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Michigan Geological Survey
FORMS USED FOR MINERAL WELLS
Download all Mineral Well forms in zipped file (approx 650 Kb).
Most of the forms on this page are in Microsoft Word format, a few are in Acrobat.
To order paper forms, call 517-241-1515.
1/27/2005: All the forms in this download can have data entered in them from the computer, if you can call it up in Microsoft Word, you can enter data from Microsoft Word. Previously, some of the forms had to be printed out and filled in by hand or typewriter.
For Permits and Bonds
For Drilling and Completion
For Production and Operating
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Abbreviations used below in "Where Filed" and "Unit":
PBU = Permits and Bonding Unit
MGW= Minerals and Groundwater Unit
DO= District Office
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Contact
517-241-1528
517-241-1532
check link at left
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MINERAL WELL PERMITS AND BONDS
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Form Name
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Form No.
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Who Originates
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When Filed
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Where Filed
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No. of Copies with Original
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*Application for Permit to Drill/Deepen/Convert, and Operate a Well
Forms marked w/ * are attached as part of a complete application to drill
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EQP 7200-1
Permit Instructions:
EQC 7200
EQC 7200-1
EQC 7200-4
EQC 7200-5
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Permit Applicant
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Application
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PBU
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5
(3 sets: 1 orig of complete app + 2 sets of copies + 3 copies of EQP 7200-1)
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| *One of the following for permit fee:
Check
or
Credit Card Transaction Authorization
or
Electronic Fund Transfer Debit Authorization
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issued by applicant
EQP 7010
EQP 7011 |
Permit Applicant |
w/ Application for Permit to Drill |
PBU |
none required |
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*Survey Record of Well Location
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EQP 7200-2
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Permit Applicant
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w/ Application for Permit to Drill
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PBU
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2
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*Wellhead Blowout Control System
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EQP 7200-4
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Permit Applicant
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w/ Application for Permit to Drill
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PBU
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2
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*Injection Well Data & attachments
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EQP 7200-14
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Permit Applicant
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w/ Application for Permit to Drill Injection Well or ACOWS
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PBU
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2
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*Soil Erosion & Sedimentation Control Plan & attachments
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EQP 7200-18
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Permit Applicant
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w/ Application for Permit to Drill
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PBU
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2
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*Environmental Impact Assessment for Mineral Wells and Surface Facilities
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EQP 7500-3
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Permit Applicant
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w/ Application for Permit to Drill
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PBU
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2
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Bond for Conformance
(use one of the below)
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Permit Applicant
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If for a single well-
w/ Application for Permit to Drill or Request for Transfer
Blanket bond docs already on file at GSD do not need to be copied for new applications
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PBU
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0
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1. Surety
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1. EQP 7200-3MW
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2. Certificate of Deposit
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2. CD
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3. Letter of Credit
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3. EQP 7598 single
3. EQP 7599 blanket
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4. Cashier's Check
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4. check
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5. Statement of Financial Responsibility
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5. EQP 7200-17MW
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IRS form W-9
Request for Taxpayer Identification Number and Certification
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Form W-9
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Permit Applicant
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w/ CD bond
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Budget Unit
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0
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Acceptance of CD as Performance Bond
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EQP 7200-15MW (single)
EQP 7200-16 MW (blanket)
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Permit Applicant
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w/ CD bond
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PBU
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0
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Well Permittee Organization Report
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EQP 7200-13
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Permit Applicant
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As requested by PB Unit: usually w/App or Request for Transfer
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PBU
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1
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Permit to Drill/Deepen/Convert and Operate a Mineral Well
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EQP 7200 M
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PB Unit
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When issued
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---
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1 canary- "original" and 3 "colored" copies
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Request for Transfer of Permit
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EQP 7200-7
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Permittee
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At change of owner or operator
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PBU
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3
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MINERAL WELLS COMPLETION AND DRILLING
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Form Name
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Form No.
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Who Originates
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When Filed
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Where Filed
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No. of Copies with Original
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Record of Well Drilling or Deepening
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EQP 7200-5
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Permittee
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Within 60 days of drilling completion
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MGW
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3
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Well Elevations
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---
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Permittee
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Within 60 days of drilling completion
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MGW
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0
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Electric or Radiation Logs
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---
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Permittee
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30 days after running log(s)
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MGW
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0
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Survey of Directionally Drilled Well
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Permittee
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30 days after drilling completion Note: a well may not be produced until survey is filed
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MGW
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3
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Water Well Record for Oil, Gas, or Mineral Well Operations
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EQP 7200-10
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Permittee
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30 days after water well completion
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DO
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3
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Certification of Casing and Sealing of Surface Hole
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EQP-7200-12
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Permittee
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30 days after drilling completion
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MGW
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1
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Mud Pit Plot
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EQP 7200-9
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Permittee
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60 days after drilling completion
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DO
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1
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Record of Well Completion
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EQP 7130
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Permittee
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Within 60 days of drilling completion
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MGW
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3
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Core descriptions
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---
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Permittee
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Within 60 days of drilling completion
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MGW
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0
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Application to Change Well Status
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EQP 7200-6
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Permittee
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Before start of operation
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DO
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3
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Application to Plug and Abandon
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EQP 7200-6
(same form as above)
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District
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When requested by permittee or GSD Compliance Unit
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Mailed to Permittee
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3
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Record of Well Plugging or Change of Well Status
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EQP 7200-8
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Permittee
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30 days after Change/Plugging
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DO
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3
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Annual Certification for Blowout Preventers, Accumulators, Pumps and Secondary Systems
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EQP 7200-11
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Drilling Contractor
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Annually or when BOP is modified
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PBU
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0
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MINERAL WELLS PRODUCTION AND OPERATING
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Form Name
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Form No.
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Who Originates
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When Filed
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Where Filed
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No. of Copies with Original
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Bottom Hole Pressure Test
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EQP 7104
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Permittee
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After completion and as requested
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MGW
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0
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Monthly Operating Report--Deep Well Injection
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EQP 7215
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Permittee
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Monthly
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MGW
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0
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Annual Mineral Well
Regulatory Fee
Assessment Report |
EQP 7140 |
Permittee |
Annually |
MGW |
0
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Liquid and Gas Analysis
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---
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Permittee
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After completion and as requested
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MGW
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0
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Annular Pressure Test
Typically not used for Part 625 injection wells, but could be used.
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EQP 7606
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Permittee
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per R324.803 and 805
Before initial injection and at least once each 5 years
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MGW
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0
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