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FORM NO. WELL CONSTRUCTION AND TEST REPORT ' For otlice use only , <br /> 9 <br /> � <br /> 31 111 STA7�-E OF COLORADO OFFICE OF THE STATE ENGINEER e <br /> 11/90 <br /> 1. WELL PERMIT NUMBER 163755 M.W.-i <br /> OWNER NAME(S) Cotter Corooration <br /> Mailing Address 12596 West Ba and Avenue #350 <br /> City, St. zip a ewood, Colorado 80228 <br /> Phone ( 303 ) 980-1292 <br /> 3. WELL LOCATION AS DRILLED: NW 1/4 SF 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 /> (north or south) (east or%eat) <br /> SUBDIVISION: LOT BLOCK FILING(UNET) <br /> STREET ADDRESS AT WELL LOCATION: <br /> 4. GROUND SURFACE ELEVATION 6590.4 ft. DRILLING METHOD Auger <br /> DATE CC=MPLETED 11-12-81 TOTAL DEPTH 25.5 ft. DEPTH COMPLETED 25.5 ft, <br /> 5. GEOLOGIC LOG; 6. HOLE DIAM. (in.) From (ft) To (ft <br /> Depth Description of Material (Type,Size, C01or,Water Location) 4" 0 25. <br /> 0' - 3' Fill - cs. angular cobbles with <br /> sine cs, grave s <br /> 3'1T'-- Brown cs. gravel with cobbles 7. PLAIN CASING <br /> and cs. to med. sand OD ('fnl Kind Wall Size From(ft) To(ft) <br /> 2-1/2 ' PVC Sch 46 +2.5 17.0 <br /> 13` - 17` Fine to cs. sand gravelly and 2-1/2" PVC Sch h 40 22.0 24.0 <br /> silty <br /> Fine to cs Silty sand wi Zh PyERF. CASING:-Screen Slot Size: — <br /> Some gravel 2-1/2" PVC Sch 40 17.0 <br /> 23' - 25.5 Bedrock, competent amph,ibol-1te <br /> 25.5 T.D. <br /> 8. FILTER PACK: S. PACKER PLACEMENT: <br /> *Hit walpr(a7.0' _ Material Si 1 i ca-Sand Type <br /> Size • 8- s - <br /> Interval 15' - 94, Depth <br /> 10. GROUTING RECORD: <br /> Material Amount Density Interval Placement <br /> REMARKS: Neat Cement 0' - 1.5' Manually <br /> 1 DISINFECTION: Type Amt. 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, 1 have read the statements made herein and know the contents thereof,and that they are taste to my knowledge.IPursuant to Section 24.4-1o4(13)(a)C.R.S.,the melting <br /> Of false statements herein constitutes perjury in the second degree and is punishable as a class 1 misdemeanor.) <br /> CONTRACTOR Cotter Corporation Phone L303) 980-1292 lac. No_R4 _ <br /> Mailing Address 12596 West Ba and Avenue #350 - Lakewood CO 80228 <br /> Name/Title Please type or print) Signature, /� Date <br /> Thomas Lepry <br /> Pine Geologist <br />