Form 8000-PM-OOGM0006 "Notice of Intent (Noi) for Coverage Under the Erosion and Sediment Control General Permit (Escgp-3) for Earth Disturbance Associated With Oil and Gas Exploration, Production, Processing, or Treatment Operations or Transmission Facilities" - Pennsylvania

What Is Form 8000-PM-OOGM0006?

This is a legal form that was released by the Pennsylvania Department of Environmental Protection - a government authority operating within Pennsylvania. Check the official instructions before completing and submitting the form.

Form Details:

  • Released on September 1, 2018;
  • The latest edition provided by the Pennsylvania Department of Environmental Protection;
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  • Fill out the form in our online filing application.

Download a printable version of Form 8000-PM-OOGM0006 by clicking the link below or browse more documents and templates provided by the Pennsylvania Department of Environmental Protection.

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Download Form 8000-PM-OOGM0006 "Notice of Intent (Noi) for Coverage Under the Erosion and Sediment Control General Permit (Escgp-3) for Earth Disturbance Associated With Oil and Gas Exploration, Production, Processing, or Treatment Operations or Transmission Facilities" - Pennsylvania

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8000-PM-OOGM0006
9/2018
Notice of Intent
COMMONWEALTH OF PENNSYLVANIA
OFFICIAL USE ONLY
DEPARTMENT OF ENVIRONMENTAL PROTECTION
ID #
OFFICE OF WATER PROGRAMS
OFFICE OF OIL AND GAS MANAGEMENT
Date Received
AUTH
SITE
CLNT
APS
Fee
Check No.
Check Date
NOTICE OF INTENT (NOI) FOR COVERAGE UNDER THE EROSION AND SEDIMENT CONTROL
GENERAL PERMIT (ESCGP-3) FOR EARTH DISTURBANCE ASSOCIATED WITH OIL AND GAS
EXPLORATION, PRODUCTION, PROCESSING, OR TREATMENT OPERATIONS OR
TRANSMISSION FACILITIES
READ THE INSTRUCTIONS PROVIDED IN THIS PERMIT APPLICATION PACKAGE BEFORE COMPLETING THIS
FORM. PLEASE PRINT OR TYPE INFORMATION IN BLACK OR BLUE INK.
SECTION A. APPLICATION TYPE
Check one:
NEW
RENEWAL
MAJOR MODIFICATIONS (Provide ESCGP number)
PHASED
(check only if applicable; note: Most projects are not submitted as phased projects)
Check one: EXPEDITED
STANDARD
If an Expedited Review Process being requested, be advised that the Expedited Review is not available for all projects.
Refer to Section D - Expedited Review Process of the ESCGP-3 NOI Instructions to determine if the project is eligible.
SECTION B. CLIENT INFORMATION
Applicant's Last Name (If applicable)
First Name
MI
Telephone No.
Organization Name or Registered Fictitious Name
Telephone No.
DEP Client ID No.
Headquarters Mailing Address
City
State
ZIP Code
Email Address
Co-Applicant's Last Name (If applicable)
First Name
MI
Telephone No.
Organization Name or Registered Fictitious Name
Telephone No.
Address
City
State
ZIP Code
Email Address
- 1 -
8000-PM-OOGM0006
9/2018
Notice of Intent
COMMONWEALTH OF PENNSYLVANIA
OFFICIAL USE ONLY
DEPARTMENT OF ENVIRONMENTAL PROTECTION
ID #
OFFICE OF WATER PROGRAMS
OFFICE OF OIL AND GAS MANAGEMENT
Date Received
AUTH
SITE
CLNT
APS
Fee
Check No.
Check Date
NOTICE OF INTENT (NOI) FOR COVERAGE UNDER THE EROSION AND SEDIMENT CONTROL
GENERAL PERMIT (ESCGP-3) FOR EARTH DISTURBANCE ASSOCIATED WITH OIL AND GAS
EXPLORATION, PRODUCTION, PROCESSING, OR TREATMENT OPERATIONS OR
TRANSMISSION FACILITIES
READ THE INSTRUCTIONS PROVIDED IN THIS PERMIT APPLICATION PACKAGE BEFORE COMPLETING THIS
FORM. PLEASE PRINT OR TYPE INFORMATION IN BLACK OR BLUE INK.
SECTION A. APPLICATION TYPE
Check one:
NEW
RENEWAL
MAJOR MODIFICATIONS (Provide ESCGP number)
PHASED
(check only if applicable; note: Most projects are not submitted as phased projects)
Check one: EXPEDITED
STANDARD
If an Expedited Review Process being requested, be advised that the Expedited Review is not available for all projects.
Refer to Section D - Expedited Review Process of the ESCGP-3 NOI Instructions to determine if the project is eligible.
SECTION B. CLIENT INFORMATION
Applicant's Last Name (If applicable)
First Name
MI
Telephone No.
Organization Name or Registered Fictitious Name
Telephone No.
DEP Client ID No.
