4VAC25-150 Virginia Gas and Oil Regulation

REGULATIONS

Vol. 25 Iss. 25 - August 17, 2009

TITLE 4. CONSERVATION AND NATURAL RESOURCES

DEPARTMENT OF MINES, MINERALS AND ENERGY

Chapter 150

Forms

NOTICE: The following forms have been filed by the Department of Mines, Minerals and Energy. The forms are available for public inspection at the Department of Mines, Minerals and Energy, Washington Building, 1100 Bank Street, 8th Floor, Richmond, VA 23219-3638, at regional office of the Department of Mines, Minerals and Energy, or at the Office of the Registrar of Regulations, General Assembly Building, 2nd Floor, Richmond, VA 23219. Copies of the forms and the addresses of the regional offices may be obtained from David Spears, Regulatory Coordinator, Department of Mines, Minerals and Energy, Washington Building, 1100 Bank Street, 8th Floor, Richmond, VA 23219-3638, telephone [phone] or email [e-mail].

Titles of Regulations: 4VAC25-20. Board of Coal Mining Examiners Certification Requirements.

4VAC25-31. Reclamation Regulations for Mineral Mining.

4VAC25-130. Coal Surface Mining Reclamation Regulations.

4VAC25-150. Virginia Gas and Oil Regulation.

4VAC25-170. Geothermal Energy Regulations.

Effective Date: August 17, 2009.

FORMS (4VAC25-20)

Application for Certification Examination, DM-BCME-1 (rev. 6/07) (rev. 5/09).

Verification of Work Experience, DM-BCME-2 (rev. 10/05).

Verification of Training Completed for General Coal Miner Certification, DM-BCME-3 (rev. 6/07) (rev. 5/09).

Application for Recertification: DMLR Endorsement/Blaster's Certification, DMLR-BCME-3 (rev. 6/95).

Verification for Training Completed for Continuing Education, DM-BCME-4 (rev. 10/05).

Application for DMLR Endorsement: Blaster's Certification (Coal Surface Mining Operation), DMLR-BCME-4 (rev. 6/95).

Advanced First Aid Practical Stations & CPR (Written & Practical), DM-BCME-5 (rev. 10/05).

FORMS (4VAC25-31)

Permit/License Application, DMM-101 (rev. 2/06).

Notice of Application to Mine, DMM-103 (rev. 2/06).

Statement Listing the Names and Addresses of Adjoining Property Owners, DMM-103a (rev. 9/99); included in DMM-103 Notice of Application to Mine.

Yearly Progress Report, DMM-105 (rev. 2/06).

Surety Bond, DMM-107 (rev. 2/06) (rev. 4/09).

Legend, DMM-109 (rev. 2/06).

Relinquishment of Mining Permit, DMM-112 (rev. 2/06).

Request for Amendment, DMM-113 (rev. 2/06).

Consolidated Biennial Report of Waivered Counties, Cities, and Towns, DMM-116 (rev. 2/06).

Biennial Waivered Counties, Cities, and Towns, Report of Individual Mining Companies, DMM-117 (rev. 2/06).

Consent for Right of Entry, DMM-120 (rev. 12/99).

Mineral Mining Annual Tonnage Report, DMM-146 (rev. 2/06).

Mineral Mining Annual Report for Contractors, DMM-146c (rev. 12/08).

DMM Application Checklist, DMM-148 (rev. 2/06).

Request for Release of Mine Map, DMM-155 (rev. 2/06).

Notice of Operator Intent, DMM-156 (rev. 2/06).

License Renewal/Transfer Application, DMM-157 (rev. 2/06).

Permit Transfer Acceptance, DMM-161 (rev. 2/06).

Permit Renewal Checklist, DMM-163 (rev. 3/06).

Certification of No Change, DMM-164 (rev. 3/06).

Surety Bond Rider, DMM-167 (rev. 2/06).

General Permit for Sand and Gravel Operations Less Than Ten Acres in Size, DMM-168 (eff. 9/03).

Certificate of Deposit, DMM-169 (eff. 2/06).

FORMS (4VAC25-130)

Anniversary Notification Report Form, DMLR-PT-028 (eff. 11/07) (rev. 3/09).

