2013-08-13_HYDROLOGY - M1977348 (2)

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FORM NO. GWS-31 412012 WELL CONSTRUCTION AND TEST REPORT STATE OF COLORADO, OFFICE OF THE STATE ENGINEER 1313 Sherman St, Ste 821, Denver, CO 80203 Main 303 8864W1 Fax 303 866-3589 wwwmater state co u For Ofte Use Only F '" z -7. T7 Lr:C-14 t-i" 1. WELL PERMIT NUMBER: 2. WELL OWNER INFORMATION NAME OF WELL OWNER: Holcim (US), Inc. 19 wa MAILING ADDRESS: 3500 Highway 120 CITY Florence STATE: Colorado ZIP CODE: 81226 TELEPHONE NUMBER w fares code: 719-784-1402 WELL LOCATION AS DRILLED: SE 1/ 114, Sec., 17 Twp x I N or S, I Range 69 ❑ E or WED DISTANCES FROM SEC. LINES: 9 ft 8 from A N or S section line and 30/ R. from Il E or 14 W section line SUBDIVISION: . LOT , BLOCK. FILING (UNIT) Optional GPS Location: GPS Unit must use the fobwing settings Format must be UTM, Units Owners Well Designation: MW -7 must be meters, Datum must be NAD83, Unit must be set to true N, I Zone 12 or I - l Zone 13 meting: 487840 STREET ADDRESS AT WELL LOCATION: 4629 North Overland Trail, Laporte, CO 80535 Northing: 4501426 . GROUND SURFACE ELEVATION 5217.22 feet DRILLING METHOD Air Hammer DATE COMPLETED 12/2912012 TOTAL DEPTH 271 feet DEPTH COMPLETED 259.2 feet 5. GEOLOGIC LOG: 6. HOLE DIAM m. From R To ft Depth Type Grain Size Color Water Loc. _ 7 -518 0 - "T - 259.2 0-27.7 silt, gravel silt, gravel brown -gray 27.7 -28.5 silty day sift, clay brown -gray 28.5-33 sifty gravel silt, gravel brown -grav 7. PLAIN CASING: OD (in) Kind Wall Size (in) From (ft) To (ft) 4.5 SCH 40 0.237 0.0 238.8 4.5 0.237 258.8 259.2 PERFORATED CASING: Screen Slot Size (in): 0.02 4.5 SCH 40 0.237 238.8 258.8 33-87.6 limestone -shale sift light gray 1 87.6 - 109.4 lime shale w /dav sift, clay gray&olwe qrav 109.4-153.4 1 limestone -shale sit gray 153.4 -153.5 clay day olive arav 153.5 -180 limestone -shale situ dark gray 180 -180.2 daV clav olive qray 180.2-1875 limestone -shale silt dark arav 187.5 -187.8 silty sand sift. v.f. sand It. brown -fl 187.8-2016 limestone -shale silt dark arav 201-6-201.7 silt, sand olive arav 201.7-203.5 limestone -shale sift dark arav 8. FILTER PACK Material sand Size 10/20 Interval 236.1 -259.: 9. PACKER PLACEMENT: Type Depth 203.5 -203.6 sandy sift sift. sand olive orav 203.6 -245.9 limestone -shale silt dark grav 245.9 -262 limestone silt v. ft. grav 262 -271 sifts sandstone silt, v.f. sand arav &black 10. GROUTING RECORD Material Amount Density Interval Placement Bentonne 100 1135 231.2 -236.' aravity Bent Gro 40 baps 30% sulk 231.2 -3.0 tremie Concrete 14 bags 0.0-3.0 Remarks: Bentonde grout mixed ban of Cetco Pureaold arout for 14 gallons of water to each 50 lb. 309'6 solids Geologic loq from adiacent NO corehole. 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 Wei Test TESTING METHOD Static Level fL Date/Time measured Production Rats gpm. Pumping Level R Date/Time measured Test Length (hrs) Remarks: 13. 1 haw mad the sfarisinen s mada heroin and know the contan a thereof, and tiny are true b my knwmhK pe. This docunent In signed (or name entered H f&V online) and cwtI ad in accordance with Rub 17.4 of the Water Well Construction Rulers, 2 CCR 402-1 Ttn filing of a document that contains fake statements Is a violation of section 37491- 108(1Ke), C.R.S., and Is punishable by flnes up to 550W andlor revocation afthecontractinglicense. If filling online the stab Engineer consldem ardering of licensed contractor name to be compliance with Rub 17.4 Company Name: Golder Associates, Inc. Phone Warea code 1303-980-0540 License Number: maiiipR Address: 44 Union Blvd., Suite 300, Lakewood, CO 80228 S or enter me if Ixi ' e) lChnstopher Print Name and Title Krambis Senior Staff Hyd tst Data 02/25/2013