5500-PM-OG0001i Rev. 4/97
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF ENVIRONMENTAL PROTECTION OIL AND GAS MANAGEMENT PROGRAM
INSTRUCTIONS FOR COMPLETING AN APPLICATION FOR A PERMIT TO DRILL OR ALTER AN OIL OR GAS WELL
(Forms 5500-PM-OG0001 and 5500-PM-OG0002)
GENERAL INFORMATION
These permit application forms are used to apply to Pennsylvania‟s Department of Environmental Protection, seeking approval to drill a new oil or gas well, or to redrill, alter or deepen an existing well. Several additional forms may be required with your application, depending on the type of well, bond agreement, waivers, or variances required. A permit fee is also required, except for a permit to rehabilitate an orphan well. Please read through this application form and instructions to determine which additional forms and documents you need. Please type or print legibly to fill in these forms. Unreadable information will delay processing, and may result in your application being returned to you. Information required on this form is mostly selfexplanatory. Instructions are written only for those items which need some explanation. If an item is not relevant to your application, enter “NA” in that space. Before commencing site preparation or drilling you must be able to demonstrate that you have effective plans for the site and the work, for waste handling and disposal, pollution prevention and control (PPC), and erosion and sedimentation control (E&S). Also, if you intend to use any alternate methods or materials in drilling or waste management, please submit requests for those approvals along with your permit application. A checklist is included with this application form. Please use it to check that your application is complete before you submit it. Incomplete, illegible or inadequate applications will be returned. If you do not have an oil and gas well bond in effect now, you should complete the bond application process before submitting your application for an oil or gas well permit. Your permit application will not be processed until your bond is approved. If your bond is already in effect, you must submit an “Exhibit A“ (Form 5500-FM-OGO0042) which identifies this well to be added to your bond. If you have a “Phased Deposit“ bond, you also need to submit additional collateral for deposit along with the “Exhibit A“ form. -1-
If you have any questions about this application, or need more information or additional forms, contact the appropriate DEP regional oil and gas office. Refer to the regional office map in your permit application package. PA DEP Oil and Gas Management Program Northwest Regional Office Phone 814-332-6860 230 Chestnut Street Fax 814-332-6121 Meadville, PA 16335-3481 PA DEP Oil and Gas Management Program Southwest Regional Office Phone 412-442-4015 400 Waterfront Drive Fax 412-442-4328 Pittsburgh, PA 15222-4745 This form may also be available as a word processing file for your software. If you would like to have a copy, please contact: PA DEP Bureau of Oil and Gas Management PO Box 8765 Phone 717-772-2199 Harrisburg, PA 17105-8765 Fax 717-772-2291
Form 5500-PM-OG0001, page 1 Applicant Name
Enter the name of the business or individual that will be the operator of this well. The Applicant Name on this permit application form must exactly match the Operator Name on the applicant„s bond form. DEP will issue a permit only to an individual doing business in his or her own name, or to a duly registered corporation, partnership, or company, or to the registered fictitious name of a business entity or individual. A fictitious-named business or organization must already be registered with the Corporation Bureau of the Pennsylvania Department of State before this permit application will be processed. Partnerships must list the business name of the partnership, not an individual„s name. Proof of incorporation or registration of a fictitious business name must be provided in the bond application. Therefore, having already been shown, proof of registration or incorporation is not required with this permit application.
DEP ID# is the applicant„s unique identification
number with the Department of Environmental Protection. It will be common to all the applicant„s business with the department. Your DEP ID number has already been assigned, or will be assigned when we process your bond application. If you do not know your DEP ID number, please call one of the regional offices or the bureau office in Harrisburg.
casing of the same diameter to the same depth is not by itself an “alteration”). In coal areas, changing or repairing the production casing where it is also the coal protective casing is an alteration requiring a permit. Work on the production string which affects the coal protective casing is an alteration which requires a permit. If the application is for something other than above, check “Other” and specify the intended purpose. Change in Use -- means to change the use or purpose of a well, for example to change an oil production well to an injection well. (Also check the applicable box under TYPE OF WELL). Rehabilitate an orphan well -- includes all activities to clean out an orphan well, service it, and reequip it for production without re-drilling the bore or drilling the well deeper. (Also check “Other” under TYPE OF WELL). If for another purpose, specify the intended activity.
