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Home My WebLink About20251174.tiffNORTH WELD COUNTY WATER DISTRICT P.O. BOX 56 32825 CR 39 LUCERNE, CO 80646 PHONE: (970) 356-3020 • FAX: (970) 395-0997 • E-MAIL. water@nwcwd.org ACCOUNT NUMBER NAME AND SERVICE ADDRESS BILLING PERIOD PATRICIA J. CONLON 6006 2480 N 35TH AVENUE 10/20/2023-11/20/2023 GREELEY, CO 80631 71 Water Class P (KGal) 70 % of 1.000 Acre Foot 228 Transferred Water 0 Allocation Adjustment 0 Less YTD Usage 13 Remaining Water Allocation 215 Plant Investment Class 70 % of 1.000 Acre Foot 228 Less YTD Usage 13 Remaining PI Allocation 215 Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Prey. Read Curr. Read Usage Unit Amount Previous Balance 79.92 11/07/2023 Payment - Check -100.00 11/20/2023 Standard - Full 6010 6023 13 kgal 57.72 Current Amount 57.72 Total Amount Due 37.64 DETACH HERE NORTH WELD COUNTY WATER DISTRICT P.O. BOX 56 LUCERNE, CO 80646 PHONE: (970) 356-3020 • FAX (970) 395-0997 • E-MAIL: water@nwcwd.org Any payment received after the 15th of the month may not show on this billing. Please note that all accounts are due by the 15th of the month. Return this stub with your payment Thank you. ACCOUNT NUMBER SERVICE ADDRESS AMOUNT DUE BY: 12/15/2023 AMOUNT PAID 6006 2480 N 35TH AVENUE GREELEY, CO 80631 $37.64 ""*"*"`AUTO""SCH 5 DIGIT 80632 PATRICIA J. CONLON 2781 AA ST GREELEY CO 80631-9425 17 > 3887 IIIII'll'll'llllllllllllll�lllllll�lllllll�l�ll•lllllllll„�IIIII NORTH WELD COUNTY WATER DISTRICT P.O. BOX 778 Gretna. NE 68028-0778 000006006000006C0 00003764 ,on Number: App Type: Applicant Name: Owner Name: Parcel #: Legal Desc: Site Address: Septic Permit - Final SP -0900066 Health\Residential\Repair\Septic DON BUXMAN BUXMAN EXCAVATING 1729 67TH AVENUE GREELEY, CO 80634 GERRY JOHN D 080525200007-R8284500 PT E2NW4 25-6-66 LOT B REC EXEMPT RE -2485 (1.84R) 2480 N 35 AV WELD 000000000 Weld County Environmental Health Services Depart' 1555 N. 17th Av Greeley, CO E Phone: (970) 304 - Fax: (970) 304- www.co.weld. 2480 N 35TH AVE GREELEY, CO 80631 Status: Ready to FinE Applied: 05/01/2009 Issued: 05/01/2009 Finaled: App Specific Info: 1/2 Bathrooms 3/4 Bathrooms Application Date Associated Building Permit Associated Building Permit Number Basement Plumbing Full Bathrooms Location Description Number of Bedrooms Number of Persons Other Water Supply Utility Parcel Acres Private Water Supply Private Water Supply Permit Reference Number Public Water Supply Public Water Supply Utility Repair Reason Type Septic Permit Expiration Date Waive Fees Waive Fees Comment Year Installed 0 0 05/01/2009 No 1. 2480 N 35TH AVENUE, GREELEY 2 4 73 Yes NWCWD Repair for Failure No EHS Perc Test (Site): Engineer Design Required Engineer Evaluation Received Engineer Job Number Engineer Letter Received Ground Slope In 100 Year Flood Plain Limiting Zone Feet Limiting Zone Inches Limiting Zone Qualifier Percolation Rate Qualifier Percolation Rate Value Slope Direction Soil Description Soil Type Suitable Variance Required No No 454 No 1 No 8 Greater Than Equal To 22 NE Yes No COLORADO r"_ -..d County Environmental Healt. Septic Permit - Final Minimum Installation: Absorption Bed 836 Absorption Trench 643 Additional Terms and Conditions Y Bed Option 1 27 Bed Option 2 45 Bed Option 3 36 Chamber Option 1 Biodiffuser Chamber Option 2 Infiltrator Quick4 Chamber Option 3 ARC 36 Septic Tank Size 1000 Trench Option 1 21 Trench Option 2 35 Trench