Laserfiche WebLink
FORM No. <br />W4531 <br />IW94 <br />' WELL CONSTRUCTION AND TEST REPORT <br />&rATE OF COLORADO, OFFICE OF THE STATE ENGINEER <br />1BA3-Sherman %_ Rm 81% Dernter. Q0 80203 <br />For once use only <br />?- LLEII/ ?, <br />1. WELL PERMIT NUMBER 2 2- Cr > DEC 18 1998 <br /> <br />2 <br />OWNER NAME(S) Qv1q Y h <br />Mailing Address W :174 V <br />City, St. Zip <br />Phone ( ) :VA tE k hf SC,utU. , <br />STAT?o,NFEF <br />a WELL LOCATION AS DRILLED: W W114 SW 1/4, Sec. Twp. Range <br />DISTANCES FROM SEC. LINE <br />2 ft. from Sto sec. line. and ft. from Sec. line. OR <br />SUBDIVISION: c i `vin LOT BLOCK FILING(UNIT) <br />STREET ADDRESS AT WELL LOCATION: <br />4. GROUND SURFACE ELEVATION q ft. DRILLING ETHOD i YnP??'-u4?SL? <br />DATE COMPLETED ? TOTAL DEPTH ft. DEPTH COMPLETED 32-D ft. <br />S GEOLOGIC LOG: <br />Depth ` Description of Material (Type, Size, Color, Water Location) <br />-' <br />r n To C'0'1 G, HO Dj,4M, (in.) From (ft) To (ft) <br />((0 <br /> <br />e*> <br />_ L. <br />`. --? <br />R-- <br />r iv . <br />_ r Y <br />L4- Q <br />` 7. PLAIN CASING <br /> <br />(ft) To(ft) <br />Fro <br />Wall <br />OD Kind <br />- ` 182 <br />- <br />1 <br /> <br /> <br />9 3 2,L-5 J <br />' 3p ` v?; 'lea PERF. CAS NG: Screen Slot Size: trR ' o1e <br /> <br /> <br /> <br /> <br /> <br /> & FILTER PACK. 9. PACKER P CEMENT: <br /> Material t6v Type A- <br /> Size <br /> Interval Depth <br /> <br /> 14 GROUTING RECORD: <br /> Material Amount Density, Interval Placement <br />REMARKS: t ( ` z w Ll + l v (? <br /> <br />11, DISINFECTION: Type R: T t? Amt. Used ` I <br />12 WELL TEST DATA: Check box if Test Data is submitted on Form No. GWS 39 Supplemental Well Test. <br />TESTING METHOD ?Ii Y P I <br />_ - 40 Static Level ft. Date/rime measured , Production Rate . 5 gpm. <br />Pumping level " ft. Date/Time measured k1 a,4,,- I- , Test length (hrs.) 9_ <br />Remarks <br />3. f 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) <br />C.R.S., the making of false statements herein constitutes perjury in the second degree and is punishable as a class 1 misdemeanor.] <br />CONTRACTOR <br />C'_ a AA WA I V I "' V k F ne tic. No. ? <br />Mailing Address V <br />Name/Title (Please type or print <br />V7_YoLvi?A F . v>?t ? Signature <br />2' Date <br />12 G 8 <br />le