2013-08-13_HYDROLOGY - M1977348 (2)

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FORM NO. GWS-31 4t2012 WELL CONSTRUCTION AND TEST REPORT STATE OF COLORADO, OFFICE OF THE STATE ENGINEER 1313 Sherman St., Ste 621, Denver, CO 8=3 Main 303 8663581 Fax 303 886 -3569 www.water.sta co u For Olrtce Use Only ?� ; -Y Y- 1. WELL PERMIT NUMBER: C 2. WELL OWNER INFORMATION;; NAME OF WELL OWNER: Hokim (US), Inc. MAILING ADDRESS: 3500 Highway 120 CITY. Florence STATE: Colorado ZIP CODE: 81226 TELEPHONE NUMBER wlarea code: 719 -784 -1402 3. WELL LOCATION AS DRILLED' SE 114, SW 114, Sec., 8 Twp 8 x IN or I Range 69 ❑ E or W 0 DISTANCES FROM SEC. LINES: ft_ from JL N or S sects hne and 1 ft from u E or L'A'W section line SUBDIVISION: . LOT , BLOCK . FILING (UNIT) Opt4onal GPS Location: GPS Unit must use the folowing settings Format must be UTM, Units Owners Well Designation: MW-6 must be mates, Datum must be NAD83, Unit must be set to true N, I Zone 12 or I - II Zone 13 Easbng: 48767 STREET ADDRESS AT WELL LOCATION: 4629 North Overland Trail, Laporte, CO 80535 Northing: 4502021 . GROUND SURFACE ELEVATION 5237.64 feet DRILLING METHOD Air Hammer DATE COMPLETED 12127/2012 TOTAL DEPTH 231 1 feet DEPTH COMPLETED 229.7 feet S. GEOLOGIC LOG: 6. HOLE DIAM (in. From ft To ft Depth Type Grain Size Color Water Loc. 7 -518 0 231,1 0-20 silt, gravel silt. cravel dark gray 20-75 limestone -shale sift dark gray 75-80 clay Clay dark arav 7. PLAIN CASING OD (in) Kurd Wail Srze (in) From (ft) To (ft) 4.5 qQH 40 0.237 0.0 209.7 4.5 �_ 0.237 229.2 229.7 PERFORATED CASING. Screen Slot Sae (in): 0.02 4.5 SCH 40 x.237 209.7 229.2 80-135 limestone-shale silt darts gray 135-215 limestone -shale silt clay gray-black with fossils&clav 215-230 silty limestone silt. sand v. liqht qra 230-231.1 silty sandstone sift. v.f. sa v. Iight gray 8. FILTER PACK Material sand Sue 10120 lntwval 205.5 -231.1 9. PACKER PLACEMENT Type pepth 0. GROUTING RECORD Material Amount Densdy Interval Placement Bentonite 50 Ibs 203-205.5 gravity Bent Gro 22 bags 30% solk 3.2-203 tremie Concrete 13 bags 00-3.2 Remarks: Bentonite grout mixed bao of Cetco Puremicl arout for 14 gallons of water to each 50 lb. 30% solids 11. DISINFECTION: Type none I Amt Used none 12. WELL TEST DATA: ❑ Check box if Test Data is submitted on Form Number GWS 39 Supplemental Well Test TESTING METHOD Static Level 522. ft DateMme measured: 01/312013 Production Rate gpm_ Pumping Level ft Date/Time measured Test Length (hrs) Remarks: Death to water measured below land surface. 13. 1 have road On stalsnMnts made herein and know the contents fheroof, and they are true to my knowledge. This document Is signed (or name entered If fling online) and certified in accordance with Rule 17.4 of the Water Well Constructlon Rules, 2 CCR 482.2. The fiO V of a document that cada[no lfake stehm nts is a violation of section 37 -91- 106(1X9), C.R.S., and Is punishable by Nnsa up to $5000 andlor revocation of the contracting license. If fl online the Stabs Engineer considers on of licensed contractor name to be can Ounce with Rums 17A Company Name Golder Associates, Inc. Phone w /area code: 303 - 980 -0540 Lx�ttse Number Mailing Address: 44 Union Blvd., Suite 300, Lakewood, CO 80228 S a enie namert fit lne) Print Name and Title Christopher Krambis Senior Staff Hydrogeologist Date 02/25/2013