Form 22 "Permit to Drill" - Montana

What Is Form 22?

This is a legal form that was released by the Montana Department of Natural Resources and Conservation - a government authority operating within Montana. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on October 1, 2009;
  • The latest edition provided by the Montana Department of Natural Resources and Conservation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form 22 by clicking the link below or browse more documents and templates provided by the Montana Department of Natural Resources and Conservation.

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Download Form 22 "Permit to Drill" - Montana

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FORM NO. 22 R 10/09
ARM 36.22.307
Lease Name:
SUBMIT IN QUADRUPLICATE TO:
ARM 36.22.601
MONTANA BOARD OF OIL AND GAS CONSERVATION
Lease Type (Private/State/Federal):
2535 ST. JOHNS AVENUE, BILLINGS, MONTANA 59102
Application for Permit To:
Well Number:
Drill
Deepen
Re-enter
Oil
Gas
Other
Field Name or Wildcat:
Operator:
Address:
Unit Name (if applicable):
City:
State:
Zip:
Telephone Number:
Objective Formation(s):
Surface Location of Well (quarter-quarter and footage measurements):
Township, Range, and Section:
Proposed Total Depth and Bottom-hole Location(s) if directional or horizontal well:
County:
Elevation (indicate GL or KB):
Size and description of drilling/spacing unit and applicable order, if any:
Formation at total depth:
Anticipated Spud Date:
Hole Size
Casing Size
Weight / Foot
Grade (API)
Depth
Sacks of Cement
Type of Cement
Describe Proposed Operations:
Describe or attach labeled diagram of blowout preventer equipment. Indicate if air drilled or describe mud program.
BOARD USE ONLY
The undersigned hereby certifies that the information
Approved (date)
Permit Fee
contained on this application is true and correct:
Check Number
By
Signed (Agent)
Permit Expires
Title
Title
Permit Number
Date
THIS PERMIT IS SUBJECT TO THE
API Number: 25 -
-
CONDITIONS OF APPROVAL
STATED ON THE BACK
Telephone Number
NONE
ALL
FROM
feet to
feet
Samples Required:
Core chips to address below, full cores to USGS, Core Laboratory, Arvada, CO. Required samples must be washed, dried and delivered prepaid to:
Montana Board of Oil and Gas Conservation
2535 St. Johns Avenue
Billings, MT 59102
FORM NO. 22 R 10/09
ARM 36.22.307
Lease Name:
SUBMIT IN QUADRUPLICATE TO:
ARM 36.22.601
MONTANA BOARD OF OIL AND GAS CONSERVATION
Lease Type (Private/State/Federal):
2535 ST. JOHNS AVENUE, BILLINGS, MONTANA 59102
Application for Permit To:
Well Number:
Drill
Deepen
Re-enter
Oil
Gas
Other
Field Name or Wildcat:
Operator:
Address:
Unit Name (if applicable):
City:
State:
Zip:
Telephone Number:
Objective Formation(s):
Surface Location of Well (quarter-quarter and footage measurements):
Township, Range, and Section:
Proposed Total Depth and Bottom-hole Location(s) if directional or horizontal well:
County:
Elevation (indicate GL or KB):
Size and description of drilling/spacing unit and applicable order, if any:
Formation at total depth:
Anticipated Spud Date:
Hole Size
Casing Size
Weight / Foot
Grade (API)
Depth
Sacks of Cement
Type of Cement
Describe Proposed Operations:
Describe or attach labeled diagram of blowout preventer equipment. Indicate if air drilled or describe mud program.
BOARD USE ONLY
The undersigned hereby certifies that the information
Approved (date)
Permit Fee
contained on this application is true and correct:
Check Number
By
Signed (Agent)
Permit Expires
Title
Title
Permit Number
Date
THIS PERMIT IS SUBJECT TO THE
API Number: 25 -
-
CONDITIONS OF APPROVAL
STATED ON THE BACK
Telephone Number
NONE
ALL
FROM
feet to
feet
Samples Required:
Core chips to address below, full cores to USGS, Core Laboratory, Arvada, CO. Required samples must be washed, dried and delivered prepaid to:
Montana Board of Oil and Gas Conservation
2535 St. Johns Avenue
Billings, MT 59102
SUPPLEMENTAL INFORMATION
Note: Additional information or attachments may be required by Rule or by special request.
1. Attach a survey plat certified by a registered surveyor. The survey plat must show the location of the well with
reference to the nearest lines of an established public survey.
2.
Attach an 8 1/2 x 11" photocopy of that portion of a topographic map showing the well location, the access route
from county or other established roads, residences, and water wells within a 1/2 mile radius of the well.
Attach a sketch of the well site showing the dimensions and orientation of the site, the size and location of pits, topsoil
3.
stockpile, and the estimated cut/fill at the corners and centerstake. (Note: the diagram need not be done by an
engineer or surveyor). Attach a sketch of a top view and two side views of the reserve pit(s), if utilized. The reserve
pit sketch must show the length, width, depth, cut and fill, amount of freeboard, area of topsoil stockpile, and the
height and width of berms.
4.
Describe the type and amount of material or liner, if any, to be used to seal the reserve pit. If a synthetic liner is used,
indicate the liner thickness (mils), bursting strength, tensile strength, tear strength, puncture resistance, hydrostatic
resistance, or attach the manufacturer's specifications.
5.
Describe the proposed plan for the treatment and/or the disposal of reserve pit fluids and solids after the well is
drilled. If the operator intends to dispose of or treat the reserve pit contents off-site, specify the location and the
method of waste treatment and disposal. (Note: The operator must comply with all applicable federal, state, county,
and local laws and regulations with regard to the handling, transportation, treatment, and disposal of solid wastes.)
6.
Does construction of the access road or location, or some other aspect of the drilling operation require additional
federal, state, or local permits or authorizations? If yes, indicate the type of permit or authorization required:
No additional permits needed
310 Permit (apply through county conservation district)
Air quality permit (apply through Montana Department of Environmental Quality)
Water discharge permit (apply through Montana Department of Environmental Quality)
Water use permit (apply through Montana Department of Natural Resources and Conservation)
Solid waste disposal permit (apply through Montana Department of Environmental Quality)
State lands drilling authorization (apply through Montana Department of Natural Resources and Conservation)
Federal drilling permit (specify agency)
Other federal, state, county, or local permit or authorization: (specify type)
NOTICES:
1. Date and time of spudding must be reported to the Board verbally or in writing within 72 hours after the
commencement of drilling operations.
2. The operator must give notice of drilling operations to the surface owner as required by Section 82-10-503, MCA,
before the commencement of any surface activity.
BOARD USE ONLY
CONDITIONS OF APPROVAL
The operator must comply with the following condition(s) of approval:
WARNING: Failure to comply with conditions of approval may void this permit.
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