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FORM'NO. V _ PUMP INSTALLATION AND TEST REPORT For Office use onty <br /> GbA-32 _ ' <br /> 11i90 STATE OF COLORADO, OFFICE OF THE STATE ENGINEER RECEIVED <br /> ECEI ED <br /> WELL PERMIT NUMBER 9 9 4 5 6—A B <br /> Jt1N 0 7 '94 <br /> 2. OWNER NAMES) Clear Creek Distributing Co <br /> Mailing Address p _'0_ Box 316 0 STATERC�� <br /> City, St. Zip Idaho Springs, Co 80452 0o. <br /> Phone ( 303 ) 674-1974 <br /> 3. WELL LOCATION AS DRILLED: SE 1/4 NE 1/4,Sec.32 Twp. 3 S , Range 72 W <br /> DISTANCES FROM SEC. LINES: <br /> 2300 ft. from North Sec. line. and 500 ft. from East Sec. line. <br /> (north or so east or west <br /> SUBDIVISION: LOT BLOCK FILING(UNIT) <br /> STREET ADDRESS AT WELL LOCATION: <br /> 4. PUMP DATA:Type submersible Installation Completed 5-20-94 <br /> Pump Manufacturer Red Jacket Pump Model No.1 SnCntgw1 -rN-,1 RgrT <br /> Design GPM 10 at RPM HP , Volts 2 3 0 , Full Load Amps 1 <br /> Pump Intake Depth 1 5 Feet, Drop/Column Pipe Size 1 Inches, Find P�ir Gr-h 80 <br /> ADDITIONAL INFORMATION FOR PUMPS GREATER THAT 50 GPM: <br /> TURBINE DRIVER TYPE: ❑ Electric ❑ Engine ❑Other <br /> Design Head feet, Number of Stages , Shaft size inches. <br /> 5. OTHER EQUIPMENT: <br /> Airline Installed❑Yes❑ No, Orifice Depth ft. Monitor Tube Installed ❑Yes❑No, Depth ft. <br /> Flow Meter Mfg. Meter Serial No. <br /> Meter Readout❑Gallons, ❑Thousand Gallons, ❑ Acre feet, ❑ Beginning Reading <br /> 6. TEST DATA: ❑ Check box if Test data is submitted on Supplemental Form. <br /> Date 9=20-94 <br /> Total Well Depth 4 2 5 ' Time <br /> Static Level Q ' Rate (GPM) 2 5 0+ <br /> Date Measured 5-20-9!L Pumping Lvl. 315 <br /> 7. DISINFECTION: Type granular chlorine Amt. Used 4 oz <br /> S. Water Quality analysis available. ❑ Yes ® No <br /> 9. Remarks <br /> 0. 1 have read the statements made herein and know the contents thereof, and that they are true to my knowledge. <br /> [Pursuant to Section 24-4-104 (13)(a) C.R.S., the making of false statements herein constitutes perjury in the second <br /> degree and is punishable as a class 1 misdemeanor.] <br /> CONTRACTOR Aspen DRillina Co. , Inc . Phone 3( 03 ) 697-8335 Lic. No. 949 <br /> ':ailing Address anc;a S _ 14WY 29 M rr ',$on, o 8O4655 <br /> ame/Title (Please type or print) Signature Date <br /> L. J . Beery, pres 5-20-94 <br />