Mailing Address
Enter the applicant‟s current mailing address. Operators are required to notify the department in writing of an address change, within 30 days of the change.
WELL INFORMATION
Enter the farm name, well number, and serial number and project number as applicable. The Farm Name, Well number and Serial number are the applicant„s designations to identify the well. Project number is a designation assigned to a group of wells associated by production field or farm. If applicable, this number would have already been or will be assigned by DEP.
Previous Permit Or Registration
If the well was previously permitted, registered, orphaned, or assigned a plugging number, enter the number which was assigned by the department. For an existing well that has no DEP permit or registration identification, please provide all available information known about the well. Provide records that you have, such as: date drilled, ownership documents, well record, driller‟s log, geophysical log, production data, or other relevant information.
Type Of Well
Mark the box indicating the intended use of this well. The permit application fee is shown in parentheses. Check OTHER for any type not listed, please specify.
Permit Fee (Plus Surcharges)
The permit fee plus surcharges must accompany the permit application. The total amount depends on the type of well being permitted. The surcharges are paid into the orphaned and abandoned well plugging funds. Application fees are not refundable. The specific amount is calculated as follows: Gas Well [includes gas storage wells, combination gas & oil wells (in non-coal areas only), and coalbed methane wells]:
$100 (Permit fee) + $250 (Surcharge) = $350 (Application Fee)
PERMIT TYPE
Please check the appropriate descriptions of the activity to be permitted and the type of well.
Application is for :
Drill New Well: a location where no well has ever been drilled. Deepen, Re-drill, or Alter an Existing Well: Deepen: to drill an existing well below the original total depth. Re-drill: to drill through a well plug for the purpose of putting the well into production. Alter: any operation which changes the use of the well, or drills out the well bore, or depending on the work, it may include removing, repairing or changing the casing. (Remove, repair, or change casing means to alter the casing by changing the depth or diameter of the well, or to remove, repair or change casings in coal areas. Replacement of -2-
Oil Well (including injection - recovery wells): Injection - Disposal Well:
$100 (Permit fee) + $150 (Surcharge) = $250 (Application Fee) $100 (Permit fee) + $50 (Surcharge) = $150 (Application Fee)
Change in Use (change the use or purpose of an existing well): Redrill / Drill Deeper / Alteration:
$100 (Permit fee) + $0 (Surcharge) = $100 (Application Fee) $100 (Permit fee) + $0 (Surcharge) = $100 (Application Fee)
Rehabilitation Of Orphaned Well), check “Other” and specify:
No permit fee - No surcharge- No Application Fee
Make your check or money order payable to the “Commonwealth of Pennsylvania”. For your convenience, you may pay with one check for all applications submitted at the same time. Attach the payment to the front of the application form. Personal and business checks are acceptable.
COORDINATION WITH REGULATIONS AND OTHER PERMITS. Oil and Gas Conservation Law
A “non-conservation well“ is a well not subject to the Oil and Gas Conservation Law (Act 359, 58 PS §401 et seq.). This law applies to any well (drilled after July 25, 1961) drilled deeper than 3800 feet which also penetrates the Onondaga horizon. All development wells in a pool discovered by a conservation well are also subject to the law, regardless of completion depth or horizons penetrated. No gas storage well is subject to this law. Deepening an old well as described above would subject it to this law. If in doubt, please call DEP‟s regional oil and gas office to find out. The Oil and Gas Conservation Law also established spacing criteria for wells subject to the law. Some areas of the state are covered by specific spacing orders which were issued by the department; elsewhere spacing regulations apply. Maps of areas covered by spacing orders are filed in the office of the Recorder of Deeds in the respective county, as well as the DEP office for the region. See DEP regulations, Chapter 79 - Oil and Gas Conservation for details. Conservation wells to be drilled in areas that are not covered by spacing orders may be located no closer than 330 feet from the outside boundary of the lease or unit.
