Well ID: 134804
Legal Location North
X
---------One M ile---------- Each square is 10-acres
MULTI-PURPOSE WELL COMPLETION & PLUGGING REPORT
Oklahoma Water Resources Board 3800 North Classen Boulevard Oklahoma City, OK 73118 Telephone (405) 530-8800
WELL ID NUMBER: 134804
Quarters NE-SW-SE Latitude 36.667843
Section 04
Township 25N Longitude -96.337231
Range 09EI
Date collected(latitude and longitude), if different from date the well was drilled: 08/22/2017 Method latitude and longitude was collected: Mathematical conversion program
County7 Osage WELL OWNER - NAME AND ADDRESS Well Owner Pawhuska Lower Elementary7 Address/City/State 2005 N. Boundrv Pawhuska OK Finding Location ___ Well Name ___ TYPE OF WORK: Geothermal or Heat Pump Well
Variance Request No. (if applicable) n/a
Phone ______ Zip ____
Water Rights #: USE OF WELL: Heat Exchange
NEW WELL CONSTRUCTION DATA Date Well or Boring Was Completed 03/18/2011 Number of wells or borings represented by this log 12 * (Borings are within the same 10 acre-tract and with the same general depths and lithologies) Hole Diameter 4.25 inches to a depth of 250 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
Sierra Club v. EPA 18cv3472 NDCA
Tiers 8&9
http://www.owrb.ok.gov/wd/reporting/printreport.php?siteid=l34804(8/22/2017 1:56:08 PM]
ED 002061 00172016-00001
Well ID: 134804
FILTER PACK INFORMATION Filter Pack Material: __ WELL SEAL INFORMATION Type of Surface Seal n/a Type of Annular Seal H. S. Bentonite Grout Filter Pack Seal Material n/a
TYPE OF COMPLETION: Below Ground
HYDROLOGIC INFORMATION Depth to water at time of drilling ft
Surface Seal Interval: From n/a ft to n/a ft Annular Seal Interval: From 15 ft to 250 ft Filter Pack Seal Interval: From n/a ft to n/a ft
Estimated yield of well gpm
First water zone ft
LITHOLOGY DESCRIPTION
Yellow Clay Blue Shale Limestone
F \( O i M T .K F D
! ROM
TO
IH.S
(it)
0
10
200
....................................... S \ l l K \ 1FI)
10
200
N
250 ................ 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? Y Distance of Well is < 50 feet from possible source. Type of possible source: House
PLUGGING INFORMATION
Date Well or Boring Was Plugged 03/18/2011
Total Depth of well being plugged 250 ft.
Was the well contaminated or was it plugged as though it was contaminated? No
If the well or boring was plugged as if it was contaminated, was the casing removed or perforated? No
Was the grout tremied? Yes
Backfilled with Bentonite
Backfilled from 15 ft. to 250 ft.
Grouted with H. S. Bentonite Grout
Grouted from 15 ft. to 250 ft.
Grouted with Cement
Grouted from _5_ ft. to 15 ft.
Firm Name ZAVALA DRILLING Operator Name RAUL ZAVALA Date 03/21/2011 Comments: These are geothermal heat exchange wells
D/PC No. DPC-0747 OP No. OP-1673
Sierra Club v. EPA 18cv3472 NDCA
Tiers 8&9
http://www.owrb.ok.gov/wd/reporting/printreport.php?siteid=134804[8/22/2017 1:56:08 PM]
ED 002061 00172016-00002