Anniversary Notification, DMLR-PT-028b (eff. 11/07).

Change Order Justification, DMLR-AML-065 (eff. 8/99).

Ground Water Monitoring Report, DMLR-PT-101 (rev. 11/99).

Application for Exemption Determination (Extraction of Coal Incidental to the Extraction Of Other Minerals), DMLR-211 (rev. 4/96) (rev. 3/09).

Applicant Violator System (AVS) Ownership Control Information, DMLR-AML-003 (rev. 1/95).

Consent for Right of Entry-Exploratory, DMLR-AML-122 (rev. 3/98).

Consent for Right of Entry-Construction, DMLR-AML-123 (rev. 3/98).

Consent for Right of Entry-Construction Lien Waiver, DMLR-AML-174 (rev. 3/91).

License for Performance-Acid Mine Drainage Investigations and Monitoring (Abandoned Mine Land Program), DMLR-AML-175c (11/96).

License for Performance-Acid Mine Drainage Reclamation and Construction (Abandoned Mine Land Program), DMLR-AML-176c, (rev. 12/96).

Consent for Right of Entry-Ingress/Egress, DMLR-AML-177 (rev. 3/98).

Application for Recertification: DMLR Endorsement/Blaster's Certification, DMLR-BCME-03 (rev. 5/05) (rev. 3/09).

Application for DMLR Endorsement: Blaster's Certification (Coal Surface Mining Operation), DMLR-BCME-04 (rev. 5/05) (rev. 3/09).

Geology and Hydrology Information Part A through E, DMLR-CP-186 (rev. 3/86).

Sediment and Pond Design Data Sheet, DMLR-CP-187 (rev. 12/85).

Notice of Temporary Cessation, DMLR-ENF-220 (rev. 2/96) (rev. 3/09).

Application for Small Operator's Assistance, DMLR-OA-106 (rev. 12/85).

Lands Unsuitable Petition, DMLR-OA-131 (rev. 12/85).

Application for Permit for Coal Exploration and Reclamation Operations (which Remove More Than 250 Tons) and NPDES, DMLR-PS-062 (rev. 12/85).

Chapter 19-Statement for Third Party-Certificate of Deposit, DMLR-PS-093 (rev. 12/85).

Cognovit Note, Part I and II, DMLR-PS-095 (rev. 12/85).

Application-Coal Surface Mining Reclamation Fund, DMLR-PS-162 (rev. 7/89).

Application for Performance Bond Release of Bond-Estimated Cost, DMLR-PS-212 (rev. 3/88) DMLR-PT-212 (rev. 3/09)

Application for Release of Bond-Reclamation Fund, DMLR-PS-213 (rev. 3/88).

Example-Waiver (300 Feet from Dwelling), DMLR-PT-223 (rev. 2/96).

Analysis, Premining vs Postmining Productivity Comparison (Hayland/Pasture Land Use), DMLR-PT-012 (eff. 8/03) (rev. 3/09).

Surety Bond, DMLR-PT-013 (rev. 9/04) (rev. 8/07).

Surety Bond-Federal Lands, DMLR-PT-013A (rev. 10/95) (rev. 3/09).

Surety Bond Rider, DMLR-PT-013B (rev. 9/04) (rev. 8/07).

Map Legend, DMLR-PT-017 (rev. 2/05) (rev. 3/09).

Certificate of Deposit Example, DMLR-PT-026 (rev. 9/04) (rev. 8/07).

Form Letter From Banks Issuing a CD as Performance Bond for Mining on Federal Lands, DMLR-PT-026A (rev. 8/03) (rev. 8/07).

Operator's Seeding Report, DMLR-PT-011 (rev. 3/06) (rev. 3/09).

Request for Relinquishment, DMLR-PT-027 (rev. 4/96) (rev. 3/09).

Water Supply Inventory List, DMLR-PT-030 (rev. 4/96) (rev. 3/09).

Application for Permit for Coal Surface Mining and Reclamation Operations and National Pollutant Discharge Elimination Systems System (NPDES), DMLR-PT-034 (rev. 2/99).

Request for DMLR Permit Data, DMLR-PT-034info (eff. 11/07).

