Laserfiche WebLink
I Fpm No. WELL CONSTRUCTION AND TEST REPORT For Office Use Only <br />ETA T E OF COLORADO, OFFICE OF THE STATE ENGINEER <br />vw <br />? <br />005 1313 Shuman St., R0=81 8, Denver, CO 80203 <br />04 <br />/2 <br />Phone - Info (303) 8613.3587 Main (303) 866-3581 <br />Fax 303 866-3585 y Jlwww.water state co.us <br />1, WELL PERMIT NUMBER: - <br />2. WELL OWNER INFORMATION PowerTech (USA), Inc. <br />NAME OF WELL OWNER: <br />MAILING ADDRESS: 5575 DTC Parkway, Suite 140 <br />CITY: Greenwood Vi agesTATE: CO ZtPCODe 80111 <br />- <br />- <br /> <br />7 <br />9 7528 <br />303) <br />- <br />TELEPHONE NUMBER. <br />?? , Range 6 7 0 E or (J W <br />WELL LOCATION AS DRILLED: NE114, NE 114, Sea EL, TwP. -Lo- [? N <br />3 <br />. <br />5 <br />DISTANCES FROM SEC. LINES: =0 ft from [v1N or ? S section line and ft. from ? E or l:?W section line. <br />SUBDIVISION: - . LOT , BLOCK FILING (UNIT) <br />Owner's Well Designation: T N (1 R _ <br />Optional GPS Location: GPS Unit must use the fonovAng settings: Format must be UTM. Units Easfang: <br />must be meters, Datum must be NADti3, Unit must be set to true N, 0 Zone 12 or ? Zone 13 <br />STREET ADDRESS AT WELL LOCATION: Northin : <br />GROUND SURFACE ELEVATION feet DRILLING METHOD Mud Rotary <br />DATE COMPLETED -1 5 - 0 9 TOTAL DEPTH 5 6 0 feet DEPTH COMPLETED !j -S 6 feet <br />S. GEOLOGIC LOG: 6. HOLE DIAM in. From ft To fi) <br />Depth Type Grain Size Color Water Loc n r,'13 <br /> 10 1/2 533 557 <br />- <br />_ T.ararnj p 5 3 4 557 559.5 <br />480-56 _ <br />Fox ill 7. PLAIN CASING. <br /> OD (In) Kind Wall Size (in) From (ft) To (ft) <br />531 <br /> 6 PVC SDR17 +1 <br /> <br /> <br /> <br /> PERFORATED CASING: Screen -Slot Size (in): .030 <br />6 <br /> 3 PVC 531 55 <br /> <br /> <br /> <br /> S. FILTER PACK S. PACKER PLACEMENT: <br /> Material s i l i ca s toe <br /> Size 1 20 <br /> interval 5 1-556 Depth <br /> 0. GROUTING RECORD <br /> Material Amount Density Interval Placement <br /> 531 Hallibu <br />13 lb <br />0 <br />l <br />7 <br /> s <br />- <br />s <br />6ga <br />Bent- 8 <br />Remarks: C em <br /> <br />DISINFECTION: Type Amt. Used <br />11 <br />. <br />12. WELL TESTAATA Check box if Test Data is submitted on Form Number GINS 39 Supplemental Well Test <br />TESTING METHOD <br />Static Level it Dateftime measured: Production Rate gpm. <br />Pumping Level ft. Dateflime measured Test Length (hra) <br />onitor well to be tested at a later date. <br />Remarks: <br />l have read the statements made herein and know the contents thereof, and they are true to my knowledge. This document is signed and oeMed in <br />13 <br />. <br />accordance with Rule 17.4 of the Water Well Construction Rules, 2 CCR 402-2. rrhe filing of a document that contains false statements Is a violation of <br />section 37-91-1081 a C.R.S. and Is halals by-fines to 35000 and/or revocation of the wntra license. <br />N i.lcenseNumber. <br />Company <br />ame: Sharpe Drilling Company 9523 <br />Maijino Ad ii : P Q`.BOx 20147 Cheyenne, WY 82003 <br /> PrirltName and Title Lyle Sharpe, President DTo-26-0 <br /> <br /> <br />3-MN <br />MM3 <br />ton <br />Attachment E