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140 <br />it FORM ' <br />1ow <br />WELL CONSTRUCTION AND TEST REPORT <br />STATE OF COLORADO, OFFICE OF THE STATE ENGINEER <br />1313 Sherman St., Rm 818, Denver, CO 60203 <br />For office use only <br />R:CEaVID <br />APR 2 S 2004 <br />WAU giSO11RCEa <br />UMEM <br />�A COLO. <br />t. <br />WELL PERMIT NUMBER MH•43399 <br />2. <br />OWNER NAME(S) Silver Peaks Metr000litan District No.1 <br />Mailing Address <br />City, St. Zip taste. CO 80111 <br />Phone ( 303) 773-1 <br />3. <br />WELL LOCATION AS DRILLED: NW! 114 , NE 114, Sec. 35 - Twp. ,�_ 5 Range 07 W <br />DISTANCES FROM SEC. LINES: <br />4 o o ft. from N Sec. line. and 150 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 A. DRILLING METHOD _4114" H <br />DATE COMPLETED 4115104 TOTAL DEPTH 45 ,ft. DEPTH COMPLETED 44 ft. <br />5. GEOLOGIC LOG: <br />Gaper OescdpUon of MaterM (ryps, Silo, Color. Wafer Location) <br />6. HOLE DIAM. (In.) From (ft) To (ft) <br />8 0 45 <br />0-38' Gravelly sand, fine to coarse grained, <br />7. PLAIN CASING <br />OD (in) Kind Well Size From(ft) To(ft) <br />�2 PVC SCH 40 .�S .,3=' <br />PERF. CASING: Screen Slot Size: 0.01" <br />— 2 PVC _ SCUA 34, JT -- <br />Pink -brown, moist -wet. <br />38'— 39' Clayey gravel, cobbles present, wet, pink. <br />39'— 42' Gravelly sand, wet, fine to coarse grained, <br />42'— 45' Claystone, moist. gray -dark gray, very plastic. <br />Some organics. <br />8, FILTER PACK: <br />Material Natural Cava <br />Size SendlGravel <br />Interval 6'-46! <br />9. PACKER PLACEMENT: <br />Type <br />Depth <br />10. GROUTING RECORD: <br />Material Amount Density Interval Placement <br />Concrete 1 ba 0-11' <br />Bentonite ,2 boas <br />REMARKS: MW -1 OUT <br />Water Level = 23' <br />Natural Cave = 6'— 45' <br />11. <br />DISINFECTION: Type Amt. Used <br />12 <br />WELL TEST DATA Lj Check box If Test Data is submitted on Form No. GWS 39 Supplemental Well Test. <br />TESTING METHOD <br />Static Level ft. Daterrime measured . Production Rate apm. <br />Pumping bevel R. DateMme measured , Test length (hrs.) <br />Remarks <br />13.1 have read the statements made hereln and know the contents thereof, and that they are true to my knowledge, (Pursuant to Section 244.104 (13) is) <br />C.fi.S.. the making of Wee statements hlndn caestlMas perjury In the second degree and Is punishabte a3 a dans 1 misdemeanor.) <br />CONTRACTOR Tetra Tecta RMC Phone ( 303 ) 7ZZ-5282 Lic. No. <br />Mailing Address 1900 South Sunset Street, Suite 1-F, Longmont. Colorado 80501 <br />ame�Ne (Please type or prim) <br />arshall Massaro. Scientist <br />ignature ,t� Date <br />1 t E ly -��3 0 <br />P: 305 002%Well Comir clidn ReMU%l W TOUTSDC <br />