Form OG-27 "Application for Landowner Grant - Plugging and Restoration Program" - Illinois

What Is Form OG-27?

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

Form Details:

  • Released on August 1, 2018;
  • The latest edition provided by the Illinois Department of Natural Resources;
  • 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 OG-27 by clicking the link below or browse more documents and templates provided by the Illinois Department of Natural Resources.

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Download Form OG-27 "Application for Landowner Grant - Plugging and Restoration Program" - Illinois

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Application for Landowner Grant: Instructions
General Information
The owner of the land surface on which the well is located is the only person eligible to receive a grant
under the Landowner Grant Program (provided the owner is not the current or past permittee of the
wells). Each landowner will be limited to plugging a maximum of five (5) wells per fiscal year under
the Landowner Grant Program, with funding for plugging additional wells depending on availability of
funds appropriated. The Department reserves the right to give priority to wells it determines are
creating or have the potential to create environmental damage to surface waters or groundwater or pose
an immediate danger to the health and safety of the public.
Only those wells which have been placed in the Plugging and Restoration Program by the Department
are eligible to be plugged under the Landowner Grant Program. If you are not sure if a well is eligible
contact the nearest District Office (see telephone numbers below), the manager of the Landowner Grant
Program in the Springfield office at (217) 782-7756, or you may find the list at:
https://www.dnr.illinois.gov/OilandGas/Documents/OilAndGasFillableForms/Plugging%20and%
20Restoration%20Fund%20Well%20List.pdf
Applications will be accepted until all Landowner Grant funds have been obligated for the fiscal year
(July 1 through July 30). The Department shall only accept and process grant applications received
after April 1 for the coming fiscal year. Applications received before April 1 for the coming fiscal year
shall be returned to the applicant for submission after April 1. All applications received after all
allocated grant funds have been obligated will be returned to the applicant.
The landowner is required to have a Department Well Inspector complete an OG-22 Field Inspection
Report for each well for which a grant is being requested. A copy of the OG-22 Field Inspection
Report is required to be submitted with the grant application. Contact the nearest Office of Oil and Gas
Resource Management District Office to have an inspection and report completed.
Mt. Carmel District Office (618) 262-2106
Centralia District Office
(618) 533-8979
Springfield District Office (217) 782-7756
After the grant application has been processed by the Office, a grant award document will be prepared
and sent to the landowner for signature. When the signed grant document is received by the Office,
the grant will be processed for approval by the Department. If the application is approved, a copy of
the approved grant will be sent to the landowner. Plugging of the well may commence only after the
landowner receives a copy of the approved grant. All well plugging and well site restoration activities
shall be completed by June 30 of the fiscal year in which the grant was approved unless the grant funds
are automatically re-appropriated for the next fiscal year. After the Office receives documentation
from the Well Inspector that the well has been properly plugged and the site restored, the grant award
funds will be processed for payment. The landowner should receive the funds approximately 30 to 60
days after the Office receives the appropriate documentation from the Well Inspector.
DNR OOGRM Form IL OG-27 Instructions (Rev. 8/2018)
Page 1 of 2
Application for Landowner Grant: Instructions
General Information
The owner of the land surface on which the well is located is the only person eligible to receive a grant
under the Landowner Grant Program (provided the owner is not the current or past permittee of the
wells). Each landowner will be limited to plugging a maximum of five (5) wells per fiscal year under
the Landowner Grant Program, with funding for plugging additional wells depending on availability of
funds appropriated. The Department reserves the right to give priority to wells it determines are
creating or have the potential to create environmental damage to surface waters or groundwater or pose
an immediate danger to the health and safety of the public.
Only those wells which have been placed in the Plugging and Restoration Program by the Department
are eligible to be plugged under the Landowner Grant Program. If you are not sure if a well is eligible
contact the nearest District Office (see telephone numbers below), the manager of the Landowner Grant
Program in the Springfield office at (217) 782-7756, or you may find the list at:
https://www.dnr.illinois.gov/OilandGas/Documents/OilAndGasFillableForms/Plugging%20and%
20Restoration%20Fund%20Well%20List.pdf
