Laserfiche WebLink
. ? vvcu: ?urv5 I HUt; I IUN AND TEST REPORT <br />cvs 3t I STATE OF COLORADO, OFFICE OF THE STATE ENGINEER <br />11/90 <br />WELL PERMIT NUMBER! 15701-A <br />OAR NAME(S) BERTHA W SHAW <br />Mailing Address PO BOX 67 <br />City, St. Zip WALDEN, CO 80480 <br />Phone: 970 723-4931 <br />L ATION AS DRTT.T.Fn• NEI/4 NE1/4,Sec.' 25 Twp. <br />DISTANCES FROM SECTION LINES! <br />942 ft. from NORTHSec. line 1184ft. from <br />For Office Use ony <br />ZV'-r14'? see <br />GWS31-92-02 <br />5 N, Range 43 W <br />EAST Sec. line. <br />0 .0 <br />DATE COMPLETED : <br />t;EOLOGIC LOG: <br />0 FT. DRILLING METHOD: ROTARY <br />TOTAL DEPTH: f t. nrPTR r(NiPT.7rM <br />0 90 SAND CLAY'LAYERS <br />90 120 GRAVEL LIMEROCK LAYERS <br />120 140 SAND CLAY LAYERS <br />140 180 SAND CLAY LAYERS <br />180 210 GRAVEL <br />210 215 CLAY <br />215 260 GRAVEL <br />HOLE DIAM. (in) FROM (ft) Tt) ft. <br />9 0 260 <br />0 0 0 <br />0 0 0 <br />PLAIN CASING: <br />0 ¦ <br />Material Amount Densi y Interval Placem <br />CEMENT 4?'? S ?r '044 <br />0 0 <br />0 0 <br />Size 1 <br />Interval 65-260 <br />GROUPING RECORD: <br />OD KIND WALL SIZE FROM(ft) <br />5 STEEL .188 +1 <br />5 PVC .250 20 <br />0 0 <br />0 0 <br />PERF. CASING: Screen Slot Size: .016 <br />5 PVC .250 240 <br />0 0 <br />0 0 <br />0 0 <br />FILTER PACK: PACKER PLACEMEy <br />Mat. GRAVEL NONE <br />DISINFECTION TYPE: CHLORINE AMOUNT USED: 12 OUNCES <br />WELL TEST DATA : ("-'I <br />1.? Check ho:; if Test Data is submitted on Supplemental Form. <br />Testing Method: SUBMERSIBLE <br />Static Level: 65 ft. Date/Time 10/03/01/2 00 production Rate 15 <br />Pumping Level: 67 ft. Date/Time 10/03/01/3 00 Test Length (hrs) 1 <br />3. I hr.-* read the staterrwix made henln and know t w oontents Owed, and that they w ew to my knowledge. (pursuant to Sectlon 24.4.104 (13) (a) C. R 5 . m <br />o( lake statements h"n oonedbAes penury in dw seoond degree and Is punWwN* w a class 1 mfademeanor.) <br />CONTRACTOR Twiss_& Wilson Drilling, Inc Phone (970) 332-5834 Lic. No. 9 <br />Mailing Address 36611 Hwy 385 Wray ro Rn798 _ <br />4ame/T'rtle (Please type or print) Signature Date <br />Raymond L. Twiss - President <br />'r y I?B'U