Dd Form 2680 - Military Water Well Completion Summary Report
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1
2MILITARY WATER WELL COMPLETION SUMMARY REPORT
TO
FROM (List Unit and complete mailing address to include Street
DIRECTOR
and 9-digit ZIP Code)
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
b. PVC
c. Stainless Steel
2. DATE OF REPORT
d. Set between
-
feet
Slot
3. USE
a. Military water supply
-
feet
Slot
b. Construction
c. Humanitarian
-
feet
Slot
d. Other (Specify)
13. GRAVEL PACK
a. Yes
b. No
4. LOCATION
If Yes, complete (1) thru (4)
a. Country
(1) Source
(2) Gradation
(3) Volume Used
(4) Depth to top of pack
b. Map name/edition
14. SANITARY SEAL
a. Grout Volume
c. Series/sheet number
b. Depth
-
feet
15. WELL DEVELOPMENT
d. Coordinates
a. Method
b. Date
e. Scale
c. Duration
16. PUMP
5. TOP OF HOLE ELEVATION
a. Standard
b. 600 feet
c. 1500 feet
d. Nonstandard Electric
6. TOTAL HOLE DEPTH
(1) Type
(2) Manufacturer
(3) Model Number
(4) Horsepower
7. STATIC WATER LEVEL
(5) Power Source
(6) Drop-pipe Diameter
a. Number feet
b. Below Grade
(7) Drop-pipe Material
c. Above Grade
d. Date Measured
e. Hand-Pump type
8. TYPE OF DRILLING MACHINE
f. Depth of Pump Installation (list in feet)
a. 600-ft WDS
b. ITWD
17. PUMPING TEST
a. Yes
b. No
d. Other (Specify)
(1) If Yes,
feet
Below Grade
Above Grade
c. CF-15-S
(a) Test Date
9. DRILLING METHOD
(b) Well Yield
GPM or
LPM
18. WELL-HEAD COMPLETION
a. Direct Rotary
b. Reverse Rotary
b. Nonstandard (Specify)
a. Standard
d. Other (Specify)
c. Height above ground (list in feet)
c. Air Rotary
19. WELL DISINFECTION
10. HOLE AND CASING DIAMETER (Change inches to feet)
a. Super Chlorination
a. Hole
b. Casing
b. Other (Specify)
inches =
feet
inches =
feet
c. Nearest source of possible contamination
(1) Type
inches =
feet
inches =
feet
(2) Distance
(3) Direction
inches =
feet
inches =
feet
20. GEOGRAPHIC DATA AVAILABLE
a. Yes
b. No
c. If Yes,
(1) WDRT
(2) Local
inches =
feet
inches =
feet
(3) Water-Resource Overlays
11. COMPLETION KIT USED
a. Yes
b. No
(4) Other (Specify)
1,500 ft
600 feet Standard
(1) If Yes,
d. Down-hole Log
Yes
No
(2) If No, specify type of completion materials
a. Steel
b. PVC
c. Other
e. Attached
Yes
No
DD Form 2680, OCT 93
Adobe Professional 8.0
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