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FORM NO WELL CONSTRUCTION AND TEST REPORT Far Ise Only <br /> GWS-31 STATE OF COLORADO,OFFICE OF THE STATE ENGINEER RECE <br /> 0512011 1313 Sherman SL.Room 821.Denver,CO SOM <br /> Main M 886-3W1 Fax 8 <br /> 1. WELL PERPAT N1.01111WIt 509MUH NOV 2 7 NIZ <br /> 7- VEELL OWNER NAME OFF WELL�C�i1RlER Cotter Corporation(N.S.L) �YEVR FORMTION EN EFRS <br /> COLO <br /> MAILING ADDRESS 78M E Dorado Place,Suds 210 <br /> CITY: Englewood STATE CO ZIP CODE 80111 <br /> TELEPHONE NUMBER 720 554-6211 <br /> 3. WELL LOCATION AS DRILLED: NW 1/4, SE 114. Sec. 25 Twp._2 ❑Nor®S, Range_ 1 ❑E or®W <br /> DISTANCES FROM SEC.LINES: 1.730 ft.from ❑N or®S section One and 1.820 IL from ®E or❑W section tine.. <br /> SUBDMSION: . LOT BLOCK FILING(UNIT) <br /> Optional GPS Location:GPS Uri must use the following settings: Format must be UTM,Units Owner's Well Designation:MW18 <br /> must be metiers,Datum must be NAD83,Unit must be set to true N. ❑Zone 12 or❑Zone 13 Easting: <br /> STREET ADDRESS AT WELL LOCATION: IKIW Glencoe Valley Road Golden.CO 80402 Northing: <br /> 4. GROUND SURFACE ELEVATION 6,580 feet DRILLING METHOD Conventional Air <br /> DATE COMPLETED 10/11/2012 TOTAL DEPTH 239.9 feet DEPTH COMPLETED 235.0 feet <br /> S. GEOLOGIC LOG: & HOLE DIAM in. From ft To ft <br /> Depth Type Grin Size Color Water Loc. 10.5 0 25 <br /> 0-15' ColiuvaxNFill VF to cobbles Light Brown 1w 7.5 25 239.9 <br /> 15-239.9 qWftQwuSctjd Very Fine-Rne Dark Gray <br /> 7. PLAIN CASING: <br /> OD On) Kind Wail Size On) From(ft) To(ft) <br /> 2.375 Sdt.80 pVC 0218 +2 215 <br /> PERFORATED CASING: Screen Slot Size(in):0.02 <br /> 2.375 Sch.80 PVC 0.218 215.0 235.0 <br /> 8. FILTER PACK 9. PACKER PLACEMENT: <br /> Material silica sand Type <br /> Size 10-20 <br /> Interval 208.6-239.9' Depth <br /> 0. GROUTING RECORD <br /> Material Amount Density Interval Placement <br /> Remarks: Type lnl Cement 4 gal 0-6.6' From Surface <br /> Bentonite Grout 387 gal 6.6-197.6' From Tremmle <br /> o►tite Pellets 20 gal 197.6-208.6' From Tremmie <br /> 11. DISINFECTION: Typp I Amt.Used <br /> 12. WELL TEST DATA Ll Check box if Test Data is submitted on Form Number GWS 39 Supplemental Well Test. <br /> TESTING METHOD WA-monitoring well per Rule 12.1 <br /> Static Level 2A1 ft. Dateffune measured: 10/12rt012 7:00 Production Rate gpm. <br /> Pumping Level 11. Dateillme measured Test Length(hrs) <br /> Remarks: <br /> 13. I have read the statements made herein and know the co terb thereof,and they are true to my knowledge. This document is signed and certOied in <br /> accordance with Rule 17.4 of the Water Well Construction Rules,2 CCR 402-2. [The fling of a document that contains false statements is a violation of <br /> secdon 37-91-10 1 e C.R.S. and Is punishable by fines up to$5000 and/or revocation of the contracting lice <br /> Company Name: Layne Christensen Phone. License Number <br /> 303 755-1281 1466 <br /> Mailing Ad • 17800E W Avenue,Aurora,CO 80011 <br /> Signature: Print Name and Tile Jim Hale/Licensed wen Driller 9 L6 t d/ <br />