Distance restrictions for a gas well which is not subject to the Oil and Gas Conservation Law, but which penetrates a workable coal seam are: at least 1,000 feet from all other existing wells, and 330 feet from the (well‟s) tract boundary. Any request for exception from these distance requirements must be specific, in writing, and accompany this application. A request for exception from 1000-foot well-spacing must be signed by all coal owners, as listed on the record of notification page (page 2) of the application form. See Section 7 of the Coal and Gas Resource Coordination Act for details (58 PS §507). If the proposed well location is within the permitted boundaries of an underground coal mine, or within 1,000 feet of a boundary of the mining permit area, the applicant is required to notify those coal owners and operator. Notification must be by certified mail, with a copy of this permit application, including the well location plat on form 5500-PM-OG0002 (§201.b. of the Oil and Gas Act). The coal owners and operators may give written approval of the proposed well location by signing page 2 of the permit application. If you are not sure whether your proposed well‟s location falls within the coordination area of an underground coal mine as described above, please contact DEP‟s mine permits office at: PA DEP Mine Permits Section McMurray District Office 3913 Washington Road McMurray, PA 15317-2532 Phone: 412-220-8260 Fax: 412-941-2625
Coal Mining & Coal Resources
Certain regulations on casing, spacing, and resource coordination apply to a well which will penetrate a coal seam workable by underground mining methods. As defined in DEP regulations (Chapter 78. Oil and Gas Wells), a coal area is "an area that is underlain by a workable coal seam". The applicant must cite a published reference (or submit specific information) when declaring that a proposed well location is not in a coal area. For a location in a county where there are no known workable coal seams, you need not provide a reference. Where published references are inadequate to support a claim that a well is not in a coal area, the applicant may submit information from other sources. Acceptable information could be, for example, old mine maps, coal operator‟s borehole logs, exploratory drilling logs, etc. See DEP policy guidance for detailed criteria defining a “workable coal seam”, as well as a list of acceptable published references. For advice or further explanation, contact the oil and gas permits chief at one of the DEP regional offices. -3-
Gas Storage Fields
If the proposed well location is within a gas storage area or within the reservoir protective area, the applicant must notify the gas storage operator of this well permit application, and submit proof of notification with this application. Notification must be by certified mail with a copy of this permit application, including the well location plat on form 5500-PM-OG0002. The protective area is nominally 2,000 feet from the boundary of the storage area unless otherwise designated by the Department.
Landfills
If the proposed well location is within the perimeter of an abandoned, active, or permitted landfill, draw and label the approximate perimeter of the landfill on the well location plat. Identify the owner/operator of the landfill, if known.
Location Waivers and Variances
No disturbed area of the well site may be within 100 feet of a wetland larger than one acre, or spring,
stream or body of water (identified on the most current 7½-minute USGS topographic map) unless the department has approved a waiver of this regulation. Submit a “Request for Waiver of Distance Requirements...“ on form 5500-FM-OG0057, plus an erosion and sedimentation control plan for the site. NO SITE WORK MAY PROCEED WITHIN THE 100-FOOT DISTANCE UNTIL THE WAIVER IS GRANTED. If the well site encroaches on a watercourse, body of water, or wetland, the applicant may also be required to obtain a permit for water obstructions and encroachments. A new well may not be drilled within 200 feet of an existing building or a water well without the prior written consent of the owner. Written consent may be in the form of the owners‟ signatures in the appropriate spaces on page 2 of the permit application form, or in a letter or form created by the applicant or consentor. If the owners of the water well or building refuse to grant consent in writing, the applicant must submit a “Request for Variance from Distance Restriction....“ (form 5500-FM-OG0058).
all supporting documents, and would be subject to penalty for falsification of any information in this application (18 Pa CS §4904).
