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FORM.NO. WELL CONSTRUCTION AND TEST REPORT For Office use only „ <br /> Gus-31 STATE OF COLORADO, OFFICE OF THE STATE ENGINEER <br /> 11/90 <br /> s. WELL PERMIT NUMBER - 163757 N.W.-3A _ <br /> :.. OWNER NAME(S) Cotter Corporation <br /> Mailing Address West Bayaudvenue, <br /> City, St. zip Lakewood, Colorado 80228 <br /> Phone ( 303 ) 980-1292 <br /> 3. WELL LOCATION AS DRILLED: NW 1/4 SC 114,Sec. 25 Twp. 2 S , Range 71 W <br /> DISTANCES FROM SEC. LINES: <br /> 1776 ft. from South Sec, line. and 1379 ft. from East Sec. line. OR <br /> (north or south) Ceast or west) <br /> SUBDIVISION: LOT BLOCK FILING(UNIT) <br /> STREET ADDRESS AT WELL LOCATION: <br /> 4. GROUND SURFACE ELEVATION 6576.4 ft. DRILLING METHOD Hammer/Ai r <br /> DATE COMPLETED 06/19/89 TOTAL DEPTH 15.0 ft. DEPTH COMPLETED 14.0 fE, <br /> 5. GEOLOGIC LOG: 6. HOLE DIAM. (in.) From (ft) To (ft) <br /> Depth Description of Materiel Crype,Srze,Color,water Location) 4" 0 15 <br /> 0' - 15, Alluvium ravels with fine <br /> brown dirt i 11 in par ing I <br /> T. Q. @ 15' (See remarks belowT 7. PLAIN CASING <br /> 00 (in) Kind Wall Size From <br /> 5ft) T 8) <br /> *Hit water @ 11.01. 4 PVC Sch 40 <br /> Sch 40 T37 5— T4-.U— <br /> PERF. CASING: Screen Slot Size: Q <br /> [.• 4" PVC Sch 40 8.5 13 <br /> 8. FILTER PACK: 9. PACKER TLACEMENT: <br /> rid. <br /> Material Silica Sand ' Type <br /> Size • ='�:�:s:4;::,� •• <br /> Interval 6.5 - 14.0 Depth <br /> 10. GROUTING RECORD: <br /> Material Amount Density Interval Placement <br /> REMARKS: Hole sloughed in to 14.0 could Neat Cement <br /> not clean it out Ben on1 e � Ur=�3' 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. Daterrime measured , Test length (hrs.) <br /> Remarks <br /> 3. l have read the statements made herein and know the contents theteor,and that they are true to my knowledge.(Pursuant to Section 24-4-104(19)(a)C.R.S.,the Makin <br /> of false statements herein constitutes perjury in the second degree and is punishable as a class 1 misdemeanor.I <br /> CONTRACTOR Cotter Corporation Phone { 303) 980-1292 Lie. No. N/ <br /> Mailing Address 12596 West Ba and Avenue #350 - Lakewood CO 80228 <br /> NameMtle (Please type or print) Signature Date <br /> Thomas C. Lepry <br /> mine Geolooist <br />