GOVERNMENT OF THE VIRGIN ISLANDS OF THE UNITED STATES
GOVERNMENT OF THE VIRGIN ISLANDS OF THE UNITED STATES DEPARTMENT OF PLANNING AND NATURAL RESOURCES DIVISION OF ENVIRONMENTAL PROTECTION 45 MARS HILL FREDERIKSTED, ST. CROIX, VI 00840 PHONE: (340) 773-1082, FAX: (340) 773-9310 APPLICATION FOR PERMIT TO DRILL WELL In compliance with Title 12, Chapter 5, Virgin Islands Code, the undersigned ______________________________________________________________________________ Name of Driller & License Number ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Mailing Address ______________________________________________________________________________ Telephone Number Hereby applies for a permit to: __________ Drill a well __________ Deepen an existing well __________ Clean and refurbish an existing well On the property: ________________________________________________ (Name of Property Owner) ________________________________________________ (Estate, Lot Number …
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GOVERNMENT OF THE VIRGIN ISLANDS OF THE UNITED STATES DEPARTMENT OF PLANNING AND NATURAL RESOURCES DIVISION OF ENVIRONMENTAL PROTECTION 45 MARS HILL FREDERIKSTED, ST. CROIX, VI 00840 PHONE: (340) 773-1082, FAX: (340) 773-9310 APPLICATION FOR PERMIT TO DRILL WELL In compliance with Title 12, Chapter 5, Virgin Islands Code, the undersigned ______________________________________________________________________________ Name of Driller & License Number ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Mailing Address ______________________________________________________________________________ Telephone Number Hereby applies for a permit to: __________ Drill a well __________ Deepen an existing well __________ Clean and refurbish an existing well On the property: ________________________________________________ (Name of Property Owner) ________________________________________________ (Estate, Lot Number and Island) _______________________ (Property Tax Number) The well will be drilled to the approximate depth of ______ feet and will be ______ inches in diameter. It will have ______ feet of casing, constructed of ________________ material, ______ feet of screening of _____________________ (description of screen) and will have ___________________________ (proposed type of casing seal). ___________________________________________________________________________ Purpose of well Well Driller responsibilities’: 1. Provide an he attached property map from Cadastral Survey shows the following: a) Location of proposed well relative to existing buildings or other physical features. b) Location of existing wells on the property or nearby adjacent properties. c) Location of all known sources of contamination in the vicinity. 2.The pump and the meter will be installed by well driller, provide the following information: Capacity of Pump ________ Horsepower ________ Size ________ (GPM) (HP) (Inches) 3. A log showing the various strata or formations intersected by the well, formation yields and quality, and casing and screening details will be forwarded to the Division of Environmental Protection within 30 days after completion of drilling operations. Fee of $10.00 is attached. (If check, please make payable to the Government of the Virgin Islands). _____________________________ ________________ Signature of Property Owner Date _____________________________ ________________ Signature of Well Driller Driller’s License No