Applications will be accepted until all Landowner Grant funds have been obligated for the fiscal year
(July 1 through July 30). The Department shall only accept and process grant applications received
after April 1 for the coming fiscal year. Applications received before April 1 for the coming fiscal year
shall be returned to the applicant for submission after April 1. All applications received after all
allocated grant funds have been obligated will be returned to the applicant.
The landowner is required to have a Department Well Inspector complete an OG-22 Field Inspection
Report for each well for which a grant is being requested. A copy of the OG-22 Field Inspection
Report is required to be submitted with the grant application. Contact the nearest Office of Oil and Gas
Resource Management District Office to have an inspection and report completed.
Mt. Carmel District Office (618) 262-2106
Centralia District Office
(618) 533-8979
Springfield District Office (217) 782-7756
After the grant application has been processed by the Office, a grant award document will be prepared
and sent to the landowner for signature. When the signed grant document is received by the Office,
the grant will be processed for approval by the Department. If the application is approved, a copy of
the approved grant will be sent to the landowner. Plugging of the well may commence only after the
landowner receives a copy of the approved grant. All well plugging and well site restoration activities
shall be completed by June 30 of the fiscal year in which the grant was approved unless the grant funds
are automatically re-appropriated for the next fiscal year. After the Office receives documentation
from the Well Inspector that the well has been properly plugged and the site restored, the grant award
funds will be processed for payment. The landowner should receive the funds approximately 30 to 60
days after the Office receives the appropriate documentation from the Well Inspector.
DNR OOGRM Form IL OG-27 Instructions (Rev. 8/2018)
Page 1 of 2
Instructions for completing the application form
(Please use ink and print or type the information on the form.)
1. Complete section A of the application form with the landowner information. Include the
landowner’s Social Security number (or Taxpayer ID # if the landowner is a corporation).
2. Complete section B of the application form with the well information. The well name, permit
number, reference number and location information can be found on the OG-22 Field Inspection
Report completed by the Division Well Inspector. If you are applying for grant funds to plug
more than one well, you must submit a separate application and contract for each well.
3. Complete section C of the application form with information obtained from the plugging
Contractor (the total cost to plug the well and restore the site and the estimated value of any
salvageable equipment at the site, including rods, tubing and casing). On line 1 write the total
amount of the plugging contractor’s bid to plug the well and restore the site. On line 2 write the
total amount of the estimated salvageable equipment located at the site. Subtract line 2 from line
1 and enter the difference on line 3. The maximum amount of the grant award (the amount
shown on line 3) will be the total of the plugging and restoration cost minus the total of the
equipment salvage value.
4. Read the statement on the back of the application form, sign and date the form.
5. Attach a copy of the OG-22 Field Inspection Report for the well, which was provided by the
Well Inspector.
6. Attach a completed and signed contract between the landowner and plugging contractor. The
contract is required to be on the form provided by the Department and must be completed in its
entirety, including an itemized listing of any salvageable equipment. The contract contains a
contingency clause which voids the contract if the grant is not approved or if sufficient funds are
not available.
7. Mail the completed application and all attachments to:
Department of Natural Resources
Office of Oil and Gas Resource Management
One Natural Resources Way
Springfield, IL 62702-1271
Attn: PRF Program Manager
An electronic version of application packet is available at:
https://www.dnr.illinois.gov/OilandGas/Documents/OilAndGasFillableForms/OGF-OG27ApplicationforLandownerGrantForm.pdf
Page 2 of 2
DNR OOGRM Form IL OG-27 Instructions (Rev. 8/2018)
Illinois Department of Natural Resources
Office of Oil and Gas Resource Management
One Natural Resources Way Springfield, Illinois 62702-1271
www.dnr.illinois.gov
(217) 782 - 7756
OG-27 APPLICATION FOR LANDOWNER GRANT -
PLUGGING AND RESTORATION PROGRAM
Section A
Landowner’s Name:_____________________________________________________________
Address: _____________________________________________________________________
City:________________________________ State: __________________ Zip: ___________
Home Phone: (_____)_________________
Work Phone: (_____)___________________
Social Security #: _____ - ____ - ________
or Tax ID #: ________________________
=====================================================================
Section B
Well Name : ___________________________________________________________________
Permit # : ____________________
