Laserfiche WebLink
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 dwr.colorado.gov and dwrpermitsonline@state.co.us <br /> 1. Well Permit Number: 324577 Receipt Number: &24&7-MH- 10016821 <br /> 2. Owner's Well Designation:PZ-01 <br /> 3. Well Owner Name:Monarch Mountain Minerals <br /> 4.Well Location Street Address:21421 HIGHWAY 60, Weld County <br /> 5. As Built GPS Well Location (required): ©Zone 12 a Zone 13 Easting: 515989.4 Northing:4461870.08 <br /> 6. Legal Well Location: SE 1/4, SE 1/4, Sec., 18 Twp.4 E3 N or S®, Range 66 0 E or W E, 6 P.M. <br /> County: Weld <br /> Subdivision: , Lot , Block , Filing (Unit) <br /> 7. Ground Surface Elevation:4729 feet Date Completed: 09/29/2021 Drilling Method: Sonic Boring <br /> 8. Completed Aquifer Name : S. Platte River Alluvium Total Depth: 50 feet Depth Completed: 20 feet <br /> 9. Advance Notification: Was Notification Required Prior to Construction? Yes ONo, Date Notification Given: 09/23/2021 <br /> 10. Aquifer Type: ©Type I (One Confining Layer) OType I (Multiple Confining Layers) ©Laramie-Fox Hills <br /> (Check one) OType II (Not overlain by Type III) OType 11 (Overlain by Type III) EjType III (alluvial/colluvial) <br /> 11. Geologic Log: 12. Hole Diameter(in.) From (ft) To (ft) <br /> Depth Type Grain Size Color Water Loc. 4 0 50 <br /> 0-5 SP fg -cg It brown <br /> 5-15 sp-gp fg -cg It brown <br /> 13. Plain Casing <br /> 15-24 sp fg brown OD (in) Kind Wall Size (in) From (ft) To (ft) <br /> 2 PVC SCH 40 -2.5 30 <br /> 24-25.5 ml v. fg brown <br /> 25.5-33 sp cg-v. cg brown <br /> Perforated Casing Screen Slot Size (in): <br /> 33-34 CL/ML v. fg brown OD (in) Kind Wall Size(in) From (ft) To (ft) <br /> 2 pvc SCH 40 30 50 <br /> 34-39 sm/gp cg-v. cg brown <br /> 39-40 sm fg tan <br /> 14. Filter Pack: 15. Packer Placement: <br /> 40-50 claystone v. fg bluish grey Material native sand Type <br /> Size <br /> Interval Depth <br /> 16. Grouting Record <br /> Material Amount Density Interval Method <br /> Remarks: concrete -0.5-1' placed <br /> bentonite chips 100 lbs 1 -6 poured <br /> 17. Disinfection: Type Amt. Used <br /> 18. Well Yield Estimate Data: ['Check box if Test Data is submitted on Form Number GWS-39, Well Yield Test Report <br /> Well Yield Estimate Method: <br /> Static Level: Estimated Yield (gpm) <br /> Date/Time measured: Estimate Length (hrs) <br /> Remarks: <br /> 19. I 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 Kyte@civilResources.com (408)930-2544 <br /> Mailing Address:8108 Colorado Blvd, Firestone, CO 80504 <br /> Sign (or enter name if filing online) Print Name and Title Date: <br /> Kyle Scott Regan Kyle Regan / Project Geologist 11/10/2021 <br />