Well ID: 239933

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: 239933
Quarters SW-NE-SW	Section 36	Township 21N	Range 11WI

Latitude 36.2516	Longitude -98.3318
Date collected(latitude and longitude), if different from date the well was drilled: 07/14/2025
Method latitude and longitude was collected: GPS - uncorrected data

County Major

Variance Request No. (if applicable) n/a

WELL OWNER - NAME AND ADDRESS

Well Owner Crystal Penner

Phone (580) 822-5563

Address/City/State 803 N 5th Okeen OK

Zip 73763

Finding Location From Fairview: E. on Hwy 8 to N2620/S 1.75 miles/E into

Well Name

Water Rights #:

TYPE OF WORK: Groundwater Well

USE OF WELL: Domestic

NEW WELL CONSTRUCTION DATA

Date Well or Boring Was Completed 07/14/2025

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 9 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 5 inches Casing From -2 ft to 120 ft

SCREEN OR PERFORATION INFORMATION

Type of Screen: PVC Type of Slots or Openings: Factory Slotted - 20 slot (0.020 inch) From 60 ft to 120 ft.

FILTER PACK INFORMATION

Filter Pack Material: Fine Sand

Filter Pack Interval:

From 15 ft to 120

WELL SEAL INFORMATION

Type of Surface Seal Cement Grout

Surface Seal Interval: From 2 ft to 10 ft

Type of Annular Seal Bentonite Granules/Chips

Annular Seal Interval: From 10 ft to 15 ft

Filter Pack Seal Material n/a

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

TYPE OF COMPLETION: Pitless Adapter

HYDROLOGIC INFORMATION

Depth to water at time of drilling 34 ft

Estimated yield of well 30 gpm

First water zone 34 ft

Drawdown Pumping Test
Date	Time	Start Depth	Rate(gpm)	Duration	Drawdown depth to water(ft)
07/14/2025	12:00 PM	34	30	1	63

LITHOLOGY DESCRIPTION

MATERIAL	ENCOUNTERED		SATURATED
MATERIAL	FROM (ft.)	TO (ft.)	SATURATED
fine sand	0	5	N
red broken shale	5	120	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 HOFFMAN WATER WELLS

D/PC No. DPC-0063

Operator Name JEREMY HOFFMAN

OP No. OP-2289

Date 10/30/2025

Comments: TOC 2 AGL