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FORM NO i WELL CONSTRUCTION AND TEST REPORT For Office Use Only <br /> GWS-31 STATE OF COLORADO, OFFICE OF THE STATE ENGINEER <br /> 4/2012 j 1313 Sherman St., Ste 821,Denver,CO 80203 <br /> Main 303 866-3581 Fax(3 3)866-3589 www.water state co us <br /> 1. WELL PERMIT NUMBER: 9 3 '? Identifieu a,. ..;.,v-VA RA-Mon 3 <br /> 2. WELL OWNER INFORMATIONfB <br /> NAME OF WELL OWNER: Varra Companies, Inc. <br /> MAILING ADDRESS:8120 Gage Street q ;5o <br /> CITY: Frederick STATE: CO ZIP CODE: 80516 <ct�;V,c <br /> TELEPHONE NUMBER w/area code: <br /> 3. WELL LOCATION AS DRILLED: NE 1/4, NW 1/4, Sec., 33 Twp 3 (x i Nor S, rl Ranged ❑ E or W 0 <br /> DISTANCES FROM SEC. LINES: 179 ft. from Fx- N or(— S section line and 2592 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:P-11 <br /> must be meters, Datum must be NAD83, Unit must be set to true N, F-I Zone 12 or IF-I Zone 13 Easting: <br /> STREET ADDRESS AT WELL LOCATION: None assigned Northing: <br /> 4. GROUND SURFACE ELEVATION 4802.18 feet DRILLING METHOD Direct Push <br /> DATE COMPLETED 08/06/2013 TOTAL DEPTH 44 feet DEPTH COMPLETED 44 feet <br /> 5. GEOLOGIC LOG: 6. HOLE DIAM in. From ft To ft <br /> Depth Type Grain Size Color Water Loc. 2 0 44 <br /> 7. PLAIN CASING: <br /> OD (in) Kind Wall Size (in) From (ft) To (ft) <br /> 1.05 PVC n 133 0 5 <br /> PERFORATED CASING: Screen Slot Size(in): 0.010 <br /> 1.05 PVC 0.133 5 44 <br /> 8. FILTER PACK: 9. PACKER PLACEMENT: <br /> Material Silica Sand Type <br /> Size 10-20 <br /> Interval 4-44 Depth <br /> 10. GROUTING RECORD <br /> Material Amount Density Interval Placement <br /> Remarks: direct push - no cuttings recovered Ben 2-4 positive <br /> general conditions 0-3 feet topsoil -sand and Cement 0-2 Dositive <br /> gravel to completion <br /> 11. DISINFECTION: Type N/A Amt. Used N/A <br /> 12. WELL TEST DATA: ❑Check box if Test Data is submitted on Form Number GWS 39 Supplemental Well Test, <br /> TESTING METHOD N/A- Monitoring Well Only <br /> Static Level ft. Date/Time measured: Production Rate gpm. <br /> Pumping Level ft. Date/Time measured Test Length (hrs) <br /> Remarks: <br /> 13. I have read the statements made herein and know the contents thereof,and they are true to my knowledge. This document is signed(or <br /> name entered if filing online)and certified in accordance with Rule 17.4 of the Water Well Construction Rules,2 CCR 402-2. The filing of a <br /> document that contains false statements is a violation of section 37-91-108(1)(e),C.R.S.,and is punishable by fines up to$5000 andlor revocation <br /> of the contracting license. If filing online the State Engineer considers entering of licensed contractor name to be compliance with Rule 17.4 <br /> Company Name: Phone w/area code License Number: <br /> DrillPro Services, Inc. 303-280-5380 NIA <br /> Mailinq Address: 2220 E. 74th PI., Unit A, Denver, CO 80229 <br /> Sign (or enter name if filing online) Print Name and Title Date <br /> Blake Jones I Blake Jones - President 11/05/2015 <br />