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MW-Sunl <br /> RECEIVED <br /> JW 0 4-2013 <br /> FORM NO. WELL CONSTRUCTION AND TEST REPORT For Office Use Only <br /> GWS•31 STATE OF COLORADO,OFFICE OF THE STATE ENGINEER '� T h_. <br /> S ATE EN ':v':.: <br /> 4=12 1313 Sherman St.,Ste 821,Deng,CO $0203 COLECEIVED <br /> 888.3581 Fax 303 888-35Bg www. te. <br /> 9.WELL PERNUT NUMBER: S! .IAN 2 8 2.WELL OWNER INFO ION 2013 <br /> NAME OF WELL OWNER: Z C/' eSo(r1eef 54 wAT <br /> MAILING ADDRESS: SS �vic:.wt 6&.6 ST is NPj#I <br /> CITY: STATE: CoO ZIP CODE—'VI S <br /> TELEPHONE NUMBER w/area code: 393 13T9-q JS <br /> 3. WELL LOCATION AS DRILLED: 1/4, 114, Sec., Twpe- r- N r S, 1-1 Range © E or W <br /> DISTANCES FROM SEC.LINES: R from F-Gor l S section litre and &LIJK _ft,from C@or[3 W section line. ) <br /> t <br /> SUBDIVISION: LOT BLOCK . FILING(UNIT)Option i <br /> ^ ^^,MW-Sunl <br /> must be <br /> GPS Location:GPS Unit must use the following settings: Fo be UTiN,Units Easting Owner's­­:;R Q 4 O "//,6 <br /> must be meters.Datum must be NAD83,Unit must be set to true N, 1 Zone 1 or ir1 Zone 13 - <br /> STREET ADDRESS AT WELL LOCATION: Northin : 15o2 2O Lf q,a21 8 <br /> 4. GROUND SURFACE ELEVATION_feet DRILLING METHOD /i- <br /> DATE COMPLETED ;L—S— iL TOTAL DEPTH /aYo feet DEPTH COMPLETED - feet <br /> GEOLOGIC LOG: 16. HOLE DIAM in. From ft To ft <br /> Depth Type Grain Size Color Water Loc. i O`, D )(2UF. e ,�, " a b ll L/D <br /> i t(�to <br /> 7. PLAIN CASING: <br /> ,ft '71if- <br /> OD(in) Kind Wall Size(in) From(ft) To(ft) <br /> J �VC i ,xI 5 j/i <br /> PERFORATED CASING: Screen Slot Size(in): -y�Q <br /> ,t ah P>,/L <br /> 8. FILTER PACK::jf�� 9. PACKER PLACEMENT: <br /> Material jAtAp, Type <br /> Size I a Fa o ,Y?0 <br /> Interval I?ntr.ilo1 1w9-lio iD th <br /> 0. GROUTING RECORD <br /> Mttµigl _l gray Density Interval Placement <br /> Remarks •^ - Ys J _ -i�f1a 11v3 i rartis <br /> P�„4.nQdc S ,1 ' 04- 110 ...rpc� <br /> 11. DISINFECTION: Type Art Used <br /> 12. WELL EST DATA: ❑Check box if Test Data is submitted on Form Number GWS 39 Supplemental Well Test. <br /> TESTING METHOD . <br /> Static Level it, Datefl7ime measured. Production Rate L?. gpm. <br /> Pumping Level LA,0 It DateMme measured 14• kS--1.1 Test Length(hrs) <br /> Remarks: <br /> 13. 1 have read the statements made herein and know the contents thereof,and they are true to my knowledge. This document is signed(or <br /> name entered if filing online)and certified in accordance with Rule 17.4 of the Water Well Construction Rules,2 CGR 402.2. The filing of e <br /> document that contains false statements is a violation of section 37-81-108{7)(e),C.R.S.,and is punishable by fines up to$6o00 andlor revocation <br /> of the contracti license. If firing online the State Engineer considers enteringof licensed contractcoor nname to be compliance with Rule 17.4 <br /> C am ,/ .v tGd e�`C' 0. <br /> �o�y( '/�-�Y Lice�sgj�u ar <br /> bt i A Tess v'? .6 �� l / GG7i.- S*3 2 <br /> Sig ent nine�innline) Print e�nnd Ri � D <br />