Headquarters Mailing Address
City
State
ZIP Code
Email Address
Co-Applicant's Last Name (If applicable)
First Name
MI
Telephone No.
Organization Name or Registered Fictitious Name
Telephone No.
Address
City
State
ZIP Code
Email Address
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8000-PM-OOGM0006
9/2018
Notice of Intent
SECTION C. SITE INFORMATION
Is there an existing ESCGP associated with this site?
Yes
No If yes, Permit No.
Has a well permit application been submitted for this site?
Yes
No If yes, Permit No.
Does this site have a 911 address?
Yes
No If yes, provide site location address.
Site Name
Site Location
Site No. (if another permit has been issued for the site)
Site Location – City
State
ZIP Code
Detailed Written Directions to Site
Primary Location
County
Municipality
City
Boro
Twp.
SECTION D. EXPEDITED REVIEW
I.
Expedited Review Eligibility
1. Is any part of the project in the watershed of a surface water with an existing or
Yes
No
designated use of exceptional value or high quality pursuant to Chapter 93
(relating to water quality standards), in an exceptional value wetland in accordance
with 25 Pa. Code § 105.17, or in the watershed of an impaired surface water where
the cause of the impairment is identified as siltation?
2. Will the project in which the well pad will be constructed be in or on a floodplain?
Yes
No
3. Is any earth disturbance located or proposed to be located on land known to be
Yes
No
contaminated by the release of regulated substances as defined in Section 103 of
Act 2, 35 P.S. § 6026.103?
4. Will naturally occurring geologic formations or soil conditions provide hazards to
Yes
No
the project or surrounding environment or have the potential to cause or contribute
to pollution when disturbed?
5. Do any unresolved non-compliance issues exist with the applicant or the facility?
Yes
No
6. Is the project a transmission project?
Yes
No
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8000-PM-OOGM0006
9/2018
Notice of Intent
If yes to any of the above questions the project is not eligible for Expedited Review; If the project is eligible for
Expedited Review, all the following items must be completed.
II. Expedited Review Process
1. Is the technically and administratively complete and accurate NOI package
Yes
No
prepared and certified by a licensed professional?
2. Are E&S and PCSM/Site Restoration Plan drawings and narrative prepared and
Yes
No
sealed by a licensed professional? (Include interim restoration details when
needed)
3. Include a Resource Delineation Report and answer the following questions: (If the answer to question a. is “Yes”
then skip to #4. If the answer to a. is “No” the applicant must answer “Yes” to at least one of the questions, b.
through d. to be eligible for expedited review.)
a. Were all wetland resources delineated during the growing season?
Yes
No
b. If not during the growing season, was a follow-up visit conducted during the
Yes
No
growing season to verify/adjust boundaries and look for potentially missed
resources?
c. Was a quality assurance field review conducted at a later date by an
Yes
No
independent qualified wetland professional to verify boundaries and look for
potentially missed resources? (If yes, attach Quality Assurance Field Review
Report)
d. Was a Jurisdictional Determination (JD) or Preliminary JD conducted by the
Yes
No
US Army Corps of Engineers on the whole project? (If yes, attach Preliminary
or Jurisdictional Determination Report)
4. If applicable, have you included PNDI clearance letters or other documentation
Yes
No
from applicable resource agencies?
5. If the project site contains, is along, or within 100 feet of a river, stream, creek,
Yes
No
lake, pond or reservoir, will you establish new or preserve existing riparian forest
buffer at least 100 feet in width between the top of streambank or normal pool
elevation of a lake, pond or reservoir and areas of earth disturbances.
If no, will a waiver be obtained?
Yes
No
6. Name of Licensed Professional
Company
Address
Phone
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8000-PM-OOGM0006
9/2018
Notice of Intent
SECTION E. PROJECT INFORMATION
