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F <br /> <br />ORM NO. <br />GWS- <br />/ <br />11 <br />90 0l <br />11/ <br /> <br />WELL CONSTRUCTION AND TEST REPORT <br /> <br /> <br />STATE OF COLORADO, OFFICE OF THE STATE ENGINEER <br /> <br />For Office Use only <br />1. WELL PERMIT NUMBER 163755 h0. W. -1 <br />:.. OWNER NAME(S) Cotter Corporation <br />Mailing Address 12596 West Bavaud Avenue, #350 <br />City, St. Zip Lakewood, Colorado 80228 <br />Phone( 303 ) 980-1292 <br />3. WELL LOCATION AS DRILLED: NW 1/4 SE 1/4, Sec._ 25 Twp. 1 S , Range_ 71 W . <br />DISTANCES FROM SEC. LINES: <br />2165. ft. from South Sec. line. and 1773 ft. from East Sec. line. OR <br />(north or south) (east or west) <br />SUBDIVISION: LOT BLOCK FILING(UNIT) <br />STREET ADDRESS AT WELL LOCATION: <br />4. GROUND SURFACE ELEVATION 6590.4 ft. DRILLING METHOD Auger <br />DATE CCMPLETED 11-12-81 TOTAL DEPTH 25.5 ft. DEPTH COMPLETED 25.5 <br />ft. <br />5. GEOLOGIC LOG: <br />Depth DeucAption of Material (Type, Size. Color, Water Location) <br />0` - 3' Fill - cs. -angular cobbles with 6. HOLE DIAM. (in.) From (ft) To (ft <br />4" 0 25. <br />sine cs, gravels <br /> <br /> <br />- brown cs. rave wi cobbles 7. PLAIN CASING <br />and cs. to me d. sand OD (n) Kind Wall Size From(ft) To(ft) <br /> 2-•1 2" PVC Sch 40 +2.5 17.0 <br />13' - 17' Fine to cs. sand gravelly and 2-•1/2" PVC Sch 40 22.0 24.0 <br />silty <br /> <br />17' - 23' Fin o s si l.tv sand with PERF. CASING: Screen Slot Size: - <br />somP gravel 2-1/2" PVC Sch 40 11.0 <br /> <br />23' - 25.5' Bedrock, competent amphibolite <br /> <br />25 <br />5 T <br />D <br />. <br />. <br />. <br /> 8. FILTER PACK: .9. PACKER PLACEMENT: <br />*Hit water @ 7-01 Material Silica `Sand T <br />e <br /> Size ,, 8- es yp <br /> Interval <br />94' <br />15 1 De <br />th <br /> - <br />- p <br /> <br /> 10. GROUTING RECORD: <br /> Material Amount Densit <br />Inte <br />l Pl <br /> <br />REMARKS:. y <br />rva <br />acement <br />Neat Cement 0' - 1.5' Manually <br /> <br /> <br />11, DISINFECTION: Type Amt. Used <br />12- WELL TEST DATA: Check box if Test Data is submitted on Supplemental Form. : <br />TESTING METHOD <br />Static Level _ ft. Date/Time measured , Production Rate gpm. <br />Pumping level ft. Date/Time measured , Test length (hrs.) <br />Remarks <br />3. 1 have read the statements made herein and know the contents thereof, and that they are true to my knowledge. [Pursuant to Section 244-104 (13)(a) CAS, the making <br />of false statements herein constitutes pedury, in the second degree and is punishable as a class 1 misdemeanor.) <br />CONTRACTOR Cotter Corporation _ Phone { 303) 980-1292 Uc. No. N . <br />Mailing Address 12596 West Bavaud Avenue, #350 - Lakewood CO 80228 <br />Name/Title mas P?e Le type or print) <br />Mine Geolocipe Signature, Date <br />? ,;,1 1,_-=' , --, -/ `' -