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COLORADO DIVISION OF WATER RESOURCES <br />THIS FORM MUST BE SUBMITTED 1313 Sherman Street -Room 318 <br />WITHIN 60 DA V$ OF COMPLETION Denver, Colorado 80203 <br />OF THE WORK DESCRIBED HERE <br />ON. TYPE OR PRINT IN BLACK WELL COMPLETION AND PUMP INSTALLATION REPORT wll FBR-11•C <br />INK. PERMIT NUMBER 1322bZ <br />WELL OWNER Flttfburgh & Htdrty COai F;intngso. St. '/. pr the 5E '/. of Sec. 16 , <br />ADDRESS 172J S• ilallatra ~ Olanver~ CIJ. ti0221 T.~tI R.~i ~ 6th P.M. <br />DATE COMPLETED Septes,bar 4~ 19 ~ HOLE DIAMETER <br />WELL LOG ~L in. from ~ to ~ ft. <br /> <br />From <br />To <br />Type and Color of Material Water <br />Loc. <br />0 12 cittyfip stlt aad grawi (ilas ) % <br />12 Y3ft le. gryr :Mle-lert: shat. <br />210 252 t:oal~ car-. bale aad <br /> interbttldd~d tandtto~e <br />262 320 lt. gny~ fits grattwd % <br /> ~~tldttante (K6 ss.) <br /> 324 ft• <br /> TOTAL DEPTH <br /> Use a dditional pages necessary to complete log. <br />1~ in. from ~__ Io 360- ft. <br />_~_ in. from ~~ to ~- ft. <br />DRILLING METHODS/~ fury <br />CASING RECORD: Plain Casing <br />Size 3_.13$ kindflha_rn.__Lsafrom --- to 353- ft. <br />Size __ & kind from to ft. <br />Size & kind from to ft. <br />Unlt~t~d frog 254 to 320 ft. <br />Perforated Casing <br />Size N/A & kind M/A from to ft. <br />Size & kind from to ft. <br />Size __ & kind - from to ft. <br />GROUTING RECORD <br />Portland coat <br />Material <br />Intervals ~ ~ ~~ ft• <br />Placement Method GtsrYilalal 11Nll~bor~ dliplaq• <br />M/A <br />GRAVEL PACK: Size <br />Interval N/A <br />TEST DATA <br />Date Tested <br />}g <br />Static Water Level Prior to Test fltrlrttl9 ft. <br />Type of Test Pump <br />Length of Test <br />Sustained Yield (Metered) leas thaa •25 9Pr 0 yr•il <br />Final Pumping Water Level <br />