2024-05-23_REVISION - M2022009 (2)

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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 0212017 dwr.colorado.Qov and dwrpermitsonline@state.co.us 1. Well Permit Number: Receipt Number: 62487-MH 2. Owner's Well Designation:PZ-01 3. Well Owner Name:Monarch Mountain Minerals 4. Well Location Street Address:21421 HIGHWAY 60, Weld County 5. As Built GPS Well Location (required): Zone 12 E]Zone 13 Easting: 515989.4 Northing:4461870.08 6. Legal Well Location: SE 1/4, SE 1/4, Sec., 18 Twp.4 N or S[—], Range 66 E or W�, 6 P.M. County: Weld________ Subdivision: Lot , Block , Filing (Unit) 7. Ground Surface Elevation:4729 feet Date Completed: 09/29/2021 _ Drilling Method: Sonic Boring _____ 8. Completed Aquifer Name : S. Platte River Alluvium Total Depth: 50 feet Depth Completed: 20 feet 9. Advance Notification: Was Notification Required Prior to Construction? E] Yes No, Date Notification Given: 09/23/2021 10. Aquifer Type: Type I (One Confining Layer) Type I (Multiple Confining Layers) C]Laramie-Fox Hills (Check one) OType II (Not overlain by Type III) OType II (Overlain by Type III) E]Type III (alluvial/colluvial) 11. Geologic Log: 12. Hole Diameter(in.) From (ft) To (ft) Depth Type Grain Size Color Water Loc. 4 0 50 0-5 SP fg - cg It brown 5-15 sp-gp fg - cg It brown 13. Plain Casing 15-24 sp fg brown OD (in) Kind Wall Size (in) From (ft) To (ft) 2 PVC SCH 40 -2.5 30 24-25.5 ml V. fg brown 25.5-33 sp cg -V. cg brown Perforated Casing Screen Slot Size (in): 33-34 CL/ML V. fg brown OD (in) Kind Wall Size (in) From (ft) To (ft) 2 pvc SCH 40 30 50 34-39 sm/gp cg -V. cg brown 39-40 sm fg tan 14. Filter Pack: 15. Packer Placement: 40-50 claystone V. fg bluish grey Material native sand Type Size Interval Depth 16. Grouting Record Material Amount Density Interval Method Remarks: concrete -0.5'- 1' placed bentonite chips 100 lbs 1 -6 poured 17. Disinfection: Type Amt. Used 18. Well Yield Estimate Data: 7Check 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 Kyle@civilResources.com (408) 930-2544 Mailing Address:8108 Colorado Blvd, Firestone, CO 80504 Sign (or enter name if filing online) Print Name and Title Date: Kyle Scott Regan Kyle Regan / Project Geologist 11/10/2021