GOVERNMENT OF THE UNITED STATES VIRGIN ISLANDS



Department of Planning & Natural Resources



Division of Environmental Protection

WATER GUT HOMES 1118

CHRISTIANSTED, ST. CROIX, USVI 00820-5065

(340)773-0565



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)

. (Property Tax Number)

(Telephone Number)

The soil boring will be drilled to the approximate depth of___feet and willbe

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.

APPLICATION FOR SOI BORING PERMIT

Page 2



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):