Certification - Application for Permit: Coal Surface Mining and Reclamation Operations, DMLR-PT-034D (rev. 8/07) (rev. 3/09).

Coal Exploration Notice, DMLR-PT-051 (rev. 11/98) (rev. 3/09).

Well Construction Data Sheet, DMLR-WCD-034D (rev. 5/04).

Sediment Basin Design Data Sheet, DMLR-PT-086 (rev. 10/95) (rev. 3/09).

Impoundment Construction and Annual Certification, DMLR-PT-092 (rev. 10/95) (rev. 3/09).

Road Construction Certification, DMLR-PT-098 (rev. 10/95) (rev. 3/09).

Ground Water Monitoring Report, DMLR-PT-101 (rev. 2/95) (rev. 3/09).

Rainfall Monitoring Report, DMLR-PT-102 (rev. 8/98).

Pre-Blast Survey, DMLR-PT-104 (rev. 10/95) (rev. 3/09).

Excess Spoil Fills and Refuse Embankments Construction Certification, DMLR-PT-105 (rev. 2/09) (rev. 3/09).

Stage-Area Storage Computations, DMLR-PT-111 (rev. 10/95) (rev. 3/09).

NPDES Discharge Monitoring Report, DMLR-PT-119 (rev. 2/95) (rev. 3/09).

Water Monitoring Report-Electronic File/Printout Certification, DMLR-PT-119C (rev. 5/95; included in DMLR-PT-119) (rev. 3/09).

Coal Surface Mining Reclamation Fund Application, DMLR-PT-162 (rev. 4/96) (rev. 3/09).

Conditions-Coal Surface Mining Reclamation Fund, DMLR-PT-167 (rev. 10/95) (rev. 3/09).

Coal Surface Mining Reclamation Fund Tax Reporting Form, DMLR-PT-178 (rev. 10/95) (rev. 3/09).

Surface Water Monitoring Report, DMLR-PT-210 (rev. 8/98) (rev. 3/09).

Application For Performance Bond Release, DMLR-PT-212 (rev. 4/96) (rev. 3/09).

Public Notice: Application for Transfer, Assignment, or Sale of Permit Rights under Chapter 19 of Title 45.1 of the Code of Virginia, DMLR-PT-219 (8/96) (rev. 3/09).

Public Notice: Application for Bond Reduction Under Chapter 19 of Title 45.1 of the Code of Virginia - Cost Estimate, Phase I, DMLR-PT-225 (rev. 4/96) (rev. 3/09).

Public Notice: Application for Bond Reduction Under Chapter 19 of Title 45.1 of the Code of Virginia - Cost Estimate, Phase II, DMLR-PT-226 (rev. 4/96) (rev. 3/09).

Public Notice: Application for Bond Reduction Under Chapter 19 of Title 45.1 of the Code of Virginia - Cost Estimate, Phase III, DMLR-PT-227 (rev. 4/96) (rev. 3/09).

Public Notice: Application for Bond Reduction Under Chapter 19 of Title 45.1 of the Code of Virginia - Pool Bonding, Incremental Bond Reduction, DMLR-PT-228 (rev. 4/96) (rev. 3/09).

Public Notice: Application for Bond Reduction Under Chapter 19 of Title 45.1 of the Code of Virginia - Pool Bonding, Entire Permit Bond Reduction, DMLR-PT-229 (rev. 9/95).

Public Notice: Application for Bond Reduction Under Chapter 19 of Title 45.1 of the Code of Virginia - Pool Bonding, Entire Permit Bond Release, DMLR-PT-230 (rev. 4/96).

Verification of Public Display of Application, DMLR-PT-236 (8/01).

Affidavit (Permit Application Information: Ownership and Control Information and Violation History Information), DMLR-PT-240 (rev. 7/07) (rev. 3/09).

Stream Channel Diversion(s) Certification, DMLR-PT-233 (rev. 2/96) (rev. 3/09).

Quarterly Acid-Base Monitoring Report, DMLR-PT-239 (rev. 6/95) (rev. 3/09).

Affidavit (No Legal Change in a Company's Identity), DMLR-PT-250 (rev. 12/98) (rev. 3/09).

