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
  x    
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
«——— One Mile ———»
Each square is 10-acres
WELL ID NUMBER:    7128  

Quarters    NE-NW-NW   Section    34   Township    13N   Range    02WI  
Latitude    35.564666   Longitude    -97.403653  

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    Oklahoma   Variance Request No. (if applicable)    n/a  
WELL OWNER - NAME AND ADDRESS
Well Owner    Don Chouoz   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    04/12/1983  
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    6.75   inches  to a depth of   180   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   inches Casing From      ft to   180   ft
 
SCREEN OR PERFORATION INFORMATION
Type of Screen:    PVC      Type of Slots or Openings:    Hand Slotted    From    160   ft to   180   ft.
 

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    60   gpm First water zone    40  ft
 
LITHOLOGY DESCRIPTION
MATERIAL ENCOUNTERED SATURATED
FROM
(ft.)		 TO
(ft.)
sandrock 0 20 N
shale 20 40 N
watersand 40 70 N
shale 70 95 N
sandrock 95 130 N
shale 130 140 N
watersand 140 180 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    W.BUSBY   D/PC No.       
Operator Name        OP No.       
Date    n/a  
Comments:  n/a

IMPORTANT NOTE:
This site has been redesigned using Cascading Style Sheets (CSS). If you are seeing this message you are using an older browser which lacks support for CSS. Please upgrade your browser to the latest version of Internet Explorer, Netscape or other CSS compatible browser to view this page properly.