Form 5500-PM-OG0001, Page 2 Record of Notification / Written Consent
Instructions and explanation for page 2 of the application form are also on the back of that page. Please be sure to include those instructions with your mailings to the parties to be notified. Fill in “Applicant Name” and “Farm Name - Well #” in the upper right corner of the form. Leave “Application Tracking #” blank. Use this form to record and report the names and addresses of all parties whose interests may be affected by the proposed well or activity, that is: surface ownership, coal rights, water supply, and gas storage operations. If you need more spaces for listings, use additional forms. An applicant for a well permit is required to notify certain parties of this application. Send a copy of it by certified mail to:
SIGNATURE of Applicant
If the well operator is an individual, either doing business in his own name or under a fictitious name (registered or not), he must sign his own name. Individuals in joint ownership must authorize one person to sign on behalf of all; attach the authorizing resolution or power-of-attorney. An unincorporated business entity using a fictitious (business) name must have the name registered with the Corporation Bureau of the Pennsylvania Department of State. Only an owner or an individual duly authorized by the owners of such a business may sign this permit application. If the well operator is a partnership, the application must be signed by all partners or an authorized general partner. Attach the authorizing resolution. Use additional attachments for signatures if needed. If the well operator is a corporation, the application must be signed by an authorized corporate officer. Attach the authorizing resolution. A well operator may empower another person, by specific power-of-attorney, to sign permit applications on behalf of the operator. To change this designation include a new power-of-attorney with the permit application. Names and titles must be printed or typed next to each signature. Words crossed-out or other corrections must be initialed and dated by all parties signing this form. Be advised that a signatory to this form attests to the truthfulness of the information in the application and -4-
the surface landowner (names and addresses of landowners as recorded by the county real estate tax office); all surface landowners or water purveyors whose water supplies are within 1,000 feet of the proposed well location; the owners and lessees of all underlying workable coal seams; every coal operator or (underground) mining permit holder, as required. This includes any coal operator with a permitted underground mine boundary within 1,000 feet of the proposed well location. (See instructions for page 1, COORDINATION WITH REGULATIONS AND OTHER PERMITS about Coal Mining and Coal Resources.) gas storage operator, if the proposed well location is within a gas storage or reservoir protective area (nominally, within 2,000 feet of the perimeter of the storage area).
Your mailing must include a copy of pages 1 and 2 (filled-in) of your application form, 5500-FM-OG0001, as well as the corresponding location plat on form 5500-PM-OG0002 (including additional list, if used) Landowners with water supplies within 1,000 feet of the location, and water supply purveyors with water supplies within 1,000 feet must be notified of their rights regarding protection of their water supplies. Send the “Landowner Notification of Well Drilling or
Alterations -- Water Supply Protection” (form 5500-FMOG0052). This notice informs those with water supplies of their rights and options regarding a survey of their water supply prior to the proposed well activity, and the procedure to file written objections. A notified party can give written consent to this well location or proposed activity and waive their objection period by signing the appropriate space on this page (page 2 of form 5500-PM-OG0001). Such signature would also serve as proof of notification. If certified mail is returned undeliverable, please submit a photocopy of the returned envelope and certified mail reply card, as well as a completed affidavit attesting to attempted delivery. For your convenience, a blank affidavit form is included in your application forms packet.
Latitude and Longitude
As with past practice, record latitude and longitude as offset distances in the spaces along the plat frame lines. Also, in the box at the upper left corner of the plat frame, record the true latitude and longitude, in degrees, minutes, seconds and decimal fraction of a second. True latitude and longitude data will be recorded in a GIS database, so please report this information to the accuracy and precision your survey yields. If you back-calculate from the well location plotted on the USGS map, round to the nearest tenth of a second. If you surveyed from a USGS survey station or used the direct results from a GPS survey, round to the nearest hundredth of a second. If your surveyor cannot calculate these figures accurately, please contact the oil and gas technical services supervisor at the appropriate DEP regional office for advice.
