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/'~ <br />"ausNsi ~ ~I-L CONSTRUCTION AND TEST REPORT <br />t ,j~~ STATE OF COLORADO, OFFICE OF THE STATE ENGINEER <br />t. WELL PERMIT NUMBER fa omos troe ay <br />~t?~~~¢~C! ~f~~~ <br />~J <br />2 OWNER NAME(S) Michael Miller <br />Mailing Address t 9 3 3 E . 16 th . St . <br />City, SL Zip [;rPP7PV co. A06"tl ~Q~,~ •~ r~~ , <br />;rrn.lt eesouacF.9 <br />sTAC£tNt65~ <br /> Phone (303) 356-2594 - <br />3. WELL LOCATION AS DRILLED: SE 1/a NW 1/a, Sec. 10 Twp. 5 N ,Range 6 5 W <br />DISTANCES FROM SEC. LINES: <br />244n ft. from Sec. line. and 2730 tt. from East Sec. line. OR <br />mrm a ) ieut a wasp <br />SUBDIVISION: LOT BLOCK FILING(UNIT) <br />STREET AOORESS AT WELL LOCATION: <br />4. GROUND SURFACE ELEVATION ft. DRIWNG METHOD Rotary <br />DATE COMPLETED 11-12-91 TOTAL DEPTH 37 ffi DEPTH COMPLETED 37 tt. <br />5. GEOLOGIC LOG: <br />. wpm Deralp6on m Matedel tyype. Stm, cola, Water lncagon) <br />n_~ Top soil 6. HOLE DIAM. (ln.) From (ftj To (ft) <br />S 7 / S 0 3 7 <br />Z-tn 1/4" gravel <br />to-ts k" gravel <br />1 5-20 1 /4" to k" gavel x 7. PLAIN CASING <br />2n-79 pea ysavel w/sand x OD (n) land Wall S¢e From(tt) To(ft) <br />z~-'t7 Sandv clay Iarav) F 5/A SYPP1 2~0 ~] <br />~ <br /> _ <br />_ <br />_ PVC .277 5 17 <br /> <br /> <br /> PERF. CASING: Screen Slot Size: 0 ~ 5 <br /> H_S"G .2SO <br />~ <br />2 <br />1 <br />~L <br /> _ <br />_ <br />__. <br />. <br /> <br /> <br /> <br /> & FILTER PACK: 9. PACKER PLACEMENT: <br /> Material Type <br /> Slze 3 8 <br /> Interval 6-37 Depth <br /> <br /> 10. GROUTING RECORD: <br /> Material Amount Density Interval Placement <br />REMARKS: Cement 1 Sk. 1.86 0-6 poured <br /> <br /> <br />1 DISINFECTION: T e HIH Amt. Used 1 # <br /> WELL TEST DATA: ^ Check box if Test Oata is submitted on Supplemental Form. <br />TESTING METHOD 13ailed <br />Static Level 6 ft. Da[e(Time measuretl 11-12-91 ,Production Rate 15 gpm. <br />Pumping level 7 ft. DateRime measured 11-12-91 ,Test length (hrs.) 2 Hrs. <br />Remarks <br />3. 1 have read e,e amtemants made heroin and know tllo contarea mereot, aM met meY are true ro my krrowledge. (Pursuant W Sectlon 24<-104 (13)(x1 C.fl.g., fha makin <br />of false awemarda heroin fAnbgtUtea perjury In me second degree and b punishable ee a clpaa f miademaana.l <br />CONTRACTOR R & R,fpt911 ti Pmm~ Tnc- Phone(i03)~3_311A Lic.NO.857 <br />Mailing Address <br />Name~tle (Please type or print) <br />(OWNER Signature Date <br />ti-27-91 <br /> <br />