1. Total Project Area/Project Site (Ac):
Total Disturbed Area (Ac):
Increased disturbed acreage
(for permit modification only)
Fee: (For additional information regarding fees, refer to NOI Instructions #3 Permit NOI Filing
$
Fees.)
2. Project Name:
3. Project Type (Check all that apply)
1
Oil/Gas Well
Transmission Facility
Gathering Facility
Processing Facility
Treatment Facility
Well Development Impoundment
Compressor Station
Non-FERC regulated Transmission Facility
Pipeline
Ground/Surface Water Withdrawal Site
Storage Field Facility
Other
1
If Oil/Gas Well; is the well conventional or unconventional?
Conventional
Unconventional
Project Description
Provide the date of pre-application meeting (if conducted with the Department)
4. Provide the latitude and longitude coordinates for the center of the project. The coordinates should be in Decimal
degrees and North American Datum 1983. The coordinates must meet the current DEP policy regarding locational
accuracy. For linear projects provide the project’s termini.
Latitude (DD)
Longitude (DD)
.
-
.
Latitude (DD)
Longitude (DD)
.
-
.
DEP’s eMAP
Horizontal Collection Method:
GPS
Interpolated from U.S.G.S. Topographic Map
5. U.S.G.S. 7.5 min. topographic quadrangle Name
(
Include a copy of the project area on the 7.5 min quad map)
6. Will the project be conducted as a phased permit project?
Yes
No
If Yes, Include Master Site Plan Estimated Timetable for Phased Projects.
Additional sheet(s) attached.
Phase No.
Disturbed
or Name
Description
Total Area
Area
Start Date
End Date
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8000-PM-OOGM0006
9/2018
Notice of Intent
7. List existing and previous land use for a minimum of the previous 5 years.
8. Other Pollutants: Will the stormwater discharge contain pollutional substances other than sediment?
Yes
No
If yes, explain and provide any available quantitative data.
9. Will fuels, chemicals, solvents, other hazardous waste or materials be used or stored on site during earth disturbance
activities or will Horizontal Directional Drilling (HDD) activities be conducted?
Yes
No
(If yes, Preparedness, Prevention and Contingency (PPC) Plan must be maintained on site
during earth disturbance. See NOI Instructions, E.9 PPC Plan Guidance for further information.)
10. Is the project in the watershed of an impaired surface water where the cause of the impairment is identified as siltation?
Yes
No
(If yes, show how the project will not result in a net change in volume, rate or water quality. See
section I below, and E.10 of NOI instructions.)
11. Are there potentially hazardous naturally occurring geological or soil conditions in any portion of the project or
surrounding area? Yes
No
If yes, do the potentially hazardous geologic or soil conditions have the potential to cause or contribute to pollution as a
result of the proposed earth disturbance activities?
If no, provide an explanation.
If yes, Geologic Hazard Mitigation Plan must be attached and explain where in this application details are provided.
12. Has the Act 14 Municipal Notification and proof of receipt of notification been attached to the NOI?
Yes
No
(If not, the NOI is not complete, see E.12 and #4 Municipal Notification in the NOI Instructions for
additional guidance.)
13. Has the PNDI receipt been attached to the NOI?
Yes
No
(If not, the NOI is not complete, see E.13 and #5 PNHP in the NOI Instructions for additional
guidance.)
14. Have the E&S Plan and PCSM/SR Plan been planned and designed to be consistent?
Yes
No
15. Have existing and/or proposed Riparian Forest Buffers been identified?
Yes
N/A
(If yes, they must be shown on the E&S Plan as well as the PCSM/SR Plans.)
16. Have antidegradation implementation requirements for special protection waters been addressed?
Yes
No
N/A
(If yes, antidegradation requirements must be included in the plan.)
17. Has the seasonal high groundwater level been identified and 20-inch separation established at all excavation locations
for pits for conventional operations and Well Development Impoundments for unconventional operations?
Yes
No
N/A
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