Option 3 28 Phont Fax 1Mh . Actual Installation: Septic Tank: 1 + O p C.) Design Type: (7; 19 gallons Absorption Trench: sq ft Absorption Bed : t -T3 :, sq ft Chamber Model 9 Chambers i--1 Z' NOTICE The issuance of this permit does not imply compliance with other state, county, or local regulatory or building requirements, nor shall it act to certify that the subject system will operate in compliance with applicable state, county and local regulations adopted persuant to Article 10, Title 25, CRS as amended, except for the purpose of establishing final approval of installed system for issuance of a local occupancy permit persuant to CRS 1973 25-10-111 (2). This permit is non -transferable and non-refundable. The Weld County Department of Public Health and Evnironment reserves the right to impose additional terms and conditions required t eet our re ulations on a continuing basis. Final permit approval was contingent upon the final inspection of the completed system by the V el County Cpartment of Public Health and Environment. X Envirental Health Specialist Date NORTH WELD COUNTY WATER DISTRICT P.O. BOX 56 32825 CR 39 LUCERNE, CO 80646 PHONE: (970) 356-3020 • FAX: (970) 395-0997 • E-MAIL: water@nwcwd.org ACCOUNT NUMBER NAME AND SERVICE ADDRESS BILLING PERIOD PATRICIA J. CONLON 98000 2781 AA STREET 10/20/2023-11/20/2023 GREELEY, CO 80631 17 Water Class P (KGal) 70 % of 1.000 Acre Foot 228 Transferred Water 0 Allocation Adjustment 0 Less YTD Usage 4 Remaining Water Allocation 224 Plant Investment Class 70 % of 1.000 Acre Foot 228 Less YTD Usage 4 Remaining PI Allocation 224 Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Prey. Read Curr. Read Usage Unit Amount Previous Balance -378.16 11/20/2023 Standard - Full 493 497 4 kgal 26.64 Current Amount 26.64 Total Credit -351.52 DETACH HERE NORTH WELD COUNTY WATER DISTRICT P.O. BOX 56 LUCERNE, CO 80646 PHONE: (970) 356-3020 • FAX: (970) 395-0997 • E-MAIL: water@nwcwd.org Any payment received after the 15th of the month may not show on this billing. Please note that all accounts are due by the 15th of the month. Return this stub with your payment Thank you. ACCOUNT NUMBER SERVICE ADDRESS AMOUNT DUE BY: 12/15/2023 AMOUNT PAID 98000 2781 AA STREET GREELEY, CO 80631 CREDIT PATRICIA J. CONLON 2781 AA STREET GREELEY, CO 80631 IIIII'll'll'llllllllllllll�lllllll�lllllll,l�ll�llllnlll��lllll NORTH WELD COUNTY WATER DISTRICT P O BOX 778 Gretna, NE 68028-0778 000098000000098000000-35152 Septic Permit - Final COLORADO Application Number: SP -1000062 Owner Name: CONLON PATRICIA J Site Address: 2781 AA ST GREELEY, CO 80631 App Type: Health\Residential\Repair\Septic Applicant Name: DON BUXMAN BUXMAN EXCAVATING LLC 1900 68TH AVE #702 GREELEY, CO 80634 Parcel #: 080524000020-R1340486 Legal Desc: 17887 W2SE4/E2SW4 24 6 66 (2R2D) 2781 AA ST WELD 000000000 App Specific Info: 1/2 Bathrooms 3/4 Bathrooms Application Date Associated Building Permit Associated Building Permit Number Basement Plumbing Full Bathrooms Location Description Number of Bedrooms Number of Persons Other Water Supply Utility Parcel Acres Private Water Supply Private Water Supply Permit Reference Number Public Water Supply Public Water Supply Utility Repair Reason Type Septic Permit Expiration Date Waive Fees Waive Fees Comment Year Installed Weld County Environmental Health Services Department 1555 N. 17th Avenue Greeley, CO 80631 Phone: (970) 304-6415 Fax: (970) 304-6411 