Form C-137 "Application for Surface Waste Management Facility" - New Mexico

What Is Form C-137?

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

Form Details:

  • Released on August 1, 2011;
  • The latest edition provided by the New Mexico Energy, Minerals and Natural Resources Department;
  • 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 printable version of Form C-137 by clicking the link below or browse more documents and templates provided by the New Mexico Energy, Minerals and Natural Resources Department.

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Download Form C-137 "Application for Surface Waste Management Facility" - New Mexico

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For State Use Only:
District I
State of New Mexico
1625 N. French Dr., Hobbs, NM 88240
Energy Minerals and Natural Resources
District II
811 S. First St., Artesia, NM 88210
Form C-137
District III
Oil Conservation Division
Revised August 1, 2011
1000 Rio Brazos Road, Aztec, NM 87410
1220 South St. Francis Dr.
District IV
Submit 1 Copy to Santa Fe Office
1220 S. St. Francis Dr., Santa Fe, NM 87505
Santa Fe, NM 87505
APPLICATION FOR SURFACE WASTE MANAGEMENT FACILITY
A meeting should be scheduled with the Division’s Santa Fe office Environmental Bureau prior to pursuing an application
for a surface waste management facility in order to determine if the proposed location is capable of satisfying the siting
requirements of Subsections A and B of 19.15.36.13 NMAC for consideration of an application submittal.
1 Application:
New
Modification
Renewal
2. Type:
Evaporation
Injection
Treating Plant
Landfill
Landfarm
Other
3. Facility Status:
Commercial
Centralized
4. Operator: _______________________________________________________________________________________
Address: _______________________________________________________________________________________
Contact Person: ____________________________________________Phone: _______________________________
5. Location: __________/4 __________/4 Section ______________Township _____________Range ___________
6. Is this an existing facility?
Yes
No
If yes, provide permit number _______________
7. Attach the names and addresses of the applicant and principal officers and owners of 25 percent or more of the applicant.
Specify the office held by each officer and identify the individual(s) primary responsible for overseeing management of the
facility.
8. Attach a plat and topographic map showing the surface waste management facility’s location in relation to governmental
surveys (quarter-quarter section, township and range); highways or roads giving access to the surface waste management
facility site; watercourses; fresh water sources, including wells and springs; and inhabited buildings within one mile of the site’s
perimeter.
9. Attach the names and addresses of the surface owners of the real property on which the surface waste management facility is
sited and surface owners of the real property within one mile of the site’s perimeter.
10. Attach a description of the surface waste management facility with a diagram indicating the location of fences and cattle
guards, and detailed construction/installation diagrams of pits, liners, dikes, piping, sprayers, tanks, roads, fences, gates, berms,
pipelines crossing the surface waste management facility, buildings and chemical storage areas.
11. Attach engineering designs, certified by a registered professional engineer, including technical data on the design elements
of each applicable treatment, remediation and disposal method and detailed designs of surface impoundments.
12. Attach a plan for management of approved oil field wastes that complies with the applicable requirements contained in
19.15.36.13, 19.15.36.14, 19.15.36.15 and 19.15.36.17 NMAC.
13. Attach an inspection and maintenance plan that complies with the requirements contained in Subsection L of 19.15.36.13
NMAC.
14. Attach a hydrogen sulfide prevention and contingency plan that complies with those provisions of 19.15.3.118 NMAC that
apply to surface waste management facilities.
Form C-137
Page 1 of 2
For State Use Only:
District I
State of New Mexico
1625 N. French Dr., Hobbs, NM 88240
Energy Minerals and Natural Resources
District II
811 S. First St., Artesia, NM 88210
Form C-137
District III
Oil Conservation Division
Revised August 1, 2011
1000 Rio Brazos Road, Aztec, NM 87410
1220 South St. Francis Dr.
District IV
Submit 1 Copy to Santa Fe Office
1220 S. St. Francis Dr., Santa Fe, NM 87505
Santa Fe, NM 87505
APPLICATION FOR SURFACE WASTE MANAGEMENT FACILITY
A meeting should be scheduled with the Division’s Santa Fe office Environmental Bureau prior to pursuing an application
for a surface waste management facility in order to determine if the proposed location is capable of satisfying the siting
requirements of Subsections A and B of 19.15.36.13 NMAC for consideration of an application submittal.
1 Application:
New
Modification
Renewal
2. Type:
Evaporation
Injection
Treating Plant
Landfill
Landfarm
Other
3. Facility Status:
Commercial
Centralized
4. Operator: _______________________________________________________________________________________
Address: _______________________________________________________________________________________
Contact Person: ____________________________________________Phone: _______________________________
5. Location: __________/4 __________/4 Section ______________Township _____________Range ___________
