2012-11-26_GENERAL DOCUMENTS - M1980183

• Permit No: M1980183
• IBM Index Class Name: General Documents
• Doc Date: 11/26/2012
• Doc Name Note: Complaint
• Doc Name: Complaint
• Media Type: D
• Archive: No

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11 WM
WELL CONSTRUCTION AND TEST REPORT
169`
STATE OF COLORADO, OFFICE OF THE STATE ENGINEER
for Office use only
1313 Sherman SL. Rm 816, Denver, CO 60203
R-2-MOV:D
1.
WELL PERMIT NUMBER MH -43399
APS 2 g 2004
2.
OWNER NAME(S) Silver Peaks Me D' 1
Mailing Address 5460, Swth Quebec Street. Suite 110
City, St. zip Greenw w LAIage CO 60111
oUncw
WAn Rlaom
srA COL.
Phone ( 303) 773-IQN
3.
WELL LOCATION AS DEJILLED: NW 114 _,g-114, Sec. -Z _ Twp. 1 S - Range 07 W
DISTANCES FROM SEC. LINES:
o ft. from N Sec. line. and 150 ft. from E_ Sec. line. OR
__Lo
SUBDIVISION, LOT �o BLOCK FILING(UNIT)
STREET ADDRESS AT WELL LOCATION: NIA
4
GROUND SURFACE ELEVATION 5030 ft. DRILLING METHOD _4114" HSA
DATE COMPLETED 4115104 TOTAL DEPTH _,§ _ft. DEPTH COMPLETED 44 ft.
6. HOLE D1AM. (In.) From (ft) To (ft)
5. GEOLOGIC LOG:
8 a 45
thpih description of Malarial (Type. Size. Calor, Welar Locallon►
D -- 38' Gravelly sand. fine to coarse grained,
7. PLAIN CASING
OD (In) Kind Wan Size From(ft) To(ft)
. 2 PVC SCH 40 -3 AGS .fit'
PERF_ CASING* Screen Slot Size: 0.01"
2 PVC SCFL4Q.. -$4= _•
Pink -brown, moist -wet.
38'- 39' Clayey gravel, cobbles present, wet, pink.
39'- 42' Gravelly sand, wet, fine to coarse grained_
42'- 45' Claystons, moist, gray -dark gray, very plastic.
Some organics.
8, FILTER PACK:
Material_ Natural Cave
Size Sand*ravel
Interval 6'- 46'
9. PACKER PLACEMENT=
Type
Depth
10_ GROUTING RECORD:
Material Amount Denslly Interval Placement
Concrete 1 bm 0-1:_
Bentorille,$,
REMARKS: MWA OUT
Water Level 23'
Natural Cave - 6'- 45'
11.
DISINFECTION: Type Amt. Used
12
WELL TEST DATA Check box if Test Data is submitted on Form No. GWS 39 Supplemental Well Test.
TESTING METHOD
Static Level ft. DateMme measured , Production Rate Opm,
Pumping level ft. Dale/Time measured , Test length (hrs.)
Remarks
13.1 have read the statements made herein and know the contents thereof, and that May are We to my knowledge (Pursuant to SK9m 24.4.104 (13) (e)
C.R.S.. the making or false statements hereh canatkutw pedwy In Uwe secand degree and Is purdshoWe m a Baas 1 misdemeanor.)
CONTRACTOR Tetra Tech RMC Phone ( 303 ) ,U.2.5282 Lic. No.
Mailing Address 1900 South Sunset Street, Suite 1-F, Longmont, Colorado 80501
Name/Title (Please type or print)
Pignature
ate
T
arshali Massaro, Scientist
I
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