www.co.weld.co.us Status: Ready to Final Applied: 05/19/2010 Issued: 05/21/2010 Finaled: 0 0 05/19/2010 No 1 2781 AA STREET 3 2 156 Yes NWCWD Repair for Upgrade No UNKN EHS Perc Test (Site): Engineer Design Required Engineer Evaluation Received Engineer Job Number Engineer Letter Received Ground Slope In 100 Year Flood Plain Limiting Zone Feet Limiting Zone Inches Limiting Zone Qualifier Percolation Rate Qualifier Percolation Rate Value Slope Direction Soil Description Soil Type Suitable Variance Required No Yes 039-10 No 0 No 8 0 Greater Than Equal To 15 Yes No Report ID: EHS00033v002 Print Date Time: 8/5/2010 3:23:54PM Page 1 of 3 Weld County Environn, Septic Permit - Final Application Number: SP -1000062 Owner Name: CONLON PATRICIA J Site Address: 2781 AA ST GREELEY, CO 80631 Minimum Installation: ,:-54-6415 rax: (970) 304-6411 www.co.weld.CO.US Absorption Bed Absorption Trench Additional Terms and Conditions Bed Option 1 Bed Option 2 Bed Option 3 Bed Option 4 Chamber Option 1 Chamber Option 2 Chamber Option 3 Chamber Option 4 Septic Tank Size Trench Option 1 Trench Option 2 Trench Option 3 Trench Option 4 971 747 Y. EXISTING 1000 GALLON TANK. 31 53 42 76 Biodiffuser Infiltrator Quick4 ARC 36 Infiltrator Quick4 EQ36 1000 24 41 32 58 Actual Installation: Septic Tank: I CY)CM gallons Absorption Trench: sq ft Absorption Bed : sq ft Design Type: c'-) 74) Chamber Model (� Chambers NOTICE The issuance of this permit does not imply compliance with other state, county, or local regulatory or building requirements, nor shall it act to certify that the subject system will operate in compliance with applicable state, county and local regulations adopted persuant to Article 10, Title 25, CRS as amended, except for the purpose of establishing final approval of installed system for issuance of a local occupancy permit persuant to CRS 1973 25-10-111 (2). This permit is non -transferable and non -refund bl. The Weld County Department of Public Health and Environment reserves the right to impose additio al terms and conditions req 're to meet our egulations on a continuing basis. Final permit approval was contingent upon the final ins. = ion of the completed system b the1W�4d.�oun�y Department of Public Health and Environment. Enviro ental Health Specialist ( — Date Report ID: EHS00033v002 Page 2 of 3 Print Date Time: 8/5/2010 3:23:54PM s Form No. COLORADO WATER CONSERVATION BOARD Location: T 6" R 66 Sec. Owned by ilfired waver Tenant LOG AND HISTORY P. M. ' .''' 1/4 Secs. gF i County Drilled by Rep* INC. rlati ' f/ Weld Address 1124 - 5th St., Greeley, n Colo. ++ Greeley, Colo. Water Well Drillers License No. IO Well Permit Igo. Type of Well: Domestic ® , Industrial Q , Municipal ❑ , Stock ❑ , irrigation ❑ Drainage Q Other Cased: O ft. to 2Th ft. Type std. j2idAixe le Wt. of Casing: Lbs./ft.IIIJI 11 ft. to ft. n n u 11 a +i tt ft. to ft. It 11 11 11 11 11 Perforated or Screened: Ft. to Ft. ; Ft. to Ft. *Type of Screen or Perforation Date Start July 18, 1953 Static Water Level or Shut in Pressure Pumping Hater Level } ) 160 FtDate July 2T, T951 Date Completed _July 2Ii1953 252 Ft. at 4 g p m yield Horn Tested: 4^ bey 20 Ft. bucsketLength of Test L Hours. Put Formation Log on Reverse Side REMARKS: (Gravel Packing, Cementing, Packers, Type of Shut Off, Depth of Shut Off, Method of Drilling, etc.) Rotary drilled, shut4off made by driving casing into shale. RECEIVED NOV6 -1953 coLooAoc 'YAM CON*" nsf SOAK, TO BE MADE IN TRIPLICATE: Blue copy to owner, White copy to Colorado Water Conservation Board, and Yellow copy to Driller. LUG OF WELL , DESGRIPTIOR OF $ATER1AL DRILLED Feet - - - 00 soil 4 to 12 ' chap 12 to 20 gravel 20 to ?5 clay • 25' to 35 gravel ___35__ to .... _ shale ..