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North Carolina Department of Environment Quality

NC Department of Environment and Natural Resources
Energy Mineral and Land Resources - Forms

Energy Mineral and Land Resources

Oil & Gas Program Forms

All forms should be submitted to the Oil and Gas Program electronically or by U.S. Postal Service to the addresses shown at the bottom of this page. 

Forms

Instructions

Examples

Form 1 – Financial Responsibility Ownership

 

 

Form 2 – Oil or Gas Well Permit Application

 

 

Form 3 – Well Construction Design

 

 

Form 4 – Water Management Plan

 

 

Form 5 – Waste Management Plan

 

 

Form 6 – Well Site Reclamation Plan

 

 

Form 7 – Irrevocable Letter of Standby Credit

 

 

Form 8 – Surety Bond

 

 

Form 9 – Assignment of Savings

 

 

Form 10 – Cash Deposit

 

 

Form 11 – Required Notifications to the Department

 

 

Form 12 – Well Drilling Report 

 

 

Form 13 - Reserved for future use.

 

 

Form 14 – Plugging and Abandonment 

 

 

Form 15 – Oil or Gas Well Status 

 

 

Form 16 – Mechanical Integrity Test Results  

 

 

Form 17 – Notification of Return of Oil or Gas Well to Active Status

 

 

Form 18 – Well Stimulation Report

 

 

Form 18A- Well Stimulation Report - Addendum

 

 

Form 19 – Chemical Disclosure Report

 

 

Form 20 – Confidential Information Claim

 

 

Form 21 – Water Supply Investigation Request

 

 

Form 22 – Water Supply Testing ReportForm 22A- Water Supply Testing- Data Tables

 

 

Form 23 – Annual Water Use Report

 

 

Form 24 – Annual E & P Waste Management Report

 

 

Form 25 – Pit Closure Report

 

 

Form 26 – Spill and Release Report

 

 

Form 27 – Site Investigation and Remediation Work Plan

 

 

Form 28 – Monthly Production Report

 

 

Form 29 – Well Site Inspection Report

 

 

Supplemental Form - Comments/Reporting

 

 

 

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Oil and Gas Program Staff

Walt Haven, P.G. - Oil & Gas Program Supervisor  919-707-9234

Ryan Channell, P.G. - Senior Geologist  919-707-9236

Katherine Marciniak, P.G. - Senior Specialist  919-707-9231

Chandler Warner, E.I.- Environmental Engineer  919-707-9208

Rosalind Harris - Office Administrator  919-707-9234

Mailing Address:

DEMLR/Oil & Gas Program
1612 Mail Service Center
Raleigh, NC  27699-1612

General Email Address:

DEMLRoilandgas@ncdenr.gov
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