Well ID: 86267

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: 86267
Quarters NW-SW-SW	Section 12	Township 02S	Range 06EI

Latitude 34.393413736	Longitude -96.635545181
Date collected(latitude and longitude), if different from date the well was drilled: 01/30/2014
Method latitude and longitude was collected: GPS - corrected data (DGPS)

County Johnston

Variance Request No. (if applicable) n/a

WELL OWNER - NAME AND ADDRESS

Well Owner Pat Ferris

Phone (580) 421-7354

Address/City/State OK

Zip

Finding Location 3 miles S. of Connerville on Hwy 377, across road from white house, well on east side of highway

Well Name

Water Rights #:

TYPE OF WORK: Groundwater Well

USE OF WELL: Domestic

NEW WELL CONSTRUCTION DATA

Date Well or Boring Was Completed 01/01/1900

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 75 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 H.C. Steel Casing Diameter 4.5 inches Casing From 0 ft to 75 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: Above Ground

HYDROLOGIC INFORMATION

Depth to water at time of drilling 26.6 ft

Estimated yield of well gpm

First water zone ft

LITHOLOGY DESCRIPTION

MATERIAL	ENCOUNTERED		SATURATED
MATERIAL	FROM (ft.)	TO (ft.)	SATURATED
none	0	75	N

WELL LOCATION TO POTENTIAL SOURCES OF POLLUTION

Has this well been disinfected after completion of work? No

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

D/PC No.

Operator Name

OP No.

Date 04/30/2004

Comments: abandoned domestic well, no drillers information, all data came from landowner and OWRB staff during well inspection.