- 45 to 75 aandatdne - 75 to 85 - shale' 85 to Ilk 87 rock 87 to 120 shale 120 to 22 rock 122 to 165 shale 165 to -66 root 166 to Mai 2,18 shale 218 to 220 rock 226 to .305 sandstone & shale mixed 305 to 308 rock 308 to 325 sandstone 325 to 328 blue shale 328 r • Forst No. 3 NOTIFICATION OF INTENTION TO DRILL ® , REDRILL ❑ , RECASE ❑ , OR DEEPEN ❑ , k NOM WELL. Iistrict No. Designation by which well shall be known Alfred Leavei., Don -_tio- .bane of Driller P (.' ”e s s t�.y.122 r s inc. 1535 - eth Ave., Ore:,1ey, Colo. Well Drillers License No. I.0 Land Owner's Name Address Alfred leaver 1124 - 5th; St.., Creelo r, Colo. 2.1; ' I proximate Depth of Well ,250 Ft. Location of Well: T 6 , R.66, S. Diameter of well 5 In. of 6th P.M.,l/4 Sec. , and indicate hereon the- Sec . of the above 1/4 Sec. IliDiameter of Casing 5 In. Weight of Casing 7li_STLbs./ft. Type of Caging stan:iasd black steel pipe Type o£ Well: Domestic Irrigation ;:thod to be used in drilling Municipal Industrial rotary �jE a of 5E Stock s 1 t}the r • Estimated Depth of Bottom & Top o£ Shut Off one shut off, esfi mated 150 ft. Type of Shut Off casin, driven in shale RECEIVED JUL 15 1953 COL C.;il,► Dry IVA fER cow "h•• °MAID' Form No. GWS-31 02/2017 WELL CONSTRUCTION AND YIELD ESTIMATE REPORT State of Colorado, Office of the State Engineer 1313 Sherman St., Room 821, Denver, CO 80203 303.866.3581 www.water.state.co.us and dwrpermitsontine@state.co.us For Office Use Only 1. Well Permit Number: 64254-MH Receipt Number: 2. Owner's Well Designation:BH01 3. Well Owner Name: PDC Energy, Inc. 4. Well Location Street Address: see coordinates below 5. As Built GPS Well Location (required): Zone 12 ■': Zone 13 Easting: 523090.3 Northing: 4480202.95 6. Legal Well County: Location: NE 1/4, SW 1/4, Sec., 24 Twp.6 ■ : N or S Lot f, Range 66 E or W , 6 P.M. Weld Block Filing (Unit) Subdivision: , , , 7. Ground Surface 8. Completed Elevation:4720.09 feet Date Completed: Total 01/06/2023 Drilling Method: Depth Direct Push Rie Aquifer Name : Alluvial Depth: 14 feet Completed: 14 feet 9. Advance Notification: Was Notification Required Prior to Construction? Yes No, Date Notification Given: 10. Aquifer Type: (Check one) E3Type I (One Confining Layer) ype I (Multiple Confining Layers) (Not overlain by Type III) Type II (Overlain by Type III) Laramie -Fox Hills Type III (alluvial/colluvial) Type II 11. Geologic Log: 12. Hole Diameter (in.) 3.00 From (ft) To (ft) 0 14 Depth Type Grain Size Color Water Loc. 0' - 9' clayey sand clay - f.g. brown 7' 9' - 11' sandy clay clay - f.g. tan 11' - 14' clay clay tan 13. Plain Casing OD (in) Kind Wall Size (in) From (ft) To (ft) 1.315 Sch40PVC 0.133 0 4 Perforated Casing Screen Slot Size (in): OD (in) Kind Wall Size (in) 1.315 Sch40PVC 0.133 0.010 From (ft) To (ft) 4 14 14. Filter Pack: Material Size Interval Silica Sand 15. Packer Type Depth Placement: N/A 10/20 N/A 3-14' 16. Grouting Record Material Amount Density Interval Method Bentonite 3 lbs Chips 0' - 3' Manual Remarks: 17. Disinfection: Type N/A Amt. Used N/A 18. Well Yield Estimate Data: OCheck box if Test Data is submitted on Form Number GWS-39, Well Yield Test