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FORM NO. <br />11/•31^ <br />11/90 WELL CONSTRUCTION ANDJEST REPORT <br /> <br />STATE OF COLORADO, OFFICE OF THE STATE ENGINEER For Office Use only <br />?. WELL PERMIT NUMBER 163761 M.W. -7 <br /> OWNER NAME(S) Cotter Corporation <br />Mailing Address es ayau venue, 0 <br />City, St. Zip a ewoo Colorado 80228 <br />Phone ( 303 ) 980-1292 , <br />3. WELL LOCATION AS DRILLED: SE 1/4 SE 1/4, Sec._25 Twp. 2 S , Range 71 W <br />DISTANCES. FROM SEC, LINES: <br />1174 ft. from South Sec. line, and 565 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 6540.3 ft. DRILLING METHOD Hammer/Ai r <br />DATE COMPLETED 06/20/89 TOTAL DEPTH 11.0 ft. DEPTH COMPLETED 11.0 ft <br />5. GEOLOGIC LOG: <br />Depth Description of Material (type, Size. Color, Water Location) <br />0' - 8'• Roadfill and some Alluvium 6?? HOLE DIAM. (in.) FroOm (ft) Toi& <br />11 <br />_ <br /> <br />8' 11' - C <br />ompetent Bedrock Hornblende <br />Gneiss 7. PLAIN CASING <br /> OD (in) Kind Wall Size From(ft) To(ft) <br />11.0' T.D. 2" PVC Sch 40 +2.0 5.0 <br /> <br />*Hi water (a 6.0' <br /> <br /> PERF. CASING: Screen Slot Size: <br /> 2" PUC Sch 40 <br />5. 0 <br /> - - <br /> <br /> <br /> <br /> <br /> 8. FILTER. PACK: .9. PACKER PLACEMENT: <br /> Material Si 1 i ca Sand Type <br /> Size ::8-12 Mesh <br /> Interval <br />3.0' - 11 <br />0' Depth <br /> . <br />. <br /> <br /> 10. GROUTING RECORD: <br /> Material Amount Density Interval Placement <br />REMARKS: Neat Cement <br />_ ntu't"CT' 5 Manually <br /> <br /> <br />1 DISINFECTION: Type Amt. Used <br />12 <br />'- 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 levei 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 24-4.104 (13)(a) C.R.S., 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 Lic. No. N'• <br />Mailing Address 12596 West Bayaud Avenue, #350 - Lakewood CO 80228 <br />Name/Title (Please type or print) <br />Thomas C. Lepry <br />Mine Geologist Signature Date <br />- ("- - <br />-t ;-