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FORM NO. WELL CONSTRUCTION AND TEST REPORT For office Use Only <br /> GWS-31 STATE OF COLORADO,OFFICE OF THE STATE ENGINEER <br /> 04/2005 1313 Sherman St.,Room 818,Denver,CO 80203 RECEIVED <br /> Phone—Info(303)866-3587 Main(303)866-3581 <br /> Fax 303 866-3589 hftp://www.water.state.w.us FEB 14 2011 <br /> 1. WELL PERMIT NUMBER: 74573-F <br /> 2. WELL OWNER INFORMATION WATER RESOURCES <br /> NAME OF WELL OWNER: Cotter Corporation -T,TF ENGINEER <br /> COL- <br /> MAILINGADDRESS: 7800 E Dorado PL Suite 210 <br /> CITY:Englewood STATE: CO ZIP CODE: 801 1 1 <br /> TELEPHONE NUMBER: <br /> 3. WELL LOCATION AS DRILLED: _NF,_1/4, RE_1/4, Sec.2-1; , Twp. 2 ❑N or®S, Range 71 ❑E or®W <br /> DISTANCES FROM SEC.LINES: 1 805 ft.from ❑N or®S section line and 1965 ft, from ®E or❑W section line. <br /> SUBDIVISION: —, LOT_, BLOCK , FILING(UNIT) <br /> Optional GPS Location:GPS Unit must use the following settings: Format must be UTM,Units Owner's Well Designation:SUMP <br /> must be meters, Datum must be NAD83,Unit must be set to true N, ❑Zone 12 or❑Zone 13 Easting: <br /> STREET ADDRESS AT WELL LOCATION: Northing: <br /> 4. GROUND SURFACE ELEVATION (,9;73-1 R feet DRILLING METHOD Excavation <br /> DATE COMPLETED 11 12 201 0 TOTAL DEPTH 11 feet DEPTH COMPLETED 11 feet <br /> 5. GEOLOGIC LOG: 6. HOLE DIAM in. From ft To ft <br /> Depth Type Grain Size Color Water Loc. 4 R 1 1 <br /> 0 - 11 ' sand & ra el w c bble <br /> 7. PLAIN CASING: <br /> OD(in) Kind Wall Size(in) From(ft) To(ft) <br /> 4_ -;tPPI 16 claug _ 0 7" <br /> PERFORATED CASING: Screen Slot Size(in): .5" <br /> 4_ steel 16 aaug 7 11 <br /> 8. FILTER PACK: 9. PACKER PLACEMENT: <br /> Material gravel Type <br /> Size 411 <br /> Interval 4'—1 1 ' Depth <br /> 0. GROUTING RECORD <br /> Material Amount Density Interval Placement <br /> Remarks: <br /> 11. DISINFECTION: Type Amt. Used <br /> 12. WELL TEST DATA: ❑Check box if Test Data is submitted on Form Number GWS 39 Supplemental Well Test. <br /> TESTING METHOD Steady State Drawdown submersible <br /> Static Level 1 ()S ft. Datefrime measured: 2/4/11 9:5 7 Production Rate 7 5-5 F gpm. <br /> Pumping Level 1 .30 ft. Date/Time measured 214111 12!!02 Test Length(hrs) 2:05 . <br /> Remarksspecific ca acit =302.22 m - <br /> 13. 1 have read the statements made herein and know the contents thereof,and they are true to my knowlddge. This documenf is signed and certified in <br /> accordance with Rule 17.4 of the Water Well Construction Rules,2 CCR 402-2. (The filing of a document that contains false statements is a violation of <br /> section 37-91-108 1 e,C.R.S.,and is punishable by fines up to$5000 and/or revocation of the contracting license. <br /> Company Name: Phone. License Number: <br /> Frontier Environmental Services, Inc. 303 234- 9350 <br /> Mailin A ess: 5350 Vivian S reet, Unit B Arvada, CO 80002 <br /> Signature: Print Name and Title C + J Date <br /> 4n Xa� Cw ` V ttA <br />