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FOW.W. 11 WELL CONSTRUCTION AND TEST REPORT For Office use ony <br /> 11/90, 1 STATE OF COLORADO, OFFICE OF THE STATE ENGINEER <br /> 1. WELL PERMIT NUMBER 163757 N-W. <br /> 2 OWNER NAME(S) Cotter Corporation2® ` <br /> Mailing Address 12596 Westayau venue, tw� k <br /> City, St. Zip Lakewood, Colorado 90228 <br /> Phone ( 303 ) 980-1292 <br /> 3. WELL LOCATION AS DRILLED: NW 1/4 SE 1/4,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) (seat 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/Air <br /> DATE COMPLETED 06/19/89 TOTAL DEPTH 15.0 ft. DEPTH COMPLETED 14.0 ft. <br /> S. GEOLOGIC LOG: 6. HOLE DIAM. (in.) From (ft) To (ft) <br /> Depth Description of Material(Type.Size, Color,Water Location) 4" 0 15 <br /> 0' - 15' Alluvium gravels with fine <br /> brown dirt (Fill in parking of <br /> T.D. @ 15' remarks below 7. PLAIN CASING <br /> OD On) Kind Wall Size From((ft) T%ft) <br /> Hit water @ 1 44 <br /> 1 <br /> PVC Sch 40 +13.5 .5 <br /> 7-- cam" TT-.T— <br /> PERF. CASING: Screen Slot Size: 0 <br /> 4" PVC Sch 40 8.5 TT-5 <br /> 8. FILTER PACK: 9. PACKER PLACEMENT: <br /> Material Silica Sand Type <br /> Size B-12 Mesh <br /> interval -74-70T Depth <br /> 1M GROUTING RECORD: <br /> Material Amount Density Interval Placement <br /> REMARKS:_ Ho I a s I ouqhea in to 14.0 coula Neat Cement <br /> not clean it out ^'men ogle {FZ7— U J.5' Manually <br /> 1 DISINFECTION:-ape Arnt Used <br /> WELL TEST DATA: ❑ Check box if Test Data is submitted on Supplemental Form. <br /> TESTING METHOD <br /> Static Level fL Datelrime measured , Production Rate gpm. <br /> Pumping level ft. Datefrime measured , Test length (hrs.) <br /> Remarks <br /> 3. 1 have read the statements made herein and know the comkents thereof,and that they are true to my Imowledge.[Pursuant to section 24-4-104(13)(a)C.R.S.,the making <br /> of false statements twain conetlartse perjury in the second degree and is punishable as a doss 1 misdemeanor.] <br /> CONTRACTOR Cotter Corporation Phone { 303) 980-1292 Lic. No. N/A <br /> Mailing Address 12596 West Bavaud Avenue, #350 - Lakewood CO 80228 <br /> Name/Title (Please type or print) . Si ure Date <br /> Thomas C. Lepry /� / <br /> Mine Geologist / —�� <br />