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FORM No. WELL CONSTRUCTION AND TEST DEPORT For office use only <br /> cus-31 STATE OF COLORADO, OFFICE OF THE STATE ENGINEER <br /> 11/90 <br /> 1. WELL PERMIT NUMBER 163756 M.W.-2 <br /> f OWNER NAME(S) Cotter Corporation <br /> Mailing Address 12596 est ayaud venue, 350 _ <br /> City, St. Zip Lakewood, Colorado 80228 <br /> Phone ( 303 ) 980-1292 <br /> 3. WELL LOCATION AS DRILLED: NW 1/4 SE 114, Sec. 25 Twp. 2 S , Range 71 lJ <br /> DISTANCE$ FROM SEC, LINES: <br /> 1982 ft. from South Sec. line. and 1531 ft. from East Sec, line, OR. <br /> (north or south) (east or wasp <br /> SUBDIVISION: LOT BLOCK FILING(UNIT) <br /> STREET ADDRESS AT WELL LOCATION: <br /> 4. GROUND SURFACE ELEVATION 6581.3 ft. DRILLING METHOD Auger <br /> DATE COMPLETED 12/.12/81 TOTAL DEPTH 22.5 ft. DEPTH COMPLETED 22.5 ft. <br /> 5. GEOLOGIC LOG: 6. HOLE DIAM. (in.) From (ft) To <br /> 22 )5 <br /> Depth Description of Material (Type,Size, Color,Water Location) 411 <br /> 0' - 3.5' Fill - Cs. Cobbles, some cs. <br /> gravels <br /> 5' - 12.0' Boulders, cs. Gravel with cobbles 7. PLAIN CASING <br /> and cs. to med. sand OD (in� Kind Wall Size From(ft) To(ft) <br /> 2-1/2' PVC Sch 40 +3.0 8.4 <br /> - 21, Sane as above with increased 2-1/P PVC - h 40 13.4 15.4 <br /> gravel and sand <br /> j 21 - 22.5' Bedrock, sound comgg Qnt PER CASING: Screen Slot Size: T <br /> amohibolite 2-1/2" PVC Sch 40 8:4 13.4 <br /> 22.5' T.D. <br /> NHL+ wafiPr 7 n' S. FILTER PACK: 9. PACKER PLACEMENT: <br /> Material Si 1 i ca Sand Type <br /> Size 8-12 Mesh <br /> Interval 5' - 20' Depth <br /> 14. GROUTING RECORD: <br /> Material Amount Density Interval Placement <br /> REMARKS: Neat Cement 0' - 1.0' . Manually <br /> i DISINFECTION: T pe Ault. Used <br /> 12- 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. i have read the statements made herein and know the contents thereof,and that they are true to my knowledge. [Pursuant to Section 244-104(13)(a)c.R s„the makinc <br /> of false statements herein constitutes perjury in the second degree and is punishable as a c!zm 1 misdemeanor.] <br /> I CONTRACTOR Cotter Corporation Phone c 3a3) 980-1292 Lic. No. N/A <br /> MailingAddress est Bayaud Avenue, #350 - Lakewood CO B0228 <br /> N�giegjtleLPle� spertype or print) Sianature Date <br /> Y <br /> Mine Geologist l \l _ <br />