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FdkWNO. WELL CONSTRUCTION AND TEST REPORT ' For orrice use only <br /> c STATE OF COLORADO, OFFICE OF THE STATE ENGINEER REC'L!t."I i <br /> ' 11/90/90 <br /> 1. WELL PERMIT NUMBER 163755 M.W.-1 NOV 2O'92 <br /> 2 OWNER NAME(S) Cotter Corporation yy URCES <br /> Mailing Address 12596 West Ba and Avenue #350 5ACHNEER <br /> City, St. Zip Lakewood, Colorado 80228 <br /> Phone ( 303 ) 980-1292 <br /> 3. WELL LOCATION AS DRILLED: NW 114 SE 1/4,Sec. 25 Twp, 1 S , Range 71 W <br /> DISTANCES FROM SEC. LINES: <br /> 2165 ft. from South Sec. line. and 1773 ft. from East Sec, line. OR <br /> { oiwrt� r south) (east or wesq <br /> SUBDIVISION: LOT BLOCK FILING(UNM <br /> STREET ADDRESS AT WELL LOCATION: <br /> 4. GROUND SURFACE ELEVATION 6590.4 ft. DRILLING METHOD Auger <br /> DATE COMPLETED 11-12-81 TOTAL DEPTH 25.5 ft. DEPTH COMPLETED 25.5 ft. <br /> 5. GEOLOGIC LOG: B. 4" 5 <br /> HOLE DIAM. (in.) From (ft) To (ft <br /> Depth Description of flows"(type. Size. Color.Water l_ocadon) <br /> 0' - 3' Fill - cs. angular cobbles with <br /> sine cs, gravers <br /> 131 Brown cs. gravel with cobbles 7. PLAIN CASING <br /> and cs. to med. sand' OD (in) Kind Wail Slze From(ft) To(ft) <br /> 2-1 2" PVC Sch 40 +2.5 1 .0 <br /> 13' - 17' Fine to cs. sand gravelly and 2-1 2" �— c 40 22.0 24.0 <br /> silty <br /> 17' - _23' Fine to cs. silty sand with PERF. CASING: Screen Slot Size: ZTg — <br /> some Gravel 2-1./2" PVC Sch 40 <br /> 23 - 25.5 Bedrock, competent amphi o ite <br /> 25.5 T. D. <br /> a. FILTER PACK: 9. PACKER PLACEMENT: <br /> *Hit water @ 7.0' Material Silica Sand Type <br /> Size 8-12 Mesh <br /> Interval 1 5' - 24, Depth <br /> iQ GROUTING RECORD: <br /> Material Amount Density Interval Placement <br /> REMARKS: Neat Cement 0' - 1.5' Manually <br /> 1 DISINFECTION: T e Amt. Used <br /> WELL TEST DATA: ❑ Check box if Test Data is submitted on Supplemental Form. <br /> TESTING METHOD <br /> Static Level ft. Date/Time measured , Production Rate gpm. <br /> Pumping level ft. Date/Time measured , Test length (hrs.) <br /> Remarks <br /> 3. t have read the statements made herein and know the contents thereof,and that they are true to my knowledge,jPursuant to Section 24-4-104(13)(a)C.R.S..the maidn <br /> of false statements herein constitutes perjury in the second degree and is punishable as a class 1 misdemeanor.] <br /> CONTRACTOR Cotter Corporation Phone ( 303) 980-1292 Lic. No. N/A <br /> Mailing Address 12596 West Ba and Avenue #350 - Lakewood CO 80228 <br /> NameMtle Please type or print) StgrCatu� Date <br /> Thomas Lepry <br /> Mine Geologist <br />