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c rs 1 <br />1owI <br />WELL CONSTRUCTION AND TEST REPORT <br />STATE OF COLORADO, OFFICE OF THE STATE ENGINEER <br />1313 Sherman St.. Rm 816, Denver, CO 80203 <br />For Office Use only <br />APR 2 6 2oa4 <br />wRrCtr .-r• rms <br />aT�rbow. R <br />1 1 <br />WELL PERMIT NUMB ER_MH-43399 <br />2- <br />OWNER NAMES) Silver Peaks Metropolitan District No.1 <br />Mailing Address 1 <br />City, St. Zip Greenwood VfNaoe. CO 80911 <br />Phone ( 303) 773-1SQ§ _ <br />3. <br />WELL LOCATION AS DRILLED: NW 114 X1/4, Sec. _j§_ Twp. I S , Range 87 W <br />DISTANCES FROM SEC- LINES: <br />__4.U—R. From N Sec. line. and 1150 ft, from Sec. line, OR <br />pnowamm 1amwww1 <br />SUBDIVISION- LOT BLOCK FILING(UNIT) <br />STREET ADDRESS AT WELL LOCATION, NIA <br />4 <br />GROUND SURFACE ELEVATION 5030 ft. DRILLING METHOD 4 1W HSA <br />DATE COMPLETED 4115104 —TOTAL TOTAL DEPTH 30.5 ft. DEPTH COMPLETED 29 ft. <br />5. GEOLOGIC LOG: <br />Depth Descrlptlon of Material (Type. Size, Color, Water Location) <br />B. HOLE WAM. (in.) from (ft) To (ft) <br />8 0 30.5 <br />0-2' Clay, ver sandy. grovels present, moist. <br />7- PLAIN CASING <br />OD (in) Kind Wall Size From(ft) To(ft) <br />2 PVC SCH 40 3' GS 19' . <br />PERF. CASING: Screen Slot Size: 0.01" <br />VC _SCH_40 1w 29' - <br />2'– 27' Gravelly sand, well graded sand, dry, to wet, <br />Gray -pink. <br />27'– 30,5' Clays;one, medium plastic, moist, gray. <br />8. FILTER PACK, <br />Material Sand <br />Size 10-20 <br />Interval 5'– <br />9. PACKER PLACEMENT: <br />Type <br />Depth! <br />10. GROUTING RECORD: <br />Material Amount Density Interval Placement <br />Concxete 1 batt 0--1' <br />Bentonite 2 bans 9' – 5' <br />REMARKS: MW-30UT <br />Water Level = 13.5' <br />Natural Cave =13' -» 30.5' <br />11. <br />DISINFECTION: Type Ami. Used <br />12. <br />WELL TEST DATA: CJ Check box if Test Data is submitted on Form No. GWS 39 Supplemental Well Test. <br />TESTING METHOD <br />Static Level ft. DateMme measured . Production Rate rpm. <br />Pumping level ft. DatelTime measured , Test length (hrs.) <br />Remarks <br />13.1 have read the statements made herein and know the contents thereof. and that they ars ave to my knawtedge. IPuausnt to Section 24-4-104 (13) (a) <br />C.R.S., ft making of false statements herein constitutes perjury in the second degree and is punishable as a days 1 misdemeanor.) <br />CONTRACTOR Tetra -Tech -RMC Phone 03 772-5282 Lic. No. <br />Mailing Address 1900 South Sunset Street, Suite 1-F, Longmont, Colorado 80501 <br />Nameffille (Please type or print) <br />Marshall Massaro, Scientist <br />2Ignature <br />Dat / <br />(;41505 002UMICoauounionRgwrwWW3011T.dac <br />