Reference # : _____________________
Location: _________ ft. North/South, __________ ft. East/West of the __________ corner,
___________ quarter, ___________ quarter, ___________ quarter, of Section _________,
Township ______ North/South, Range______East/West, _____________________County, IL.
Notice: If you are applying for grant funds to plug more than one well (maximum of 5), you
must submit a separate grant application and contract for each well.
=====================================================================
Section C
1. Total cost to plug well and restore site:
$ _______________
2. Total estimated salvage value of equipment:
- $ _______________
=============
3. Total of Grant request (subtract 2. from 1.):
$ _______________
4. Attach the signed contract between the Landowner and Plugging Contractor.
5. Attach a copy of the OG-22 Field Inspection Report completed by a Department Well Inspector.
DNR OOGRM Form IL OG-27 (Rev. 8/2018)
Page 1 of 2
Applicant: Please read the statement below, then sign and date the application.
Upon the Department’s award of any grant pursuant to this Application, applicant agrees to assume
the entire liability and agrees to hold harmless, indemnify and defend the Department against any
loss, damage, demand, lien, action, liability, obligation, fine, penalty, cost or expense of any nature
due to its own negligence and fault and the negligence and fault of its employees, contractors and/or
subcontractors related to any activity associated with the plugging and site restoration of the well
identified on this Application.
Applicant hereby certifies that it is the surface owner of the land upon which the well identified on
this Application is located, and by acceptance of any grant awarded pursuant hereto agrees to
assume all responsibility and costs of plugging and restoring the site of such well in accordance with
applicable statutory and regulatory authority.
____________________________________________________
____________________
Landowner’s Signature
Date
=====================================================================
For Department Use Only
Grant Application #: LOG - _______ - _____ - ___________________________________
Well approved for plugging (Reference #): ________________________
Grant amount recommended for payment: $_______________________
Grant recommended: ___________________________________
Date:________________
PRF Program Manager
Grant recommendation approved: __________________________
Date:_________________
Director of OOGRM
DNR OOGRM Form IL OG-27 (Rev. 8/2018)
Page 2 of 2
Landowner Grant Program
WELL PLUGGING CONTRACT
This contract is entered into this __________ day of _________________, 20___, by and
between ________________________ (“Landowner”), and _________________________
(“Contractor”), for the purpose of properly plugging and restoring the site of the following
listed well:
Well name:
Reference #:_________________
legally described as:
Sec:
, Township:
, Range:
, County:
, Illinois,
and includes the following associated salvageable equipment:
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
It is understood between the parties hereto that the well described herein (“Well”) has been
determined by the Illinois Department of Natural Resources, Office of Oil and Gas Resource
Management (“Department”), to be abandoned, or has otherwise been ordered by the
Department to be plugged and restored in accordance with the Illinois Oil and Gas Act(“Act”),
225 ILCS 725/1 et seq., and all associated Rules, 62 Ill. Adm. Code 240.10 et seq., and is
currently listed in the Oil and Gas Well Site Plugging and Restoration Fund Program.
The Contractor hereby agrees to plug the well and restore the site in accordance with the Act
and all applicable Rules, for the total amount of $______________ and the salvageable
equipment, if any, listed above. The Contractor is required to provide all necessary equipment
and personnel to perform these well plugging and site restoration services.
The Landowner hereby agrees to provide ingress and egress and adequate surface area to the
Contractor to permit the Contractor to carry out its obligations under the terms of this Contract.
The Landowner and Contractor hereby agree to hold harmless, indemnify and defend the
Department and the State of Illinois against any loss, damage, demand, lien, action, liability,
obligation, fine, penalty, cost or expense of any nature due to their own negligence and fault
and the negligence and fault of their employees, contractors and/or subcontractors related to
any activity associated with the plugging and site restoration of the well identified above in this
Contract.
The Landowner and Contractor hereby agree that if the Department fails to approve the
Landowner Grant Application (incorporated herein by reference) submitted for the plugging
and restoration of the Well, or the term, including extensions, of the awarded grant expires
without the well being plugged, this Contract shall become null and void and none of the
parties hereto shall have any further responsibility, obligation or liability under the terms of
this Contract.
Landowner Grant Contract (Rev. 8/2018)
Approved as to form by IDNR Office of Legal Counsel on 8/9/2018.
Page 1 of 2