U.S. DOD Form dod-dd-2680
MILITARY WATER WELL COMPLETION SUMMARY REPORT
TO
FROM (List Unit and complete mailing address to include Street
and 9-digit ZIP Code)
DIRECTOR
US Army Topographic Engineer Center
ATTN: CETEC-TC-H
Ft. Belvoir, VA 22060-5546
(703) 355-2921
PHONE NUMBER (Include Area Code)
1. PROJECT TITLE OR WELL NUMBER
12. SCREENS
a. Completion Kit
2. DATE OF REPORT
3. USE
a.
b.
c.
d.
e. Set between
Military water supply
Construction
Humanitarian
Other (Specify)
b. Map name/edition
c. Series/sheet number
d. Coordinates
e. Scale
5. TOP OF HOLE ELEVATION
6. TOTAL HOLE DEPTH
7. STATIC WATER LEVEL
a. Number feet
b. Below Grade
c. Above Grade
d. Date Measured
8. TYPE OF DRILLING MACHINE
a. 600-ft WDS
b. ITWD
d. Other (Specify)
c. CF-15-S
9. DRILLING METHOD
b. Reverse Rotary
d. Other (Specify)
c. Air Rotary
10. HOLE AND CASING DIAMETER (Change inches to feet)
a. Hole
b. Casing
-
feet
Slot
-
feet
Slot
-
feet
Slot
b. Other (Specify)
inches =
feet
inches =
feet
inches =
feet
inches =
feet
inches =
feet
inches =
feet
inches =
feet
inches =
feet
a. Yes
b. No
11. COMPLETION KIT USED
(1) If Yes,
1,500 ft
600 feet Standard
(1) If No, specify type of completion materials
a. Steel
b. PVC
c. Other
DD Form 2680, OCT 93
c. Stainless Steel
13. GRAVEL PACK
a. Yes
b. No
If Yes, complete (1) thru (4)
(1) Source
(2) Gradation
(3) Volume Used
(4) Depth to top of pack
14. SANITARY SEAL
a. Grout Volume
b. Depth
feet
15. WELL DEVELOPMENT
a. Method
b. Date
c. Duration
16. PUMP
a. Standard
b. 600 feet
c. 1500 feet
d. Nonstandard Electric
(1) Type
(2) Manufacturer
(3) Model Number
(4) Horsepower
(5) Power Source
(7) Drop-pipe Diameter
(7) Drop-pipe Material
e. Hand-Pump type
f. Depth of Pump Installation (list in feet)
17. PUMPING TEST
a. Yes
b. No
(1) If Yes,
feet
Below Grade
Above Grade
(a) Test Date
(b) Well Yield
GPM or
LPM
18. WELL-HEAD COMPLETION
a. Standard
b. Nonstandard (Specify)
c. Height above ground (list in feet)
19. WELL DISINFECTION
a. Super Chlorination
4. LOCATION
a. Country
a. Direct Rotary
b. PVC
c. Nearest source of possible contamination
(1) Type
(2) Distance
(3) Direction
20. GEOGRAPHIC DATA AVAILABLE
c. If Yes,
(1) WDRT
(3) Water-Resource Overlays
(4) Other (Specify)
d. Down-hole Log
e. Attached
a. Yes
(2) Local
b. No
Yes
Yes
No
No
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28. SKETCH OF WELL AND PUMP
21. OVERBURDEN MATERIALS
a. Unconsolidated
c. Limestone
e. Other (Specify)
b. Sandstone
d. Igneous
22. AQUIFER MATERIALS
a. Sand and Gravel
c. Limestone
23. MARKER BEDS (Describe)
b. Sandstone
d. Igneous
at
at
at
at
24. WATER QUALITY
a. Tested
(1) Yes
(2) No
b. Fresh
c. Brackish
25. SKETCH OF LOCATION
feet
feet
feet
feet
(3) Date
d. Saline
SCALE
26. REMARKS
27a. SUBMITTED BY (Type or print name)
27b. GRADE/RANK
27c. UNIT
DD Form 2680, OCT 93 (BACK)
29. SIGNATURE OF PROJECT OFFICIAL
30. DATE OF
SIGNATURE
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