1. PERMIT APPLICATION TO DRILL AND OPERATE A WELL
  2. COAL MODULE
  3. COAL MODULE
  4. RECORD OF NOTIFICATION / WRITTEN CONSENT

8000-PM-OOGM0001c Rev. 2/2017  COMMONWEALTH OF PENNSYLVANIA

 DEPARTMENT OF ENVIRONMENTAL PROTECTION

 OFFICE OF OIL AND GAS MANAGEMENT
 

PERMIT APPLICATION TO DRILL AND OPERATE A WELL

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COAL MODULE

Coal module attachment to address coal related issues with drilling, altering, or operating wells.
 
Yes
No
1.   Will the well penetrate a workable   coal seam ?

If “No,” attach justification and supporting documentation

 
   
a. Have the coal rights been severed from the surface estate
   
2.   If the well will penetrate a workable coal seam and the well is a “non-conservation” gas well, does the location comply with the distance requirements of section 7 of the Coal and Gas Resource Coordination Act? (At least 1,000 feet from all existing wells). 58 P.S. §§ 501 - 518.
   
a.   If “No,” is the required exception request attached? (Check N/A if re-working an existing well: N/A)

b.   Will the well be part of a Well Cluster that is an area within a well pad intended to host multiple horizontal wells and which comprises an area no greater than 5,000 square feet?

   
c.      
3.   Will this well be drilled in solid coal or into an open underground void?
solid coal

 

open void

 

 
Yes
No
4.   Will the well be drilled through an operating coal mine , or within 1,000 feet of the boundary?
   
a.   If “Yes,” provide the names of: Mine       and Operator      

b.   If yes, does it meet the Gas Well Pillar Study? 58 P.S. § 512.1.

c.   If yes, provide a copy of the most recent underground mine workings map that shows well location, a map scale, the lease/unit boundary, and a north arrow.

   
5.   If the well will be a Coal Bed Methane (CMB) well is the alternate method request of drilling/completing the well attached Proposed Alternate Method or Material for Casing, Plugging, Venting or Equipping a Well form 8000-PM-OOGM0024?
   
6.   If the well is a CBM well, has the surface landowner been notified and provided a copy of Landowner Notification of Right to Participate in Alternate Dispute Resolution to Coal Bed Methane Wells , form 8000-FM-OOGM0052?
   

 
 
 
 

 

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COAL MODULE

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RECORD OF NOTIFICATION / WRITTEN CONSENT

List the following: all coal owners and lessees of all underlying coal seams; operators of operating coal mines at the proposed location; and coal operators with Operating Coal Mine. Mark the boxes “X” that show the parties’ interests. Use additional forms if you need more space. You are required to notify each of these parties.
Coal Owner Coal Lessee Operator of Operating Coal Miner
Within 1,000 ft.
Notification
Note the Means and Attach Proof
      Coal Mine

Operator

Certified Mail Dates
Address Affidavit
Written Consent
       
Sent
Return Receipt
 
Name       
     
Address       
      

      

       
     
     
 
Name       
     
Address       
      

      

       
     
     
 
Name       
     
Address       
      

      

       
     
     
 
Name       
     
Address       
      

      

       
     
     
 
Name       
     
Address       
      

      

       
     
     
Optional: Signature below indicates the party’s approval of the well location and waives the 15-day objection period. Check applicable box.
Coal Operator, Owner, or Lessee Date

     

Coal Operator, Owner, or Lessee Date

     

Coal Operator, Owner, or Lessee Date

     

Coal Operator within 1,000 feet of proposed location

     

Date

       

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