Report Well Yield Estimate Method: N/A Static Level: Date/Time 7.60' bgs Estimated Yield Estimate Length (gpm) N/A measured: 1/17/2023 (hrs) N/A Remarks: 19. I 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: Tasman Geosciences Email: raronoff@tasman-geo.com Phone w/area code: (303) 487-1228 License Number: PG -4208 Mailing Address: 6855 W. 119th Avenue, Broomfield, CO 80020 Sign (or enter name if filing online) Robert Aronoff Print Name and Title Robert Aronoff / Staff Geologist Date: 01/31/2023 Form No. GWS-31 02/2017 WELL CONSTRUCTION AND YIELD ESTIMATE REPORT State of Colorado, Office of the State Engineer 1313 Sherman St., Room 821, Denver, CO 80203 303.866.3581 www.water.state.co.us and dwrpermitsontine@state.co.us For Office Use Only 1. Well Permit Number: 64254-MH Receipt Number: 2. Owner's Well Designation:BH02 3. Well Owner Name: PDC Energy, Inc. 4. Well Location Street Address: see coordinates below 5. As Built GPS Well Location (required): Zone 12 ■': Zone 13 Easting: 523090.1 Northing: 4480211.38 6. Legal Well County: Location: NE 1/4, SW 1/4, Sec., 24 Twp.6 ■ : N or S Lot f, Range 66 E or W , 6 P.M. Weld Block Filing (Unit) Subdivision: , , , 7. Ground Surface 8. Completed Elevation:4720.60 feet Date Completed: Total 01/06/2023 Drilling Method: Depth Direct Push Rie Aquifer Name : Alluvial Depth: 14 feet Completed: 14 feet 9. Advance Notification: Was Notification Required Prior to Construction? Yes No, Date Notification Given: 10. Aquifer Type: (Check one) E3Type I (One Confining Layer) ype I (Multiple Confining Layers) (Not overlain by Type III) Type II (Overlain by Type III) Laramie -Fox Hills Type III (alluvial/colluvial) Type II 11. Geologic Log: 12. Hole Diameter (in.) 3.00 From (ft) To (ft) 0 14 Depth Type Grain Size Color Water Loc. 0' - 9' clayey sand clay - f.g. brown - tan 7' 9' - 11' sandy clay clay - f.g. tan 11' - 14' clay clay tan - brown 13. Plain Casing OD (in) Kind Wall Size (in) From (ft) To (ft) 1.315 Sch40PVC 0.133 0 4 Perforated Casing Screen Slot Size (in): OD (in) Kind Wall Size (in) 1.315 Sch40PVC 0.133 0.010 From (ft) To (ft) 4 14 14. Filter Pack: Material Size Interval Silica Sand 15. Packer Type Depth Placement: N/A 10/20 N/A 3-14' 16. Grouting Record Material Amount Density Interval Method Bentonite 3 lbs Chips 0' - 3' Manual Remarks: 17. Disinfection: Type N/A Amt. Used N/A 18. Well Yield Estimate Data: OCheck box if Test Data is submitted on Form Number GWS-39, Well Yield Test Report Well Yield Estimate Method: N/A Static Level: Date/Time 7.56' bgs Estimated Yield Estimate Length (gpm) N/A measured: 1/17/2023 (hrs) N/A Remarks: 19. I 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: Tasman Geosciences Email: raronoff@tasman-geo.com Phone w/area code: (303) 487-1228 License Number: PG -4208 Mailing Address: 6855 W. 119th Avenue, Broomfield, CO 80020 Sign (or enter name if filing online) Robert Aronoff Print Name and Title Robert Aronoff / Staff Geologist Date: 01/31/2023 Form No. GWS-31 02/2017 WELL CONSTRUCTION AND YIELD ESTIMATE REPORT State of Colorado, Office of the State Engineer 1313 Sherman St., Room 821, Denver, CO 80203 303.866.3581 www.water.state.co.us and dwrpermitsontine@state.co.us For Office Use Only 1. Well Permit Number: 64254-MH Receipt Number: 2. Owner's Well Designation:BH03 3. Well Owner Name: PDC Energy, Inc. 4. Well Location Street Address: see coordinates below 5. As Built GPS Well Location (required): Zone 