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 SOIL BORING PERMIT 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: __________ Install a soil boring On the property: ________________________________________________ (Name of Property Owner) ________________________________________________ (Estate, Lot Number and Island) ______________________________________________________________ ( …
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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 SOIL BORING PERMIT 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: __________ Install a soil boring On the property: ________________________________________________ (Name of Property Owner) ________________________________________________ (Estate, Lot Number and Island) ______________________________________________________________ (Mailing Address/ Telephone Number) _______________________ (Property Tax Number) The soil boring will be drilled to the approximate depth of ______ feet and will be ______ inches in diameter. ______________________________________________________________________________ _ Purpose of soil boring The attached sketch (property map from Cadastral Survey) shows location of proposed soil boring relative to existing buildings or other physical features, the location of existing wells on the property or nearby adjacent properties, and the location of all known sources of contamination in the vicinity. To prevent contamination of subsurface soils and the ground water aquifer, the soil boring will be sealed upon completion of drilling activities. The soil boring will be tremie-grouted with a cement-bentonite mixture to the surface. A log showing the various strata or formations intersected by the soil boring, depth to first water encountered, static water level, etc., 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 Driller Driller=s License No FOR DEPARTMENT USE ONLY: DATE: _____________ APPROVED: _______________ DISAPPROVED: ___________ REMARKS and/or SPECIAL CONDITIONS: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ _____________________________________________________ SIGNATURE OF INSPECTOR: ____________________________________ DRILLING PERMIT No. (If approved):_______________________________