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t <br />FOR 11/190 M?O. WELL CONSTRUCTION AND TEST REPORT <br />cu90 -TTE OF COLORADO, OFFICE OF THE STATE ENGINEER <br />IV For oft+ U l <br /> <br /> <br />EIVE <br />E <br />C <br />1. WELL PERMIT NUMBER 161062 - - <br />2 OWNER NAME(S) Bonnie L. Ganley , <br />Mailing Address 5131 va a tree <br /> <br />„?? <br />City, St. Zip Aurora, CO 150011 <br />Phone ( 303 } 343-9142 -' $ 3'92 <br /> <br /> <br />?R11F?p)PCEs <br />fit[ fr:u!Sdi ER <br />3. WELL LOCATION AS DRILLED: SE 1/4 PBd 1/4, Sec. 23 Twp. 3 S , Range 73 W <br />DISTANCES FROM SEC. LINES: <br />1500 ft. from north Sec. line. and 3600 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 9200 ft. DRILLING METHOD air percussion <br />DATE COMPLETED 10-26-91 TOTAL DEPTH 240 ft. DEPTH COMPLETED 240 ft, <br />5. GEOLOGIC LOG: <br />Depth Description of Material (Type. Size. Color. Wetter Location) <br />0 - lft. Black top soil 6. HOLE DIAM. (in.) From (ft) To (ft) <br />$" 0 20 <br />6" 20 240 <br />1 - 135ft. Gray & black shist <br />135 140ft. Gray shist & white quartz <br />140 - 195f t . Gray & black shi st 7. PLAIN CASING <br />19 5 - 197ft. Whi tP g tart,, OD (in) Kind Wail Size - From(ft) To(ft) <br />197 - 240ft. Gray & black shist 200 ft. _ " stapl .188 -1 20 <br /> `t1 PVC 200psi 15 180 <br /> J <br /> <br /> PERF. CASING: Screen Slot Size: 17?hole <br /> 4" PVC 200psi 180 240 <br /> <br /> <br /> <br /> <br /> S. FILTER PACK: 9. PACKER PLACEMENT: <br /> Material N/A Type N/A <br /> Size <br /> Interval Depth <br /> <br /> 10. GROUTING RECORD: <br /> Material Amount Density Interval Placement <br />REMARKS: cement: 1881bs. 141b. 10-20 pour & vibE <br /> <br /> <br />i DISINFECTION: Type chlorine Amt. Used 1 quart <br />2 WELL TEST DATA: ? Check box if Test Data is submitted on Supplemental Form. <br />TESTING METHOD air <br />Static Level 60 ft. Date/Time measured 5:00 p.m. , Production Rate 4 gpm. <br />Pumping level 235 ft. Date/Time measured 0]. 26-91 , Test length (hrs.) 2 <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) ORS., the makinG <br />of false statements herein constitutes perjury in the second degree and is punishable as a class 1 misdemeanor.) <br />CONTRACTOR C.R. Smith Drilling Phone C123 ) 642-3339 Lic. No. 328 <br />Mailing Address 109 Gap Road Black Hawk, Co 80422 <br />NameiTitie (Please type or print) <br />Calvin Smith/Driller Si gnat Date <br />1-9-91 <br />e <br />