Well ID: 15736

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

			x

«——— One Mile ———»
Each square is 10-acres

WELL ID NUMBER: 15736
Quarters NE-NE-NE	Section 33	Township 29N	Range 23EI

Latitude 36.957092	Longitude -94.813773
Date collected(latitude and longitude), if different from date the well was drilled: 01/08/1998
Method latitude and longitude was collected: Interpolation from PLSS

County Ottawa

Variance Request No. (if applicable) n/a

WELL OWNER - NAME AND ADDRESS

Well Owner Fred Dorrell

Phone

Address/City/State

Zip

Finding Location

Well Name

Water Rights #:

TYPE OF WORK: Groundwater Well

USE OF WELL: Domestic

NEW WELL CONSTRUCTION DATA

Date Well or Boring Was Completed 07/12/1983

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 6 inches to a depth of 120 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 6.25 inches Casing From ft to 107 ft

SCREEN OR PERFORATION INFORMATION

FILTER PACK INFORMATION

Filter Pack Material:

WELL SEAL INFORMATION

Type of Surface Seal Cement Grout

Surface Seal Interval: From n/a ft to 10 ft

Type of Annular Seal n/a

Annular Seal Interval: From n/a ft to n/a ft

Filter Pack Seal Material n/a

Filter Pack Seal Interval: From n/a ft to n/a ft

TYPE OF COMPLETION:

HYDROLOGIC INFORMATION

Depth to water at time of drilling ft

Estimated yield of well 12 gpm

First water zone 60 ft

LITHOLOGY DESCRIPTION

MATERIAL	ENCOUNTERED		SATURATED
MATERIAL	FROM (ft.)	TO (ft.)	SATURATED
surface dirt rocks clay	0	4	N
shell flint rocks	4	8	N
clay	8	22	N
clay & gravel	22	44	N
yellow sand	44	60	N
red clay & gravel	60	80	N
water	80	120	N

WELL LOCATION TO POTENTIAL SOURCES OF POLLUTION

Has this well been disinfected after completion of work? n/a

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 YOST	D/PC No.
Operator Name	OP No.
Date n/a
Comments: n/a