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FORM No. <br />11/-31 <br />1 1/40 WELL CONSTRUCTION AND TEST REPORT <br /> <br />STATE OF COLORADO, OFFICE OF THE STATE ENGINEER For Office Use only <br />1. WELL PERMIT NUMBER 163757 <br /> OWNER NANIE(S) Cotter Corporation <br />Mailing Address es ayau venue, <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. 2 S , Range 71 W <br />DISTANCES FROM SEC. LINES: <br />1776 ft. from South Sec. line. and 1379 ft. from East Sec. line. OR <br />(north or south) (east or west) <br />SUBDIVISION: LOT BLOCK FILING(UNIT) <br />STREET ADDIESS AT WELL LOCATION: <br />4. GROUND SURFACE ELEVATION 6576.4 ft. DRILLING METHOD Hammer/Ai r <br />DATE COMPLETED 06/19/89 TOTAL DEPTH 15.0 ft. DEPTH COMPLETED 14.0 ft. <br />5. GEOLOGIC LOG: <br />Depth Description of Material (rype, Size. Color, Water Location) <br />0' - 15' Alluvium ravels with fine 6. HOLE DIAM. (in.) From (ft) To (ft) <br />_4" 0 15 <br />brown dirt Fill in parking lot) _ <br /> <br />T.D. @ 15' (See remarks below 7. PLAIN CASING <br /> OD (in) Kind Wall Size From(ft) To(ft) <br />*Hit water @ 11.0 4" PVC Sch 40 +13.5 8.5 <br />- <br />_ <br />- _ <br /> r37 5 <br />T47 U <br />4" PVC ci h0 <br /> <br /> <br /> PERF. CASING: Screen Slot Size: 0 <br /> 4" PVC Sch'40 8.5 13. <br /> <br /> <br /> <br /> <br /> 8. FILTER PACK:. 9. PACKER PLACEMENT: <br /> Material Silica.Sand Type <br /> Size 8-12 es -- <br /> Interval 6.5 - 14.0 Depth <br /> <br /> 1A. GROUTING RECORD: <br /> Material Amount Density Interval Placement <br />REMARKS: Hole sloughed into 14.0', could <br />not clean it out Neat Cement <br />--&-6en one e C5%T- X3-5' Manua y <br /> <br /> <br />1 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. DateMme 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 24-4-114 (19)(a) C.R.S., the.rpakin <br />of false statements herein constitutes perjury in the second degree and is punishable as a class 1 misdemeanor.] <br />CONTRACTOR Cotter Corporation Phone( 303) 980-1292 Lic. No. N/!. <br />Mailing Address 12596 West Bayaud Avenue, #350 - Lakewood CO 80228 <br />Name/Titie (Ple.ise type or print) <br />Thomas C. 1_apry <br />iIine Geologist Signature Date