PERMFILE138116

• Permit No: M2001012
• IBM Index Class Name: Permit File
• Doc Date: 3/23/1992
• Doc Name: STATEMENT OF BENEFICIAL USE
• Media Type: D
• Archive: No

PUMP
AND TEST REPORT
STATE OF'COLORADO; OFFICE OF THE STATE ENGINEER
:.~ WELL PERMfT NUMBER 1620
OWNER NAME(S) J 3 L Farms_ Lynn Shook
Mailing Address 30500 Co. Rd. BB
Ciry, St. Zip akrp~ rn Ro720
Phone ( ,,,,,,) 6452
For Offiu Uw Dory
+/ ~.
M r~/`
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WELL LOCATION AS DRILLED: _~t/4 ~~1/4, Sec.~L Twp. 1 _fL, Range 52
DISTANCES FROM SEC. ONES:
1440 h. from South Sec. line. and 2007 1L from East Sec. line.
npN a uum~ (Wl or wit)
SUBDIVISION: LOT_BLOCK FIUNG(UNIT)
STREET ADDRESS AT WELL LOCATION:
4. PUMP DATA: Type Submersible Installation Completed 3/21/92
Pump Manufacturer Could Pump Model No. 13EM
Design GPM 15 at RPM 3450 HP 1 ,Volts 230 ,Full Loatl At
Pump Intake Depth 140 Feet, Drop/Column Pipe S¢e 1L~~ Inches, Kind PVC
TURBINE DRIVER TYPE: LJ Electric LJ Engine LJ Other
Design Head feet. Number of Stages Shaft size inches.
OTHER EQUIPMENT:
Airline Installed ^ Yes ^ No, Orifice Depth fL Monitor Tube Installed ^ Yes ^ No, Depth
Flow Meter Mfg. Meter Serial No.
Meter Readout ^ Gallons, ^ Thousand Gallons, ^ Acre feet, ^ Beginning Reading
6. TEST DATA: ^ Check box if Test data is submitted on Supplemental Form.
Daze 3/21/92
Total Well Depth ~ 159 Time 1 hr. _
Static Level ~ Oq Rate (GPM) 15 _
Date Measured 3/21192 Pumoinq Lvl. 116
7.I DISINFECTION: Type HTH Amt. Used
1 cup
B.I Water Quality analysis available. ^ Yes ®No
Remarks
0. I have read the statements made herein and know the contents thereof, and that they are true to my knc
(Pursuant to Section 2a~-10a (13)(a) C.R.S., the making of false statements herein constitutes perjury in the
degree and is punishable as a class 1 misdemeanor.]
CONTRACTOR Kttntz Pwno ,c We11 Suooly Phone ( 30~ 522-2035 Lic. No. 1085 .
Mailing Address 'r 80722
Name/Title (Please type or print) Signatur ~~ ~ ~ Q/~ Date
Jerald 4f. Kun[z ~~ fti`,~'r ~ 3/21/92