Blasting Plan Data, DMLR-PT-103 (rev. 4/96).

Affidavit (Reclamation Fee Payment), DMLR-PT-244 (rev. 7/07) (rev. 3/09).

Application-National Pollutant Discharge Elimination System (NPDES) Permit-Short Form C, DMLR-PT-128 (rev. 5/96) (rev. 3/09).

National Pollutant Discharge Elimination System (NPDES) Short Form C-Instructions Application Instructions, DMLR-PT-128A (rev. 5/96) (rev. 3/09).

Impoundment Inspection Report, DMLR-PT-251 (rev. 12/93) (rev. 3/09).

Water Sample Tag, DMLR-TS-107 (rev. 3/83).

Surface Water Baseline Data Summary, DMLR-TS-114 (rev. 4/82).

Diversion Design Computation Sheet, DMLR-TS-120 (rev. 12/85).

Sediment Channel Design Data Sheet, DMLR-TS-127 (rev. 12/85).

Virginia Stream Survey, DMLR-TS-217 (rev. 1/87).

Line Transect-Forest Land Count, DMLR-PT-224 (rev. 2/96) (rev. 3/09).

Applicant Violator System (AVS) Ownership & Control Information, DMLR-AML-003 (rev. 4/97).

Application for Permit Renewal Coal Surface Mining and Reclamation Operations, DMLR-PT-034R (eff. 6/97).

Application for Coal Exploration Permit and National Pollutant Discharge Elimination System Permit, DMLR-PT-062 (formerly DMLR-PS-062) (rev. 6/97) (rev. 3/09).

Conditions-Coal Surface Mining Reclamation Fund, DMLR-PT-167 (rev. 10/95).

Vibration Observations, DMLR-ENF-032V (eff. 9/97).

Application for Small Operator Assistance, DMLR-PT-106 (formerly CP-106) (rev. 9/97).

Application-National Pollutant Discharge Elimination System Application Instructions, DMLR-PT-128 (rev. 9/97).

Blasting Plan Data, DMLR-PT-103 (rev. 10/97).

Request for Relinquishment, DMLR-PT-027 (rev. 1/98).

Written Findings, DMLR-PT-237 (rev. 1/98).

Irrevocable Standby Letter of Credit, DMLR-PT-255 (rev. 9/04) (rev. 8/07).

Confirmation of Irrevocable Standby Letter of Credit, DMLR-PT-255A (eff. 8/03).

Affidavit DMLR-AML-312 (eff. 7/98).

Indemnity Agreement - Self Bond, DMLR-PT-221 (eff. 12/07).

Permittee Consent to Service by Electronic Mail, DMLR-PT-265 (eff. 1/09) (rev. 3/09).

FORMS (4VAC25-150)

Registration Form, DGO-GO-A, rev. 1/98 (rev. 6/09).

Application for a New Permit, Permit Modification, or Transfer of Permit Rights, DGO-GO-1 (rev. 11/99) (rev. 6/09).

Operator's Surety Bond, DGO-GO-2 (rev. 11/99) (rev. 6/09).

Operator's Cash Bond, DGO-GO-3 (rev. 11/99) (rev. 6/09).

Notice of Application for a Permit or Permit Modification, DGO-GO-4 (rev. 11/99) (rev. 6/09).

Persons Receiving Official Notice of Permit Application or Permit Modification, DGO-GO-5, rev. 1/98 (rev. 6/09).

Notice by Publication of an Application for a Permit, DGO-GO-6, rev. 1/98 (rev. 6/09).

Well Location Plat, DGO-GO-7, rev. 1/98.

Information Sheet for Applications to Transfer Permit Rights, DGO-GO-8, rev. 1/98 (rev. 6/09).

Technical Data Sheet for Permit Applications Under § 45.1-361.29, DGO-GO-9 (Rev. 10/96) (rev. 6/09).

Technical Data Sheet for Gathering Pipelines and Associated Facilities, DGO-GO-10, rev. 1/98 (rev. 6/09).

Technical Data Sheet for Permit Modification to Plug or Replug, DGO-GO-11 (rev. 11/99) (rev. 6/09).

