Form 23 "Application for Permit to Construct or Operate an Earthen Pit or Pond" - Montana

What Is Form 23?

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 23 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 23 "Application for Permit to Construct or Operate an Earthen Pit or Pond" - Montana

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Submit in triplicate to:
FORM NO. 23 R 10/09
ARM 36.22.307
36.22.1226
36.22.1403
MONTANA BOARD OF OIL AND GAS CONSERVATION
2535 ST. JOHNS AVENUE
BILLINGS, MONTANA 59102
(406) 656-0040
Application For Permit To Construct Or Operate An Earthen Pit Or Pond
(Production Facility Only)
Lease Name:
New pit
Existing pit
Lease Type (Private/State/Federal):
Operator
Unit Name:
Address
Field or Area:
County:
City
State
Zip Code
Location of Pit-
)
Telephone:
(
Fax: (
)
Township, Range, Section, 1/4 1/4:
Describe the purpose of the earthen pit or pond (if temporary, indicate anticipated time pit will be in use):
|
|
API # of Well Associated With This Pit:
25
Number of Wells Using Pit:
Average water inflow:
bbls./day
Maximum pit volume:
bbls.
Describe type and origin of fluids, name and location of source wells, producing formations, and approximate fluid volume
contributed by each well: (Use additional sheets if necessary)
Provide a copy of full water analysis with application for new pits only. Board may require a water analysis for existing pits. The water analysis must
include the date and source of sample (treater, wellhead, pit, etc.), and the name, address, and telephone numbers of laboratories. Standard
methods must be used for all collection and testing of samples.
BOARD USE ONLY
Signed (Agent)
Approved (Date)
Permit Expires
Typed Name and Title
By
CONDITIONS OF APPROVAL
ON REVERSE.
Title
Date
Submit in triplicate to:
FORM NO. 23 R 10/09
ARM 36.22.307
36.22.1226
36.22.1403
MONTANA BOARD OF OIL AND GAS CONSERVATION
2535 ST. JOHNS AVENUE
BILLINGS, MONTANA 59102
(406) 656-0040
Application For Permit To Construct Or Operate An Earthen Pit Or Pond
(Production Facility Only)
Lease Name:
New pit
Existing pit
Lease Type (Private/State/Federal):
Operator
Unit Name:
Address
Field or Area:
County:
City
State
Zip Code
Location of Pit-
)
Telephone:
(
Fax: (
)
Township, Range, Section, 1/4 1/4:
Describe the purpose of the earthen pit or pond (if temporary, indicate anticipated time pit will be in use):
|
|
API # of Well Associated With This Pit:
25
Number of Wells Using Pit:
Average water inflow:
bbls./day
Maximum pit volume:
bbls.
Describe type and origin of fluids, name and location of source wells, producing formations, and approximate fluid volume
contributed by each well: (Use additional sheets if necessary)
Provide a copy of full water analysis with application for new pits only. Board may require a water analysis for existing pits. The water analysis must
include the date and source of sample (treater, wellhead, pit, etc.), and the name, address, and telephone numbers of laboratories. Standard
methods must be used for all collection and testing of samples.
BOARD USE ONLY
Signed (Agent)
Approved (Date)
Permit Expires
Typed Name and Title
By
CONDITIONS OF APPROVAL
ON REVERSE.
Title
Date
SUPPLEMENTAL INFORMATION
Attach the following information to this permit application:
FOR NEW PITS: Attach diagrams of a top view and two side views of the pit or pond. The diagrams must show the
length, width, depth, cut and fill, maximum fluid level, area of topsoil stockpile, and the height and width of berms.
Identify the location of additional items such as fences, liners, monitoring wells, tanks, lines, siphons, or other
equipment if used. Diagrams need not be prepared by an engineer or surveyor.
FOR EXISTING PITS: Attach color 3"x 5" (or larger) photographs of existing pit or pond. Indicate the date photographs
were taken and name and address of the photographer. All photographs must accurately portray the size and condition
of the earthen pit or pond at the time this application is submitted.
Describe the type and amount of material or liner used, if any, to seal the pit or pond. 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 specification sheet to this application.
Describe the proposed method of treatment and/or disposal of the liquid and solid contents upon abandonment of the
pit or pond:
NOTE: The Operator must comply with all applicable federal, state, county, and local laws and regulations concerning
the handling, treatment, and disposal of wastes.
NAME OF SURFACE OWNER:
SURFACE OWNER CONTACTED (date):
This pit or pond was previously permitted by
(operator(s)) on the
day of
,
Attach a copy(ies) of the previous permit(s).
BOARD USE ONLY
CONDITIONS OF APPROVAL
The operator must comply with the following condition(s):
Failure to comply with conditions of approval may void this permit.
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