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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 dwr.colorado.gov and dwrpermitsonline@state.co.us <br /> 1.Well Permit Number: 324583 Receipt Number:.4g8.{ _ 10016827 <br /> 2. Owner's Well Designation:PZ-27 <br /> 3. Well Owner Name:Monarch Mountain Minerals <br /> 4. Well Location Street Address:20203 HIGHWAY 60, Weld County <br /> 5. As Built GPS Well Location (required): El Zone 12 Q Zone 13 Easting: 514538.5 Northing: 4459152.06 <br /> 6. Legal Well Location: SW 1/4, NW 1/4, Sec., 30 Twp.4 ED N or S®, Range 66 ®E or W®, 6 P.M. <br /> County: Weld <br /> Subdivision: , Lot , Block , Filing (Unit) <br /> 7. Ground Surface Elevation:4760 feet Date Completed: 09/28/2021 Drilling Method: Sonic Boring <br /> 8. Completed Aquifer Name : S. Platte River Alluvium Total Depth: 55 feet Depth Completed: 55 feet <br /> 9. Advance Notification: Was Notification Required Prior to Construction? p Yes ❑No, Date Notification Given: 09/23/2021 <br /> 10.Aquifer Type: ❑Type I (One Confining Layer) Type I (Multiple Confining Layers) El 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. 4 0 60 <br /> 0-1 SP(topsoil) fg-cg black <br /> 1-39 SP/GP fg-cg brown 13. Plain Casing <br /> OD (in) Kind Wall Size (in) From (ft) To (ft) <br /> 39-42 CL/ML fg brown 2 PVC SCH 40 -2.5 35 <br /> 42-43.5 GP cg brown <br /> 43.5-48.5 SP/GP cg -v. cg brown Perforated Casing Screen Slot Size (in): <br /> OD (in) Kind Wall Size (in) From (ft) To (ft) <br /> 48.5 - 55 Claystone v. fg bluish grey 2 pvc SCH 40 35 55 <br /> 14. Filter Pack: 15. Packer Placement: <br /> Material native sand Type <br /> Size <br /> Interval Depth <br /> 16. Grouting Record <br /> Material Amount Density Interval Method <br /> Remarks: concrete 1/2 bag -0.5'-1' placed <br /> bentonite chips 100 lbs 1 -5 poured <br /> 17. Disinfection: Type Amt. Used <br /> 18. Well Yield Estimate Data: QCheck 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 Kyle@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 <br /> Kyle Regan / Project Geologist 11/10/2021 <br />