Well Drilling Permit App
DIVISION OF ENVIRONMENTAL PROTECTION PH # (340) 774-3320 FAX # (340) 714-9528 GOVERNMENT OF THE UNITED STATES VIRGIN ISLANDS a an DEPARTMENT OF PLANNING AND NATURAL RESOURCES DIVISION OF ENVIRONMENTAL PROTECTION CYRIL E. KING AIRPORT TERMINAL BUILDING, SECOND FLOOR ST. THOMAS, U.S. V.1, 00802 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: C] Drill a well C) Deepen an exiting well QO 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 Drilling Permit Application Page 2. …
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DIVISION OF ENVIRONMENTAL PROTECTION PH # (340) 774-3320 FAX # (340) 714-9528 GOVERNMENT OF THE UNITED STATES VIRGIN ISLANDS a an DEPARTMENT OF PLANNING AND NATURAL RESOURCES DIVISION OF ENVIRONMENTAL PROTECTION CYRIL E. KING AIRPORT TERMINAL BUILDING, SECOND FLOOR ST. THOMAS, U.S. V.1, 00802 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: C] Drill a well C) Deepen an exiting well QO 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 Drilling Permit Application Page 2. The attached sketch (property map from Cadastral Survey) shows location of proposed well 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. Lf pump will be installed by driller, answer the following: Capacity of Pump Horsepower Size (GPM) (HP) (Inches) 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 thirty (30) days after completion of drilling operations. Fee of $10.00 is attached. (If paying by check, please make payable to the Government of the Virgin Islands). Signature of Property Owner Date Signature of Well Driller Driller’s License Number FOR DEPARTMENT USE ONLY: DATE: APPROVED: DISAPPROVED REMARKS and/or SPECIAL CONDITIONS: SIGNATURE OF WELL INSPECTOR: DRILLING PERMIT NUMBER (If approved): drwlappl/retyped 2/2001