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] hftp:/Aivww.water.state.co.us
For Office Use Only
1. WELL PERMIT NUMBER: MH - 48088
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 El N or ? S, Range 17 ? E or ? 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)

m Egnation: MMW1
Optional GPS Location: GIPS Unit must use the following settings: Format must be UTM, Units Owner'Fasting:s W694.356.2 ell Well Designation:
must be meters, Datum must be NAD83, Unit must be set to true N. [Z Zone 12 or E] Zone 13
STREET ADDRESS AT WELL LOCATION: Northin : 4,234,476.1 m N
4. GROUND SURFACE ELEVATION 6454 feet DRILLING METHOD Air Rota
DATE COMPLETED 10-1-08 TOTAL DEPTH 340 feet DEPTH COMPLETED 310 feet
5. GEOLOGIC LOG: 6. HOLE DIAM in. From ft To ft
Depth Type Grain Size Color Water Loc. 6.5 0 340

7. PLAIN CASING: flush joint Schedule 40
OD (in) Kind Wall Size (in) From (ft) To (ft)
2 PVC 3/16 +2 270
2 PVC 3/16 300 310

PERFORATED CASING: Screen Slot Size (in): 20
2 PVC 3/16 270 300
SEE FOLLO WING PAGE

8. FILTER PACK: 9. PACKER PLACEMENT:
Material sand Type
Size 10-20
Interval 250-310 Depth
0. GROUTING RECORD
Material Amount Density Interval Placement
Remarks:
See comments on following page. brit chips 5 sx 10-3 hand
bnt chips 18 sx 270" hand
lost circulation
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 Bailer
Static Level 290 ft. Date/Time measured: 10-1-08, 2:00 Production Rate 0 gpm.
Pumping Level 310 ft. Datelrime measured 10-1-08,3:00 Test Length (hrs) 1
Remarks: Well was d on 10-2, 10-3, 10-8, and 10-23
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'e-
V471110 ?G(? 1 Print Name and Title
E. Thomas Cavanaugh Operations Manager Date
11-2-08