HYDRO23844

• Permit No: M1980244
• IBM Index Class Name: Hydrology
• Doc Date: 4/6/2001
• Doc Name: WELL CONSTRUCTION & TEST REPORT
• Media Type: D
• Archive: No

xx.'NO. WELL CONSTRUCTION gnln_TGS-r_aGpL1R'T
~~ ~ STPrTE OF COLORADO, OFFICE OFT II I'll I II III IIII III
e env 999
~. WELL PERMff NUMBER G V M v.~- I I A -SO For office use ony
2 0WNER NAME(S) Cr~oola. Ct~e~ +F UTc,~ Gold I"I~r~,n~ Co.
Mailing Address P.b , Box 191
City, St. Zip U i c.~a- CO 80860
Phone (7/9) 6 89 -~ ~`rl
3. WELL LOCATION AS DRILLED: SC- 1/4 N W 1/4, Sec. Twp.~_ S ,Range 69 W
DISTANCES FROM SEC. LINES:
ft. from Sec. line. and ft. from Sec. line. OR
~T
SUBDNISION; LOT_ BLOCK FILJNG(UNI'n
STREET ADDRESS AT WELL LOCATION:
4. GROUND SURFACE ELEVATION /0 278.9 ft. DRIWNG METHOD Con~leh~'.ro na~ - Apt Harr.me:-
DATE COMPLETED z to Zodo .TOTAL DEPTH ~0 ft. DEPTH COMPLETED SO ft.
5. GEOLOGIC LOG:
Depth Dexription of Material (Type, Sae, Color, Water Location) 6. HOLE DIAM. (in.) From (ft) To (ft)
8" ~ ~_
~Sre ~: a

7. PLAIN CASING
OD (n) fend Wall Size From(ft) To(ft)
S" S~ee~ O zo
'fir' p V L Srl. ~o O 30

PERF. CASING: Screen Slot Size: 20 slat
~" P VG ~o ~_ So

8. FILTER PACK: 9. PACKER PLACEMEPIT:
Material Sr 1• cn SQ~ Type
Size
Interval 2 2 " Q Depth

10. GROUTING RECORD:
Material Amourrt Density Interval Placement
REMARKS: Bet. q 4,o~~n# n-ZZ
d
1 DISINFECTION: Type Ups-,(, Antt. Use
WELL TEST DATA: ^ Check box 'If Test Data is submitted on Form No. GWS 39 Supplemental We(I Test.
TESTING METHOD
Static Level R DateTme measured ,Production Rate gpm.
Pumping level ft. Date>Tme measured ,Test length (hrs.)
Remarks
$. I have read rho statement made herein and know the eontarrta thereof, and that they are true to my knowledge. [Purouam to Section 24.4-104 (13) (e)
C.R.S., the making of }eke sttemsnb herein conatitutea perjury in the second degroa and ~ puniaha6le d a elaza 1 mkdemeenor.]
CONTRACTOR AK Dr:11(no~ Phone (_~ Lic. No.
Mailin Address P.O.fbox Id9 (Zar•.su. T YS
Name the Please type or print)
a$V Signature Date ~ O
/