12 ■': Zone 13 Easting: 523079.9 Northing: 4480202.83 6. Legal Well County: Location: NE 1/4, SW 1/4, Sec., 24 Twp.6 ■ : N or S Lot f, Range 66 E or W , 6 P.M. Weld Block Filing (Unit) Subdivision: , , , 7. Ground Surface 8. Completed Elevation:4719.81 feet Date Completed: Total 01/06/2023 Drilling Method: Depth Direct Push Rie Aquifer Name : Alluvial Depth: 14 feet Completed: 14 feet 9. Advance Notification: Was Notification Required Prior to Construction? Yes No, Date Notification Given: 10. Aquifer Type: (Check one) E3Type I (One Confining Layer) ype I (Multiple Confining Layers) (Not overlain by Type III) Type II (Overlain by Type III) Laramie -Fox Hills Type III (alluvial/colluvial) Type II 11. Geologic Log: 12. Hole Diameter (in.) 3.00 From (ft) To (ft) 0 14 Depth Type Grain Size Color Water Loc. 0' - 9' clayey sand clay - f.g. brown 7' 9' - 11' sandy clay clay - f.g. tan 11' - 14' clay clay tan 13. Plain Casing OD (in) Kind Wall Size (in) From (ft) To (ft) 1.315 Sch40PVC 0.133 0 4 Perforated Casing Screen Slot Size (in): OD (in) Kind Wall Size (in) 1.315 Sch40PVC 0.133 0.010 From (ft) To (ft) 4 14 14. Filter Pack: Material Size Interval Silica Sand 15. Packer Type Depth Placement: N/A 10/20 N/A 3-14' 16. Grouting Record Material Amount Density Interval Method Bentonite 3 lbs Chips 0' - 3' Manual Remarks: 17. Disinfection: Type N/A Amt. Used N/A 18. Well Yield Estimate Data: OCheck box if Test Data is submitted on Form Number GWS-39, Well Yield Test Report Well Yield Estimate Method: N/A Static Level: Date/Time 7.25' bgs Estimated Yield Estimate Length (gpm) N/A measured: 1/17/2023 (hrs) N/A Remarks: 19. I 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: Tasman Geosciences Email: raronoff@tasman-geo.com Phone w/area code: (303) 487-1228 License Number: PG -4208 Mailing Address: 6855 W. 119th Avenue, Broomfield, CO 80020 Sign (or enter name if filing online) Robert Aronoff Print Name and Title Robert Aronoff / Staff Geologist Date: 01/31/2023 Form No. GWS-31 02/2017 WELL CONSTRUCTION AND YIELD ESTIMATE REPORT State of Colorado, Office of the State Engineer 1313 Sherman St., Room 821, Denver, CO 80203 303.866.3581 www.water.state.co.us and dwrpermitsontine@state.co.us For Office Use Only 1. Well Permit Number: 64254-MH Receipt Number: 2. Owner's Well Designation:BH04 3. Well Owner Name: PDC Energy, Inc. 4. Well Location Street Address: see coordinates below 5. As Built GPS Well Location (required): Zone 12 ■': Zone 13 Easting: 523089.9 Northing: 4480193.1 6. Legal Well County: Location: NE 1/4, SW 1/4, Sec., 24 Twp.6 ■ : N or S Lot f, Range 66 E or W , 6 P.M. Weld Block Filing (Unit) Subdivision: , , , 7. Ground Surface 8. Completed Elevation:4719.50 feet Date Completed: Total 01/06/2023 Drilling Method: Depth Direct Push Rie Aquifer Name : Alluvial Depth: 14 feet Completed: 14 feet 9. Advance Notification: Was Notification Required Prior to Construction? Yes No, Date Notification Given: 10. Aquifer Type: (Check one) E3Type I (One Confining Layer) ype I (Multiple Confining Layers) (Not overlain by Type III) Type II (Overlain by Type III) Laramie -Fox Hills Type III (alluvial/colluvial) Type II 11. Geologic Log: 12. Hole Diameter (in.) 3.00 From (ft) To (ft) 0 14 Depth Type Grain Size Color Water Loc. 0' - 11' clayey sand clay - f.g. tan 7' 11' - 14' clay clay tan - brown 13. Plain Casing OD (in) Kind Wall Size (in) From (ft) To (ft) 1.315 Sch40PVC 0.133 0 4 Perforated