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:    62138  

Quarters    NW-NE-SW   Section    12   Township    21N   Range    04WI  
Latitude    36.310051   Longitude    -97.580753  

Date collected(latitude and longitude), if different from date the well was drilled:      09/05/2001  
Method latitude and longitude was collected:      Interpolation from PLSS  



County    Garfield   Variance Request No. (if applicable)    n/a  
WELL OWNER - NAME AND ADDRESS
Well Owner    Covington - Douglas School   Phone                
Address/City/State    Box 9  Covington  OK   Zip    73730  
Finding Location         
Well Name            Water Rights #:        
TYPE OF WORK:    Groundwater Test Hole   USE OF WELL:    Water Location  
 
NEW WELL CONSTRUCTION DATA
Date Well or Boring Was Completed    06/08/2001  
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    8.75   inches  to a depth of   100   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
 
SCREEN OR PERFORATION INFORMATION
 

FILTER PACK INFORMATION
Filter Pack Material:      
WELL SEAL INFORMATION
Type of Surface Seal    n/a   Surface Seal Interval: From    n/a   ft to   n/a   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        gpm First water zone    12  ft
 
LITHOLOGY DESCRIPTION
MATERIAL ENCOUNTERED SATURATED
FROM
(ft.)		 TO
(ft.)
no lithological description obtained      
 
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    Ewbank, Inc.   D/PC No.    DPC-0063  
Operator Name        OP No.       
Date    n/a  
Comments:  n/a

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