6. Is this an existing facility?
Yes
No
If yes, provide permit number _______________
7. Attach the names and addresses of the applicant and principal officers and owners of 25 percent or more of the applicant.
Specify the office held by each officer and identify the individual(s) primary responsible for overseeing management of the
facility.
8. Attach a plat and topographic map showing the surface waste management facility’s location in relation to governmental
surveys (quarter-quarter section, township and range); highways or roads giving access to the surface waste management
facility site; watercourses; fresh water sources, including wells and springs; and inhabited buildings within one mile of the site’s
perimeter.
9. Attach the names and addresses of the surface owners of the real property on which the surface waste management facility is
sited and surface owners of the real property within one mile of the site’s perimeter.
10. Attach a description of the surface waste management facility with a diagram indicating the location of fences and cattle
guards, and detailed construction/installation diagrams of pits, liners, dikes, piping, sprayers, tanks, roads, fences, gates, berms,
pipelines crossing the surface waste management facility, buildings and chemical storage areas.
11. Attach engineering designs, certified by a registered professional engineer, including technical data on the design elements
of each applicable treatment, remediation and disposal method and detailed designs of surface impoundments.
12. Attach a plan for management of approved oil field wastes that complies with the applicable requirements contained in
19.15.36.13, 19.15.36.14, 19.15.36.15 and 19.15.36.17 NMAC.
13. Attach an inspection and maintenance plan that complies with the requirements contained in Subsection L of 19.15.36.13
NMAC.
14. Attach a hydrogen sulfide prevention and contingency plan that complies with those provisions of 19.15.3.118 NMAC that
apply to surface waste management facilities.
Form C-137
Page 1 of 2
15. Attach a closure and post closure plan, including a responsible third party contractor’s cost estimate, sufficient to close the
surface waste management facility in a manner that will protect fresh water, public health, safety and the environment (the
closure and post closure plan shall comply with the requirements contained in Subsection D of 19.15.36.18 NMAC).
16 Attach a contingency plan that complies with the requirements of Subsection N of 19.15.36.13 NMAC and with NMSA
1978, Sections 12-12-1 through 12-12-30, as amended (the Emergency Management Act).
17. Attach a plan to control run-on water onto the site and run-off water from the site that complies with the requirements of
Subsection M of 19.15.36.13 NMAC.
18. In the case of an application to permit a new or expanded landfill, attach a leachate management plan that describes the
anticipated amount of leachate that will be generated and the leachate’s handling, storage, treatment and disposal, including
final post closure options.
19. In the case of an application to permit a new or expanded landfill, attach a gas safety management plan that complies with
the requirements of Subsection O of 19.15.36.13 NMAC
20. Attach a best management practice plan to ensure protection of fresh water, public health, safety and the environment.
21. Attach a demonstration of compliance with the siting requirements of Subsections A and B of 19.15.36.13 NMAC.
22. Attach geological/hydrological data including:
(a)
a map showing names and location of streams, springs or other watercourses, and water wells within one mile of
the site;
(b)
laboratory analyses, performed by an independent commercial laboratory, for major cations and anions; benzene,
toluene, ethyl benzene and xylenes (BTEX); RCRA metals; and total dissolved solids (TDS) of ground water samples of the
shallowest fresh water aquifer beneath the proposed site;
(c)
depth to, formation name, type and thickness of the shallowest fresh water aquifer;
(d)
soil types beneath the proposed surface waste management facility, including a lithologic description of soil and
rock members from ground surface down to the top of the shallowest fresh water aquifer;
(e)
geologic cross-sections;
(f)
potentiometric maps for the shallowest fresh water aquifer; and
(g)
porosity, permeability, conductivity, compaction ratios and swelling characteristics for the sediments on which
the contaminated soils will be placed.
23. In the case of an existing surface waste management facility applying for a minor modification, describe the proposed
change and identify information that has changed from the last C-137 filing.
24. The division may require additional information to demonstrate that the surface waste management facility’s operation
will not adversely impact fresh water, public health, safety or the environment and that the surface waste management facility
will comply with division rules and orders
25. CERTIFICATION
I hereby certify that the information submitted with this application is true, accurate and complete to the best of my knowledge
and belief.
Name: ______________________________________________
Title: ___________________________________
Date: ___________________________________
Signature: ___________________________________________
E-mail Address: _____________________________________
Form C-137
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