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,tio1 J STATE OF COLORADO 'OFFICE OF THE STATE ENGINEER
I. WELL PERM
IT NUMBER 161886 C 0 PY
2. OWNER NAME(S) Craig A. McConnell
Mailing Address 7 5483 WCR 100
City, St Zip S toneharn , CO . 807 54
Phone ( 303 ) 735-2426
3. WELL LOCATION AS DRILLED:
NE 1/4 NW 1/4, Sec. 1 Twp, 8 N , Range 56 W
DISTANCES FROM SEC. LINES:
5420 ft. from south Sec. line. and 2610 tt. from (east weal)
Sec. line. OR
(north or south) LOT BLOCK FILING(UNIT)_
SUBDIVISION;
STREET ADDRESS AT WELL LOCATION:
4. GROUND SURFACE ELEVATION ft. DRILLING METHOD Rotary
DATE COMPLETED 10/09/91
TOTAL DEPTH 46 ft. DEPTH COMPLETED_ 46 f•
6. HOLE DIAM. (in.) From (ft) To (ft)
5. GEOLOGIC LOG: 8, 0 46
Depth Description of Material(Type, Slze, Color,Wets( Location) z
0-1 sand - •
L-4 sand,fine sand
4-27 gravehfew boulders 7 PLAIN CASING
?2-46 shah O0 (in) Kind Wall Size From(ft) To(ft)
6 5/8 steel .188 +2 20
___5____ plastic _ .20 +2 20
• PERF. CASING: Screen Slot Size: .032
5 plastic .20 20 46
8. FILTER PACK: 9. PACKER PLACEMENT:
Material Gravel Type
Size Buckshot
Interval 20'-46' Depth
10. GROUTING RECORD:
Material Amount Density Interval Placement
REMARKS: cpmpnt 3 sack neat. +1-20'
11. DISINFECTION: Type H'1 l Dry powder Amt. Used 1 cup
12. WELL TEST DATA: ❑ Check box it Test Data is submitted on Supplemental Form.
TESTING METHOD Bailed •
, production 12 gpm.
Static Level 13' ft. Date/Time measured 10/09/91 , Test length Rate 2
Pumping level 44' ft. Date/Time measured 10/09/91
Remarks
13. 1 have read the statements made herein and know the contents thereof,and that they are true to my knowledge. [Pursuant to Sectlon 24-4-104 (13)(.)C.n S.,the making
of lets.statements herein constitutes perjury In the second degree and le punishable as a class 1 misdemeanor.) 65
Phone (303 ) 867-2943 LIc. No. 7
CONTRACTOR Canfield Drilling Co.
Mailing Address 'P.O. Box 519, Fort Morgan, CO. 80701
Si e �// /7/1
� Date
1Vame/Title (Please type or print) 9 1
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10/12191 .�George C��lnffield / Dri.11er g51114
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