Casing Screen Slot Size (in): OD (in) Kind Wall Size (in) 1.315 Sch40PVC 0.133 0.010 From (ft) To (ft) 4 14 14. Filter Pack: Material Size Interval Silica Sand 15. Packer Type Depth Placement: N/A 10/20 N/A 3-14' 16. Grouting Record Material Amount Density Interval Method Bentonite 3 lbs Chips 0' - 3' Manual Remarks: 17. Disinfection: Type N/A Amt. Used N/A 18. Well Yield Estimate Data: OCheck box if Test Data is submitted on Form Number GWS-39, Well Yield Test Report Well Yield Estimate Method: N/A Static Level: Date/Time 7.32' bgs Estimated Yield Estimate Length (gpm) N/A measured: 1/17/2023 (hrs) N/A Remarks: 19. I 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: Tasman Geosciences Email: raronoff@tasman-geo.com Phone w/area code: (303) 487-1228 License Number: PG -4208 Mailing Address: 6855 W. 119th Avenue, Broomfield, CO 80020 Sign (or enter name if filing online) Robert Aronoff Print Name and Title Robert Aronoff / Staff Geologist Date: 01/31/2023 Form No. GWS-31 02/2017 WELL CONSTRUCTION AND YIELD ESTIMATE REPORT State of Colorado, Office of the State Engineer 1313 Sherman St., Room 821, Denver, CO 80203 303.866.3581 www.water.state.co.us and dwrpermitsontine@state.co.us For Office Use Only 1. Well Permit Number: 64254-MH Receipt Number: 2. Owner's Well Designation:BH05 3. Well Owner Name: PDC Energy, Inc. 4. Well Location Street Address: see coordinates below 5. As Built GPS Well Location (required): Zone 12 ■': Zone 13 Easting: 523100.2 Northing: 4480202.66 6. Legal Well County: Location: NE 1/4, SW 1/4, Sec., 24 Twp.6 ■ : N or S Lot f, Range 66 E or W , 6 P.M. Weld Block Filing (Unit) Subdivision: , , , 7. Ground Surface 8. Completed Elevation:4720.49 feet Date Completed: Total 01/06/2023 Drilling Method: Depth Direct Push Rie Aquifer Name : Alluvial Depth: 14 feet Completed: 14 feet 9. Advance Notification: Was Notification Required Prior to Construction? Yes No, Date Notification Given: 10. Aquifer Type: (Check one) E3Type I (One Confining Layer) ype I (Multiple Confining Layers) (Not overlain by Type III) Type II (Overlain by Type III) Laramie -Fox Hills Type III (alluvial/colluvial) Type II 11. Geologic Log: 12. Hole Diameter (in.) 3.00 From (ft) To (ft) 0 14 Depth Type Grain Size Color Water Loc. 0' - 8' clayey sand clay - f.g. brown 7' 8' - 11' sandy clay clay - f.g. tan 11' - 14' clay clay tan 13. Plain Casing OD (in) Kind Wall Size (in) From (ft) To (ft) 1.315 Sch40PVC 0.133 0 4 Perforated Casing Screen Slot Size (in): OD (in) Kind Wall Size (in) 1.315 Sch40PVC 0.133 0.010 From (ft) To (ft) 4 14 14. Filter Pack: Material Size Interval Silica Sand 15. Packer Type Depth Placement: N/A 10/20 N/A 3-14' 16. Grouting Record Material Amount Density Interval Method Bentonite 3 lbs Chips 0' - 3' Manual Remarks: 17. Disinfection: Type N/A Amt. Used N/A 18. Well Yield Estimate Data: OCheck box if Test Data is submitted on Form Number GWS-39, Well Yield Test Report Well Yield Estimate Method: N/A Static Level: Date/Time 7.46' bgs Estimated Yield Estimate Length (gpm) N/A measured: 1/17/2023 (hrs) N/A Remarks: 19. I 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: Tasman Geosciences Email: raronoff@tasman-geo.com Phone w/area code: (303) 487-1228 License Number: PG -4208 Mailing Address: 6855 W. 119th Avenue, Broomfield, CO 80020 Sign (or enter name if filing online) Robert Aronoff Print Name and Title Robert Aronoff / Staff Geologist Date: 01/31/2023 Hello