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HYDRO30707
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Entry Properties
Last modified
8/24/2016 8:49:22 PM
Creation date
11/21/2007 12:44:44 AM
Metadata
Fields
Template:
DRMS Permit Index
Permit No
M1980244
IBM Index Class Name
Hydrology
Doc Date
4/6/2001
Doc Name
WELL CONSTRUCTION TEST AND REPORT
Media Type
D
Archive
No
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<br />F°eA1 NO' WELL CONSTRUCI'll'II'II I III~O <br />r~p1 STATE OF COLORADO, OFF IGINEER <br />e <br />1. WELL PERMff NUMBER ~ V M W - 13 L~ - 5So For office use ony <br />2 OWNER NAME(S) Gran nee. Creek $' U ~ c.~f Gb~d 1`I: r:`nw ~U, <br />Mailing Address P . I I <br />Ciry, St. Zip _l1 ~ c~or Co ~ o r o go S(oo <br /> Phone (719) 6 89 - ft0~ <br />3. WELL LOCATION AS DRILLED: SF_ 1/4 flu) 1/4, Sec.~_ Twp. / S .s ,Range ~ q tL <br />DISTANCES FROM SEC. LINES: <br />ft. from Sec, line. and ft. from Sec. line. OR <br />~T <br />SUBDNISION: LOT_BLOCK FILING(UN[f) <br />STREET ADDRESS AT WELL LOCATION: <br />4. GROUND SURFACE ELEVATION D (o ft. DRIWNG METHOD Cohy c-~.~,.or~ Air Na. tr.m+er <br />DATE COMPLETED I Z ZDGL~ .TOTAL DEPTH 53 O ft. DEPTH COMPLETED SS o ft. <br />5. GEOLOGIC LOG: <br />Depth Description of Material (Type, Sae, Color, Water Location) & HOLE DIAM. (n.) From (ft) To (ft) <br />8 d O SSO <br />See Qtk)GCZc <br /> <br /> 7. PLAIN CASING <br /> OD (n) Kind Wall Size From(ft) To(ft) <br /> A~~~~ O Zo <br /> PAC, ~~ O ~ <br /> <br /> <br /> PERF. CASING: Screen Slot Size: 20 <br /> S~'~ ~ V G S SO ~5 ~ .SSO <br /> <br /> <br /> <br /> <br /> S. FILTER PACK: 1 9. PACKER PLACEMENT: <br /> Material S ~ ~ ~ coy Ord Type <br /> Size <br /> Interval 3d -SS Depth <br /> <br /> 10. GROUTING RECORD: <br /> at nal urtt DerLSity Imerval Placement <br />~ <br />REMARKS: f l~- y~ <br />~' <br /> <br />1 DISINFECTION: Type Nome- Amt. Used <br /> WELL TEST DATA: ^ Check box if Test Data is submitted on Fonn No. GWS 39 Supplememal Well Test. <br />TESTING METHOD <br />Static Level ft. Datefiime measured ,Production Rate gpm. <br />Pumping level ft. Date~me measured ,Test length (hrs.) <br />Remarks <br />3. I have read the stetemanb made herein and know the eorrtems thereof, end that they are true to my knowledge. [Pursuant to Seetion 244704 (13)(a) <br />C.0.S., the making of feLse statemerds herein constitutes perjury in the second degree and is punishable es a class 1 m'rsdameanor.] <br />CONTRACTOR A K p r ~ I ~ ~ n~ Phone (~ Lic. No. <br />Mailin Address . o. ~K loq cxw. T 7 S~8 <br />Name/Trtle (Please type or print) <br />Scott A. Lew;s/ Mrzr.a~e~ EhJ, <br />air cc e V Signature Date <br />~ ,Q <br />V <br />
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