Operations Plan -- Checklist, DGO-GO-12 (rev. 11/99) (rev. 6/09).

Operations Plan -- Checklist, DGO-GO-12A (7/95; included in DGO-GO-12).

Drilling Report, DGO-GO-14, rev. 1/98 (rev. 6/09).

Completion Report, DGO-GO-15, rev. 1/98 (rev. 6/09).

Application for Disposal of Pit or Produced Fluids, DGO-GO-16, rev. 1/98 (rev. 6/09).

Application to Complete Abandoned Gas or Oil Well as a Water Well, DGO-GO-17, rev. 1/98 (rev. 6/09).

Plugging Affidavit, DGO-GO-18 (rev. 11/99) (rev. 6/09).

Monthly Gas Production Report, DGO-GO-19 (rev. 11/99) (rev. 6/09).

Monthly Oil Production, DGO-GO-20 (rev. 11/99) (rev. 6/09).

Notice of Right to Object, DGO-GO-21 (rev. 11/99) (rev. 6/09).

License to Perform -- Plugging of Orphaned Well, DGO-GO-23 (rev. 11/99) (rev. 6/09).

License to Perform -- Plugging of Well/Bond Forfeiture, DGO-GO-24 (rev. 11/99) (rev. 6/09).

Affidavit and Release in Support of Surface Owner's Application to the Virginia Division of Gas and Oil for Use of an Orphaned Well as a Water Well, DGO-GO-25 (rev. 11/99) (rev. 6/09).

FORMS (4VAC25-170)

Registration Form for Drillers, Owners and Operators of Geothermal Wells, DGO-G-01 (rev. 6/89) (rev. 6/09).

Application for Exploration Permit, DGO-G-02 (rev. 6/89) (rev. 6/09).

Application Appendix for Exploration Permit if the Well Work Involves Drilling, Redrilling or Deepening, DGO-G-02A (rev. 6/89; included in DGO-G-02) (rev. 6/09).

Geothermal Resource Well Operator's Bond, DGO-G-03 (rev. 6/89) (rev. 6/09).

Release of Geothermal Resource Well Operator's Surety Bond, DGO-G-03A (rev. 6/09).

Geothermal Well Plat, DGO-G-04 (rev. 6/89).

Certification of Location of New Well, DGO-G-04A (rev. 6/89; included in DGO-G-04) (rev. 6/09).

Report on Completion of Well Work, DGO-G-05 (rev. 6/89) (rev. 6/09).

Report on of Completion of Work if Drilling, Redrilling or Deepening is Involved, DGO-G-05A (rev. 6/89; included in DGO-G-5) (rev. 6/09).

Notice of Intent to Plug or Abandon, and Affidavit, DGO-G-05B (rev. 6/89; included in DGO-G-5) (rev. 6/09).

Casing and Tubing Program, DGO-G-05C (rev. 6/89; included in DGO-G-5; included in DGO-G-5) (rev. 6/09).

Driller's Log, DGO-G-05D (rev. 6/89; included in DGO-G-5) (rev. 6/09).

Notice of Intent to Proceed, DGO-G-06 (rev. 6/89) (rev. 6/09).

Geothermal Resource Production or Injection Report, DGO-G-07 (rev. 6/89) (rev. 6/09).

Groundwater Monitoring Report, DGO-G-08 (rev. 6/89) (rev. 6/09).

Geothermal Fluid Monitoring Report, DGO-G-09 (rev. 6/89) (rev. 6/09).

Notification of Chemical Cleaning of a Geothermal Well, DGO-G-10 (rev. 6/89) (rev. 6/09).

Surveyor's Report on Subsidence, DGO-G-11 (rev. 6/89) (rev. 6/09).

Application for Reclassification of a Geothermal Area, DGO-G-12 (rev. 6/89) (rev. 6/09).

Request for Permission to Engage in Sequential Utilization, DGO-G-13 (rev. 6/89) (rev. 6/09).

Application for Exemption from Injection Requirement, DGO-G-14 (rev. 6/89) (rev. 6/09).

VA.R. Doc. No. R09-1936; Filed July 22, 2009, 9:12 a.m.