LOCATION PLAT FOR OIL OR GAS WELL (DEP form 5500-PM-OG0002) General
Four copies are required with the application. Show the road for access to the site and include the road‟s name or number. Using notes and arrows, indicate travel directions from main roads to the well site. Include a description of the property and courses and distances to the well‟s location from two or more permanent identifiable points or land marks on the tract boundary corners. Show these features if present: all buildings and water supplies within 200 feet of the proposed well, water supplies within 1,000 feet of the proposed well location, wetlands within 100 feet of the anticipated perimeter of the disturbed area of the well site, and every spring, stream or body of water (as identified on the most current 7½‟ topographic map) which is within 100 feet of the disturbed area.
Applicant (Well Operator) Information
Print or type the applicant‟s name and DEP ID# exactly as they appear on page 1 of the permit application, form 5500-PM-OG0001.
Well ID Information
Enter the Well (Farm) Name, Well#, and Serial# exactly as they appear on page 1 of the permit application, form 5500-PM-OG0001. If this as an application to rework an existing permitted or registered well, enter the well‟s permit number in the space labeled DEP USE ONLY at the upper right corner of the page. If this well has a project number, enter it in the appropriate space in the same box.
Reference to buildings, springs, bodies of water, wetlands, and water supplies within 1,000 feet is not required for a well-plugging plat. A registered professional surveyor or engineer must prepare this plat. The preparer‟s seal or stamp must appear on the page, anywhere. As explained in the instructions for page 2 of the permit application form (5500-PM-OG0001), the applicant must send a copy of the application -including this location plat -- to each party to be notified of this pending application. -5-
Well Location Information
County Name and Code. Please be sure to enter the county name and correct two-digit code from the list below. This is the state government county code, not the county designation used in the API well permit number. Adams Allegheny Armstrong Beaver Bedford Berks Blair Bradford Bucks Butler Cambria Cameron Carbon Centre Chester Clarion Clearfield Clinton Columbia Crawford Cumberland Dauphin Delaware 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 Elk Erie Fayette Forest Franklin Fulton Greene Huntingdon Indiana Jefferson Juniata Lackawanna Lancaster Lawrence Lebanon Lehigh Luzerne Lycoming McKean Mercer Mifflin Monroe Montgomery 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 Montour Northampton Northumberland Perry Philadelphia Pike Potter Schuylkill Snyder Somerset Sullivan Susquehanna Tioga Union Venango Warren Washington Wayne Westmoreland Wyoming York 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67
temperature-compensated sensitive altimeter. However, elevation estimated from the proposed well location plotted on the USGS map is acceptable. Elevation data from pseudo-ranging GPS surveys should not be used; elevations from carrier-phased GPS surveys are acceptable. The ideal elevation survey should first establish an elevation reference point outside the anticipated disturbed area of the well site, with a final survey shot to the exact location after site construction. To aid accuracy in geologic mapping, wireline logs should include the elevation differential between the surveyed ground elevation and the logs‟ reference point (e.g. rig floor, rotary table, or kelly bushing). Anticipated total depth. This is the expected depth of the drilled hole, not the depth to producing formations. For deviated boreholes, the total depth should be given as two numbers -- the well‟s true vertical depth as well as its apparent depth (borehole length).
CHECKLIST
The checklist is not a required form for submission , but using it will help you properly complete your application. An incomplete application will be returned to you for completion before we will begin to process it.
If you are using DEP‟s word-processing disk file for this form, you may have a drop-down list of the county names and codes you use most, or you may be able to create one. Municpality Fill in the name of the municipality and include the type -- township (twp), borough (boro), or city. USGS Map Name Enter the name of the USGS 7½-minute quadrangle map where the well is located. Enter the map section number. Section numbers run left to right, with 1 being the northwest corner and 9 being the southeast corner. Angle and Course of Deviation (Drilling). If the well will be drilled at an angle from vertical, enter the estimated angle of total gross borehole deviation from the surface to total depth, and directional course. On the graphic portion of the plat, depict both the proposed well‟s surface location and its intended location at total depth. Surface Elevation. This is the elevation of the surface at the well location, relative to mean sea level. The best elevation data would be from a survey including a USGS bench mark, or referenced to a benchmark using a -6-