Laserfiche WebLink
WELL CONSTRUCTION AND TEST REPORT Far Office Use Only <br />FORM NO. <br />Gvrl%31 STATE OF COLORADO, OFFICE OF THE STATE ENGINEER <br />0412005 1313 Sherman SL, Roan 818, Denver, CO 80203 <br />Phone - Info (303) 886-3587 Mein (303) 866-3581 <br />Fax 303 866-3688 htt lMvw.wate xtate.co.us <br />1. WELL PERMIT NUMBER: 0 4 8 5 0 2- MH <br />L WELL OWNER INFORMA`nON <br />PowerTech (USA), Inc. <br />NAME OF WELL OWNER: <br />5575 DTC Parkway, Suite 140 <br />MAILING ADDRESS: <br />CITY: reenwoo 1 ageaTA• E: ZIP CODE: <br />TELEPHONE NUMBER: - <br />WELL LOCATION AS DRILLED: SW 114, NE 114, Sec. 3 3 Twp. 1 0 ff Nor [IS, Range 67 0 E or 0 W <br />3 <br />. <br />DISTANCES FROM SEC. LINES =9 4 fir from El N or 0 S section One and 3 6 ft. from 0 E or [f W scion line. <br />SUBDIVISION: LOT BLOCK . FILING (UNIT) 3 3 <br />D 8 - <br />Order=s Weil Designatiflr.N <br />_ . <br />Optional GPS Location: GPS Unit must use the foaovring settings: Format must be UTM, Units Fasting: <br />must be meters, Datum must be NA083, Unit must be set to true N, 0 Zone 12 or 0 Zone 13 <br />STREET ADDRESS AT WELL LOCATION: Northin : <br /> <br />u Rotary <br />. GROUND SURFACE ELEVATION feet DRILUNG METHOD <br />6 3 4 <br />feet <br />DATE COMPLETED 9-18-09 TOTAL DEPTH 636 feet DEPTH COMPLETED <br />GEOLOGIC LOG: <br />5 S. HOLE DIAM in. From ft To ft <br />. <br />Depth Type Grain Size Color Water I 0 614 <br /> 0 1/2 614 635 <br />----- --r- ---"_ <br />-r <br /> 635 <br />374 <br />1 0 - 4 7. PLAIN CASING: <br /> <br />455-636 <br />FoxHills {{ FF <br />OD r_) PVC Wall Size 7rn) From (ft) 61ft <br /> <br /> <br /> <br /> UJU <br /> <br />irn): <br />PER ORATEp C SING: S een Slot Size <br />80 613 ?T33 <br />c <br />VC <br />F <br /> i <br />s <br />3 P <br /> <br /> <br /> <br /> 8. RLTER PACK: 9. PACKER PLACEMENT: <br /> Mater s 11 i c a s a <br /> <br /> Size 1 0/20 <br /> interval 613-633 Depth <br /> 0. GROUTING RECORD <br /> Material Amount 1) ?nsrty interval Placement <br /> 613 Hallib : <br />131b <br />1002 <br />1 <br />0 <br />B <br />t <br /> s <br />- <br />en <br />ga <br />s <br />- <br />Remarkr: m <br /> <br />11. DISINFECTION: T e AmL Used <br />12. WELL LL TEST D, ATA_ Check box if Test Data is submitted on Form Number GWS 39 Supplemental Well Test. <br />TESTING METHOD <br />Static Level ft. Datelrime measured: Production Rate gpm. <br />Pumping Level ft. Date/Time measured Test Length (hrs) <br />- <br />For well to be tested at a later date. <br />Mori <br />Remarks: <br />1 have read the statements made herein and know the contenis thereof, and they are true to my knowledge. This document is signed and certified in <br />13 <br />. <br />accordance with Rute 17.4 of the Water Wes Consttu0bon Rules, 2 CCR 402-2. ('The filing of a document that contains false statements Is a violation of <br />section 37-91-108 1 e , C.R.S., and is punishable fines to $3000 and/or revocation of the contracting ticense• <br />Company Name: Sharpe Drilling Company 307 632- 9523 License Number. 131 <br />hJlailin Address:. 'P:O/-BOx 20147 Cheyenne, WY 82003 <br />Signature- ti--! P"rrtNa'neand Title Lyle Sharpe, President 10Date <br />-26-09 <br /> <br />-MUU l <br />/fUU1 <br />ton <br />Attachment E