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<br />I i <br />~i <br />I <br />I <br />i <br />1 <br />I <br />I <br />I~ <br />I <br />~) <br />roan :o. <br />cus•3t • <br />tvvo WELL CONSTRUCTION AND TEST REPORT <br />STATE OF COLORADO, OFFICE OF THE STATE ENGINEER Fo< oalro the any <br />,~ t r~ <br />t~.i:~I,r1.Qj ~~~~ <br />1. WELL PERMR NUMBER <br />2 OWNER NAME(S) Michael Miller <br />Mailing Address 1993 F.. 16 th. St. <br />Cay. SL. Zlp (:r Pal P}+. rn. R(1631 ~~~,QSt~ <br />v.i=re.esouR~ <br />SIRIS it7Uu.~ <br /> Phone (303) 356-2594 - <br />3. WELL LOCATION AS DRILLED: SE 1/4 NW 1/4, Sea i 0 Twp. 5 N ,Range 6 5 W <br />DISTANCES FAOM SEC. LINES: <br />~49n ft. from Nor~th_Sec, line. and ~_R from East Sec. line. OR <br />( or eoaN) (u>t « rnnp <br />SUBDMStON: LOT~SLOCK FILING(UNIT) <br />STREET ADDRESS AT WELL LOCATION: <br />4. GROUND SURFACE ELEVATION R DRIWNG METHOD Rotary `• <br />DATE COMPLETED 11-12-91 TOTAL DEPTH 37 R DEPTH COMPLETED 37 ft. <br />5. GEOLOGIC LOG: <br />1xpN npcdl%bn d araesA.l (type. sae, cau, wam, I.ofadora <br />~_~ TOP Soil & HOLE DIAM. (in.) From (ft) To (ft) <br />8 7 8 0 3 7 <br />2-10 t/9" gravel <br />tn_ts k" aravel <br />15_2Q_I /4" to k" aravel x 7. PWN CASING <br />7n_g Paa ~ravPt w/sand x OD (n) Kind Wall Size From(ft) To(ft) <br />z~_z7 Sandv clav (arav) (~ S/R Stpr>l .750 4l _@ <br /> _ <br />PVC .277 5 17 <br />S. <br /> _ <br /> <br /> PERF. CASING: Screen Slot Size: 035 <br /> H_R.R .250 ~ ~~ <br />~ <br /> _ <br />_ ~ ~ <br />-~ <br /> .. <br /> <br />_ I & FILTER PACK: 9. PACKER PLACEMENT: <br /> Material r;raval Type <br /> Size 3/8 <br /> Irnerval E-37 Depth <br /> <br />_ 10. GROUTING RECORD: <br /> Material Amount Density tntervat Placement <br />REMARKS: ement 1 Sk. 1.86 0-5 pcured <br /> <br /> <br />1 DISINFECTION: T e HIH Amt. Used 1 # <br /> <br />~ WELL TEST DATA: ^ Check box it Test Data is submitted on Suppiemental Form. <br />TESTING METHOD Bailed <br />Static Level 6 ft. Datemme measured 1 1-12-9 1 ,Production Hate 1 5 gpm. <br />Pumping level 7 ft. Date~me measured 11-12-91 ,Test length (hrs.) 2 Hrs. <br />Remarks <br />3. I Mw reatl dm sfetertlenb made nereln and imow the cereaM Nmeot, and Net Ney w Ova m mY knaMadga. [Pursaanl m Sectl~n 2H-1fk (1T(e( G.RS., the maki <br />d false eWamerM Naraln opnedWlea penury in Ne eemnd dprea and is punhMWa as adesa 1 miademeatmr.l <br />CONTRACTOR R & e Wa11 ~ Pump 7nr•_ Phone(~nv)~5't_z11R Lic.NO.R57 <br />Mailing Address <br />Name/Title (Please type or print) <br />OWNER Signature Date <br />11-27-91 <br />