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wnl+do. <br />GW331 <br />. )wv+ WELL CONSTRUCTION AND TEST REPORT <br /> <br />STATE OF COLORADO, OFFICE OF THE STATE ENGINEER Por office use Doty <br />t. WELL PERMfI' NUMBER''tM-379/O ~ntw-e) <br />2 OWNER NAME(S) Nol..ran, r,.re. <br />Mailing Address _ 3500 St~'e N;w rJav / zo <br />City, Sl. Zip _F/o.en+ce <br />C.~ B/z ~o <br /> r <br />Phone (7y ) S`/- I2o4 <br />3. WELL LOCATION AS DRILLED: N E t /4 S E 1/4, Sec. 17 Twp. ! 9 S ,Range Co ~ W <br />DISTANCES FROM SEC. LINES: <br />22r~0 (t. Irom ~S~TSec. line. and 550 tt, from Sec. line. OR <br />SUBDIVISION: LOT_ BLOCK - FILING(UNIT) <br />STREET ADDRESS AT WELL LOCATION: <br />4. GROUND SURFACE ELEVATION $/7S it. DRIWNG METHOD ~ir FI-a.Wmer <br />DATE COMPLETED 5f-/8 - oo .TOTAL DEPTH /~If'.J ft. DEPTH COMPLETED // ~ IL <br />5. GEOLOGIC LOG: <br />Depth Oeacriptlon of Material (type, Slza, Color, Water Location) <br />. 6. HOLE DIAM. (in.) From (It) To (ft) <br />/O O 83 <br />9 S ~ /~3 <br />O- 82 ~i,.re1 o.Je 5 e r46d I2 4S <br />6e.~fL~t t( ;N ord ..,;u;Ny ~~-t. <br /> 7. PLAIN CASING <br />2 - ' Sa.~ 7<oNC ar OD (in) Kind Wall Size From(ft) To(ft) <br />1 <br />v..w.'i'iwX I{', raca,a 7'o Fr', 9rn~ <br />A/EG ~ et 0. 322 -~(. 8 <br />r <br />T rn.++ s <br />TZ - 9s' ~ yc cl,. 40 't f z <br />~ <br />r <br />rf. a~ rev }y..n. 95 - // B' _ <br />'f ~ yL Se.).. CFO t !3 <br /> <br />ray t> 4 q <br />[/B ~ - /5~3 S a c <br />rdu_ PERF. CASING: Screen Slot Size: o, olo" <br />_ <br />f <br />~ // ~r _ ~ VC 5~1.. Yo ~~ <br /> <br /> <br /> +f~ set,, ~O = O./2S" rx.(/SiT <br /> <br /> 8. FILTER PACK: 9. PACKER PLACEMENT: <br /> Material Co/orado Srrrua Type <br /> Size f o - 20 _ <br /> Interval 3 f - 1 Zo' Depth <br /> <br /> 10. GROUTING RECORD: <br /> Material Amount Density Interval Placement <br />REMARKS: Sw..r ..ae ca.. s w 8 " s c ro..:f• ' ' G yis.clt...%x O- 8 'n n.y~~ <br />Y <br />~/4 cs.L ~ ~tn,.~ O - 83r s.y~ Or.w./'e~ .. ~~ a O-2/o <br />ew~- <br /> <br /> <br />1 DISINFECTION: T e ~ohrG- Amt. Used <br /> WELL TEST DATA: ^ Check box 'tf Test Data is submitted on Form No. GWS 39 Supplemental Well Test. <br />TESTING METHOD iJoNa <br />Static Level /05,10 [t. Date~me measured S ~ oc /2: So ,Production Rate gpm. <br />Pumping level fL Date~me measured .Test length (hrs.) <br />Remarks ' <br />3. I have read Iha elelemenla made herein and know the coolants thereof, and Thal they ere 4ue to my knowledge. (Pursuant to Saellon 24-4-104 (13)(s) <br />C.RS., the making of false statements herein eonetiluteo perjury N the second degree end la punishable as a class 1 misdemeanor.] <br />CONTRACTOR ~ Phone ~~ Lic. No. <br />ail ddr ss <br />N me/THIe (/P~l'ease type or print) <br />~O/J4/I -(. ~/NGr~ ~~./CO NJK /7 atilt Sig - - - fin[/n <br />r,//Y4~"'T ~' /~ Date C~ <br />S~ ( -~ <br />