owrb logo MULTI-PURPOSE WELL COMPLETION & PLUGGING REPORT

Oklahoma Water Resources Board
3800 North Classen Boulevard
Oklahoma City, OK 73118
Telephone (405) 530-8800
Legal Location
North
       
       
       
       
       
       
       
       
       
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«——— One Mile ———»
Each square is 10-acres
WELL ID NUMBER:    176570  

Quarters    SE-NE-SW   Section    25   Township    04S   Range    08WI  
Latitude    34.17667   Longitude    -97.993122  

Date collected(latitude and longitude), if different from date the well was drilled:      10/04/2016  
Method latitude and longitude was collected:      Mathematical conversion program  



County    Jefferson   Variance Request No. (if applicable)    n/a  
WELL OWNER - NAME AND ADDRESS
Well Owner    Larry James   Phone    (580) 313-0155  
Address/City/State    1127 Pine  Waurika  OK   Zip    73573  
Finding Location         
Well Name    673313     Water Rights #:        
TYPE OF WORK:    Groundwater Well   USE OF WELL:    Domestic  
 
NEW WELL CONSTRUCTION DATA
Date Well or Boring Was Completed    10/04/2016  
Number of wells or borings represented by this log    1  
*  (Borings are within the same 10 acre-tract and with the same general depths and lithologies)
Hole Diameter    8   inches  to a depth of   45   ft.
 
CASING INFORMATION  *Note: If surface casing is used please indicate that on the appropriate well casing information line.
Surface Pipe Material:          Surface Pipe Diameter        inches  Surface Pipe From        ft to       ft
1)  Well Casing Material    PVC   Casing Diameter    4.5   inches Casing From   1.5   ft to   20   ft
 
SCREEN OR PERFORATION INFORMATION
Type of Screen:    PVC      Type of Slots or Openings:    Factory Slotted    From    20   ft to   45   ft.
 

FILTER PACK INFORMATION
Filter Pack Material:    Fine Gravel  
Filter Pack Interval:     From    10   ft to   45  
WELL SEAL INFORMATION
Type of Surface Seal    n/a   Surface Seal Interval: From    n/a   ft to   n/a   ft
Type of Annular Seal    Cement Grout   Annular Seal Interval: From    0   ft to   10   ft
Filter Pack Seal Material    n/a   Filter Pack Seal Interval: From    n/a   ft to   n/a   ft
 
TYPE OF COMPLETION:    Above Ground  
 
HYDROLOGIC INFORMATION
Depth to water at time of drilling    22   ft Estimated yield of well    10   gpm First water zone    10  ft
 
LITHOLOGY DESCRIPTION
MATERIAL ENCOUNTERED SATURATED
FROM
(ft.)		 TO
(ft.)
sand 0 20 N
quicksand 20 32 Y
clay 32 45 N
 
WELL LOCATION TO POTENTIAL SOURCES OF POLLUTION
Has this well been disinfected after completion of work?    Yes  
Are than any potential sources of pollution or wastewater lagoons within 300 ft. of the well?    n/a  
Distance of Well is    n/a   from possible source.  Type of possible source:    n/a  
 
PLUGGING INFORMATION
Date Well or Boring Was Plugged    n/a   Total Depth of well being plugged       ft.
Was the well contaminated or was it plugged as though it was contaminated?    n/a  
If the well or boring was plugged as if it was contaminated, was the casing removed or perforated?    n/a  
Was the grout tremied?    n/a  
Backfilled with    n/a   Backfilled from     _   ft. to     _   ft.
Grouted with    n/a   Grouted from        ft. to        ft.
Grouted with    Cement    Grouted from        ft. to        ft.
 
Firm Name    ARLEN MAY   D/PC No.    DPC-0615  
Operator Name    ARLEN MAY   OP No.    OP-1239  
Date    10/04/2016  
Comments:  n/a

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