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FOAO <br />cwsoi ' <br />WELL CONSTRUCTION AND TEST REPORT <br />lam <br />STATE OF COLORADO, OFFICE OF THE STATE ENGINEER <br />For orncs Use only <br />1313 Sherman Sl., Rm 818, Denver, CO 60203 <br />R::: 02 <br />1. <br />WELL PERMIT NUMBER MH -4340_0 - <br />APR ZOD4 <br />2. <br />OWNER NAMES) Silver Peaks M itan 0 .1 <br />Mailing Address 5460 South Quebec Sheet. Sults 110__ _ <br />City, St. Zip greenwood V111age,6011 <br />I"r_ <br />CO'La. "A <br />Phone ( 303 ) 773-1005 <br />3• <br />WF-LLLQC&TION AS DRILLED: SW 114_N 114, Sec- 35 Twp- 1 S ,,, Range67 W <br />DISTANCES FROM SEC. LINES; <br />20§Q ft. from N Sec. line. and _ 700 ft. from E Sec. line. OR <br />SUBDIVISION: LOT BLOCK FILING(UNIT) <br />STREET ADDRESS AT WELL LOCATION. NIA <br />4. <br />GROUND SURFACE ELEVATION 5030 ft. DRILLING METHOD 4114"HSA <br />DATE COMPLETED 4114104 TOTAL DEPTH aft. DEPTH COMPLETED 33 ft. <br />6. HOLE DIAM. (in.) From (ft) To (ft) <br />5. GEOLOGIC LOG; <br />8 0 35 <br />Depth oeseA mon w Matedsi unw. size. color, Water Loeallonj <br />0 — 8.5' Clayey sand, fine to medium grained sand, <br />7. PLAIN CASING <br />OD (in) Kind Wall Size From(ft) To(ft) <br />2 PVC SCH 40 T . <br />PERF. CASING: Screen Slot Size: 0.01" <br />2 PVC SCH 40 7.3, <br />Slightly moist -moist, brown -dark brown to <br />Orange -brown. loose. <br />8.6'— 131 Sand, poorly graded, some coarse sand. <br />Some 1" gravel, slightly molal -moist, <br />Light brown -brown. <br />13'— 16' Clayey sand, fine to medium sand, molst-wet, <br />Brown to orange -brown, loose, sl htly iplastic. <br />18'— 33' Gravelly sand to sandy gravel <br />8. FILTER PACK; <br />Material Sand <br />Size 10-20_ <br />Interval 5'— IS' <br />9- PACKER PLACEMENT: <br />Type <br />D th <br />33'— 35' Sandy claystone, fine grained sand, <br />Slightly moist, brown -yellow, orange staining, <br />Dense. <br />10. GROUTING RECORD: <br />Material Amount Density Interval Placement <br />C,gncrete 11 beg, 0-11' <br />Elentonks 1.5 bens 1*5• <br />REMARKS: MW-20UT <br />Water Level = 22' <br />Natural Cave =16' -- 35' <br />11. <br />DISINFECTION: Type Amt. Used <br />12 <br />WELL TEST DATA: n Check box if Test Data Is submitted on Form No. GWS 39 Supplemental Well Test. <br />TESTING METHOD <br />Static Level ft. Dalaliime measured , Production Rale _t7pm. <br />Pumping level ft. DateMme measured , Test length Mrs.) <br />Remarks <br />13. I have toad the sralemork made herein and know the oorntatds thereof. and Out they are We to my tuxWedgo. IN ntuant to Softn 24-4-404 (13) lel <br />C.R.B,, the moldng of false statemerrta herein cansdMes perjury in the second dogma arrd Is punishable as a lose 4 misdemeanor-) <br />CONTRACTOR Tetra Tech RMC Phone ( 303 } 772-5282 Lic. No. <br />Mailing Address 1900 South Sunset Street, Suite i -F, Longmont, Colorado 80501 <br />ame/Tille (Please type or print) <br />Ignature <br />jDate <br />arshall Massaro, Scientist <br />I?/•.ef��2.3�� <br />F.W303 WZWsllConswrlknRcponri%iW70U'1'.dw <br />