COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF ENVIRONMENTAL PROTECTION
OFFICE OF OIL AND GAS MANAGEMENT
CHECKLIST FOR COMPLETING AN APPLICATION
FOR A PERMIT TO DRILL, OPERATE OR ALTER
AN OIL OR GAS WELL
Farm Name - Well #
(Forms 8000-PM-OOGM0001 and 8000-PM-OOGM0002)
This optional checklist is for your use to help assure that you submit a complete application. Failure to provide all required
information will delay processing. Compare your finished application to this list to make sure you include all the required information,
forms, and documents. Mark the box in the appropriate column for those items which are attached, or not applicable.
Included N/A Included
a. Page 1 with all spaces filled in where applicable.
b. Page 2, with names, addresses, and signatures (surface owner, water supplies
purveyors, coal mines, and gas storage operator municipality and adjacent
c. Location plat, form 8000-PM-OOGM0002, Original and one copy
d. Application fee based on permit fee calculator, check or money order payable to
“Commonwealth of Pennsylvania.”
e. Proof and record of notifications and/or written consent, as applicable:
1. Attach copies of signed and dated certified mail receipt cards or a completed
"Affidavit of Non-Delivery of Certified Mail" as proof that you notified the parties
listed on page 2. Note that you are required to send a copy of the whole
application (pages 1 and 2 of form 8000-PM-OOGM0001 as well as the plat, form
8000-PM-OOGM0002 and attachments). Also, to parties with water supplies within
1,000 or 3,000 feet of the well location as applicable, include “Landowner
Notification of Well Drilling or Alterations,” form (8000-FM-OOGM0052).
2. For required or optional written consent from a notified party -- is the party’s
signature in ink on the appropriate blank on Page 2, or on a separate document.
f. Bond instrument, if not already in effect
g. Bond Agreement Id # provided on Page 1 if bond is in effect
h. For a “Phased Deposit” bond -- additional collateral, if required.
“Coal well” -- spacing exception
request or well cluster spacing.
Request for Waiver for Distance Requirements from Springs, Stream, Body of Water, or
Wetland, form 8000-FM-OOGM0057.
k. Request For Variance From Distance Restriction From Existing Building Or Water
Supply, form 8000-FM-OOGM0058.
(form 5500-PM-OG0071), if needed.
m. Proposed Alternate Method of Casing, Plugging, Venting or Equipping
(form 8000-PM-OOGM0024), if needed.
n. Coordination of a Well Location with Public Resources (form 8000-PM-OOGM0076), if
o. For a disposal well or an enhanced recovery well, include the additional information
required by regulations §78.18 (EPA UIC permit; control and disposal plan; erosion and
sedimentation control plan).
p. Attach a copy of your PNDI check for the proposed well location shown on your plat.
q. Earth Disturbance Permit: Attached on prior ESCGP approval.
r. WMP for Unconventional Well: Attached prior approval.
Signature of Applicant
s. On page 1 of the application -- the signature, and printed name and title of the person
authorized to submit the application, and date. See instructions,