2010-03-10_PERMIT FILE - M2008012 ‎(2)‎

• Permit No: M2008012
• IBM Index Class Name: PERMIT FILE
• Doc Date: 3/10/2010
• Doc Name: Storm water management plan ‎(part 2)‎ Appendix E-groundwater monitoring
• From: Nuvemco, LLC
• To: DRMS
• Email Name: GRM
• Email Name: ACS
• Email Name: DB2
• Media Type: D
• Archive: No

FORM NO.
GWS-31
04/2005 WELL CONSTRUCTION AND TEST REPORT
STATE OF COLORADO, OFFICE OF THE STATE ENGINEER
1313 Sherman St., Room 818, Denver, CO 80203
Phone - Info [phone] Main [phone]
Fax [phone] http:/twww.water.state.co.us For Office Use Only
1. WELL PERMIT NUMBER: MH - 48032
2. WELL OWNER INFORMATION
NAME OF WELL OWNER: Nuvemco, LLC
MAILING ADDRESS: 10771 3200 Road
CITY: Hotchkiss STATE: CO ZIP CODE: 81419
TELEPHONE NUMBER: 970 872 - 3009
3. WELL LOCATION AS DRILLED: NE 1/4, SE 1/4, Sec. 18 , Twp. 46 Q N or ? S, Range 17 ? E or ?D W
DISTANCES FROM SEC. LINES: ft. from ? N or ? S section line and ft. from ? E or ? W section line.
SUBDIVISION: LOT , BLOCK , FILING (UNIT)
Optional GPS Location: GPS Unit must use the following settings: Format must be UTM, Units Owners Well Designation: MMW2
must be meters, Datum must be NAD83, Unit must be set to true N, ? Zone 12 or ? Zone 13 Easting: 693,777.7 m N
STREET ADDRESS AT WELL LOCATION: NA Northin : 4,234,543.6 m W
4. GROUND SURFACE ELEVATION 6629 feet DRILLING METHOD Air Rota
DATE COMPLETED 10-1-08 TOTAL DEPTH feet DEPTH COMPLETED 10-1-08 feet
5. GEOLOGIC LOG: 6. HOLE DIAM in. From ft To ft
Depth Type Grain Size Color Water Loc. 6 0 210

7. PLAIN CASING:
OD (in) Kind Wall Size (in) From (ft) To (ft)
23/8 PVC 3/16 +2 133
23/8 PVC 3/16 168 153

PERFORATED CASING: Screen Slot Size (in): 20
23/8 PVC 3/16 133 153
SEE FOLLO WING PAGE

8. FILTER PACK: 9. PACKER PLACEMENT:
Material sand Type n/a
Size 10-20
Interval 155-130 Depth
0. GROUTING RECORD
Material Amount Density Interval Placement
Remarks: hole was very dry to TD and on subsequent days. Brit Pellet 6 buckets 168-155 hand
Bnt Chips 5 sx 10-3 hand
cement 2 sx 3-surface hand
11. DISINFECTION: Type NA Amt. Used
12. WELL TEST DATA: ? Check box if Test Data is submitted on Form Number GWS 39 Supplemental Well Test.
TESTING METHOD Dry
Static Level NA ft. Date/Time measured: 10-2-08, 10 am Production Rate 0 gpm.
Pumping Level NA ft. Date/Time measured 10-2-08, 10 am Test Length (hrs) 1
Remarks: Borehole was d
13. 1 have read the statements made herein and know the contents thereof, and they are true to my knowledge. This document is signed 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 b fines u to $5000 and/or revocation of the contracting license.
Company Name:
O&G Environmental Consulting Phone.
720 529- 9777 License Number:
CPG - 10493
Mailing Address: 11 Inverness Way South, Englewood, CO 80112
Signature: p
G gyp Cf/y? Print Name and Title
E. Thomas Cavanaugh Operations Manager Date
11-02-08
C.11