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FORM flu WELL CONSTRUCTION AND TEST REPORT r;or Office Use only <br /> 1/90t 1 STATE OF COLORADO, OFFICE OF THE STATE ENGINEER <br /> • ,,9D REUED <br /> 1. WELL PERMIT NUMBER 163756 M.W.-2 <br /> 020'92 <br /> 2 OWNER NAMES) Cotter Corporation <br /> Mailing Address 12596 West Bayaud Avenue, # 50 � ,;;,: <br /> City, St. Zip Lakewood, Colorado 80228 STATE E 'G'Ectf� <br /> Phone ( 303 ) 980-1292 COW <br /> 3. WELL LOCATION AS DRILLED: NW 1/4 SE 114,Sec. 25 Twp. 2 S , Range 71 W <br /> DISTANCE$ FROM SEC. LINES: <br /> 1982 ft. from South Sec. line. and 1531 ft. from East Sec. line. OR <br /> (rwrlh or south) (east or wsat) <br /> SUBDIVISION: LOT BLOCK FILING(UNIT) <br /> STREET ADDRESS AT WELL LOCATION: <br /> 4. GROUND SURFACE ELEVATION 6581.3 <br /> � ft. DRILLING METHOD Auger <br /> DATE COMPLETED 11/.12/81 TOTAL DEPTH 22.5 fL DEPTH COMPLETED 22.5 ft. <br /> 5. GEOLOGIC LOG: 6. HOLE DIAM. (in.) FroOm (ft) T 2�ft)5 <br /> Depth Description of Materiel (Type,Size.Color.water Location) <br /> 0' - 3.5' Fill - Cs. Cobbles, some cs. <br /> gravels <br /> 5' - .0' Boulders cs. Gravel with cobbles 7. PLAIN CASING <br /> and cs. to med. sand O1/rin Kind PVC Wall Size 40 +3o0(ft) To(8)4 <br /> - Same as above with increased 2-1 2 ' PVC c�Fi 40 13.4 15.4 <br /> gravel an sand <br /> 21 - 22.5 Bedrock, sound competent PERF. CASING: Screen Slot Size: -- T7r <br /> am hiboli a 2-1/2 PVC Sch 40 8.4 13.4 <br /> 22.5' T.D. <br /> 8. FILTER PACK: S. PACKER PLACEMENT: <br /> Material Si 1 ica Sand Type <br /> Size 8-1Z Mesh <br /> Interval 5' - 20' Depth <br /> 10. GROUTING RECORD: <br /> Material Amount Density Interval Placement <br /> REMARKS: Neat Cement 0' - 1.0' Manually <br /> i <br /> 1 DISINFECTION:___Type Amt. Used <br /> 12 WELL TEST DATA: ❑ Check box N Test Data is submitted on Supplemental Form. <br /> TESTING METHOD <br /> Static Level ft. Datefrime measured , Production Rate gpm. <br /> Pumping level ft. Datefrime measured , Test length (hrs.) <br /> Remarks <br /> 3. l have read the statements made herein and know the contents thereof,and that they are true to my knowledge.[Pursuant to Section 24.4.104(13)(a)CAS..the making <br /> of[alas statements herein constitutes perjury in the second degree and is punishable as a class 1 misdemeanor.] <br /> CONTRACTOR Cotter Cor oration Phone ( 303) 980-1292 Uc. No. N/. <br /> Mailing Address iZb9b West Bayaud Avenue, #350 - Lakewood CO 80228 <br /> Nfnoe jisle�Pleaq type or print) i nature Date <br /> Mine Geologist //�� <br />