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rortn no• <br />cus•tt <br />,,,9° WELL CONSTf~ClION I~NU IESf• IIEPOfii' <br />STATE OF COLOHA FFICE OF THE STATE ENGINEER <br />~ : <br />a~~C~F=i1iFC <br />t. 1NELL PERMfT NUMBEf~ 174785-A AU <br /> <br />2 <br />OWNER NAME(S) Ella Mav & Rex Ortgiesen Gibson <br />Mailing Address 735 N. 28th. Ave. <br />City, St. Zlp _ Greeley. Co. 80631 G ~. <br />1 199 1 <br /> <br />rN~S;onulnvnelalsaueulD <br /> <br />Pltolte (303 ) 353-3150 9Y <br />3. WELL LOCATION AS DRILLED_ x_1/4 X1/4, Sec._~• Twp. 6 N , Range ~ 66 W <br />DISTANCES FROM SEC. LINES: , <br />tam It. Irom' Rnurh Sec.,line. end 7575 It. Irom ~asi< Sec. Ilna. OR <br />(lroltll W eeutll) (ne~l O! wee1) <br />SUBDIVISION: LOT_ BL'OCK' FILING(UNIT) <br />STREET ADDFlESS AT WELL LOCAIION: <br />4. GROUNp SURFACE ELEVATION ft. DRILLINGTAETHOD Rotary ~. <br />DATE COMPLETED ~_1A-94 TOTAL DEPTH 60 It. DEPTH COMPLETED 60 Ih <br />5. GEOLOGIC LOG: <br />Dsptll Deec,lptlon of Mnte,lel (type, Sln. Cobr, Weter Locetlan) <br />n-~ Tnn tinil G, HOLE DIAM. (Itt.) Ftortt (Il) Ta (It) <br />9 7 i a n (i n <br />' <br />7_"t9 rnaY4P canr7 to 7" oravPl mix x <br />32-~6 Rrpyn rla~ <br />36-53 Coarse sand to 2" gravel mix x 7. PLAIN CASING <br />53-54 Silted clay OD (Irt) Klrtd Wall Slze ~ Front(fl) To(fl) <br />4-60 Shale 8 5 8 Steel .188 +1 20 <br /> 8 PVC .277 20 40 <br /> <br /> <br /> PERF, CASING: Screen Slot Slze: .035 <br /> $ <br />PVC .277 <br />4(1 ~_ <br /> _ <br />_ <br />_ <br /> <br /> <br /> <br /> 8. FILTER PACK: 9. PACKER PLACEMENT: <br /> Matetlal Gravel Type <br />_ ShA llA <br /> Interval 70-60 Depth <br /> <br /> 1U. GFlOUIING FlECOFlD: <br />__ Material Amount Dertslly Interval Placelnettt <br />REMARI(S; /'PmPn•• ~_ 1 _A6 n-7n P<lllrPr9 <br /> <br /> <br />I I DISINFECTION: T e And, Used <br />12 WELL TEST DATA: ^ Check box i( Test Data Is submitted on Supplemental Fonn, <br />TESTING METHOD Bailed <br />Static Level 25 It. Dale~me measured 3-18-94 Production Flate 20 gpm. <br />Pumping level 30 I[. Date/Tlme measured 3- 1 8-94 ,Test length (hrs.) 3 <br />Flen,arks <br />_ _ _ ____ ___ <br />13. I linve lend Itle elelnmenh mode hn,eln end Xnvn the rnieend Ilieleol, end IINI tl~ry Ne hne M my Mrtmie.,g+. If unuenl to Becllon 2~-~-101 (, ~J (e) C.Fl9., tl~e meWn <br />or Inlsa etetenienb heleln Conetlhl,ee pe,lury In tlN ~ewM deplee end le punl~heLle ee • eleee 1 mlxlemeerwl.l <br />CONTRACTOR a• x a wPt l ~, Pmm~ Inc. _ Phone (303 ) 353-31 18 Llc, No. 857 <br />Mailing Address v n anv 577 GrPP1P~ Co A063 <br />Name/Title (Please type or prlrtl) <br />OWNER Glenn A. Clement Slynaturo ~ <br />/ 7~ Date <br />3-31-94 <br />