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,WJIL=6]] <br />COLORADO DIVISION OF WATER RESOURCES <br />THIS FORM MUST BE SUBMITTED 1313 Sherman Street Room 318 <br />WITHIN 60 DAYS OF COMPLETION Denver, Colorado 80203 <br />OF THE WORK DESCRIBED HERE <br />ON. TYPE OR PRINT IN BLACK WELL COMPLETION AND PUMP INSTALLATION REPORT ill~ll FNfi•12-Y <br />INK' PERMIT NUMBER 1322$4 <br />WELL OWNER Vittsburah ~ ?lit~UAY COa~ bi~piny Co. SM % of the ~ '/. of Sec lrl , <br />ADDRESS U2G S`[~11 ~a~M Str Ue~VL~ CO• i30Z22 T ~.4L -_. R. ~Mt~ 6th P.M. <br />DATE COMPLETED ~pt~ i1 . 19 ,~. HOLE DIAMETER <br />WELL LOG -~- in. from ~_ to -1~ (t. <br />_~_ in. from _~_ to -14_- f[. <br /> <br />From <br />To <br />Type and Color of Material Water <br />Loc <br />0 2.5 ak• praM clay <br />Z.5 12 tat~rbaddtd :hale and <br /> alltstoaai coaly at top <br />12 74 lt. grays Etna grala~d % <br /> falldat0aa (K6 SandatoM) <br /> TOTAL DEPTH 74 ft• <br /> Use a dditional pages necessary to complete log. <br />in. from to ft. <br />DRILLING METHOD air/rud rotary <br />CASING RECORD: Plain Casing <br />Size ~-j/j$I kind i_(b/L^~lail~rom ~ to ~- ft. <br />Size __ & kind from to ft. <br />Size & kind from to ft. <br />tN+cata~d iron 14 to 74 ft. <br />Perforated Casing <br />Size M A & kind ~A from to ft. <br />Size & kind from to ft. <br />Size - & kind from to ft. <br />GROUTING RECORD <br />Material -ortlao0 oarant <br />Intervals 0 - 14 it• <br />Placement Method arl>rity <br />GRAVEL PACK: Size <br />Interval ~A <br />N/A <br />TEST DATA <br />Date Tested <br />Static Water Level Prior to Test <br />Type of Test Pump <br />Length of Test <br />Sustained Yield (Metered) <br />Final Pumping Water Level <br />19 <br />ft. <br />