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FORD NO.,�d WELL CONSTRUCTION AND TEST REPORT For Office Use only <br /> f;"*" STATE OF COLORADO, OFFICE OF THE STATE ENGINEER <br /> 1. WELL PERMIT NUMBER 163760 M.W.-6 Io��11ORECEIVED <br /> WNER NAME(S) Cotter Corporation a20'92 <br /> ailing Address IZ596 Westayau venue, <br /> City, St. Zip Lakewood, v!' TLa`F <br /> 1xfi fr 40%, <br /> Phone ( 303 ) 980-1292 C01.0 <br /> 3. WELL LOCATION AS DRILLED: NE 1/4 SE 1/4, Sec. 25 Twp. 2 S , Range 71 W <br /> DISTANCES FROM SEC. LINES: <br /> 1400 ft. from South Sec. line. and 822 ft. from East Sec. line. OR <br /> (north or south) (east or west) <br /> SUBDIVISION: LOT BLOCK FILING(UNIT) <br /> STREET ADDRESS AT WELL LOCATION: <br /> 4. GROUND SURFACE ELEVATION 6551.1 ft. DRILLING METHOD Hammer/Ai r <br /> DATE COMPLETED 06/20/89 TOTAL DEPTH 15.0 ft. DEPTH COMPLETED 15.0 ft. <br /> S. GEOLOGIC LOG: 6. o <br /> HOLE <br /> DIAM. (in.) From (ft) To1(ft) <br /> Depth Description of Material (Type.Sim. Color,Water Location) 55 <br /> 0' - 12' Unconsolidated Road Fill (BRN) <br /> 12' - 13" Alluvial Gravels <br /> 7. PLAIN CASING <br /> 13' - 15 Competent Bedrock Hornblende OD (in) Kind Wall Size From(ft) To(ft) <br /> Gneiss 2" PVC Sch 40 +1.8 5.0 <br /> 15.0' T.D. <br /> *Hit Water @ 67 PERF. CASING: Screen Slot Size: Q,03" <br /> 2" PVC Sch 40 5.0 15.0 <br /> 8. FILTER PACK: 9. PACKER PLACEMENT: <br /> Material Silica Sand Type <br /> Size 8-12 Mesh <br /> Interval 3.0' - 15.0' I Depth <br /> 10. GROUTING RECORD: <br /> Material Amount Density interval Placement <br /> REMARKS: Neat Cement <br /> Feeriton1 a go T-0'-1.-�' Manua Y <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. Date/Time measured , Test length (hrs.) <br /> Remarks <br /> 3. 1 have read the statements made herein and know the contents thereof,and that they are true to my knowledge.[Pursuant to Section 24-4-104(13)(a)CAS,the making <br /> -f false statements herein constitutes perjury in the second degree and is punishable as a class 1 misdemeanor.) <br /> TRACTOR Cotter Corporation Phone ( 303) 980-1292 Lic. No. N A <br /> Mailing Address 12596 West Bavaud Avenue. #350 - Lakewood CO 80228 <br /> NamelTitle (Please type or print) fgnature Date <br /> Thomas C. Lepry /6 _ 9Z <br /> Mine Geologist <br />