/A Amt. Used N/A
18. Well Yield Estimate Data: r7Check box if Test Data is submitted on Form Number GWS-39, Well Yield Test Report
Well 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:
Civil Resources, LLC. [e-mail] [phone] N/A
Mailing Address:
Sign (or enter name if filing online) Print Name and Title Date:
Noah Hagen Noah Hagen, Field Engeneering Tech. 04/14/2023