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F°"" "o. <br />GW53] <br />tags. WELL CONSTRUCTION AND TEST REPORT <br /> <br />STATE OF COLORADO, OFFICE OF THE STATE ENGINEER <br />a Rm C For office use ony <br /> <br />- <br />t WELL PERMIT NUMBER a 5 7 `'~ 5 ~( <br />2 OWNER NAME(S) seeecc~ t'o~., ~ Co• <br />Mailing Address "- -~ '^ pex67o <br />City, St. Zip ~. ~ C [ 6 3 <br /> Phone ( p) - <br />3. WELL LOCATION AS DRILLED: 5 W 1/4 S'W 1/4, Sec. a 6 Twp.~ N ,Range g g ~ <br />DISTANCES FROM SEC. LINES-~T <br />l `et5O ft. from So~Sec. tine. and ~~ (L from 6+1Sec. line. OR <br />SUBDIVISION: LOT_ BLOCK FILING(UNI'1] <br />STREET ADDRESS AT WELL LOCATION: <br /> <br />4. / <br />GROUND SURFACE ELEVATION ~O ft. DRILLING METHOD V'e~a~y rt / GJ ~ r-e/t <br />DATE COMPLETED ~I ' I D - ~ `{ .TOTAL DEPTH D .3 ft. DEPT COMPLETED39~ • ~ ft. <br />5. GEOLOGIC LOG: <br />Depth Description of Material (Type, Size, Color, Water Location) <br />p-~D 50~1~ ues.~dl.Qr.eeQ 1rec~ 6. HOLE DIAM. (in.) From (ft) To (ft) <br />Jr. 6 a S ~ Uo 1.3 <br />',l b-69 ~ 1•N'FEN ~cfo~St't le t5i li Sd rnE <br />_ <br />--I1 eel- Lekt^ <br />-11-125 2Kie,.(oodk.QacQSL.~e~s:l+sde~+¢ 7. PLAIN CASING <br />- • S Co - W~o:2 OD (in) Fend Wall Size From(it) To(ft) <br />I~g.5-146 S,.devIa..A.k s>,.Olets:lisdey.a 3-5 ~8o PUG D.~3" O 3Y7.6 <br />Q - 54 (_M. <br />aoZ -any ~~ae.. bees sl,~.le,s; ds'~e`.~ <br />~9t~-3o1 C.~e,t- uAe41iV• fJcld-C~. <br />'tc~l - ~0 6 6rKa. S; I+ ado ~ p PERF. CASING: Screen Slot Size: p, 0 30 " <br />306- 3~2 Seca l - lor..~err Wo l& Cv . 3.5 ~ go PU c.. o- a 3.' 3417.6 3 L• I <br />3aa -3~G sH<tQ <br />326 -3z`d caw <br />3d8 -360 SnnBS~oN~ (s ~• <br />~S6C~-363 Gt.e.•r c14..tCnass.ble c~c(n Inat~ <br />363-401 St Idcrleh cewn s_I1glP_ ti 8 FILTER PACK: f(~~ 9. PACKER PLACEMENT: <br />Sa~S-Soar Material S t (icg Sr4wcX Type .~, <br /> <br />Size 10-~O _ <br /> Interval 32 ~ 6.8 -''101.3 Depth <br /> <br /> 10. GROUTING RECORD: <br /> Material .amount Density Irnerval Placement <br />REMARKS: 1 <br />'1~tttco«~e~ b¢~ ern:\~ 4b e s 'ot•b1~i~ 307 3:t~ etir <br />~~- <br />> ~6.~yta~~ ' u-~~ <br />t3 4 ern ~'oNi~E Ctni - <br />Ga d' ..~L 3~ O- e" tiv <br />1 DISINFECTION: Type 4LOLl@ kaorn : ~oe ~ e l I Am[. Used <br /> WELL TEST DATA: ^ Check box 'rf Test Data is submitted on Form No. GWS 39 Supplemental Well Test. <br />TESTING METHOD <br />Static Level ft. Date/Time measured ,Production Rate gpm. <br />Pumping level ft. Date~me measured ,Test length (hrs.) <br />Remarks <br />3. I have read the statements made herein and know the contents thereof, and that they are true to my krrowledge. [Pursuant to Section 24-4-704 (13)(a) <br />C.R.S., the making of false IsfatemeMS herein constitutes perjury in the second degree and is punishable as a class t misdemeanor.] <br />CONTRACTOR ~ d~S'ycrn l~mr%"-c°~ t~r- ] ~•'tj Phone (9 ~.-) 3is &~ v5 Lic. No. i~ <br />Mailin Address % • u rY~ r 7s4 e^~•c ~'~. r414 <br />Name/Title (PlJ~ease type or print) Signature j!/f Date <br /> <br /> <br />. J <br />l.~ ln) C ~ ~. S~ C *~ ~~ <br />