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 
 
WELL DRILLER’S REPORT 
 
_____________________________________________________ 
(Well drilling Permit No.; Drillers License No.) 
 
______________________________________________ 
 (Name of Property Owner) 
 
______________________________________________________________ 
 (Mailing Address, Telephone) 
 
____________________________________________________________ 
 (Location; Latitude; Longitude) 
 
Type:  
Drilled 
( 
)                 
Driven 
( 
)                 
Other: ( ) 
 
Started: _______________________________   Finished: ______________________________ 
 
Total Depth: ________________          Casing Type:       ( ) Galv.       ( ) Black      ( ) Other 
 
Depth: ________________ feet       Diameter: ______________ inch       Water Level: ______________           
Flowing: ( ) yes   ( ) no       If not, how far down?   _________ Feet 
 
Yield:   Flow ____________ GPM      Pump___________ GPM or ____________ GPH 
 
Drawdown from pumping: ___________ feet or ____________ vac.  
 
Use: ___________   Taste: ___________   Odor: ________   Hardness: ________    Iron: _________ 
 
Permanent Pump Installation: _________________      Manufacture: ____________________________ 
 
Type: __________   HP: __________   Capacity: ____________ GPM 
 
Installed by: ______________________    Date: _____________________ 
 
Person Filling Out Form: _______________________________________________________ 
 
Address: ____________________________________________________________________ 
 
DRILLE’S LOG 
 
From 
To 
Material Description 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Remark: Well log shall be completed and delivered to the Office of the Commissioner of Planning and 
Natural Resources within thirty (30) days after the completion of the well drilling operation, for each 
hole.